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Kim E, Lee M, Park I. Risk of Obstructive Sleep Apnea, Chronic Dizziness, and Sleep Duration. Nurs Res 2024; 73:313-319. [PMID: 38498868 DOI: 10.1097/nnr.0000000000000733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/20/2024]
Abstract
BACKGROUND Although it is recommended that obstructive sleep apnea (OSA) be screened for using a validated self-report questionnaire in patients experiencing dizziness, there is still a lack of research on the relationship between high risk of OSA and chronic dizziness. OBJECTIVES The study aimed to examine the relationship between the high risk of OSA and chronic dizziness and investigate how this relationship is affected by sleep duration. METHODS This cross-sectional study used data from the 8th Korea National Health and Nutrition Examination Survey (2019-2021). Adults aged 40 years or older were included and divided into two groups using the STOP-Bang Questionnaire (SBQ): a high-risk group for OSA or not. Complex samples logistic regression analyses were performed to examine the odds ratios of chronic dizziness based on the national population estimates. RESULTS Our findings showed that individuals in the high-risk group for OSA were significantly more likely to experience chronic dizziness. Specifically, among subgroups based on sleep duration, the high-risk group for OSA with a short sleep duration of ≤5 hours demonstrated the highest odds of chronic dizziness, showing a significantly 2.48-fold increased likelihood compared to the non-high risk for OSA with a sleep duration of 5-9 hours. DISCUSSION The SBQ can be beneficial when other causes do not explain chronic dizziness, helping to rule in the possibility of OSA. Educating individuals suspected of having OSA or who have been diagnosed with OSA about the importance of adequate sleep duration may help reduce the risk of chronic dizziness.
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Jansen LA, van Wier MF, Vernimmen FPJ, Goderie T, van de Berg R, Lemke U, Lissenberg-Witte BI, Kramer SE. Ten-year association between change in speech-in-noise recognition and falls due to balance problems: a longitudinal cohort study. BMC Public Health 2024; 24:732. [PMID: 38454406 PMCID: PMC10919036 DOI: 10.1186/s12889-024-18187-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2023] [Accepted: 02/22/2024] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND This study examined the relationship between speech-in-noise recognition and incident/recurrent falls due to balance problems ten years later (RQ-1); 10-year change in speech-in-noise recognition and falls (RQ-2a), as well as the role of dizziness in this relationship (RQ-2b). The association between hearing aid use and falls was also examined (RQ-3). METHODS Data was collected from the Netherlands Longitudinal Study on Hearing between 2006 and December 2022. Participants completed an online survey and digits-in-noise test every five years. For this study, data was divided into two 10-year follow-up time intervals: T0 (baseline) to T2 (10-year follow-up), and T1 (5-years) to T3 (15-years). For all RQs, participants aged ≥ 40 years at baseline, without congenital hearing loss, and non-CI users were eligible (n = 592). Additionally, for RQ-3 participants with a speech reception threshold in noise (SRTn) ≥ -5.5 dB signal-to-noise ratio were included (n = 422). Analyses used survey variables on hearing, dizziness, falls due to balance problems, chronic health conditions, and psychosocial health. Logistic regressions using General Estimating Equations were conducted to assess all RQs. RESULTS Among individuals with obesity, those with poor baseline SRTn had a higher odds of incident falls ten years later (odds ratio (OR):14.7, 95% confidence interval (CI) [2.12, 103]). A 10-year worsening of SRTn was significantly associated with a higher odds of recurrent (OR: 2.20, 95% CI [1.03, 4.71]) but not incident falls. No interaction was found between dizziness and change in SRTn. Hearing aid use (no use/ < 2 years use vs. ≥ 2 years) was not significantly associated with incident nor recurrent falls. Although there was a significant interaction with sex for this association, the effect of hearing aid use on incident/recurrent falls was not statistically significant among males nor females. CONCLUSIONS A longitudinal association between the deterioration in SRTn and recurrent falls due to balance problems after 10 years was confirmed in this study. This result stresses the importance of identifying declines in hearing earlier and justifies including hearing ability assessments within fall risk prevention programs. Mixed results of hearing aid use on fall risk warrant further investigation into the temporality of this association and possible differences between men and women.
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Affiliation(s)
- Lotte A Jansen
- Department of Otolaryngology - Head and Neck Surgery, Section Ear and Hearing, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands.
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands.
| | - Marieke F van Wier
- Department of Otolaryngology - Head and Neck Surgery, Section Ear and Hearing, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Freek P J Vernimmen
- Department of Otolaryngology - Head and Neck Surgery, Section Ear and Hearing, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Thadé Goderie
- Department of Otolaryngology - Head and Neck Surgery, Section Ear and Hearing, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
| | - Raymond van de Berg
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Vestibular Disorders, Maastricht University Medical Centre, P. Debyelaan 25, Maastricht, The Netherlands
| | - Ulrike Lemke
- Research & Development, Sonova AG, Staefa, Switzerland
| | - Birgit I Lissenberg-Witte
- Department of Epidemiology and Data Science, Amsterdam UMC Location Vrije Universiteit Amsterdam, Meibergdreef 9, Amsterdam, the Netherlands
| | - Sophia E Kramer
- Department of Otolaryngology - Head and Neck Surgery, Section Ear and Hearing, Amsterdam UMC Location Vrije Universiteit Amsterdam, De Boelelaan 1117, Amsterdam, the Netherlands
- Amsterdam Public Health Research Institute, Quality of Care, Amsterdam, the Netherlands
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Li Y, Smith RM, Whitney SL, Seemungal BM, Ellmers TJ. We should be screening for benign paroxysmal positional vertigo (BPPV) in all older adults at risk of falling: a commentary on the World Falls Guidelines. Age Ageing 2023; 52:afad206. [PMID: 37979182 DOI: 10.1093/ageing/afad206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 09/06/2023] [Indexed: 11/20/2023] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is amongst the commonest causes of dizziness and falls in older adults. Diagnosing and treating BPPV can reduce falls, and thereby reduce fall-related morbidity and mortality. Recent World Falls Guidelines recommend formal assessment for BPPV in older adults at risk of falling, but only if they report vertigo. However, this recommendation ignores the data that (i) many older adults with BPPV experience dizziness as vague unsteadiness (rather than vertigo), and (ii) others may experience no symptoms of dizziness at all. BPPV without vertigo is due to an impaired vestibular perception of self-motion, termed 'vestibular agnosia'. Vestibular agnosia is found in ageing, neurodegeneration and traumatic brain injury, and results in dramatically increased missed BPPV diagnoses. Patients with BPPV without vertigo are typically the most vulnerable for negative outcomes associated with this disorder. We thus recommend simplifying the World Falls Guidelines: all older adults (>60 years) with objective or subjective balance problems, irrespective of symptomatic complaint, should have positional testing to examine for BPPV.
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Affiliation(s)
- Yuxiao Li
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, UK
| | - Rebecca M Smith
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, UK
| | - Susan L Whitney
- Department of Physical Therapy, School of Health and Rehabilitation Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Barry M Seemungal
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, UK
| | - Toby J Ellmers
- Centre for Vestibular Neurology, Department of Brain Sciences, Imperial College London, London, UK
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Lee MJ, Seo BJ, Kim MY. Time-Varying Hazard of Patient Falls in Hospital: A Retrospective Case-Control Study. Healthcare (Basel) 2023; 11:2194. [PMID: 37570434 PMCID: PMC10419100 DOI: 10.3390/healthcare11152194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2023] [Revised: 07/31/2023] [Accepted: 08/01/2023] [Indexed: 08/13/2023] Open
Abstract
This study aims to evaluate the association between patient falls and relevant factors and to quantify their effect on fall risk. This is a retrospective case-control study using the secondary data collected from a tertiary general hospital. Study subjects were 450 patients who were admitted to the hospital between January 2016 and December 2020. The prevalence of falls was associated with the fall risk level by the Morse Fall Scale (MFS) and individual status at admission including history of admission, dizziness, sleep disorder, bowel dysfunction, and urinary incontinence. The odds ratios of patient falls were higher in the low-risk group by the MFS score (odds ratio (OR) = 2.61, p < 0.001) and the high-risk group (OR = 5.51, p < 0.001) compared to the no-risk group. The hazard ratio of patient falls was higher in the high-risk group by the MFS score (hazard ratio (HR) = 3.85, p < 0.001). The MFS had a significant explanatory power to predict fall risk. Sleep disorder and urinary incontinence were the significant factors influencing patient falls.
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Affiliation(s)
- Mi-Joon Lee
- Department of Medical Information, Kongju National University, 56 Gongjudaehak-ro, Gongju-si 32588, Republic of Korea;
| | - Bum-Jeun Seo
- Department of Medical Information, Kongju National University, 56 Gongjudaehak-ro, Gongju-si 32588, Republic of Korea;
| | - Myo-Youn Kim
- Department of Nursing, Kangbuk Samsung Hospital, Sungkyunkwan University School of Medicine, Seoul 03181, Republic of Korea;
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Kim EK, Sienko N, Gardi A, Krauter R, Pasquesi L, Sharon JD. Visually enhanced vestibulo-ocular reflex gain in patients with vestibular disease. Laryngoscope Investig Otolaryngol 2023; 8:1061-1067. [PMID: 37621269 PMCID: PMC10446303 DOI: 10.1002/lio2.1106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2023] [Revised: 06/16/2023] [Accepted: 06/22/2023] [Indexed: 08/26/2023] Open
Abstract
Objective Vestibular migraine (VM) is a diagnostic challenge. Visually enhanced vestibulo-ocular reflex (VVOR) gain, a measure of the visual-vestibular interaction, has been proposed as a tool for diagnosing VM. This study seeks to evaluate VVOR gain's diagnostic capability to predict VM and to compare the phenotypes of vestibular patients with elevated versus normal/low VVOR gain. Methods A retrospective review of consecutive adult patients at a dizziness clinic from October 2016 and December 2020 was conducted. VVOR gain's diagnostic performance was assessed with the area under the receiver operating characteristic (AUROC) analysis. Demographic factors and clinical presentations were compared between vestibular patients with elevated versus normal/low VVOR gain. Results One hundred forty patients (70 with VM) were analyzed. VVOR gain was elevated in 68.6% of patients with VM, compared to 52.9% of patients without VM (p = .057). The AUROC of VVOR gain was 0.5902 (95% confidence interval: 0.4958-0.6846). Vestibular patients with elevated VVOR gain were younger than those with normal/low VVOR gain (mean age 50 vs. 62, p < .0001). A higher proportion of subjects with elevated VVOR gain had symptoms triggered by certain foods (17.6% vs. 5.5%, p = .040) and experienced sound sensitivity (34.1% vs. 18.2%, p = .040) and motion sensitivity (23.5% vs. 9.1%, p = .041). A greater proportion of VM patients with elevated VVOR gain were triggered by certain foods (27.1% vs. 0%, p = .006). Conclusion VVOR gain alone has limited ability to discriminate VM from other vestibular conditions and must be interpreted carefully. VVOR gain elevation may be associated with food triggers and motion and sound sensitivity. Level of Evidence IV.
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Affiliation(s)
- Eric K. Kim
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Natalie Sienko
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Adam Gardi
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Roseanne Krauter
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
- Department of Family Health Care Nursing, School of NursingUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Lauren Pasquesi
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
| | - Jeffrey D. Sharon
- Department of Otolaryngology—Head and Neck SurgeryUniversity of California, San FranciscoSan FranciscoCaliforniaUSA
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Cheng HJ, Sun ZJ, Lu FH, Yang YC, Chang CJ, Wu JS. Functional status associated with postural dizziness, but not postural hypotension, in older adults: a community-based study. BMC Geriatr 2023; 23:383. [PMID: 37344784 DOI: 10.1186/s12877-023-04100-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2022] [Accepted: 06/09/2023] [Indexed: 06/23/2023] Open
Abstract
BACKGROUND Functional status, postural dizziness (PD), and postural hypotension (PH) were important issues in older adults. Only one study on the relationship for the three of them in female was without adjusting some important associated factors. This study was intended to investigate the association of PD and PH with functional status in older people of both genders. METHODS Based on a stratified randomized cluster sampling, 1361 subjects ≥ 65 years in the community were recruited from Tainan City, Taiwan, from 2000 to 2001. PH was defined as a decrease in systolic/diastolic blood pressure of ≥ 20/10 mm Hg after 1 or 2 min of standing. PD was defined by a positive response to dizziness-like symptoms after standing up from a supine position. Functional status included the activities of daily living (ADLs) and instrumental activities of daily living (IADLs). RESULTS After adjusting other variables, ADL disability (OR: 1.84, 95% CI: 1.35-2.51) and IADL disability (OR: 1.62, 95% CI: 1.21-2.17) were associated with PD, but not PH. In male and female subgroups, ADL disability (male OR: 1.70, 95% CI: 1.08-2.67; female OR 1.96, 95% CI: 1.26-3.07) was associated with PD. In male, IADL disability was associated with PD (OR: 2.32, 95% CI: 1.36-3.95). CONCLUSIONS Impaired functional status, shown using ADLs or IADLs, was positively associated with PD, but not PH in older adults ≥ 65 years. Clinically, it may be important to evaluate PD in older adults with ADL or IADL disability.
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Affiliation(s)
- Hsiang-Ju Cheng
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Zih-Jie Sun
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Family Medicine, National Cheng Kung University Hospital Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Feng-Hwa Lu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Yi-Ching Yang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
| | - Chih-Jen Chang
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan
- Department of Family Medicine, Ditmanson Medical Foundation Chia-Yi Christian Hospital, Chia-Yi, Taiwan
| | - Jin-Shang Wu
- Department of Family Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Department of Family Medicine, National Cheng Kung University Hospital Dou-Liou Branch, College of Medicine, National Cheng Kung University, Yunlin, Taiwan.
- Department of Family Medicine, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
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Wu P, Liu X, Dai Q, Yu J, Zhao J, Yu F, Liu Y, Gao Y, Li H, Li W. Diagnosing the benign paroxysmal positional vertigo via 1D and deep-learning composite model. J Neurol 2023:10.1007/s00415-023-11662-w. [PMID: 37076600 DOI: 10.1007/s00415-023-11662-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Revised: 03/08/2023] [Accepted: 03/08/2023] [Indexed: 04/21/2023]
Abstract
BACKGROUND Benign Paroxysmal Positional Vertigo (BPPV) is the leading cause of vertigo, and its characteristic nystagmus induced by positional maneuvers makes it a good model for Artificial Intelligence (AI) diagnosis. However, during the testing procedure, up to 10 min of indivisible long-range temporal correlation data are produced, making the AI-informed real-time diagnosing unlikely in clinical practice. METHODS A combined 1D and Deep-Learning (DL) composite model was proposed. Two separate cohorts were recruited, with one for model generation and the other for evaluation of model's real-world generalizability. Eight features, including two head traces and three eye traces and their corresponding slow phase velocity (SPV) value, were served as the inputs. Three candidate models were tested, and a sensitivity study was conducted to determine the saliently important features. RESULTS The study included 2671 patients in the training cohort and 703 in the test cohort. A hybrid DL model achieved a micro-area under the receiver operating curve (AUROC) of 0.982 (95% CI 0.965, 0.994) and macro-AUROC of 0.965 (95% CI 0.898, 0.999) for overall classification. The highest accuracy was observed for right posterior BPPV, with an AUROC of 0.991 (95% CI 0.972, 1.000), followed by left posterior BPPV, with an AUROC of 0.979 (95% CI 0.940, 0.998), the lowest AUROC was 0.928 (95% CI 0.878, 0.966) for lateral BPPV. The SPV was consistently identified as the most predictive feature in the models. If the model process is carried out 100 times for a 10-min data, one single running takes 0.79 ± 0.06 s. CONCLUSION This study designed DL models which can accurately detect and categorize the subtype of BPPV, enabling a quick and straightforward diagnosis of BPPV in clinical setting. The critical feature identified in the model helps expand our understanding of this disorder.
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Affiliation(s)
- Peixia Wu
- ENT Institute and Otorhinolaryngology Department of Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
- Nursing Department, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Xuebing Liu
- Department of Computer Science and Engineering, Jeonbuk National University, Jeonju, South Korea
| | - Qi Dai
- ENT Institute and Otorhinolaryngology Department of Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Jiaoda Yu
- ENT Institute and Otorhinolaryngology Department of Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Jieli Zhao
- ENT Institute and Otorhinolaryngology Department of Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
- Nursing Department, Eye and ENT Hospital, Fudan University, Shanghai, China
| | - Fangzhou Yu
- ENT Institute and Otorhinolaryngology Department of Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Yaoqian Liu
- ENT Institute and Otorhinolaryngology Department of Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China
| | - Yongbin Gao
- School of Electronic and Electronics Engineering, Shanghai University of Engineering Science, Shanghai, China
| | - Huawei Li
- ENT Institute and Otorhinolaryngology Department of Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China.
- Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China.
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 20003, China.
- The Institutes of Brain Science and the Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, 200032, China.
| | - Wenyan Li
- ENT Institute and Otorhinolaryngology Department of Eye and ENT Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Fudan University, Shanghai, China.
- Institutes of Biomedical Sciences, Fudan University, Shanghai, 200032, China.
- NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai, 20003, China.
- The Institutes of Brain Science and the Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, 200032, China.
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Wu PL, Lin HC, Chien WC, Chung CH, Chen JW. Increased Risk of Injury in Ménière's Disease and Effects of Treatment: Population-Based Retrospective Cohort Study. Otolaryngol Head Neck Surg 2023; 168:443-452. [PMID: 35763347 DOI: 10.1177/01945998221106628] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2022] [Accepted: 05/25/2022] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the risk of injury in patients with Ménière's disease (MD) and the effects of treatment. STUDY DESIGN Population-based retrospective cohort study. SETTING Data were collected from the Longitudinal Health Insurance Database 2005, containing the information of 2 million randomly selected individuals in Taiwan. METHODS We enrolled 90,481 patients with newly diagnosed MD between 2000 and 2017 and 361,924 matched individuals without MD. The study outcomes were diagnoses of all-cause injuries. The Kaplan-Meier method was used to determine the cumulative incidence rates of injury in the MD and non-MD cohorts, and a log-rank test was used to analyze the differences between the cohorts. Cox proportional hazards models were used to calculate the 18-year hazard ratios of each cohort. RESULTS A total of 80,151 patients were diagnosed with injuries during the follow-up period: 24,031 and 56,120 from the MD and non-MD cohorts, respectively. The adjusted hazard ratio (aHR) was 2.19 (95% CI, 2.16-2.35) after adjusting for demographic characteristics and comorbidities. Subgroup analysis revealed that MD was associated with an increased incidence of unintentional and intentional injuries (aHR, 2.24 [95% CI, 2.21-2.41] and 2.05 [95% CI, 2.01-2.19], respectively). Treatment with diuretics, antivertigo medications, or surgery did not reduce the risk of injury (aHR, 0.98 [95% CI, 0.59-1.54], 0.94 [95% CI, 0.58-1.50], and 0.99 [95% CI, 0.61-1.54]). CONCLUSION MD is independently associated with an increased risk of injuries. Medical or surgical treatment for MD does not reduce the risk of injury in patients with MD. Physicians should counsel patients with MD regarding preventive measures for avoiding subsequent injuries.
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Affiliation(s)
- Po-Ling Wu
- Department of Medical Education and Research, Cardinal Tien Hospital, New Taipei City
| | - Hung-Che Lin
- Graduate Institute of Medical Sciences, National Defense Medical Center, Taipei
- Department of Otolaryngology-Head and Neck Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei
| | - Wu-Chien Chien
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei
- Graduate Institute of Life Sciences, National Defense Medical Center, Taipei
- School of Public Health, National Defense Medical Center, Taipei
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei
| | - Chi-Hsiang Chung
- Department of Medical Research, Tri-Service General Hospital, National Defense Medical Center, Taipei
- School of Public Health, National Defense Medical Center, Taipei
- Taiwanese Injury Prevention and Safety Promotion Association, Taipei
| | - Jeng-Wen Chen
- Department of Medical Education and Research, Cardinal Tien Hospital, New Taipei City
- Department of Otolaryngology-Head and Neck Surgery, Cardinal Tien Hospital and School of Medicine, Fu Jen Catholic University, New Taipei City
- Master Program of Big Data in Biomedicine, School of Medicine, Fu Jen Catholic University, New Taipei City
- Cardinal Tien Junior College of Healthcare and Management, New Taipei City
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Curry SD, Carotenuto A, Huang Y, Maar DJ, DeLuna DA, Siebler JC, Hatch JL. Older Adults with Vestibular Disorders and Hip Fractures Have High Rates of Meclizine Use. Otol Neurotol 2023; 44:e178-e183. [PMID: 36728629 DOI: 10.1097/mao.0000000000003792] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVES To examine the risk factors for hip fracture in patients with vestibular disorders and the association between antihistamine use and hip fracture in patients with vestibular disorders. STUDY DESIGN Retrospective case series with chart review. SETTING Tertiary academic medical center. METHODS A retrospective review of adult patients with hip fracture based on International Classification of Diseases, Tenth Revision (ICD-10) code S72 from January 2013 to December 2019 who had previously been diagnosed with a vestibular disorder based on ICD-10 codes H81-83, A88.1, and R42. RESULTS A total of 201 patients were identified meeting the inclusion criteria. The average age at the time of hip fracture was 78.8 years and the majority were female (64.7%). Most patients were diagnosed with nonspecific dizziness (60.2%) or vertigo (23.9%). Those with a peripheral vestibular disorder included benign paroxysmal positional vertigo (BPPV) in 13.4% and Ménière's disease in 2.5%. Overall, meclizine was prescribed to 38.3% of patients, including 29.9% of patients before hip fracture. Meclizine was prescribed to 66.7% of patients with BPPV. Patients were seen for vestibular symptoms 0.67 ± 2.51 years before hip fracture, and 98 patients (48.8%) presented with vestibular concerns within 1 year prior. CONCLUSION Patients with vestibular disorders who sustain a ground level fall resulting in hip fracture are a vulnerable population of predominantly older adults with multiple comorbidities. Patients were frequently diagnosed with dizziness or vertigo rather than more specific causes being identified. Multifactorial interventions to prevent hip fractures in older adults have been recommended; however, this study suggests that meclizine use was common among patients diagnosed with dizziness, vertigo, or BPPV before hip fracture.
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Affiliation(s)
- Steven D Curry
- Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center
| | - Alessandro Carotenuto
- Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center
| | - Ye Huang
- College of Medicine, University of Nebraska Medical Center
| | - Dennis J Maar
- College of Medicine, University of Nebraska Medical Center
| | - Devin A DeLuna
- College of Medicine, University of Nebraska Medical Center
| | - Justin C Siebler
- Department of Orthopaedic Surgery and Rehabilitation, University of Nebraska Medical Center, Omaha, NE
| | - Jonathan L Hatch
- Department of Otolaryngology-Head and Neck Surgery, University of Nebraska Medical Center
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Horstmannshoff C, Skudlik S, Petermann J, Kiesel T, Döringer T, Crispin A, Hermsdörfer J, Köberlein-Neu J, Jahn K, Schädler S, Bauer P, Voigt K, Müller M. Effectiveness of an evidence-based care pathway to improve mobility and participation in older patients with vertigo and balance disorders in primary care (MobilE-PHY2): study protocol for a multicentre cluster-randomised controlled trial. Trials 2023; 24:91. [PMID: 36747256 PMCID: PMC9902065 DOI: 10.1186/s13063-022-07017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/15/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Vertigo, dizziness or balance disorders (VDB) are common leading symptoms in older people, which can have a negative impact on their mobility and participation in daily live, yet, diagnosis is challenging and specific treatment is often insufficient. An evidence-based, multidisciplinary care pathway (CPW) in primary care was developed and pilot tested in a previous study. The aim of the present study is to evaluate the effectiveness and safety of the CPW in terms of improving mobility and participation in community-dwelling older people with VDB in primary care. METHODS For this multicentre cluster randomised controlled clinic trial, general practitioners (GP) will be recruited in two regions of Germany. A total of 120 patients over 60 years old with VDB will be included. The intervention is an algorithmized CPW. GPs receive a checklist for standardise clinical decision making regarding diagnostic screening and treatment of VDB. Physiotherapists (PT) receive a decision tree for evidence-based physiotherapeutic clinical reasoning and treatment of VDB. Implementation strategies comprises educational trainings as well as a workshop to give a platform for exchange for the GPs and PTs, an information meeting and a pocket card for home care nurses and informal caregivers and telephone peer counselling to give all participants the capability, opportunity and the motivation to apply the intervention. In order to ensure an optimised usual care in the control group, GPs get an information meeting addressing the national guideline. The primary outcome is the impact of VDB on participation and mobility of patients after 6 month follow-up, assessed using the Dizziness Handicap Inventory (DHI) questionnaire. Secondary outcomes are physical activity, static and dynamic balance, falls and fear of falling as well as quality of life. We will also evaluate safety and health economic aspects of the intervention. Behavioural changes of the participants as well as barriers, facilitating factors and mechanisms of impact of the implementation will be investigated with a comprehensive process evaluation in a mixed-methods design. DISCUSSION With our results, we aim to improve evidence-based health care of community-dwelling older people with VDB in primary care. TRIAL REGISTRATION DRKS, DRKS00028524 retrospectively registered on March 24, 2022.
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Affiliation(s)
- Caren Horstmannshoff
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024, Rosenheim, Germany. .,Department of Sport and Health Sciences, Chair of Human Movement Science, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany.
| | - Stefanie Skudlik
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024, Rosenheim, Germany
| | - Jenny Petermann
- Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 1307, Dresden, Germany
| | - Theresia Kiesel
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024, Rosenheim, Germany
| | - Tobias Döringer
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024, Rosenheim, Germany
| | - Alexander Crispin
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilian University of Munich, Marchioninistr. 15, 81377, Munich, Germany
| | - Joachim Hermsdörfer
- Department of Sport and Health Sciences, Chair of Human Movement Science, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992, Munich, Germany
| | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, University of Wuppertal, Rainer-Gruenter-Str. 21, 42119, Wuppertal, Germany
| | - Klaus Jahn
- German Centre for Vertigo and Balance Disorders, Ludwig-Maximilian University of Munich, Marchioninistraße 15, 81377, Munich, Germany.,Schoen Clinic Bad Aibling, Kolbermoorer Str. 72, 83043, Bad Aibling, Germany
| | - Stefan Schädler
- Physiotherapie im Schloss, Schloss 88, 3454, Sumiswald, Switzerland
| | - Petra Bauer
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024, Rosenheim, Germany
| | - Karen Voigt
- Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 1307, Dresden, Germany
| | - Martin Müller
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024, Rosenheim, Germany.,Department of Primary Care and Health Services Research, Medical Faculty, Heidelberg University, Im Neuenheimer Feld 130.3, 69120, Heidelberg, Germany
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11
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Alves CS, Santos M, Castro A, Lino J, Freitas SV, Almeida e Sousa C, da Silva ÁM. Geriatric otorhinolaryngology: reasons for outpatient referrals from generalists to ENT specialists. Eur Arch Otorhinolaryngol 2023; 280:461-467. [PMID: 36094563 PMCID: PMC9466320 DOI: 10.1007/s00405-022-07641-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2021] [Accepted: 11/25/2021] [Indexed: 01/07/2023]
Abstract
PURPOSE To determine the main symptoms leading to referral of geriatric patients from primary care to otorhinolaryngology. METHODS Retrospective, observational study performed on patients aged 65 and older, referred from Primary Care to the Otorhinolaryngology and Head and Neck Surgery department of a tertiary centre during 2019 and 2020. Symptoms leading to otorhinolaryngological referral were categorized as "Oto-neurological symptoms", "Nasal symptoms", "Pharyngolaryngeal symptoms", "Other Head and Neck symptoms" and "Other Reasons". Data regarding age, gender and whether patients maintain follow-up or have been discharged was also collected. RESULTS The study population included a total of 1304 patients (697 female; 607 male). Oto-neurological symptoms were found to be the most prevalent symptoms, with 65% of patients reporting oto-neurological symptoms as at least one of the reasons for referral. Hearing loss was the most commonly reported symptom, with an association found between this symptom and age (p < 0.001). Results also showed an association between the female gender and vertigo/dizziness (p < 0.001) and tinnitus (p = 0.007). An association between the male gender and nasal symptoms was also found (p = 0.018), particularly nasal obstruction (p = 0.003) and epistaxis (p = 0.028). No statistically significant associations were found among the pharyngolaryngeal group. CONCLUSIONS This retrospective observational study allowed for a better understanding of the type of otorhinolaryngological symptoms affecting elderly patients and driving otorhinolaryngology evaluation, cementing hearing loss as one of the major complaints among older adults and allowing for a better preparation by otorhinolaryngologists for the changing needs of this subset of the population.
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Affiliation(s)
- Clara Serdoura Alves
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Largo Professor Abel Salazar, 4100-099 Porto, Portugal
| | - Mariline Santos
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Largo Professor Abel Salazar, 4100-099 Porto, Portugal
| | - Afonso Castro
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Largo Professor Abel Salazar, 4100-099 Porto, Portugal
| | - João Lino
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Largo Professor Abel Salazar, 4100-099 Porto, Portugal
| | - Susana Vaz Freitas
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Largo Professor Abel Salazar, 4100-099 Porto, Portugal ,Faculdade de Ciências da Saúde, Universidade Fernando Pessoa, Porto, Portugal ,LIAAD, Laboratório de Inteligência Artificial e Apoio à Decisão, INESCTEC, Porto, Portugal
| | - Cecília Almeida e Sousa
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Largo Professor Abel Salazar, 4100-099 Porto, Portugal
| | - Álvaro Moreira da Silva
- Centro Hospitalar Universitário do Porto, Instituto de Ciências Biomédicas Abel Salazar, Universidade do Porto, Largo Professor Abel Salazar, 4100-099 Porto, Portugal
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12
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Nelson MD, Bennett DM, Lehman ME, Okonji AI. Dizziness, Falls, and Hearing Loss in Adults Living With Sickle Cell Disease. Am J Audiol 2022; 31:1178-1190. [DOI: 10.1044/2022_aja-22-00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective:
The aim of this study was to assess the prevalence of reported dizziness/imbalance, frequency of falls, and hearing loss in adults with sickle cell disease (SCD) and determine the relationship of these self-reported problems both during and in the absence of an SCD crisis. Also, the impact of educational level and health insurance on seeking treatment services, as well as the relationship of falls to stroke, legal blindness, and other orthopedic problems, was assessed. Interrupted blood flow to shared vestibular and auditory arteries supports the notion of increased likelihood of balance deficits and increased falls in this population.
Design:
A cross-sectional survey study design was used. Adults living with SCD responded to a questionnaire that was distributed online and through traditional mail.
Study Sample:
Adults living with SCD (
N
= 135) participated in the study.
Results:
Responses revealed 70% of participants with SCD experienced dizziness/imbalance and 23% reported hearing loss. Furthermore, 33% of participants reported falling one or more times in the last year. The prevalence of dizziness/imbalance, falling, and hearing loss in the respondents with SCD was much higher than that of the general population of the United States. Additionally, for dizziness and falling, the prevalence was higher not only than the national average but also for persons over 65 years of age. A significant association was demonstrated between dizziness/imbalance and hearing loss as well as dizziness/imbalance and falls for adults living with SCD. In fact, participants with self-reported hearing loss were 5.2 times more likely to also report dizziness/imbalance. They were 4.9 times more likely to fall if they also reported dizziness/imbalance. Numbness of the feet was revealed to significantly impact the likelihood of falling in this disease population and should be further studied. Regarding SCD crisis status, dizziness/imbalance and falls were more likely to occur outside of SCD crisis than during a crisis. Furthermore, pain levels were significantly associated with dizziness/imbalance only when respondents were in crisis and not in the absence of a crisis. In crisis, higher pain levels were reported from respondents who also reported dizziness/imbalance than from those who did not report dizziness. No significant relationship was revealed between hearing loss and falls.
Discussion:
These results provide justification for patient and health care provider education regarding appropriate referrals for vestibular/balance assessments and provision of fall prevention strategies. Future studies on balance and SCD are encouraged.
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13
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Cerebral Blood Flow Velocity Modulation and Clinical Efficacy of Acupuncture for Posterior Circulation Infarction Vertigo: A Systematic Review and Meta-Analysis. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:3740856. [PMID: 35800002 PMCID: PMC9256413 DOI: 10.1155/2022/3740856] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/26/2021] [Revised: 05/19/2022] [Accepted: 05/23/2022] [Indexed: 12/04/2022]
Abstract
Background Vertigo is a cardinal symptom of posterior circulation infarction (POCI). Acupuncture is demonstrated to have a beneficial effect on posterior circulation infarction vertigo (PCIV). However, the mechanism of acupuncture therapy is not clarified. This study aims to assess the cerebral blood flow velocity modulation and clinical efficacy of acupuncture for PCIV patients. Methods We conducted this systematic review for clinical randomized controlled trials (RCTs) regarding acupuncture on PCIV. The study duration was from September 2020 to September 2021. We searched the PubMed, EMBASE, Cochrane Library, Web of Science, Chinese Biomedical Literature Database (CBM), China National Knowledge Infrastructure (CNKI), Wanfang Database, and VIP. The publication date was set from inception to August 31, 2020. Based on the inclusion and exclusion criteria, two researchers independently screened literature and extracted data including basic study information, intervention details, outcome details, and adverse events. Outcome measures included the blood flow velocities of vertebrobasilar arteries and the Clinical Effective Rate of posterior circulation infarction vertigo. Pooled data were presented as standardized mean differences (SMDs) and relative risks (RR), with 95% confidence intervals (CIs). The meta-analysis was conducted using Review Manager software version 5.3.0. Results A total of 20 eligible RCTs (1541 participants) were included in this review, which compared acupuncture therapy (1 RCT) or acupuncture combined with pharmaceutical therapy (19 RCTs) to pharmaceutical therapy in patients with posterior circulation infarction vertigo. 7 studies assessed the blood flow velocities of the basilar artery examined by Transcranial Doppler (TCD), 8 studies assessed the bilateral vertebral arteries, and 13 studies evaluated the Clinical Effective Rate of posterior circulation infarction vertigo. Meta-analysis results showed that blood flow velocities of the basilar artery (SMD = 0.58, 95% CI = 0.40–0.76; P < 0.05), left vertebral artery (SMD = 0.48, 95% CI = 0.22–0.73; P < 0.05), and right vertebral artery (SMD = 0.44, 95% CI = 0.19–0.69; P < 0.05) were significantly higher in the acupuncture group compared with the control group. Clinical Effective Rate (RR = 1.22, 95% CI = 1.15–1.29; P = 0.792) was significantly better in the acupuncture group compared with the control group. Conclusions This study shows that acupuncture therapy is useful in improving the blood flow velocity of vertebrobasilar arteries and Clinical Effective Rate in patients with posterior circulation infarction vertigo. However, double-blind, sham-controlled trials with large sample sizes are required to support our conclusions.
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14
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Lu W, Li Z, Li Y, Li J, Chen Z, Feng Y, Wang H, Luo Q, Wang Y, Pan J, Gu L, Yu D, Zhang Y, Shi H, Yin S. A Deep Learning Model for Three-Dimensional Nystagmus Detection and Its Preliminary Application. Front Neurosci 2022; 16:930028. [PMID: 35769696 PMCID: PMC9236194 DOI: 10.3389/fnins.2022.930028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/13/2022] [Indexed: 12/02/2022] Open
Abstract
Symptoms of vertigo are frequently reported and are usually accompanied by eye-movements called nystagmus. In this article, we designed a three-dimensional nystagmus recognition model and a benign paroxysmal positional vertigo automatic diagnosis system based on deep neural network architectures (Chinese Clinical Trials Registry ChiCTR-IOR-17010506). An object detection model was constructed to track the movement of the pupil centre. Convolutional neural network-based models were trained to detect nystagmus patterns in three dimensions. Our nystagmus detection models obtained high areas under the curve; 0.982 in horizontal tests, 0.893 in vertical tests, and 0.957 in torsional tests. Moreover, our automatic benign paroxysmal positional vertigo diagnosis system achieved a sensitivity of 0.8848, specificity of 0.8841, accuracy of 0.8845, and an F1 score of 0.8914. Compared with previous studies, our system provides a clinical reference, facilitates nystagmus detection and diagnosis, and it can be applied in real-world medical practices.
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Affiliation(s)
- Wen Lu
- Department of Otolaryngology—Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Zhuangzhuang Li
- Department of Otolaryngology—Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Yini Li
- Department of Otolaryngology—Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Jie Li
- Department of Otolaryngology—Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Zhengnong Chen
- Department of Otolaryngology—Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Yanmei Feng
- Department of Otolaryngology—Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Hui Wang
- Department of Otolaryngology—Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Qiong Luo
- Department of Otolaryngology—Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | | | - Jun Pan
- IceKredit Inc., Shanghai, China
| | | | - Dongzhen Yu
- Department of Otolaryngology—Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Yudong Zhang
- School of Computing and Mathematical Sciences, University of Leicester, Leicester, United Kingdom
| | - Haibo Shi
- Department of Otolaryngology—Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Shankai Yin
- Department of Otolaryngology—Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
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15
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Viola P, Marcianò G, Casarella A, Pisani D, Astorina A, Scarpa A, Siccardi E, Basile E, De Sarro G, Gallelli L, Chiarella G. The Pharmacological Treatment of Pediatric Vertigo. CHILDREN 2022; 9:children9050584. [PMID: 35626761 PMCID: PMC9139449 DOI: 10.3390/children9050584] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 03/14/2022] [Revised: 04/09/2022] [Accepted: 04/15/2022] [Indexed: 12/25/2022]
Abstract
Vertigo in children is a challenging topic. The lack of dedicated trials, guidelines and papers causes inhomogeneity in the treatment of vertigo in children. Meniere’s disease, migraine equivalents, vestibular neuritis, paroxysmal positional benign vertigo (BPPV), persistent postural-perceptual dizziness (PPPD) and motion sickness may affect children with various degrees of incidence and clinical severity compared to adults. Several drugs are proposed for the management of these conditions, even if their use is subordinated to the child’s age. In this review, we summarize the existing evidence related to the use of drugs for this clinical condition in children as a start point for new trials, stating the urgent need for international guidelines.
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Affiliation(s)
- Pasquale Viola
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (P.V.); (D.P.); (A.A.)
| | - Gianmarco Marcianò
- Clinical Pharmacology and Pharmacovigilance Unit, Department of Health Science, School of Medicine, University of Catanzaro, Mater Domini Hospital, 88100 Catanzaro, Italy; (G.M.); (A.C.); (E.B.); (G.D.S.); (L.G.)
| | - Alessandro Casarella
- Clinical Pharmacology and Pharmacovigilance Unit, Department of Health Science, School of Medicine, University of Catanzaro, Mater Domini Hospital, 88100 Catanzaro, Italy; (G.M.); (A.C.); (E.B.); (G.D.S.); (L.G.)
| | - Davide Pisani
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (P.V.); (D.P.); (A.A.)
| | - Alessia Astorina
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (P.V.); (D.P.); (A.A.)
| | - Alfonso Scarpa
- Department of Medicine and Surgery, University of Salerno, 84081 Baronissi, Italy;
| | | | - Emanuele Basile
- Clinical Pharmacology and Pharmacovigilance Unit, Department of Health Science, School of Medicine, University of Catanzaro, Mater Domini Hospital, 88100 Catanzaro, Italy; (G.M.); (A.C.); (E.B.); (G.D.S.); (L.G.)
| | - Giovambattista De Sarro
- Clinical Pharmacology and Pharmacovigilance Unit, Department of Health Science, School of Medicine, University of Catanzaro, Mater Domini Hospital, 88100 Catanzaro, Italy; (G.M.); (A.C.); (E.B.); (G.D.S.); (L.G.)
- Research Center FAS@UMG, Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy
| | - Luca Gallelli
- Clinical Pharmacology and Pharmacovigilance Unit, Department of Health Science, School of Medicine, University of Catanzaro, Mater Domini Hospital, 88100 Catanzaro, Italy; (G.M.); (A.C.); (E.B.); (G.D.S.); (L.G.)
- Research Center FAS@UMG, Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy
- Medifarmagen SRL, Department of Health Science, Magna Graecia University, 88100 Catanzaro, Italy
| | - Giuseppe Chiarella
- Unit of Audiology, Regional Centre of Cochlear Implants and ENT Diseases, Department of Experimental and Clinical Medicine, Magna Graecia University, 88100 Catanzaro, Italy; (P.V.); (D.P.); (A.A.)
- Correspondence: ; Tel.: +39-0961364-7124
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Cao Q, Shen Y, Hou Z, Li D, Tang B, Xu L, Li Y. The Relationship Between Patent Foramen Ovale and Unexplained Dizziness: A Prospective Analysis in China. Neuropsychiatr Dis Treat 2022; 18:1495-1505. [PMID: 35923299 PMCID: PMC9341455 DOI: 10.2147/ndt.s367140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Accepted: 06/29/2022] [Indexed: 11/23/2022] Open
Abstract
INTRODUCTION Patent foramen ovale (PFO) is potentially associated with abnormal embolisms, and it results in mixing of arteriovenous blood when its right-to-left shunt (RLS) emerges. Present studies have found that PFO is a risk factor that can lead to many diseases. However, few studies have examined the relationship between PFO and dizziness. METHODS This study was a large single-center, prospective, controlled study. From March 2019 to March 2021, we recruited patients with dizziness were divided into two groups: "explained" and "unexplained". All patients were submitted to contrast-enhanced transcranial Doppler ultrasound and screened for PFO. Transesophageal heart ultrasound or right heart catheterization was used to confirm PFO. Additionally, multiple factors were collected and statistical analysis was performed between the two groups. RESULTS Among the 244 patients included, 123 were in the "explained" group and 121 were in the "unexplained" group. The prevalence of PFO in the "explained" group was 34 (27.4%) compared to 79 (64.7%) in the "unexplained" group. In the "explained" group, 7 were RLS level IV, 6 were level III, 7 were level II, and 14 were level I. For the "unexplained" group, the numbers of patients with levels IV, III, II and I were 27, 26, 12 and 14, respectively. Univariate analysis revealed that PFO (χ2= 34.77, P < 0.001) and age (t = -3.49, P < 0.001) seemed to be potential risk factor candidates for "unexplained" dizziness. In multiple regression analysis, age (OR = 0.97; 95% CI 0.95-0.99) and the prevalence of PFO (OR = 4.37; 95% CI 2.50-7.63) were statistically significant. Massively shunted PFO showed more pronounced risk factors (OR = 8.76; 95% CI 4.04-19.03). CONCLUSION There was a high prevalence of PFO and a greater RLS level in unexplained dizziness. PFO and age were independent risk factors for unexplained dizziness. When treating with unexplained dizziness, especially among young people, we must pay attention to the presence of PFO.
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Affiliation(s)
- Qian Cao
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Yu Shen
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China.,Department of Neurology, The First Affiliated Hospital of Nanchang University, Nanchang, People's Republic of China
| | - Zhuo Hou
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Defu Li
- Jiangxi Provincial Key Laboratory of Preventive Medicine, Nanchang University School of Public Health, Nanchang, Jiangxi, People's Republic of China
| | - Boji Tang
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Lijun Xu
- Department of Neurology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
| | - Yanping Li
- Department of Neuroelectrophysiology, The Second Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, People's Republic of China
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Lopes AL, Lemos SMA, Figueiredo PHS, Gonçalves DU, Santos JN. Lian gong as a Therapeutic Treatment Option in Primary Care for Patients with Dizziness: A Randomized Controlled Trial. Int Arch Otorhinolaryngol 2021; 25:e509-e516. [PMID: 34737821 PMCID: PMC8558947 DOI: 10.1055/s-0040-1718956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/23/2020] [Indexed: 11/08/2022] Open
Abstract
Introduction Dizziness is one of the most common reasons for seeking primary health care. Vestibular rehabilitation (VR) is a conventional treatment method for peripheral balance disorders that effectively decreases symptoms. Lian gong [LG] is believed to benefit patients with dizziness and to reduce the impact of the condition on quality of life by stimulating visual fixation, attention, body balance, and neuroplasticity. Objective The present study aimed to evaluate the effects of LG on the impact of dizziness on quality of life and fear of falling in primary health care patients. Methods This was a two-arm, parallel randomized clinical trial that included 36 patients with dizziness not caused by central changes. After specific medical evaluations and indications for treatment, the participants were randomly assigned to 3 groups: the LG group ( n = 11), the VR group ( n = 11), and the control group ( n = 14). The interventions were conducted collectively over a period of 12 weeks. Results Lian gong reduced the influence of dizziness on quality of life in physical (1.8 points, 95% confidence interval [CI]: 0.2-3.4), functional (4.0 points, 95% CI: 2.1-5.9), and emotional domains of quality of life (4.4 points, 95% CI: 1.7-7.2), with no differences compared with VR. There were similar concerns among the groups about the risk of falling. Conclusion Lian gong was shown to be an effective balance rehabilitation strategy to reduce the impact of dizziness on quality of life, with similar results to those of VR.
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Affiliation(s)
- Aline Lamas Lopes
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Fonoaudiológicas, Belo Horizonte, MG, Brazil
| | - Stela Maris Aguiar Lemos
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Fonoaudiológicas, Belo Horizonte, MG, Brazil
| | - Pedro Henrique Scheidt Figueiredo
- Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Faculdade de Ciências Biológicas e da Saúde, Diamantina, MG, Brazil
| | - Denise Utsch Gonçalves
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Fonoaudiológicas, Belo Horizonte, MG, Brazil
| | - Juliana Nunes Santos
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Fonoaudiológicas, Belo Horizonte, MG, Brazil
- Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Faculdade de Ciências Biológicas e da Saúde, Diamantina, MG, Brazil
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Rojas Castro MY, Avalos M, Contrand B, Dupuy M, Sztal-Kutas C, Orriols L, Lagarde E. Health conditions and the risk of home injury in French adults: results from a prospective study of the MAVIE cohort. Inj Prev 2021; 28:141-147. [PMID: 34413074 DOI: 10.1136/injuryprev-2020-044033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 08/10/2021] [Indexed: 11/03/2022]
Abstract
BACKGROUND Home injury (HI) is a significant cause of mortality and morbidity in adults of all ages. Health conditions significantly impact HI among old adults, but little is known for other adults. STUDY DESIGN Prospective cohort study. OBJECTIVE We assessed the associations between health-related factors and HI's risk in a French study, the MAVIE (Mutualistes pour la recherche contre les Accidents de la VIE courante) cohort. METHODS Poisson mixed models were fitted using health-related data information (diseases, treatments and disabilities) at baseline and the number of injuries prospectively recorded during the follow-up, adjusting for significant sociodemographics and exposure to a range of home activities. Attributable fractions were estimated based on risk ratio (RR) estimations measured in the fully adjusted models. RESULTS A total of 6146 dwelling adults aged 15 or older were followed up for 5.1 years on average. Vertigo or dizziness (RR=2.36, 95% CI 1.06 to 5.01) and sciatica or back pain (RR=1.49, 95% CI 1.08 to 2.05) were independently associated with an increased risk of HI. These two groups of conditions showed the most significant associations among people aged 15-49, whereas musculoskeletal diseases other than rachialgias and arthropathies were the most significant health-related risk factor in people aged 50 and older. Sciatica or back pain represented the highest burden of HIs in overall adults (8%) and among people aged 15-49 (12%). CONCLUSION Our results suggest that adults with musculoskeletal disorders and vertigo or dizziness symptoms have a higher risk of HI, regardless of age.
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Affiliation(s)
- Madelyn Yiseth Rojas Castro
- U1219, INSERM, Bordeaux, Nouvelle-Aquitaine, France.,U1219, Universite de Bordeaux, Bordeaux, Aquitaine, France
| | - Marta Avalos
- U1219, INSERM, Bordeaux, Nouvelle-Aquitaine, France.,SISTM Team, Inria, Talence, Aquitaine, France
| | - Benjamin Contrand
- U1219, INSERM, Bordeaux, Nouvelle-Aquitaine, France.,U1219, Universite de Bordeaux, Bordeaux, Aquitaine, France
| | - Marion Dupuy
- Calyxis, Centre of Risk Expertise, Niort, France
| | | | - Ludivine Orriols
- U1219, INSERM, Bordeaux, Nouvelle-Aquitaine, France.,U1219, Universite de Bordeaux, Bordeaux, Aquitaine, France
| | - Emmanuel Lagarde
- U1219, INSERM, Bordeaux, Nouvelle-Aquitaine, France .,U1219, Universite de Bordeaux, Bordeaux, Aquitaine, France
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19
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Kin Kok M, Vlaskovsky P, Low E, Shim R, Lian A. Within-unit bed moves in a short-stay in-patient unit are associated with increased falls. AUST HEALTH REV 2021; 45:497-503. [PMID: 33757625 DOI: 10.1071/ah20196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Accepted: 12/15/2020] [Indexed: 11/23/2022]
Abstract
Objective This study evaluated a patient's likelihood of a fall using information available at the time of presentation to a short-stay acute medical unit (AMU) with a high patient turnover rate and estimated the effect of within-unit bed moves on the occurrence of in-patient falls. Methods This study was a 3-year retrospective cross-sectional study of 28713 consecutive admissions comparing patients who fell and patients who did not fall. Factors assessed included premorbid falls risk factors, presenting issues and within-unit bed moves. Logistic regression was used to identify factors associated with patients who fell. Each admission was treated as a unit of measure. Results Of 28713 admissions, 182 (0.6%) involved at least one fall event. The fall rate was 5.67 falls per 1000 occupied bed days. Premorbid cognitive impairment (odds ratio (OR) 4.88), a presenting issue of confusion (OR 2.92) and a fall immediately before admission (OR 2.49) were associated with patients who fell (all P<0.001). Each bed move corresponded to a 27% increase in the odds of a fall (OR 1.27; P=0.027). Conclusion Premorbid cognitive impairment was the strongest risk factor for an in-patient fall on the unit. Within-unit bed moves significantly increased the risk of an in-patient fall and should be minimised. What is known about the topic? In-patient falls can cause significant patient harm at cost to the health system. There is limited research examining the association between within-unit bed moves and falls in a short-stay AMU. What does this paper add? Care in the short-stay AMU is complex and the number of bed moves is a modifiable factor that can reduce a patient's risk of an in-patient fall. What are the implications for practitioners? Bed moves need to be minimised, especially for patients with cognitive impairment. If bed moves are inevitable, operational plans can be designed to mitigate the increased risk caused by these moves.
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Affiliation(s)
- Mui Kin Kok
- Department of Internal Medicine, Royal Perth Hospital, Wellington Street, Perth, WA 6000, Australia. Emails: ; ; ; and Corresponding author.
| | - Philip Vlaskovsky
- The University of Western Australia, Mounts Bay Road, Crawley, WA 6009, Australia.
| | - Evelyn Low
- Department of Internal Medicine, Royal Perth Hospital, Wellington Street, Perth, WA 6000, Australia. Emails: ; ;
| | - Rae Shim
- Department of Internal Medicine, Royal Perth Hospital, Wellington Street, Perth, WA 6000, Australia. Emails: ; ;
| | - Alwin Lian
- Department of Internal Medicine, Royal Perth Hospital, Wellington Street, Perth, WA 6000, Australia. Emails: ; ;
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20
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Ayas M, AlAmadi A. Emerging and distinct video head impulse test responses in elderly with vestibular symptoms. Braz J Otorhinolaryngol 2021; 88 Suppl 1:S18-S23. [PMID: 33775614 PMCID: PMC9734266 DOI: 10.1016/j.bjorl.2021.02.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 02/11/2021] [Accepted: 02/23/2021] [Indexed: 12/16/2022] Open
Abstract
INTRODUCTION Dizziness has been reported to be the most common symptom in elderly population. Video head impulse test, VHIT, allows clinicians to assess the vestibular function in elderly individuals, during their initial stages of vestibular symptoms. Inferences from VHIT responses were traditionally low vestibulo-ocular reflex gain or a normal vestibulo-ocular reflex gain. However, the possibility of a third and new variant of the vestibulo-ocular reflex gain has not been clinically explored yet. OBJECTIVES To determine and report distinct patterns of vestibulo-ocular reflex gain using VHIT in elderly individuals with vestibular symptoms. METHODS Retrospective cross-sectional study was done on a group of elderly patients who were above 70 years of age. These individuals were subjected to VHIT during their symptomatic phase. A vestibulo-ocular reflex gain value between 0.80-01.20 (Horizontal plane) was considered normal. The gain above and below this cutoff range was considered abnormal. RESULTS 39 elderly patients (15 males and 24 females) whose mean age range was 74.71 years were evaluated for the VHIT response. Vestibulo-ocular reflex gain obtained was categorized into three distinct patterns: (i) normal vestibulo-ocular reflex gain, (ii) reduced vestibulo- ocular reflex gain and (iii) increased vestibulo-ocular reflex gain. The mean vestibulo- ocular reflex gain for both left and right horizontal canals varied significantly between the three groups (p < 0.05). No significant effect of age and vestibulo-ocular reflex gain was noted, though vestibulo-ocular reflex gain was higher in 80 years and above age (p > 0.05). CONCLUSION Elderly individuals with dizziness may show varying responses with vestibulo-ocular reflex gain during the symptomatic period. The third type of hyperactive vestibule-ocular reflex responses that emerged from the current study were potential indicators of fluid dynamic changes in the inner ear. These responses need to be explored further as it relates to new clinical markers for both peripheral and central vestibular disorders.
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Affiliation(s)
- Muhammed Ayas
- University Hospital Sharjah, Audiology Unit, Sharjah, United Arab Emirates; University of Sharjah, College of Medicine, Sharjah, United Arab Emirates.
| | - Ahmad AlAmadi
- University of Sharjah, College of Medicine, Sharjah, United Arab Emirates; Advanced Hearing and Balance Center, Dubai, United Arab Emirates
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21
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Ruthberg JS, Rasendran C, Kocharyan A, Mowry SE, Otteson TD. The economic burden of vertigo and dizziness in the United States. J Vestib Res 2021; 31:81-90. [PMID: 33285661 DOI: 10.3233/ves-201531] [Citation(s) in RCA: 25] [Impact Index Per Article: 8.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Vertigo and dizziness are extremely common conditions in the adult population and therefore place a significant social and economic burden on both patients and the healthcare system. However, limited information is available for the economic burden of vertigo and dizziness across various health care settings. OBJECTIVE Estimate the economic burden of vertigo and dizziness, controlling for demographic, socioeconomic, and clinical comorbidities. METHODS A retrospective analysis of data from the Medical Expenditures Panel Survey (2007-2015) was performed to analyze individuals with vertigo or dizziness from a nationally representative sample of the United States. Participants were included via self-reported data and International Classification of Diseases, 9th Revision Clinical Modification codes. A cross-validated 2-component generalized linear model was utilized to assess vertigo and dizziness expenditures across demographic, socioeconomic and clinical characteristics while controlling for covariates. Costs and utilization across various health care service sectors, including inpatient, outpatient, emergency department, home health, and prescription medications were evaluated. RESULTS Of 221,273 patients over 18 years, 5,275 (66% female, 34% male) reported either vertigo or dizziness during 2007-2015. More patients with vertigo or dizziness were female, older, non-Hispanic Caucasian, publicly insured, and had significant clinical comorbidities compared to patients without either condition. Furthermore, each of these demographic, socioeconomic, and clinical characteristics lead to significantly elevated costs due to having these conditions for patients. Significantly higher medical expenditures and utilization across various healthcare sectors were associated with vertigo or dizziness (p < 0.001). The mean incremental annual healthcare expenditure directly associated with vertigo or dizziness was $2,658.73 (95% CI: 1868.79, 3385.66) after controlling for socioeconomic and demographic characteristics. Total annual medical expenditures for patients with dizziness or vertigo was $48.1 billion. CONCLUSION Vertigo and dizziness lead to substantial expenses for patients across various healthcare settings. Determining how to limit costs and improve the delivery of care for these patients is of the utmost importance given the severe morbidity, disruption to daily living, and major socioeconomic burden associated with these conditions.
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Affiliation(s)
- Jeremy S Ruthberg
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Armine Kocharyan
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sarah E Mowry
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Todd D Otteson
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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22
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Zhang R, Liu B, Bi J, Chen Y. Relationship Between Chronic Conditions and Balance Disorders in Outpatients with Dizziness: A Hospital-Based Cross-Sectional Study. Med Sci Monit 2021; 27:e928719. [PMID: 33611335 PMCID: PMC7905961 DOI: 10.12659/msm.928719] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Background Balance dysfunction is common in adult outpatients with dizziness, especially those who are older, which can lead to catastrophic outcomes such as falls. The aim of this study was to investigate the association between chronic conditions and balance disorders in patients with dizziness, especially those who are elderly. Material/Methods A cross-sectional study was conducted in adult outpatients diagnosed with dizziness referred to the Department of Otolaryngology at Beijing Tongren Hospital from September 2017 to August 2018. All of the patients completed a self-administered, structured questionnaire. Demographic data and information on history of chronic conditions were collected and the patients were divided into 2 groups based on whether their balance was normal or abnormal. Results Three hundred and thirty-two patients were included in this study, 168 in the normal balance group and 164 in the abnormal balance group. The incidence of chronic conditions, including hypertension and diabetes, in the abnormal balance group was higher than that in the normal balance group (all P<0.05). In subgroup analysis based on age, in those who were aged ≥60 years, the prevalence of chronic diseases was higher in the abnormal balance group than in the normal balance group (P=0.002), while there was no difference in age between the groups with abnormal and normal balance. Hypertension (OR: 2.268; 95%CI: 1.038–4.957; P<0.05) was a risk factor for balance disorders in elderly patients rather than those who were younger (P>0.05). Conclusions Our results show that chronic conditions are associated with balance function in older patients with dizziness. Thus, specialists should consider chronic conditions, especially hypertension, in elderly patients with dizziness.
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Affiliation(s)
- Ruihua Zhang
- Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, China (mainland)
| | - Bo Liu
- Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Ministry of Education, Beijing, China (mainland).,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China (mainland)
| | - Jingtao Bi
- Key Laboratory of Otolaryngology Head and Neck Surgery, Capital Medical University, Ministry of Education, Beijing, China (mainland).,Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China (mainland)
| | - Yiwen Chen
- Department of Geriatrics, Beijing Tongren Hospital, Capital Medical University, Beijing, China (mainland)
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23
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Shu F, Shu J. An eight-camera fall detection system using human fall pattern recognition via machine learning by a low-cost android box. Sci Rep 2021; 11:2471. [PMID: 33510202 PMCID: PMC7844246 DOI: 10.1038/s41598-021-81115-9] [Citation(s) in RCA: 15] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 12/29/2020] [Indexed: 02/06/2023] Open
Abstract
Falls are a leading cause of unintentional injuries and can result in devastating disabilities and fatalities when left undetected and not treated in time. Current detection methods have one or more of the following problems: frequent battery replacements, wearer discomfort, high costs, complicated setup, furniture occlusion, and intensive computation. In fact, all non-wearable methods fail to detect falls beyond ten meters. Here, we design a house-wide fall detection system capable of detecting stumbling, slipping, fainting, and various other types of falls at 60 m and beyond, including through transparent glasses, screens, and rain. By analyzing the fall pattern using machine learning and crafted rules via a local, low-cost single-board computer, true falls can be differentiated from daily activities and monitored through conventionally available surveillance systems. Either a multi-camera setup in one room or single cameras installed at high altitudes can avoid occlusion. This system's flexibility enables a wide-coverage set-up, ensuring safety in senior homes, rehab centers, and nursing facilities. It can also be configured into high-precision and high-recall application to capture every single fall in high-risk zones.
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Affiliation(s)
- Francy Shu
- Division of Neuromuscular Medicine, Department of Neurology, Los Angeles Medical Center, University of California, 300 Medical Plaza B200, Los Angeles, CA, 90095, USA.
| | - Jeff Shu
- SpeedyAI, Inc, 19940 Ridge Estate Ct, Walnut, CA, 91789, USA
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24
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Little C, Cosetti MK. A Narrative Review of Pharmacologic Treatments for COVID-19: Safety Considerations and Ototoxicity. Laryngoscope 2021; 131:1626-1632. [PMID: 33491234 PMCID: PMC8014300 DOI: 10.1002/lary.29424] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Revised: 01/12/2021] [Accepted: 01/14/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVE/HYPOTHESIS The purpose of this review is to summarize evidence-based data regarding the ototoxic effects of potential COVID-19 therapeutics to treat patients suffering from SARS-CoV-2. METHODS Medications under investigation as novel therapeutics to treat COVID-19 were identified using the search term coronavirus therapeutics, COVID therapeutics, and SARS-CoV-2 therapeutics on ClinicalTrials.gov and the PubMed Database. A literature review was performed using the PubMed Database for each proposed COVID-19 therapeutic to identify relevant articles. Search criteria included Medical Subject Headings (MeSH) and key word search terms for ototoxicity, vestibulotoxicity, hearing disorders, and vertigo. RESULTS Six proposed COVID-19 therapeutics were identified as possessing ototoxic side effects including chloroquine and hydroxychloroquine, azithromycin, lopinavir-ritonavir, interferon, ribavirin, and ivermectin. CONCLUSIONS Available evidence suggests that ototoxic effects may be improved or mitigated by stopping the offending agent. Recognition of hearing loss, tinnitus, or imbalance/vertigo is therefore crucial to facilitate early intervention and prevent long-term damage. Hospitals should consider the inclusion of audiologic monitoring protocols for patients receiving COVID-19 therapeutics with known ototoxicity, especially in high-risk patient groups such as the elderly and hearing impaired. Laryngoscope, 131:1626-1632, 2021.
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Affiliation(s)
- Christine Little
- Department of Otolaryngology‐Head and Neck SurgeryIcahn School of Medicine at Mount SinaiNew YorkNew YorkU.S.A.
| | - Maura K. Cosetti
- Department of Otolaryngology‐Head and Neck SurgeryIcahn School of Medicine at Mount SinaiNew YorkNew YorkU.S.A.
- Ear InstituteNew York Eye and Ear Infirmary of Mount SinaiNew YorkNew YorkU.S.A.
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25
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Guarnizo A, Farah K, Lelli DA, Tse D, Zakhari N. Limited usefulness of routine head and neck CT angiogram in the imaging assessment of dizziness in the emergency department. Neuroradiol J 2021; 34:335-340. [PMID: 33487089 PMCID: PMC8447815 DOI: 10.1177/1971400920988665] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
OBJECTIVE To assess the usefulness of head and neck computed tomography angiogram for the investigation of isolated dizziness in the emergency department in detecting significant acute findings leading to a change in management in comparison to non-contrast computed tomography scan of the head. METHODS Patients presenting with isolated dizziness in the emergency department investigated with non-contrast computed tomography and computed tomography angiogram over the span of 36 months were included. Findings on non-contrast computed tomography were classified as related to the emergency department presentation versus unrelated/no significant abnormality. Similarly, computed tomography angiogram scans were classified as positive or negative posterior circulation findings. RESULTS One hundred and fifty-three patients were imaged as a result of emergency department presentation with isolated dizziness. Fourteen cases were diagnosed clinically as of central aetiology. Non-contrast computed tomography was positive in three patients, all with central causes with sensitivity 21.4%, specificity 100%, positive predictive value 100%, negative predictive value 92.6% and accuracy 92.8%. Computed tomography angiogram was positive for angiographic posterior circulation abnormalities in five cases, and only two of them had a central cause of dizziness, with sensitivity 14.3%, specificity 97.7%, positive predictive value 40%, negative predictive value 91.46% and accuracy 92.1%. CONCLUSION Both non-contrast computed tomography and computed tomography angiogram of the head and neck have low diagnostic yield for the detection of central causes of dizziness, However, non-contrast computed tomography has higher sensitivity and positive predictive value than computed tomography angiogram, implying a lack of diagnostic advantage from the routine use of computed tomography angiogram in the emergency department for the investigation of isolated dizziness. Further studies are required to determine the role of computed tomography angiogram in the work-up of isolated dizziness in the emergency department.
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Affiliation(s)
- Angela Guarnizo
- Department of Radiology, University of Ottawa, The Ottawa Hospital, Canada
| | - Kevin Farah
- Department of Radiology, University of Ottawa, The Ottawa Hospital, Canada
| | - Daniel A Lelli
- Department of Medicine, Division of Neurology, University of Ottawa, The Ottawa Hospital, Canada
| | - Darren Tse
- Department of Otolaryngology, Head and Neck Surgery, University of Ottawa, The Ottawa Hospital, Canada
| | - Nader Zakhari
- Department of Radiology, University of Ottawa, The Ottawa Hospital, Canada
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26
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Guseva AL, Pal'chun VT. [Clinical diagnosis and treatment of chronic dizziness]. Zh Nevrol Psikhiatr Im S S Korsakova 2021; 120:131-137. [PMID: 33459553 DOI: 10.17116/jnevro2020120121131] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Chronic dizziness is defined as a complex of symptoms lasting months or years, including oscillopsia, nystagmus, and postural instability. Diagnostic search includes peripheral vestibulopathy - chronic unilateral vestibulopathy resulting from vestibular neuronitis, schwannoma of the 8th pair of cranial nerves, medical or surgical ablation of the labyrinth, and bilateral vestibulopathy; central vestibulopathy - syndromes accompanied by central vertical nystagmus, small vessel disease in patients with chronic cerebral ischemia; general somatic diseases, peripheral polyneuropathy, side-effects of medications as well as persistent postural-perceptual dizziness. Often, when collecting an anamnesis, it is not possible to identify specific features of dizziness and instability, therefore, clinical and instrumental examination of the patient is of particular importance. In the otoneurological examination, the greatest attention is paid to static/coordination tests, oculomotor tests aimed at identifying signs of damage to the vestibulo-ocular reflex. The principles of treatment depend on the diagnosed cause of dizziness and instability and can, to varying degrees, combine pharmacotherapy, vestibular rehabilitation and psychotherapy, as well as correction of therapy for the underlying disease that caused vestibulopathy.
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Affiliation(s)
- A L Guseva
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - V T Pal'chun
- Pirogov Russian National Research Medical University, Moscow, Russia.,Sverzhevsky Research Institute of Clinical Otorhinolaryngology, Moscow, Russia
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27
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Choi J, Choi SM, Lee JS, Seo SS, Kim JY, Kim HY, Kim SR. Development and validation of the fall risk perception questionnaire for patients in acute care hospitals. J Clin Nurs 2020; 30:406-414. [PMID: 33141494 DOI: 10.1111/jocn.15550] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 10/05/2020] [Accepted: 10/23/2020] [Indexed: 01/13/2023]
Abstract
AIMS AND OBJECTIVES This study aimed to develop a fall risk perception questionnaire for patients admitted to acute care hospitals and to establish its reliability and validity. BACKGROUND To prevent falls during patients' hospitalisation, it is essential for them to accurately perceive their risk of falling. DESIGN This methodological study was performed to develop a fall risk perception questionnaire. METHODS After generating a preliminary questionnaire, two rounds of content validity testing were performed with nine experts. Following a pilot test, a convenience sample of 236 participants was recruited from an acute care hospital between 2 May 2018 and 15 December 2019. Construct, convergent and known-group validity of the questionnaire was evaluated, and reliability was estimated by calculating the internal consistency reliability coefficients. The study adhered to STROBE guidelines. RESULTS Exploratory factor analysis yielded a three-factor solution with 27 items. The questionnaire showed statistically significant positive correlation with the Korean Falls Efficacy Scale-International and the Morse Fall Scale, thus establishing convergent validity. For known-group comparison, Morse Fall Scale scores were categorised into two groups by cut-off score. The risk for falls group had a significantly higher perceived fall risk than the no risk for falls group, thus establishing known-group validity. Cronbach's alpha values indicated good to excellent reliability for the overall questionnaire with 27 items and for each of the three subfactors. CONCLUSIONS The fall risk perception questionnaire demonstrated satisfactory reliability and validity in an acute care hospital setting. RELEVANCE TO CLINICAL PRACTICE Because understanding patients' perceptions of their fall risk is essential for preventing falls, it is necessary to regularly assess patients' fall risk perception using tools with established reliability and validity.
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Affiliation(s)
- Jieun Choi
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Se Min Choi
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Jeong Sin Lee
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Soon Seok Seo
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Ja Yeon Kim
- Department of Nursing, Asan Medical Center, Seoul, Korea
| | - Hye Young Kim
- College of Nursing, Jeonbuk Research Institute of Nursing Science, Jeonbuk National University, Jeonju-si, Korea
| | - Sung Reul Kim
- College of Nursing, Korea University Nursing Research Institute, Korea University, Seoul, Korea
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28
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Ekvall Hansson E, Pessah-Rasmussen H, Bring A, Vahlberg B, Persson L. Vestibular rehabilitation for persons with stroke and concomitant dizziness-a pilot study. Pilot Feasibility Stud 2020; 6:146. [PMID: 33005434 PMCID: PMC7526152 DOI: 10.1186/s40814-020-00690-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 09/21/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Dizziness is common among patients with first time stroke. It affects self-perceived health and is a risk factor for falls. Vestibular rehabilitation (VR) is effective for treating dizziness among various conditions, but the effect of dizziness with origin in the central nervous system is poorly studied.This pilot study of a randomized controlled trial aimed at investigating a vestibular rehabilitation programme among patients with first time stroke and concomitant dizziness. A second aim was to study the feasibility of performing the randomized controlled trial. METHODS The participants were computer generated randomized to either an intervention or a control group. The intervention comprised of four different vestibular rehabilitation exercises, adapted for each patient and usual rehabilitation. The control group received usual rehabilitation without the vestibular rehabilitation exercises. Outcome measures used were The Activities-specific Balance Confidence Scale, the Berg Balance Scale, the Functional Gait Assessment Scale and the EuroQol-5D. Feasibility was studied in terms of recruitment, adherence and retention rates, also as the ability to collect primary and secondary outcomes as well as to find indications of treatment differences. RESULTS Self-rated health improved for all participants. No other differences between baseline and follow-up were detected neither within nor between groups. Recruitment rate was 23%, adherence to the intervention 90%, retention rate 69% and ability to collect outcome measures 90%. No adverse events occurred. CONCLUSION Both the intervention and the control groups improved in self-perceived health. The measures of feasibility were satisfactory in this study, apart from a low recruitment rate.
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Affiliation(s)
- Eva Ekvall Hansson
- Department of Health Sciences, Division of Physiotherapy, Lund University, Health Science Centre, Box 157, 221 00 Lund, Sweden
| | - Hélène Pessah-Rasmussen
- Department of Neurology and Rehabilitation Medicine, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences, Lund University, Lund, Sweden
| | - Annika Bring
- Academic Primary Health Center, Primary Care and Health, Uppsala County Council, Uppsala, Sweden
- Department of Neuroscience, Physiotherapy, Uppsala University, Uppsala, Sweden
| | - Birgit Vahlberg
- Department of Public Health and Caring Sciences, Clinical Nutrition and Metabolism, Uppsala University, Uppsala, Sweden
| | - Liselott Persson
- Department of Health Sciences, Division of Physiotherapy, Lund University, Health Science Centre, Box 157, 221 00 Lund, Sweden
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29
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Yang TH, Xirasagar S, Cheng YF, Wu CS, Kuo NW, Lin HC. Peripheral Vestibular Disorders: Nationwide Evidence From Taiwan. Laryngoscope 2020; 131:639-643. [PMID: 32621538 DOI: 10.1002/lary.28877] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2020] [Revised: 05/25/2020] [Accepted: 06/01/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVES/HYPOTHESIS This study aimed to evaluate the prevalence of peripheral vestibular disorders in an Asian population of predominantly Han Chinese ethnicity. STUDY DESIGN Cross-sectional study. METHODS Patients with a peripheral vertigo disorder were identified from the Taiwan Health Insurance Research Database, a database of all medical claims of a randomly selected, population-representative sample of 2 million enrollees of Taiwan's National Health Insurance system covering over 99% of Taiwan's citizens. In 2016, 59,986 patients received a diagnosis of peripheral vestibular disorders in Taiwan. We calculated the population-wide prevalence rates of peripheral vestibular disorders in 2016 by sex and age group (20 to 24, 25 to 29, 30 to 34, 35 to 39, 40 to 44, 45 to 49, 50 to 54, 55 to 59, 60 to 64, 65 to 69, and ≥ 70 years) stratified into five urbanization levels. RESULTS The prevalence rate of peripheral vestibular disorders was 2,833.4 per 100,000 population during the year. Prevalence of Meniere's disease was 70.4 per 100,000, benign paroxysmal positional vertigo, 446.4, vestibular neuritis 307.2, and other or unspecified peripheral vestibular dizziness, 2,009.5 per 100,000. Prevalence rates steadily increased with age for every type of peripheral vestibular disorder, and were higher among females compared to males. The female-to-male gender ratios were 1.84, 1.89, and 1.93 for Meniere's disease, vestibular neuritis, and other peripheral vestibular dizziness, respectively. Counties with the lowest urbanization level had the highest prevalence rates of all types of peripheral vestibular disorders except vestibular neuritis. CONCLUSIONS Results showed that peripheral vestibular disorders are common in Taiwan, increase with age, are predominantly female, and show higher prevalence in rural areas. LEVEL OF EVIDENCE 2b Laryngoscope, 131:639-643, 2021.
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Affiliation(s)
- Tzong-Hann Yang
- Department of Otorhinolaryngology, Taipei City Hospital, Taipei, Taiwan.,Department of Speech, Language, and Audiology, National Taipei University of Nursing and Health, Taipei, Taiwan.,Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sudha Xirasagar
- Department of Health Services Policy and Management, Arnold School of Public Health, University of South Carolina, Columbia, South Carolina, U.S.A
| | - Yen-Fu Cheng
- Department of Speech, Language, and Audiology, National Taipei University of Nursing and Health, Taipei, Taiwan.,Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chuan-Song Wu
- Department of Otorhinolaryngology, Taipei City Hospital, Taipei, Taiwan.,Research Center of Sleep Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan.,College of Science and Engineering, Fu Jen University, New Taipei City, Taiwan
| | - Nai-Wen Kuo
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Herng-Ching Lin
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan.,Sleep Research Center, Taipei Medical University Hospital, Taipei, Taiwan
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Immersive Virtual Reality in Stroke Patients as a New Approach for Reducing Postural Disabilities and Falls Risk: A Case Series. Brain Sci 2020; 10:brainsci10050296. [PMID: 32429085 PMCID: PMC7287864 DOI: 10.3390/brainsci10050296] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 05/06/2020] [Accepted: 05/13/2020] [Indexed: 12/16/2022] Open
Abstract
Stroke is a neurologic disorder considered the first cause of disability worldwide due to motor, cognitive, and sensorial sequels. Balance dysfunctions in stroke survivors increase the risk of falls and physiotherapeutic rehabilitation is essential to reduce it. Virtual reality (VR) seems to be an alternative to conventional physiotherapy (CT), providing virtual environments and multisensorial inputs to train balance in stroke patients. The aim of this study was to assess if immersive VR treatment is more effective than CT to improve balance after stroke. This study got the approval from the Ethics Committee of the University of Almeria. Three chronic ischemic stroke patients were selected. One patient who received 25 sessions of immersive VR intervention for two months was compared with another patient who received equivalent CT and a third patient with no intervention. Balance, gait, risk of falling, and vestibular and visual implications in the equilibrium were assessed. After the interventions, the two patients receiving any of the treatments showed an improvement in balance compared to the untreated patient. In comparison to CT, our results suggest a higher effect of immersive VR in the improvement of balance and a reduction of falls risk due to the active upright work during the VR intervention.
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Miyamoto Y, Iwagami M, Aso S, Matsui H, Doi K, Yasunaga H. Pregabalin and injury: A nested case‐control and case‐crossover study. Pharmacoepidemiol Drug Saf 2020; 29:558-564. [DOI: 10.1002/pds.4976] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2019] [Revised: 01/21/2020] [Accepted: 02/03/2020] [Indexed: 12/20/2022]
Affiliation(s)
- Yoshihisa Miyamoto
- Division of Nephrology and EndocrinologyThe University of Tokyo Tokyo Japan
| | - Masao Iwagami
- Department of Health Services ResearchUniversity of Tsukuba Tsukuba Japan
- Health Services Research and Development CenterUniversity of Tsukuba Tsukuba Japan
- Department of Non‐Communicable Disease EpidemiologyLondon School of Hygiene and Tropical Medicine London UK
| | - Shotaro Aso
- Department of Clinical Epidemiology and Health Economics, School of Public HealthThe University of Tokyo Tokyo Japan
| | - Hiroki Matsui
- Department of Clinical Epidemiology and Health Economics, School of Public HealthThe University of Tokyo Tokyo Japan
| | - Kent Doi
- Department of Acute Care MedicineThe University of Tokyo Hospital Tokyo Japan
| | - Hideo Yasunaga
- Department of Clinical Epidemiology and Health Economics, School of Public HealthThe University of Tokyo Tokyo Japan
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Micarelli A, Viziano A, Lanzillotta A, Giorgino FM, Pisano C, Ruvolo G, Alessandrini M. Postural control abnormalities related to sleep deprivation in patients with Marfan Syndrome. J Vestib Res 2019; 29:261-269. [PMID: 31707379 DOI: 10.3233/ves-190684] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Marfan syndrome (MFS) is a rare autosomal dominant connective tissue disorder affecting virtually every organ. Sleep disturbances, associated to high collapsibility in upper airways, are common in MFS; daytime sleepiness could lead to reduction in attention and motor coordination, with detrimental effects on balance. OBJECTIVE To evaluate otoneurological function in MFS patients, compared to healthy subjects, and to investigate possible correlations with sleep deprivation extent. METHODS Forty-one MFS patients underwent a thorough otoneurological examination, video Head Impulse Test (vHIT), and static posturography. Sleep parameters were recorded by home monitoring. Daytime sleepiness and dizziness-related handicap were screened by means of Dizziness Handicap Inventory (DHI) and Epworth Sleepiness Scale (ESS). Results were compared with 49 healthy controls (HC). RESULTS DHI and ESS scores were increased in MFS patients (p < 0,01). vHIT scores showed no between-group effect. Classical (surface and length) and frequency-domain posturographic parameters were significantly increased in MFS with respect to HC (p < 0,01). A positive correlation was found between ESS scores and posturographic parameters in MFS patients. CONCLUSIONS An impaired postural control, related to the extent of sleep deprivation, was found in MFS patients. Such results could advocate for screening and treating sleep deprivation and balance dysfunctions in MFS patients.
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Affiliation(s)
- Alessandro Micarelli
- Department of Clinical Sciences and Translational Medicine, Otolaryngology Unit, 'Tor Vergata' University, Rome, Italy.,ITER Center for Balance and Rehabilitation Research (ICBRR), Rome, Italy
| | - Andrea Viziano
- Department of Clinical Sciences and Translational Medicine, Otolaryngology Unit, 'Tor Vergata' University, Rome, Italy
| | - Alessia Lanzillotta
- Department of Clinical Sciences and Translational Medicine, Otolaryngology Unit, 'Tor Vergata' University, Rome, Italy
| | - Federica Maria Giorgino
- Department of Experimental Medicine, Respiratory Unit, 'Tor Vergata' University, Rome, Italy
| | - Calogera Pisano
- Department of Surgery Sciences, Cardiac Surgery Unit, 'Tor Vergata' University, Rome, Italy
| | - Giovanni Ruvolo
- Department of Surgery Sciences, Cardiac Surgery Unit, 'Tor Vergata' University, Rome, Italy
| | - Marco Alessandrini
- Department of Clinical Sciences and Translational Medicine, Otolaryngology Unit, 'Tor Vergata' University, Rome, Italy
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Ding GR, Ni JM, Zhang SJ, Xie YZ, Feng JF. Efficacy of methylprednisolone for treatment of persistent vertigo. Medicine (Baltimore) 2019; 98:e17194. [PMID: 31567966 PMCID: PMC6756734 DOI: 10.1097/md.0000000000017194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND This study will systematically investigate the efficacy and safety of methylprednisolone for treatment of persistent vertigo (PV). METHODS All following electronic databases will be searched from inception to the June 30, 2019 without language restrictions: MEDILINE, EMBASE, Cochrane Library, Web of Science, and Chinese Biomedical Literature Database. All randomized controlled trials focusing on assessing the efficacy and safety of methylprednisolone for patients with PV will be fully considered for inclusion. Cochrane risk of bias tool will be used for assessing methodological quality, and RevMan 5.3 software (Cochrane Community, London, UK) will be utilized for statistical analysis. RESULTS This study will assess the efficacy and safety of methylprednisolone for PV via assessing primary outcome of vertigo, and secondary outcomes of somatization, depression, anxiety, health-related quality of life, and adverse events. CONCLUSION This study will provide a high-quality evidence to judge whether methylprednisolone is an effective and safety therapy for patients with PV. DISSEMINATION AND ETHICS No individual data will be utilized in this study, thus, it does not need ethical approval. The results of this study will be published at peer-reviewed journals. SYSTEMATIC REVIEW REGISTRATION PROSPERO CRD42019138890.
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Affiliation(s)
| | | | | | | | - Jun-fei Feng
- Department of Respiratory Medicine, Hangzhou Fuyang Hospital of Traditional Chinese Medicine, Hangzhou, China
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Seraji-Bzorgzad N, Paulson H, Heidebrink J. Neurologic examination in the elderly. HANDBOOK OF CLINICAL NEUROLOGY 2019; 167:73-88. [PMID: 31753158 DOI: 10.1016/b978-0-12-804766-8.00005-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Clinical evaluation of neurologic disorders in the elderly requires seeking a thorough history and performing an age-appropriate neurologic examination with special attention to changes that occur with normal aging. The history should be obtained from the patient as well as collateral sources close to the patient to ensure accuracy and should include contextual elements such as medical history, social, economic, and psychological background, as well as an assessment of current functional state beyond activities of daily living. The safety of the patient, including the presence of physical, psychological, and financial threats, should be addressed during the interview. The neurological examination in older adults may need to be modified to circumvent disabilities such as hearing and visual impairment. Some elements of the neurological examination are expected to be affected by the process of aging, including pupillary reactivity, presbyopia, difficulty with ocular pursuit and up-gaze, reduced or absent distal reflexes, slower motor speed, and reduced ability to tandem walk, among others. In addition to a screening neurological assessment, evaluation of older adults with a particular complaint may require additional interview queries and examination manoeuvres. Common symptoms in the elderly include cognitive difficulties, balance and gait disorders, tremors, and neuropathy. A specialized approach to patients with cognitive difficulties must include assessment of each cognitive domain, including attention, executive function, learning and memory, perceptual-motor function, and social cognition. Balance and gait are essential parts of the neurological examination, and in patients with a history of falls or mobility issues, should become a central part of the evaluation. In patient with tremors, careful observation of the tremor quality (amplitude, frequency, and alleviating/exacerbating factors such as rest, movement, and posture) can aid diagnosis. Evaluation of neuropathy includes determining modality (numbness, tingling, pain, and weakness) and the distribution of symptoms in order to localize the site of nerve injury, which can be supplemented with nerve conduction studies/electromyography, to guide further diagnostic workup and treatment. A combination of detailed history and examination often will suggest a likely underlying neurodegenerative disorder and guide further diagnostic workup to establish a specific diagnosis.
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Affiliation(s)
- Navid Seraji-Bzorgzad
- Department of Neurology and Michigan Alzheimer's Disease Center, University of Michigan, Ann Arbor, MI, United States
| | - Henry Paulson
- Department of Neurology and Michigan Alzheimer's Disease Center, University of Michigan, Ann Arbor, MI, United States.
| | - Judith Heidebrink
- Department of Neurology and Michigan Alzheimer's Disease Center, University of Michigan, Ann Arbor, MI, United States
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