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Kaplan B, Altın B, Akyol MU, Aksoy S. Evaluation of Balance with Computerized Dynamic Posturography in Children with Otitis Media. Laryngoscope 2024; 134:4126-4133. [PMID: 38597754 DOI: 10.1002/lary.31444] [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: 01/17/2024] [Revised: 03/03/2024] [Accepted: 03/29/2024] [Indexed: 04/11/2024]
Abstract
BACKGROUND Otitis media with effusion (OME) frequently leads to vestibular symptoms in children. However, young children face difficulty expressing their symptoms due to their limited language abilities. METHODS The balance of study and patient group evaluated with computer dynamic posturography, single-leg stance test with eyes closed and regular Head Impulse Test. The study group was assessed once again after the insertion of a ventilation tube two months later. RESULTS In the Sensory Organization Test, the scores for conditions 5, 6, and composite equilibrium of the preoperative patient group were notably lower compared with both the control and postoperative patient groups (p < 0.05). Additionally, a significant correlation was found between single-leg stance test with eyes closed results and conditions 5, 6, and composite equilibrium scores. CONCLUSION The impact of OME on the vestibular system is negative. This effect can be objectively assessed using Computer Dynamic Posturography and following tube insertion, there is a notable improvement in vestibular function. Furthermore, the single-leg stance (SLS) test with eyes closed has shown its reliability in assessing balance disorders, notably in children with OME. LEVEL OF EVIDENCE 2 Laryngoscope, 134:4126-4133, 2024.
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Affiliation(s)
- Büşra Kaplan
- Department of Audiology, Faculty of Health Sciences, Ankara Medipol University, Ankara, Turkey
| | - Büşra Altın
- Department of Audiology, Faculty of Health Sciences, Hacettepe University Hospitals, Ankara, Turkey
| | - Mehmet Umut Akyol
- Department of Otorhinolaryngology-Head and Neck Surgery, Hacettepe University Hospitals, Ankara, Turkey
| | - Songül Aksoy
- Department of Audiology, Faculty of Health Sciences, Lokman Hekim University, Ankara, Turkey
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Mohd John RS, Saniasiaya J, Tengku Omar TAS. Vestibular Dysfunction Among Children with Otitis Media and Effusion in a Multiracial Setting. Indian J Otolaryngol Head Neck Surg 2024; 76:3103-3108. [PMID: 39130221 PMCID: PMC11306847 DOI: 10.1007/s12070-024-04618-7] [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: 01/01/2024] [Accepted: 03/07/2024] [Indexed: 08/13/2024] Open
Abstract
Otitis media with effusion (OME) is a common presentation to the Otorhinolaryngology clinic. Besides hearing impairment, recent evidence shows that approximately 30% of these children have some degree of vestibular and balance impairment. To assess the presence of vestibular dysfunction among children with OME. Children between 4 and 17, with and without OME, underwent vestibular assessment using video head impulse test (VHIT), subjective visual subjective (SVV), and single leg raising test (SLS). Data were recorded and analysed. 24 OME children were included with male predominance. No statistical significance was found between the VOR gain (p > 0.05), SVV (p = 0.056) and SLS (p = 0.06). Simple linear regression analysis showed that age and gender are potential factors for VOR gain. Our study found that children with OME have normal vestibular function.
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Affiliation(s)
- Redzwan Shah Mohd John
- Department of Otorhinolaryngology, Faculty of Medicine, Universiti Malaya, Jalan Universiti, Kuala Lumpur, 50603 Malaysia
| | - Jeyasakthy Saniasiaya
- Department of Otorhinolaryngology, Faculty of Medicine, Universiti Malaya, Jalan Universiti, Kuala Lumpur, 50603 Malaysia
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Mohamed ST, Hazzaa N, Abdel Rahman T, Ezz Eldin DM, Elhusseiny AM. Efficacy of vestibular rehabilitation program in children with balance disorders and sensorineural hearing loss. Int J Pediatr Otorhinolaryngol 2024; 179:111931. [PMID: 38555811 DOI: 10.1016/j.ijporl.2024.111931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 02/25/2024] [Accepted: 03/23/2024] [Indexed: 04/02/2024]
Abstract
OBJECTIVE Asses the efficacy of a Vestibular-balance rehabilitation program to minimize or reverse balance disability in children with sensorineural hearing loss. METHOD Forty-five hearing-impaired children with balance deficits (i.e., variable degrees of sensorineural hearing loss or auditory neuropathy). Thirty-five were rehabilitated with cochlear implants, and ten with hearing aids. Their age ranged from 4 to 10 years old. A Pre-rehab evaluation was done using questionnaires, neuromuscular evaluation, vestibular and balance office testing, and vestibular lab testing (using cVEMP and caloric test). Customized balances, as well as vestibular rehabilitation exercises, have been applied for three months. That was followed by post-rehab assessment, including the Arabic DHI questionnaire, PBS, BESS, HTT, and DVA test. RESULTS There was a statistically significant difference in all measured parameters (including the Arabic DHI questionnaire, PBS, BESS, HTT, and DVA test) after rehabilitation. CONCLUSIONS Vestibular-balance rehabilitation intervention positively impacts vestibular and balance functions in hearing-impaired children.
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Affiliation(s)
- Somaia Tawfik Mohamed
- Audiovestibular medicine, Audiology unit, ORL Dept., Faculty of Medicine, Ain Shams University, Abassia Street, Cairo, Egypt
| | - Nagwa Hazzaa
- Audiovestibular medicine, Audiology unit, ORL Dept., Faculty of Medicine, Ain Shams University, Abassia Street, Cairo, Egypt
| | - Tayseer Abdel Rahman
- Audiovestibular medicine, Audiology unit, ORL Dept., Faculty of Medicine, Ain Shams University, Abassia Street, Cairo, Egypt.
| | - Dalia Mohamed Ezz Eldin
- Physical medicine, rheumatology and rehabilitation, Rheumatology and Rehabilitation Dept., Faculty of Medicine, Ain Shams University, Abassia Street, Cairo, Egypt
| | - Aya Magdy Elhusseiny
- Audiovestibular medicine, Audiology unit, ORL Dept., Faculty of Medicine, Ain Shams University, Abassia Street, Cairo, Egypt
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Duarte DSB, Cabral AMDL, Britto DBLDA. Vestibular assessment in children aged zero to twelve years: an integrative review. Braz J Otorhinolaryngol 2022; 88 Suppl 3:S212-S224. [PMID: 36347786 DOI: 10.1016/j.bjorl.2022.09.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Revised: 08/10/2022] [Accepted: 09/23/2022] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To describe the main vestibular assessment tests performed in children aged zero to twelve years and the main causes of referral for vestibular assessment. METHODS The review was guided by the following question: What are the main vestibular assessment tests performed in children aged zero to twelve years and the main causes of referral for vestibular assessment? The PVO strategy was used, being defined as: Population (P) - newborns and children; study Variable (V) - causes of referral for vestibular assessment; study Outcome (O): the main vestibular assessment tests and the main findings. This study was carried out using the main available databases in the months of July, August and September 2021, with no restrictions regarding language and publication date, namely: PubMed, Web of Science, Scientific Electronic Library Online (SciELO), Latin-American and Caribbean Literature in Health Sciences (LILACS), ScienceDirect, Cochrane Library and Embase. The descriptors were obtained from the MeSH database: newborn, infant, child, children, vestibular screening, vestibular infant screening, vestibular newborn screening, test, vestibular function, vestibular function test. RESULTS A total of 7,078 studies were identified. After reading the titles and abstracts, 107 of them were selected, with 101 remaining after the exclusion of duplicates. After the full-text reading, 31 articles were included. It was observed that the most frequently used tests were: rotational tests, caloric stimulation and cervical vestibular evoked myogenic potential and the main causes of referral for vestibular evaluation were hearing loss and vestibular screening. CONCLUSION The main tests for vestibular screening and/or assessment of children aged zero to twelve years are the rotary chair testing, caloric stimulation and cervical-vestibular evoked myogenic potential. Consequently, performing these procedures is extremely important, since the presence of vestibular dysfunction is quite common in the studied population.
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Cheng Y, Zhang Q, Zhang Y, Chen Z, Ma W, Xu M. The advantages of vestibular-evoked myogenic potentials induced by bone-conducted vibration in patients with otitis media. Acta Otolaryngol 2022; 142:499-504. [PMID: 35732019 DOI: 10.1080/00016489.2022.2086705] [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: 11/01/2022]
Abstract
BACKGROUND At present, there is no consensus on the optimal methods for the diagnosis of vestibular dysfunction. OBJECTIVE To explore the advantages of bone-conducted vibration (BCV) related vestibular-evoked myogenic potentials (VEMPs). MATERIAL AND METHODS Fifty patients with otitis media volunteered for VEMP examination. They were randomly selected with air-conducted sound and BCV stimulation VEMPs assessed in both ears. RESULTS The provocation rate of BCV-VEMPs was significantly higher than that of air-conducted sound VEMPs. Among 50 affected ears, there was no significant difference in the provocation rate of BCV-VEMPs between patients with air-bone conduction gaps lower or higher than 20 dB. There was no significant difference in the provocation rate of BCV-VEMPs between both ears in 30 patients with unilateral otitis media and the comparison of BCV-oVEMP parameters made no significant difference in amplitude, N1 latency, P1 latency, or N1-P1 duration, except for the threshold. A comparison of BCV-cVEMP parameters between affected and healthy ears revealed no significant difference between groups in terms of threshold, amplitude, N1 latency, P1 latency, or n1-p1 duration. CONCLUSIONS AND SIGNIFICANCE BCV-VEMPs may be stably induced in patients with conductive hearing loss.
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Affiliation(s)
- Ying Cheng
- Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Qing Zhang
- Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Yuzhong Zhang
- Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Zichen Chen
- Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Weijun Ma
- Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
| | - Min Xu
- Department of Otolaryngology Head and Neck Surgery, the Second Affiliated Hospital of Xi'an Jiaotong University, Xi'an, China
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Impact of advancement of otitis media with effusion on vestibular organ condition in children. POSTEP HIG MED DOSW 2022. [DOI: 10.2478/ahem-2022-0041] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Abstract
Introduction
Otitis media with effusion (OME) is one of the most common otorhinolaryngological (ENT) disorders in childhood. This study aimed to investigate the vestibular organ condition in children with OME and whether the presence of vestibular disturbances depends on the advancement of OME.
Materials and Methods
Subjects were 53 children between 4 and 14 years old with bilateral OME and treated with middle ear drainage. The study group was divided into two subgroups according to the advancement of the disease. The participants were submitted to an evaluation consisting of anamnesis, ENT evaluation, static posturography, and electronystagmography (ENG). Examination was performed before surgery and one month after drainage.
Results
The posturography revealed the presence of disturbances before and after ME drainage. After drainage, the assessed parameters improved; they still, however, remained elevated. Disturbances in posturography, both before and after drainage, were expressed more fully in the subgroup with stage II compared to the stage I subgroup, especially before drainage. The analysis of the ENG confirmed that the stage of clinical advancement affects the severity of vestibular disorders in children with OME. Greater vestibular disorders in the form of the presence of spontaneous nystagmus and position were more frequent in the subgroup with stage II.
Conclusions
ME effusion affects the vestibular organ in children with OME. The degree of vestibular disturbances depends on the clinical advancement of the disease. The assessment of the vestibular organ condition is beneficial and should be included in the OME diagnostic and for qualification for surgical treatment.
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Evaluation of vestibular function in children with purulent media otitis by computer stabilometry. EUREKA: HEALTH SCIENCES 2021. [DOI: 10.21303/2504-5679.2021.002172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
The aim of the research – assessment of vestibular function in children with acute purulent otitis media by computer static stabilometry compared with typically developed children of the same age.
Materials and methods: 22 children with purulent otitis media aged 4 to 7 years and 30 practically healthy peers were examined by static stabilometry on the device “MPFI stabilograph 1” (Kharkiv, Ukraine). Indicators of variation and shape of the pressure center distribution, spectral-correlation indicators of stabilograms, as well as integral indicators of stability (length, velocity and angle of postural oscillations) were taken into account and the equilibrium functions of the two sensory states (open and closed eyes) are calculated in the StabiliS software.
Results: purulent otitis media causes posterior displacement of the absolute coordinates of the pressure center. In the state with closed eyes, children with purulent otitis differ from their healthy coevals by 14 of 24 stabilometric parameters, including stabilogram length, speed, angle and amplitude of oscillations, giving way to them in the stability of equilibrium. Children with purulent otitis media are more sensitive to the visual canal of postural control than their coevals. Involvement of visual afferents in postural control significantly improves balance maintenance in children with purulent otitis by reducing deviations of postural oscillations, which is reflected in the probable changes of 9 out of 24 stabilometric parameters compared to control.
Conclusions: In preschool age, purulent otitis media leads to latent vestibular dysfunction, which is manifested by a violation of the stability of the vertical posture in a state with closed eyes and is compensated by visual-vestibulo-proprioceptive integration in the process of postural control.
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Nystagmus in adult patients with acute otitis media or otitis media with effusion without dizziness. PLoS One 2021; 16:e0250357. [PMID: 33983960 PMCID: PMC8118351 DOI: 10.1371/journal.pone.0250357] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2020] [Accepted: 04/05/2021] [Indexed: 11/19/2022] Open
Abstract
The present study aimed to investigate the incidence and patterns of nystagmus in adult patients with acute otitis media (AOM) or otitis media with effusion (OME) without dizziness or vertigo, and discuss possible mechanisms. From February 2018 to November 2018, 34 consecutive patients with AOM or OME without dizziness were included. Nystagmus was examined with video Frenzel glasses. Of 34 adult AOM or OME patients without dizziness, nystagmus was observed in 28 patients (82%). In unilateral AOM or OME (n = 30), the most commonly observed nystagmus pattern was irritative-type direction-fixed nystagmus (n = 13), followed by paretic-type direction-fixed nystagmus (n = 8), and direction-changing positional nystagmus (n = 4). In bilateral AOM or OME (n = 4), direction-fixed nystagmus and direction-changing positional nystagmus were observed in two and one patients, respectively. Nystagmus was observed in as many as 82% of adult AOM or OME patients even though they did not complain of dizziness, and the pattern of nystagmus was either direction-fixed or direction-changing. Direct effect of inflammatory mediators penetrated from the middle ear and biochemical alteration in the inner ear fluids due to blood-perilymph barrier dysfunction may result in the presence of nystagmus in AOM or OME patients without dizziness.
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Tozar M, Cömert E, Şencan Z, Şimşek G, Muluk NB, Kılıç R. Video head impulse test in children with otitis media with effusion and dizziness. Int J Pediatr Otorhinolaryngol 2020; 129:109783. [PMID: 31760334 DOI: 10.1016/j.ijporl.2019.109783] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 10/25/2019] [Accepted: 11/14/2019] [Indexed: 11/15/2022]
Abstract
OBJECTIVE The objectives of the study were to evaluate the vestibular impairment in children with otitis media with effusion (OME) and dizziness by using vHIT test, and to compare their results with healthy children. METHODS The study population consisted of 30 pediatric patients with OME and dizziness and 30 healthy children, age between 4 and 15. Otoscopic and tympanometric examination and vHIT testing were performed to all subjects. vHIT test parameters were compared between pediatric patients with OME and dizziness and healthy children. Additionally, the differences of the mean vHIT gains between tympanogram types, otoscopic findings and the presence of saccades were analyzed. RESULTS The mean vHIT gains and gain asymmetry values of patients with OME and dizziness and healthy children were comparable. No significant difference was observed between the mean vHIT gains of patients with type B and type C2 tympanogram. Covert saccades were observed in 57% of the patients with OME and dizziness. None of the patients had over saccades and none of the healthy children had saccades. CONCLUSION Our study is a preliminary study analyzing the vestibular impairment in children with OME and dizziness using vHIT test. Based on our results, it can be assumed that the children with OME and dizziness usually don't have a great vestibular impairment that can be detected with vHIT test. The covert saccades detected in this patient group are accepted as a sign of slight vestibular impairment.
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Affiliation(s)
- Mesut Tozar
- Kırıkkale University Faculty of Medicine, Department of Otolaryngology, 1st Floor, Yenişehir, Yahşihan, Kırıkkale, Turkey.
| | - Ela Cömert
- Kırıkkale University Faculty of Medicine, Department of Otolaryngology, 1st Floor, Yenişehir, Yahşihan, Kırıkkale, Turkey.
| | - Ziya Şencan
- Kırıkkale University Faculty of Medicine, Department of Otolaryngology, 1st Floor, Yenişehir, Yahşihan, Kırıkkale, Turkey.
| | - Gökçe Şimşek
- Kırıkkale University Faculty of Medicine, Department of Otolaryngology, 1st Floor, Yenişehir, Yahşihan, Kırıkkale, Turkey.
| | - Nuray Bayar Muluk
- Kırıkkale University Faculty of Medicine, Department of Otolaryngology, 1st Floor, Yenişehir, Yahşihan, Kırıkkale, Turkey.
| | - Rahmi Kılıç
- Ankara Education and Research Hospital, Clinic of Otolaryngology Sakarya Mh. Ulucanlar Street No 89 Altındağ, Ankara, Turkey.
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Monsanto RDC, Kasemodel ALP, Tomaz A, Paparella MM, Penido NDO. Current evidence of peripheral vestibular symptoms secondary to otitis media. Ann Med 2018; 50:391-401. [PMID: 29699430 DOI: 10.1080/07853890.2018.1470665] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
BACKGROUND The association between otitis media and vestibular symptoms has been hypothesized in the past. Thus, in this study, we aimed to critically analyze (based in a systematic review of the literature) whether patients who have otitis media are at greater risk of developing vestibular impairment or not. METHODS We performed a systematic review of the literature and identified potentially relevant articles reporting vestibular symptoms and results of vestibular function tests in patients with otitis media through searches of the PubMED, Web of Science, Scopus, and Google Scholar databases. The quality of the final set of records was assessed using the "Newcaste-Ottawa Scale". RESULTS Of the 2334 records searched, 43 met our inclusion and exclusion criteria, and those included 2250 patients. The records comprised 20 longitudinal studies, 21 cross-sectional studies, and 2 case reports. Regarding the type of otitis media studied, 25 examined vestibular impairment in otitis media with effusion, 6 acute otitis media, and 12 chronic otitis media. Results of anamnesis, clinical exams, and several vestibular function tests are reported and critically discussed. CONCLUSION Most studies evaluating the association between otitis media and vestibular symptoms have potential methodological flaws. Clinical evidence suggests that patients with otitis media have increased chances for having vestibular symptoms, delayed acquisition of developmental milestones, and abnormalities in several vestibular function tests as compared with controls. Future studies with rigorous methodology aiming to assess the clinical significance (and prognostic factors) of the association between otitis media and vestibular impairment are warranted. Key message Several studies demonstrated long-term sequelae secondary to otitis media. However, the evidence supporting those assumptions are based in low-quality evidence. Thus, better structured studies are warranted to better understand the clinical relevance of such association.
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Affiliation(s)
- Rafael da Costa Monsanto
- a Department of Otorhinolaryngology, Head and Neck Surgery , Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM) , São Paulo , Brazil
| | - Ana Luiza Papi Kasemodel
- a Department of Otorhinolaryngology, Head and Neck Surgery , Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM) , São Paulo , Brazil
| | - Andreza Tomaz
- a Department of Otorhinolaryngology, Head and Neck Surgery , Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM) , São Paulo , Brazil
| | - Michael M Paparella
- b Department of Otolaryngology , University of Minnesota , Minneapolis , MN , USA.,c Paparella Ear, Head & Neck Institute , Minneapolis , MN , USA
| | - Norma de Oliveira Penido
- a Department of Otorhinolaryngology, Head and Neck Surgery , Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM) , São Paulo , Brazil
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Chang J, Hwang SY, Park SK, Kim JH, Kim HJ, Chae SW, Song JJ. Prevalence of Dizziness and Associated Factors in South Korea: A Cross-Sectional Survey From 2010 to 2012. J Epidemiol 2017; 28:176-184. [PMID: 29151473 PMCID: PMC5865008 DOI: 10.2188/jea.je20160113] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Dizziness is one of the most common complaints in medicine and a frequent symptom among older people. Dizziness has a considerable impact on life quality and is associated with high economic costs. The purpose of this study was to evaluate the prevalence of dizziness in the general population and to describe its clinical characteristics and associated factors. METHODS The Korea National Health and Nutrition Examination Survey (KNHANES) is a cross-sectional survey of the civilian, non-institutionalized population of South Korea. We evaluated data for 12,653 participants (5,450 men and 7,203 women), aged 40 years and above, whom participated in the KNHANES between 2010 and 2012. RESULTS In the age group over 40 years old, the 1-year prevalence of dizziness was 20.10%. Dizziness was more prevalent among women (25.18%) than among men (14.57%; P < 0.001) and the prevalence rate increased with age (P < 0.001). In multivariable analysis, female sex, older age, serum triglyceride level, experience of depression, limited functional status owing to visual acuity impairment, limited physical performance, smoking, alcohol consumption, and perception of stress were independently associated with dizziness. CONCLUSIONS In our study, the prevalence of dizziness in the general population was 20.10%. There was a stronger relationship between dizziness and physical performance, chronic diseases, and health behaviors compared to that with otologic diseases. Interventions for dizziness should be approached in a multifactorial manner and an understanding of various factors is necessary for the prevention and management of this condition.
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Affiliation(s)
- Jiwon Chang
- Department of Otolaryngology Head and Neck Surgery, Hallym University College of Medicine
| | - Soon Young Hwang
- Department of Biostatistics, College of Medicine, Korea University
| | - Su Kyoung Park
- Department of Otolaryngology Head and Neck Surgery, Hallym University College of Medicine
| | - Jin Hwan Kim
- Department of Otolaryngology Head and Neck Surgery, Hallym University College of Medicine
| | - Hyung-Jong Kim
- Department of Otolaryngology Head and Neck Surgery, Hallym University College of Medicine
| | - Sung-Won Chae
- Department of Otolaryngology Head and Neck Surgery, Korea University College of Medicine
| | - Jae-Jun Song
- Department of Otolaryngology Head and Neck Surgery, Korea University College of Medicine
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