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Mandalà M, Salerni L, Ferretti F, Bindi I, Gualtieri G, Corallo G, Viberti F, Gusinu R, Fantino C, Ponzo S, Astore S, Boccuzzi S, Nuti D. The incidence of vestibular neuritis in Italy. Front Neurol 2023; 14:1177621. [PMID: 37273688 PMCID: PMC10232831 DOI: 10.3389/fneur.2023.1177621] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 04/06/2023] [Indexed: 06/06/2023] Open
Abstract
Objective This study aims to estimate the incidence of Vestibular neuritis (VN) in three different districts in Italy, its epidemiological features, and the prevalence of comorbidities associated with it. Methods An observational prospective study of 198 patients referred to ENT departments in Siena, Grosseto, and Cuneo was carried out over a 2-year period. Each patient underwent a complete otoneurologic examination in the first 48 h from the onset of symptoms and a brain MRI in the early stages of the disease. The follow-up lasted for 1 year. Results The total VN incidence rate of the three municipalities was 48.497 (95% CI: 48.395-48.598) and its standardized value was 53.564 (95% CI: 53.463-53.666). The total VN incidence rate for the whole sample (municipality and district of the three centers) was 18.218 (95% CI: 18.164-18.272), and its standardized value was 20.185 (95% CI: 20.129-20.241). A significant difference was highlighted between patients living in the city compared to those living in the surrounding area (p < 0.000), this may be due to the ease of reaching the otoneurological referral center. Conclusion The total incidence rate for the three municipalities was 48.497. This result is higher than previously reported studies.
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Affiliation(s)
- Marco Mandalà
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Lorenzo Salerni
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Fabio Ferretti
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Ilaria Bindi
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Giacomo Gualtieri
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Giulia Corallo
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | - Francesca Viberti
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
| | | | - Claudio Fantino
- Department of Otorhinolaryngology, ENT Clinic, Hospital Santa Croce e Carle di Cuneo, Cuneo, Italy
| | - Silvia Ponzo
- Department of Otorhinolaryngology, ENT Clinic, Hospital Santa Croce e Carle di Cuneo, Cuneo, Italy
| | - Serena Astore
- Department of Otorhinolaryngology, ENT Clinic, Hospital Misericordia di Grosseto, Grosseto, Italy
| | - Simone Boccuzzi
- Department of Otorhinolaryngology, ENT Clinic, Hospital Misericordia di Grosseto, Grosseto, Italy
| | - Daniele Nuti
- Department of Medicine, Surgery and Neuroscience, University of Siena, Siena, Italy
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Kim Y, Kang BC, Yoo MH, Park HJ. Differential Involvement of Lateral Semicircular Canal and Otolith Organs in Common Vestibular Disorders. Front Neurol 2022; 13:819385. [PMID: 35173674 PMCID: PMC8841591 DOI: 10.3389/fneur.2022.819385] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/21/2021] [Accepted: 01/10/2022] [Indexed: 11/13/2022] Open
Abstract
Semicircular canal and otolith functions came to be evaluated recently, but comprehensive and comparative analysis of canal and otolith dysfunction in common vestibular disorders is lacking. We aimed to analyze the abnormal rates of canal and otolith function in common vestibular disorders. We enrolled 302 patients who were managed for 2 months in a dizziness clinic. Results of caloric, video head impulse test (vHIT), and cervical and ocular vestibular evoked myogenic potential (cVEMP and oVEMP) tests were analyzed and compared among various diagnoses. Vestibular disorders diagnosed included recurrent vestibulopathy (RV, 27%), vestibular migraine (VM, 21%), benign paroxysmal positional vertigo (BPPV, 17%), Meniere's disease (MD, 11%), vestibular neuritis (VN, 10%), orthostatic dizziness (7%), and central lesions (3%). Lateral canal dysfunction was found most in VN (100%) and less commonly in definite MD (75%), RV (46%) and definite VM (29%). Abnormal caloric results were more common than abnormal vHIT in all disorders. Otolith dysfunction was found more frequently than lateral canal dysfunction in most vestibular disorders except VN. An abnormal cVEMP was more frequent in definite MD than the other disorders. Isolated otolith dysfunction without lateral canal dysfunction was the most found in BPPV, followed by definite VM, RV, and definite MD in decreasing order. Various patterns of involvement in canal and otoliths were revealed in vestibular disorders, suggesting different pathogenesis.
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Affiliation(s)
- Yehree Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
| | - Byung Chul Kang
- Department of Otorhinolaryngology-Head and Neck Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan, South Korea
| | - Myung Hoon Yoo
- Department of Otorhinolaryngology-Head and Neck Surgery, School of Medicine, Kyungpook National University, Daegu, South Korea
| | - Hong Ju Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea
- *Correspondence: Hong Ju Park
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Nimmo ZM, Hwa TP, Naples JG, Shah R, Brant JA, Eliades SJ, Bigelow DC, Ruckenstein MJ. Age-related Patterns of Vestibular Dysfunction in Dizziness and Imbalance: A Review of Vestibular Testing Results Among 1,116 Patients. Otol Neurotol 2021; 42:897-905. [PMID: 34111051 DOI: 10.1097/mao.0000000000003094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To characterize differences in vestibular testing results among patients presenting with balance-related complaints; to stratify patterns of testing abnormalities by age. STUDY DESIGN Retrospective chart review. SETTING Academic Balance Center at a Tertiary Referral Center. PATIENT POPULATION All patients who underwent vestibular testing in a 1-year period from 2017 to 2018. MAIN OUTCOME MEASURE Balance function test results. RESULTS We reviewed 1,116 patients with age ranging from 11 to 94 years, including 521 patients ≥60 years. Most patients had at least 1 abnormal result, with only 21% of patients ≥60 years and 43% of patients <60 years yielding no test abnormalities (p < 0.001). Among 754 individuals with abnormal testing results, caloric testing did not show any significant difference between age groups. Patients ≥60 years of age were more likely to demonstrate abnormalities on saccadic and horizontal tracking eye movements (p < 0.01; sacc 20.8% vs 6.3%; HT 9.2% vs 4.7%), as well as positional and Dix-Hallpike testing with videonystagmography (p < 0.001; pos 52.3% vs 37.5%, DH 14.4% vs 6.8%). On computerized dynamic posturography, there were significantly more abnormal composite scores in the older group for both sensory organization and motor control testing (p < 0.001; SOT 31.8% vs 8.8%, MCT 7.6% vs 1.8%). CONCLUSION Among patients presenting balance-related complaints, a majority demonstrate at least one abnormality on vestibular testing. While caloric abnormalities occur across the life span, patients ≥60 years of age are more likely to have abnormal results in random saccades, positional, Dix-Hallpike testing, and posturography, with greater effect sizes in tests of central function. While the causes of imbalance and vertigo remain multifactorial, vestibular dysfunction can be considered a major contributor to balance dysfunction in the elderly population and should be thoroughly evaluated.
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Affiliation(s)
- Zachary M Nimmo
- Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania
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Chiao W, Krauter R, Kirk L, Steenerson K, Pasquesi L, Sharon J. Understanding Dizzy Patients a Cross-Sectional Analysis of Attitudes toward Diagnosis, Providers, and Treatment. Ann Otol Rhinol Laryngol 2021; 131:352-359. [PMID: 34085539 DOI: 10.1177/00034894211022095] [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: 11/17/2022]
Abstract
OBJECTIVE To evaluate patients' attitudes regarding their dizziness, provider capabilities, and receptiveness toward treatment. STUDY DESIGN Cross-sectional study. SETTING Tertiary care vestibular clinic. PATIENTS Ages 18 years or older, fluent in English, and who presented with a chief complaint of dizziness or vertigo. INTERVENTION(S) N/A. MAIN OUTCOMES MEASURE(S) Non-validated questionnaire surveying patients' beliefs regarding the cause of their dizziness, likelihood of successful treatment, and openness to various treatment modalities. RESULTS Patients were asked to complete an online non-validated survey regarding their dizziness prior to being evaluated in neurotology clinic. About 67 surveys were completed between January 2017 and September 2018. A majority of patients attributed their dizziness to their ears (n = 47, 70%), followed by the brain (n = 29, 43%). Most subjects chose "neither agree nor disagree" about whether their provider could identify the cause of their dizziness (27%). Most subjects also chose "neither agree nor disagree" that their dizziness would resolve with treatment (31%). These attitudes were not influenced by demographics, dizziness severity, anxiety, depression, or quality of life on multivariate ordinal regression modeling. CONCLUSIONS Patients who experience dizziness have neutral attitudes with regards to believing that their provider will be able to identify the cause of their dizziness and whether their dizziness will resolve with treatment. These neutral attitudes are experienced by a plurality of patients and do not differ by demographic information, dizziness handicap, quality of life, depression, or anxiety.
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Affiliation(s)
- Whitney Chiao
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, MN, USA
| | - Roseanne Krauter
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Laura Kirk
- University of Texas Southwestern Medical Center, Dallas, TX, USA
| | - Kristen Steenerson
- Department of Otolaryngology-Head and Neck Surgery, Otology & Neurotology Division, Stanford University, Stanford, CA, USA
| | - Lauren Pasquesi
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Jeffrey Sharon
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, CA, USA
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Zhu RT, Van Rompaey V, Ward BK, Van de Berg R, Van de Heyning P, Sharon JD. The Interrelations Between Different Causes of Dizziness: A Conceptual Framework for Understanding Vestibular Disorders. Ann Otol Rhinol Laryngol 2019; 128:869-878. [DOI: 10.1177/0003489419845014] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Background:According to population-based studies that estimate disease prevalence, the majority of patients evaluated at dizziness clinics receive a single vestibular diagnosis. However, accumulating literature supports the notion that different vestibular disorders are interrelated and often underdiagnosed.Objective:Given the complexity and richness of these interrelations, we propose that a more inclusive conceptual framework to vestibular diagnostics that explicitly acknowledges this web of association will better inform vestibular differential diagnosis.Methods:A narrative review was performed using PubMed database. Articles were included if they defined a cohort of patients, who were given specific vestibular diagnosis. The interrelations among vestibular disorders were analyzed and placed within a conceptual framework.Results:The frequency of patients currently receiving multiple vestibular diagnoses in dizziness clinic is approximately 3.7% (1263/33 968 patients). The most common vestibular diagnoses encountered in the dizziness clinic include benign paroxysmal positional vertigo (BPPV), vestibular migraine, vestibular neuritis, and Ménière’s disease.Conclusions:A review of the literature demonstrates an intricate web of interconnections among different vestibular disorders such as BPPV, vestibular migraine, Ménière’s disease, vestibular neuritis, bilateral vestibulopathy, superior canal dehiscence syndrome, persistent postural perceptual dizziness, anxiety, head trauma, and aging, among others.
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Affiliation(s)
- Richard T. Zhu
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Vincent Van Rompaey
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology & Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Bryan K. Ward
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Raymond Van de Berg
- Department of Otorhinolaryngology and Head & Neck Surgery, Maastricht University Medical Center, Maastricht, The Netherlands
| | - Paul Van de Heyning
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
- Department of Otorhinolaryngology & Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
| | - Jeffrey D. Sharon
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
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Abstract
The world's population is ageing due to increased hygiene and improved medical care. Dizziness and imbalance frequently affect the elderly and is most common among individuals over the age of 60. In this age group approximately 30% of the population experience these debilitating symptoms at some point. They contribute to falls and frailty, which often result in hospitalization causing tremendous cost for the health care systems, and increased mortality. To make the matters worse balance disorders are often complex. Physicians face the difficulty of diagnosing the patient with the exact disorder especially since each disorder may manifest differently in each patient. In addition, several treatment options exist, however, with a low level of evidence. This chapter summarizes the underlying degenerative processes of the peripheral as well as the central vestibular system, diagnostic tools, the most common balance disorders in the elderly, and possible treatment options of these disorders.
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Park MK, Lee DY, Kim YH. Risk Factors for Positional Vertigo and the Impact of Vertigo on Daily Life: The Korean National Health and Nutrition Examination Survey. J Audiol Otol 2018; 23:8-14. [PMID: 30126262 PMCID: PMC6348313 DOI: 10.7874/jao.2018.00178] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 06/01/2018] [Indexed: 11/22/2022] Open
Abstract
Background and Objectives This study aimed to analyze risk factors for positional vertigo (PV) and the influence thereof on daily life and subjective quality-of-life (QoL). Subject andMethods A cross-sectional study was conducted using data of the 2010 Korea National Health and Nutrition Examination Survey. The study population consisted of 1,274 individuals aged >40 years for whom complete dizziness-related data were available. Blood and urine tests were performed, and nutritional intake, QoL, and subjective health status were measured using a questionnaire. The associations between PV and blood/urine test data and nutritional intake were evaluated via multiple logistic regression analysis. Results A history of PV within the previous year was reported by 98 individuals (7.7%). Advanced age and female gender were both significantly associated with such a history. Serum hemoglobin, creatinine, and triglyceride levels correlated significantly with a history of PV. Carotene, vitamin A, and vitamin B2 intakes were significantly lower in individuals with PV. Multivariate analysis revealed that only age was significantly associated with a history of PV (p=0.003). Although subjective health status score was not significantly lower in subjects with PV, subjective impairments in mobility, self-care, the performance of usual activities, and anxiety/depression were more prominent in individuals with PV. A fall history and limitations of activity were also significantly higher in individuals with PV (p<0.001 and p=0.003, respectively). Conclusions Age was a risk factor for PV, which affected most QoL parameters, fall frequency, and the performance of normal activities.
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Affiliation(s)
- Moo Kyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul, Korea
| | - Doh Young Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
| | - Young Ho Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Boramae Medical Center, Seoul National University College of Medicine, Seoul, Korea
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Abstract
BACKGROUND Many patients with dizziness complain about >1 type of dizziness and therefore there may be ≥2 coexisting diagnoses. OBJECTIVE To determine how often a second or third diagnosis is present in a patient with dizziness and to establish what are the most common combinations of diagnoses. STUDY DESIGN Prospective, observational study in a tertiary center. RESULTS A consecutive cohort of 621 patients was included in the study. In 187 patients (30.1%) a second diagnosis was present. Within this group a third diagnosis was present in 35 (5.6%) patients. The most common second diagnosis was an anxiety disorder (50.1%). CONCLUSIONS Patients with dizziness frequently present themselves with >1 type of dizziness caused by 2 or 3 different diseases. In our study 30% of patients with dizziness have >1 diagnosis. Anxiety disorder is the most common second diagnosis.
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Epidemiology of Dizzy Patient Population in a Neurotology Clinic and Predictors of Peripheral Etiology. Otol Neurotol 2017; 38:870-875. [DOI: 10.1097/mao.0000000000001429] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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10
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Quantitative Analysis of Psychiatric Disorders in Intractable Peripheral Vertiginous Patients. Otol Neurotol 2016; 37:539-44. [DOI: 10.1097/mao.0000000000001002] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Abstract
This chapter gives an overview of the epidemiology of dizziness, vertigo, and imbalance, and of specific vestibular disorders. In the last decade, population-based epidemiologic studies have complemented previous publications from specialized settings and provided evidence for the high burden of dizziness and vertigo in the community. Dizziness (including vertigo) affects about 15% to over 20% of adults yearly in large population-based studies. Vestibular vertigo accounts for about a quarter of dizziness complaints and has a 12-month prevalence of 5% and an annual incidence of 1.4%. Its prevalence rises with age and is about two to three times higher in women than in men. Imbalance has been increasingly studied as a highly prevalent complaint particularly affecting healthy aging. Studies have documented the high prevalence of benign paroxysmal positional vertigo (BPPV) and vestibular migraine (VM), as well as of comorbid anxiety at the population level. BPPV and VM are largely underdiagnosed, while Menière's disease, which is about 10 times less frequent than BPPV, appears to be overdiagnosed. Risk factor research is only at its beginning, but has provided some interesting observations, such as the consistent association of vertigo and migraine, which has greatly contributed to the recognition of VM as a distinct vestibular syndrome.
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Affiliation(s)
- H K Neuhauser
- Department of Epidemiology and Health Monitoring, Robert Koch Institute, Berlin, Germany.
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Abstract
OBJECTIVES To evaluate the cost-effectiveness of obtaining a magnetic resonance imaging (MRI) in patients with abnormal electronystagmography (ENG) or videonystagmography (VNG) results. STUDY DESIGN Retrospective chart review. SETTINGS Academic specialty center. PATIENTS Patients presenting with vertigo between January 1, 2010, and August 30, 2013. METHODS Patients who fit the following abnormal criteria were included in the study: unilateral caloric weakness (≥20%), abnormal ocular motor testing, and nystagmus on positional testing. Patients with abnormal findings who then underwent MRI with gadolinium were evaluated. RESULTS Of the 1,996 charts reviewed, there were 1,358 patients who met the inclusion criteria. The average age of these patients was 62 years (12-94 yr). The male:female ratio was approximately 1:2. Of the 1,358 patients, 253 received an MRI with the following pathologies: four vestibular schwannomas, three subcortical/periventricular white matter changes suspicious for demyelinating disease, four acute cerebellar/posterior circulation infarct, two vertebral artery narrowing, one pseudomeningocele of internal auditory canal, and two white matter changes indicative of migraines. The positive detection rate on MRI was 5.5% based on MRI findings of treatable pathologies causing vertigo. Average cost of an MRI is $1,200, thereby making the average cost of identifying a patient with a positive MRI finding $15,180. CONCLUSION In our study, those patients with a positive MRI had a constellation of symptoms and findings (asymmetric sensorineural hearing loss, tinnitus, vertigo, and abnormal ENG/VNG). Cost-effectiveness can be improved by ordering an MRI only when clinical examination and VNG point toward a central pathology. Clinical examination and appropriate testing should be factored when considering the cost-effectiveness of obtaining an MRI in patients with abnormal ENG/VNG findings.
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Epidemiology of vestibular vertigo in a neuro-otology clinic population in Thailand. The Journal of Laryngology & Otology 2014; 128 Suppl 2:S31-8. [PMID: 24548658 DOI: 10.1017/s0022215113003484] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECTIVE To assess the epidemiology of vestibular vertigo, including the new entity of vestibular migraine, in a neuro-otology clinic population in the biggest public hospital in Thailand. STUDY DESIGN AND SETTING A prospective study involving all patients presenting to the neuro-otology clinic in the Rajavithi Hospital in Bangkok between November 2007 and November 2008. SUBJECTS AND METHODS The population studied consisted of adults referred to the neuro-otology clinic. Accepted international criteria and standardised otological and, when necessary, psychiatric assessment were applied to establish each diagnosis. The association between diagnoses and potential triggers was explored. RESULTS Of the 167 patients assessed, the most prevalent conditions encountered were benign paroxysmal positional vertigo and vestibular migraine. The prevalence of vestibular migraine was 29.3 per cent. No cases of Ménière's disease were encountered. An association was found between vestibular migraine and inadequate sleep, insomnia and changes of head position. CONCLUSION This study provides current data on the epidemiology of vestibular vertigo in a Thai neuro-otology out-patient population. The results include data on the prevalence of the new diagnostic entity of vestibular migraine, and on its association with potential triggers.
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Iwasaki S, Yamasoba T. Dizziness and Imbalance in the Elderly: Age-related Decline in the Vestibular System. Aging Dis 2014; 6:38-47. [PMID: 25657851 DOI: 10.14336/ad.2014.0128] [Citation(s) in RCA: 156] [Impact Index Per Article: 15.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2013] [Revised: 01/27/2014] [Accepted: 01/28/2014] [Indexed: 01/30/2023] Open
Abstract
Dizziness and imbalance are amongst the most common complaints in older people, and are a growing public health concern since they put older people at a significantly higher risk of falling. Although the causes of dizziness in older people are multifactorial, peripheral vestibular dysfunction is one of the most frequent causes. Benign paroxysmal positional vertigo is the most frequent form of vestibular dysfunction in the elderly, followed by Meniere's disease. Every factor associated with the maintenance of postural stability deteriorates during aging. Age-related deterioration of peripheral vestibular function has been demonstrated through quantitative measurements of the vestibulo-ocular reflex with rotational testing and of the vestibulo-collic reflex with testing of vestibular evoked myogenic potentials. Age-related decline of vestibular function has been shown to correlate with the age-related decrease in the number of vestibular hair cells and neurons. The mechanism of age-related cellular loss in the vestibular endorgan is unclear, but it is thought that genetic predisposition and cumulative effect of oxidative stress may both play an important role. Since the causes of dizziness in older people are multi-factorial, management of this disease should be customized according to the etiologies of each individual. Vestibular rehabilitation is found to be effective in treating both unilateral and bilateral vestibular dysfunction. Various prosthetic devices have also been developed to improve postural balance in older people. Although there have been no medical treatments improving age-related vestibular dysfunction, new medical treatments such as mitochondrial antioxidants or caloric restriction, which have been effective in preventing age-related hearing loss, should be ienvestigated in the future.
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Affiliation(s)
- Shinichi Iwasaki
- Department of Otolaryngology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, Faculty of Medicine, University of Tokyo, Tokyo, Japan
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Chiarella G, Saccomanno M, Scumaci D, Gaspari M, Faniello MC, Quaresima B, Di Domenico M, Ricciardi C, Petrolo C, Cassandro C, Costanzo FS, Cuda G, Cassandro E. Proteomics in Ménière disease. J Cell Physiol 2011; 227:308-12. [PMID: 21437900 DOI: 10.1002/jcp.22737] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022]
Abstract
Ménière's disease (MD) is a disorder of the inner ear characterized by an insidious onset and aspecific symptoms, such as dizziness, vertigo, tinnitus, and hearing loss, that may become very debilitating. The presence of endolymphatic hydrops is a common feature in MD patients, but the pathophysiology is still largely unknown. In this study, we have used a proteomics-driven approach to identify potential biomarkers of MD. To this end, plasma was obtained from whole blood of 16 individuals previously diagnosed as suffering from MD and compared to plasma from healthy donors. A depletion of the highly abundant proteins (i.e., albumin, IgG, transferrin, etc.) was performed in order to enhance the chance of detection of the less represented ones, therefore reducing the noise-background. Two-dimensional gel electrophoresis, followed by in-gel tryptic digestion of the selected spots and LC-MS/MS analysis, allowed us to identify a set of proteins whose expression appears to be differentially modulated in patients versus controls. In particular: complement factor H and B, fibrinogen alpha and gamma chains, beta-actin and pigment epithelium derived factor are over expressed; on the other hand, the levels of beta-2 glycoprotein-1, vitamin D binding protein and apolipoprotein-1 are significantly decreased in the plasma of MD-affected individuals. Even though preliminary and not necessarily linked directly to the molecular pathogenesis of the disease, our original findings suggest that a molecular signature, represented by the plasma protein profile previously described, might represent a potentially powerful, innovative and not invasive tool for early diagnosis and clinical management of MD patients. J. Cell. Physiol. 227: 308-312, 2012. © 2011 Wiley Periodicals, Inc.
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Affiliation(s)
- Giuseppe Chiarella
- Department of Experimental and Clinical Medicine, Audiology and Phoniatrics Unit, Magna Graecia University, Catanzaro, Italy.
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Lai YT, Wang TC, Chuang LJ, Chen MH, Wang PC. Epidemiology of vertigo: a National Survey. Otolaryngol Head Neck Surg 2011; 145:110-6. [PMID: 21493319 DOI: 10.1177/0194599811400007] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To investigate the epidemiology of vertigo among the general adult population in Taiwan using the National Health Insurance claims database. STUDY DESIGN Cross-sectional study. SETTING Data were retrieved from the 2006 National Health Insurance claims database.Subjects and Methods. Claims data were retrieved for patients 18 years or older with a diagnosis of vertigo (International Classification of Diseases, Ninth Revision, Clinical Modification codes 078.81, 386.XX, or 780.4) from January to December 2006. The authors describe the prevalence and recurrence of vertigo and the medical resource utilization associated with its treatment. Logistic regression models are used to assess the independent effects of age, sex, seasonal variation, institutional level of care, and specialty of care on the risk of vertigo recurrence. RESULTS A total of 527,807 adult patients (mean ± SD age, 55.1 ± 17.3 years; 1:1.96 ratio of men to women) experienced vertigo in 2006. The prevalence of vertigo was 3.13 cases per 100 adults. Within 1 year of their index vertigo attack, 199,210 patients (37.7%) experienced recurrence. The prevalence and recurrence of vertigo increased significantly with age (P < .001 for both, x² test). Age, sex, seasonal variation, institutional level of care, and specialty of care had various effects on the risk of vertigo recurrence. CONCLUSION Vertigo is a major health burden among the general adult population and tends to recur, particularly among older women
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Affiliation(s)
- Ying-Ta Lai
- Department of Otolaryngology, Cathay General Hospital, Taipei, Taiwan
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Lezius F, Adrion C, Mansmann U, Jahn K, Strupp M. High-dosage betahistine dihydrochloride between 288 and 480 mg/day in patients with severe Menière's disease: a case series. Eur Arch Otorhinolaryngol 2011; 268:1237-1240. [PMID: 21626121 DOI: 10.1007/s00405-011-1647-2] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2011] [Accepted: 05/11/2011] [Indexed: 10/18/2022]
Abstract
The objective of this study was to evaluate the clinical benefit and the side effects of high dosages of betahistine dihydrochloride (288-480 mg/day) in patients with severe Menière's disease (MD). In this case series 11 patients with MD who had not responded sufficiently to a dosage of 144 mg/day of betahistine dihydrochloride were treated on an individual basis with daily dosages between 288 and 480 mg of betahistine dihydrochloride. The number of attacks per month and the side effects were monitored. Non-parametric tests were used for statistical analysis. As a result, the frequency and the severity of vertigo were significantly reduced in all patients. The side effects were mild, self-limiting, and did not require any change in the treatment strategy. Despite the considerable limitations of an observational study--in particular in MD--high dosages of betahistine dihydrochloride between 288 and 480 mg/day seem to be effective in patients who do not sufficiently respond to lower dosages. Moreover, such dosages are well tolerated.
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Affiliation(s)
- Franziska Lezius
- Department of Neurology, Klinikum Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany.
| | - Christine Adrion
- Biometrie und Epidemiologie, Institut für medizinische Informationsverarbeitung , Klinikum Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
| | - Ulrich Mansmann
- Biometrie und Epidemiologie, Institut für medizinische Informationsverarbeitung , Klinikum Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
| | - Klaus Jahn
- Department of Neurology, Klinikum Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
| | - Michael Strupp
- Department of Neurology, Klinikum Grosshadern, Marchioninistrasse 15, 81377, Munich, Germany
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Taura A, Ohgita H, Funabiki K, Miura M, Naito Y, Ito J. Clinical study of vertigo in the outpatient clinic of Kyoto University Hospital. Acta Otolaryngol 2010:29-33. [PMID: 20879815 DOI: 10.3109/00016489.2010.486800] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
CONCLUSION The epidemiology of vertigo remains unclear. This study might contribute to an understanding of the mechanisms underlying vestibular disease. OBJECTIVE To investigate the epidemiological features of patients with vertigo. METHODS A retrospective study on 612 patients with vertigo who visited Kyoto University Hospital. RESULTS Elderly individuals comprised > 30% of patients presenting with vertigo, with more female patients than male patients.
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Affiliation(s)
- Akiko Taura
- Department of Otolaryngology-Head and Neck Surgery, Kyoto University, Kyoto, Japan.
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Isaradisaikul S, Navacharoen N, Hanprasertpong C, Kangsanarak J, Panyathong R. Causes and time-course of vertigo in an ear, nose, and throat clinic. Eur Arch Otorhinolaryngol 2010; 267:1837-41. [PMID: 20567978 DOI: 10.1007/s00405-010-1309-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2010] [Accepted: 06/07/2010] [Indexed: 11/28/2022]
Abstract
The purpose of this study is to review etiologies and identify the time-course of vertigo presenting in an ear, nose, and throat clinic, and serve as a reference guide for other clinics. The study includes retrospective chart review in a tertiary care, university hospital. The patient data with reported ICD-10 codes as causes of vertigo between April 2005 and December 2007 were extracted from the database. At each visit, the main diagnosis as to etiology, characteristics of the vertigo, its time-course, and patient demographic data were recorded. Of 547 cases, 17 diagnoses were made in 73.9%. Diagnostic categories included peripheral vertigo 72.9%, central vertigo 0.8%, psychogenic cause 0.2%, and unknown 26.1%. Common causes of vertigo were benign paroxysmal positional vertigo (BPPV) 52.5%, Meniere's disease 14.6%, and sudden idiopathic hearing loss 2.9%. Less common diagnoses were benign paroxysmal vertigo of childhood 0.7%, labyrinthitis 0.7%, and vestibular schwannoma 0.3%. Rare conditions were delayed endolymphatic hydrops, Ramsey Hunt syndrome, otosyphilis, vestibular neuritis, temporal bone fracture, post-concussion syndrome, cerebellar infarction, epilepsy, cervical vertigo, Streptococcus suis meningitis, and psychogenic vertigo. Ninety-nine cases who reported remission of vertigo during the study period had median onset of the remission at 4 weeks. In the ear, nose, and throat clinic at Chiang Mai University, a tertiary university hospital, peripheral vestibular disorders were the main etiology of vertigo. The three most common causes were BPPV, Meniere's disease, and sudden idiopathic hearing loss. Half of the cases who returned for follow up had remitted symptoms within 4 weeks.
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Affiliation(s)
- Suwicha Isaradisaikul
- Department of Otolaryngology, Faculty of Medicine, Chiang Mai University, 110 Intawaroros Road, Sriphum, Mueang, Chiang Mai, 50200, Thailand.
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Abstract
Dizziness and vertigo rank among the most common symptoms in medical practice and belong to the 10 most common reasons for a neurological examination. Epidemiological data on dizziness, vertigo and underlying specific disorders of vestibular origin are useful for clinical decision making, may contribute to a better understanding of disease mechanisms and help evaluate the state of patient care. This article gives an overview on the epidemiology of dizziness/vertigo and of four specific vestibular disorders: benign paroxysmal positional vertigo, vestibular migraine, vestibular neuritis and Menière's disease.
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Abstract
Dizziness and vertigo rank among the most common symptoms in medical practice and belong to the 10 most common reasons for a neurological examination. Epidemiological data on dizziness, vertigo and underlying specific disorders of vestibular origin are useful for clinical decision making, may contribute to a better understanding of disease mechanisms and help evaluate the state of patient care. This article gives an overview on the epidemiology of dizziness/vertigo and of four specific vestibular disorders: benign paroxysmal positional vertigo, vestibular migraine, vestibular neuritis and Menière's disease.
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Affiliation(s)
- H K Neuhauser
- Abteilung für Epidemiologie und Gesundheitsberichterstattung, Robert Koch-Institut, General-Pape-Strasse 62-66, 12101 Berlin.
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Wilhelmsen K, Ljunggren AE, Goplen F, Eide GE, Nordahl SHG. Long-term symptoms in dizzy patients examined in a university clinic. BMC EAR, NOSE, AND THROAT DISORDERS 2009; 9:2. [PMID: 19445693 PMCID: PMC2693507 DOI: 10.1186/1472-6815-9-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 12/17/2008] [Accepted: 05/16/2009] [Indexed: 11/10/2022]
Abstract
Background The long-term course of dizziness was investigated combining medical chart and survey data. The survey was undertaken median (interquartile range (IQR)) 4.6 (4.3) years after the initial medical examination. Methods Chart data comprised sex, age, diagnosis, symptom duration, postural sway and neck pain. Survey data comprised symptom severity assessed by the Vertigo Symptom Scale – Short Form (VSS-SF), and data regarding current state of dizziness, medication, neck pain and other chronic conditions. Results The sample consisted of 503 patients, the mean (standard deviation (SD)) age was 50.0 (11.6) years, women being slightly overrepresented (60%). Severe problems with dizziness (VSS-SF mean (SD) 13.9, (10.8)) were indicated in the total group and in 5 of 6 diagnostic sub-groups. Vertigo/balance- and autonomic/anxiety-related symptoms were present in all groups. Current dizziness was confirmed by 73% who had significantly more severe problems than the non-dizzy (VSS-SF mean (SD): 17.2 (10.1) versus 5.0 (7.3)). Symptoms were related to vertigo/balance more than to autonomic/anxiety (test of interaction p < 0.001). Based on simple logistic regression analysis, sex, symptom duration, neck pain, sway and diagnoses predicted dizziness. Symptom duration and neck pain remained predictors in the adjusted analysis. Age, symptom duration, neck pain, sway and diagnoses predicted vertigo/balance-related dizziness in both regression analyses. Sex, neck pain and sway predicted development of autonomic/anxiety-related dizziness according to simple regression analysis, while only neck pain remained a significant predictor in the adjusted analysis. With respect to diagnosis, simple regression analysis showed significant reduced likelihood for development of dizziness in all vestibular sub-groups when compared to the non-otogenic dizziness group. With respect to vertigo/balance- and autonomic/anxiety-related symptoms, the implication of diagnostic belonging varied. No effect of diagnoses was seen in adjusted analyses. Conclusion The majority of patients had persistent and severe problems with dizziness. The wait-and-see attitude before referral to specialist institutions may be questioned. Early, active movements seem necessary, and attention should be paid to the presence of neck pain. Diagnoses had limited prognostic value. Questionnaire-based evaluations could assist in classification and identification of type of dizziness and thereby provide a better basis for specific rehabilitation.
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Affiliation(s)
- Kjersti Wilhelmsen
- Department of Public Health and Primary Health Care, Section for Physiotherapy Science, University of Bergen, Bergen, Norway.
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A clinical epidemiological study in 2169 patients with vertigo. Auris Nasus Larynx 2009; 36:30-5. [DOI: 10.1016/j.anl.2008.03.006] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2007] [Revised: 10/30/2007] [Accepted: 03/05/2008] [Indexed: 11/19/2022]
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Occupational disability caused by dizziness and vertigo: a register-based prospective study. Br J Gen Pract 2008; 58:619-23. [PMID: 18801279 DOI: 10.3399/bjgp08x330744] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022] Open
Abstract
BACKGROUND Despite the magnitude of dizziness/vertigo in primary health care, prospective studies are scarce, and few studies have focused on vocational consequences. Using the International Classification of Primary Health Care (ICPC), GPs have two alternative diagnoses, H82 (vertiginous syndrome) and N17 (vertigo/dizziness), when issuing sickness certificates to these patients. AIM To assess the incidence of dizziness/vertigo in long-term sickness absence and to identify sociodemographic and diagnostic predictors for transition into disability pension. DESIGN OF STUDY Register-based prospective study, 5-year follow-up. SETTING All individuals in Norway eligible for sickness absence in 1997 (registered employed or unemployed). METHOD The risk of disability pension was assessed with Cox proportional hazards analysis, with medical and sociodemographic information as independent variables, stratified for sex. RESULTS Six-hundred and ninety-four women and 326 men were included. Dizziness/vertigo made up 0.9% of long-term sickness absence among women and 0.7% among men. Among both women and men, 41% was certified with H82 and 59% with N17: 23% of women and 24% of men obtained a disability pension. Age was the strongest predictor for obtaining a disability pension. Subjects with only basic education had an almost doubled risk of obtaining a disability pension compared to the highest educational group. Women with H82 had significantly higher risk for obtaining a disability pension than those with N17. The difference increased after adjustment for sociodemographic variables. Sex had no effect when all other variables were controlled for. CONCLUSION Dizziness/vertigo is an infrequent cause of certified sickness absence, but long-term sickness absentees with dizziness/vertigo have a considerable risk of obtaining a disability pension in the future.
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Radtke >A, von Brevern M, Feldmann M, Lezius F, Ziese T, Lempert T, Neuhauser H. Screening for Menière's disease in the general population - the needle in the haystack. Acta Otolaryngol 2008; 128:272-6. [PMID: 18274913 DOI: 10.1080/00016480701509933] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
CONCLUSION Based on clinical history alone, 98.4% of the population with vestibular vertigo do not qualify for a diagnosis of Menière's disease (MD). Although frequent in dizziness clinics, MD is rare in the general population. OBJECTIVE To narrow down the prevalence of MD in the general population. SUBJECTS AND METHODS A representative sample adult population sample (n=4869) was screened for moderate or severe dizziness/vertigo. Subsequently, 1003 participants completed a validated neurotologic telephone interview on vestibular vertigo (VV). Prevalence of MD was determined by stepwise application of clinical criteria according to the AAO (1995): (1) at least two vertigo attacks of > or =20 min duration, (2) unilateral hearing loss, and (3) accompanying cochlear symptoms. RESULTS Lifetime prevalence of VV was 7.4%. Of 243 participants with VV, 51 (21%) had recurrent vertigo lasting > or =20 min. Of these, nine reported unilateral hearing loss, and four had accompanying cochlear symptoms (1.6% of VV patients, population prevalence 0.12%).
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Arya AK, Nunez DA. What proportion of patients referred to an otolaryngology vertigo clinic have an otological cause for their symptoms? The Journal of Laryngology & Otology 2007; 122:145-9. [PMID: 17524169 DOI: 10.1017/s0022215107008559] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
AbstractBackground:Dizziness is a common and often complex complaint. Between nine and 13 per cent of patients seen in general practice are referred to a variety of specialist clinics. The diagnoses and outcomes of these referrals are seldom reported.Aims:To determine the proportion of patients referred to an otology led vertigo clinic in whom an otological cause for vertigo could be identified.Design of study:Prospective cohort study of consecutive new clinic attendees over one year.Setting and methods:Otology led vertigo clinic in an urban teaching hospital in England. Patients' details including age, sex, referring clinician, investigations, diagnoses, treatment and final outcome were recorded in an anonymised database.Results:91 new patients, 31 men and 60 women with a mean age of 52.6 years (range 16–81) were seen. General practitioners referred 87 per cent of the patients. Twenty-seven patients underwent further investigations including imaging, electronystagmography and other audiological tests. A labyrinthine disorder accounted for 50 per cent of the diagnoses. Ménière's disease or a variant was diagnosed in 20 patients (21 per cent). Fifty-six patients (61 per cent) reported resolution of or improvement in their symptoms. Thirty-one patients (34 per cent) were asymptomatic and free of abnormal findings on initial attendance and were discharged from hospital care.Conclusions:Forty-six patients (50.6 per cent, 95 per cent confidence interval, 40.4–60.6 per cent) had vertigo due to an otological disorder. The selection of an otolaryngology based vertigo clinic by the general practitioner for initial referral seems appropriate.
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Affiliation(s)
- A K Arya
- Department of Otolaryngology, Southmead Hospital, North Bristol NHS Trust, Bristol, UK
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Abstract
PURPOSE OF REVIEW Epidemiological findings on the distribution, determinants and outcome of vertigo can be used for clinical decision making and can help understand the underlying causes of vestibular diseases. This article gives an overview of the epidemiology of the vestibular symptom vertigo and of four specific vestibular disorders: benign paroxysmal positional vertigo, migrainous vertigo, Menière's disease and vestibular neuritis. RECENT FINDINGS Based on a neurotologic survey of the general population, 1-year prevalence estimates for vertigo were 4.9%, for migrainous vertigo 0.89% and for benign paroxysmal positional vertigo 1.6%. Diagnostic positional manoeuvres and treatments for benign paroxysmal positional vertigo, however, are still not being done by most doctors. The female preponderance among patients with benign paroxysmal positional vertigo and migrainous vertigo may be linked to migraine but is not fully understood. A recently reported prevalence of Menière's disease of 0.51% is much higher than previous estimates. Follow-up studies have shown benign paroxysmal positional vertigo recurrence rates of 50% at 5 years and a persistence of dizziness related to anxiety in almost a third of patients 1 year after vestibular neuritis. SUMMARY The epidemiology of vertigo and vestibular disorders is still an underdeveloped field. Recent studies have underscored the impact of vertigo at the population level, but its determinants and outcome are not well known yet.
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Yuan BC, Tzeng HM. Developing a predictive model for vertigo using demographic and laboratory data: An evidence-based medicine approach. Acta Otolaryngol 2006; 126:20-4. [PMID: 16308250 DOI: 10.1080/00016480510043468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
CONCLUSION The approach described in this paper may be helpful in establishing an early-warning, evidence-based mechanism for diagnosing vertigo, which can be utilized in medical education to reduce medical uncertainty. OBJECTIVE To use an evidence-based medicine approach to evaluate the probability of having vertigo using laboratory and demographic data. MATERIAL AND METHODS The study was conducted on 22 working days during July 2002. Targeted cases who visited a general hospital in southern Taiwan for routine physical examinations were asked to participate in the study and agreed to take additional tests during their visits. A total of 200 subjects were systematically and randomly selected from this data pool. We ran binary logistic regression on all these cases. RESULTS The logistic regression model explained 71.3% of the variance in having vertigo or not. The equation for having vertigo was as follows: -21.855 + (1.132 x male gender) + (0.071 x age) + (-0.023 x systolic blood pressure) + (0.057 x diastolic blood pressure) + (0.048 x fasting glucose) + (0.051 x cholesterol) + (-0.005 x triglycerides) + (-0.361 x presence of cardiovascular diseases).
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Affiliation(s)
- Ben-Chih Yuan
- Department of Otolaryngology, Kaohsiung Military General Hospital, Kaohsiung, Taiwan
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