1
|
Rizk H, Monaghan NP, Shah S, Liu Y, Keith BA, Jeong S, Nguyen SA. Efficacy of a Serotonin-Norepinephrine Reuptake Inhibitor as a Treatment for Meniere Disease: A Randomized Clinical Trial. JAMA Otolaryngol Head Neck Surg 2024:2822947. [PMID: 39235772 PMCID: PMC11378064 DOI: 10.1001/jamaoto.2024.2241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/06/2024]
Abstract
Importance Meniere disease accounts for up to 15% of new vestibular diagnoses,; however, the optimal treatment has yet to be identified. A conservative treatment that would reduce or stop the vertigo episodes has not been identified. Objective To determine the efficacy of a serotonin-norepinephrine reuptake inhibitor, venlafaxine, compared to placebo in treating patients with Meniere disease. Design, Setting, and Participants This was a randomized, double-blind, placebo-controlled, crossover pilot study spanning 22 weeks of follow-up. The clinical trial took place at a single-center tertiary referral center in Charleston, South Carolina. Participants were eligible if they were 18 years or older, had definite Meniere disease criteria as defined by Barany criteria, had at least 2 episodes in the last month, had not received intratympanic gentamycin, skull base surgery, or radiation therapy to the head or neck, not currently taking diuretics for Meniere disease, not currently taking oral steroids, and not currently taking serotonin-modulating medication. Patients were enrolled between February 2020 and September 2023. Interventions Patients received either 1 venlafaxine tablet, 37.5 mg, taken daily by mouth for 8 weeks or 1 placebo tablet taken daily by mouth for 8 weeks. Group 1 received placebo during phase 1 of the trial and venlafaxine in phase 2 of the trial. Group 2 received venlafaxine during phase 1 of the trial and placebo in phase 2 of the trial. Main Outcomes and Measures The main outcomes included the number of episodes and scores on the following scales: Dizziness Handicap Inventory, Neuropsychological Vertigo Inventory, Meniere Disease Patient-Oriented Symptom Index, 20-Item Short Form Health Survey, Penn State Worry Questionnaire, Cognitive Failure Questionnaire. Results A total of 182 patients were screened, and 40 participants with Meniere disease enrolled in the trial. The mean (SD) age of participants was 56.6 (14.3) years, and 22 (55%) were female. Participants had a mean (SD) of 13.8 (10.1) episodes per phase at baseline, 5.4 (4.4) episodes (Δ8.4) during the venlafaxine phase, and 5.0 (4.6) episodes (Δ8.8) during the placebo phase. No significant difference was identified between venlafaxine and placebo groups in the number of episodes or quality-of-life metrics. Conclusions and Relevance This randomized clinical trial failed to identify a difference between venlafaxine and placebo in number of episodes and other quality-of-life metrics. Future studies may benefit from different dosing regimens, larger cohorts, and longer lengths of therapy. Trial Registration ClinicalTrials.gov Identifier: NCT04218123.
Collapse
Affiliation(s)
- Habib Rizk
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Neil P Monaghan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
- College of Medicine, Medical University of South Carolina, Charleston
| | - Sunny Shah
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| | - Yuan Liu
- Department of Otolaryngology-Head and Neck Surgery, Loma Linda University Health, Loma Linda, California
| | - Brian A Keith
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
- School of Osteopathic Medicine, Campbell University, Lillington, North Carolina
| | - Seth Jeong
- Department of Otolaryngology-Head and Neck Surgery, The State University of New York Upstate, Syracuse
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston
| |
Collapse
|
2
|
Schöne CG, Vibert D, Mast FW. Executive functions in patients with bilateral and unilateral peripheral vestibular dysfunction. J Neurol 2024; 271:3291-3308. [PMID: 38466421 PMCID: PMC11136862 DOI: 10.1007/s00415-024-12267-7] [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: 10/31/2023] [Revised: 02/16/2024] [Accepted: 02/17/2024] [Indexed: 03/13/2024]
Abstract
Previous research suggests that patients with peripheral vestibular dysfunction (PVD) suffer from nonspatial cognitive problems, including executive impairments. However, previous studies that assessed executive functions are conflicting, limited to single executive components, and assessments are confounded by other cognitive functions. We compared performance in a comprehensive executive test battery in a large sample of 83 patients with several conditions of PVD (34 bilateral, 29 chronic unilateral, 20 acute unilateral) to healthy controls who were pairwise matched to patients regarding age, sex, and education. We assessed basic and complex executive functions with validated neuropsychological tests. Patients with bilateral PVD performed worse than controls in verbal initiation and working memory span, while other executive functions were preserved. Patients with chronic unilateral PVD had equal executive performance as controls. Patients with acute unilateral PVD performed worse than controls in the exact same tests as patients with bilateral PVD (verbal initiation, working memory span); however, this effect in patients with acute PVD diminished after correcting for multiple comparisons. Hearing loss and affective disorders did not influence our results. Vestibular related variables (disease duration, symptoms, dizziness handicap, deafferentation degree, and compensation) did not predict verbal initiation or working memory span in patients with bilateral PVD. The results suggest that bilateral PVD not only manifests in difficulties when solving spatial tasks but leads to more general neurocognitive deficits. This understanding is important for multidisciplinary workgroups (e.g., neurotologists, neurologists, audiologists) that are involved in diagnosing and treating patients with PVD. We recommend screening patients with PVD for executive impairments and if indicated providing them with cognitive training or psychoeducational support.
Collapse
Affiliation(s)
- Corina G Schöne
- Department of Psychology, University of Bern, Bern, Switzerland.
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland.
| | - Dominique Vibert
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Fred W Mast
- Department of Psychology, University of Bern, Bern, Switzerland
| |
Collapse
|
3
|
Gillard DM, Hum M, Gardi A, Centore L, Sharon JD. Does Catastrophizing Predict Response to Treatment in Patients With Vestibular Disorders? A Prospective Cohort Study. Otol Neurotol 2024; 45:e107-e112. [PMID: 38082481 DOI: 10.1097/mao.0000000000004067] [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: 01/12/2024]
Abstract
OBJECTIVE Determine levels of catastrophizing in patients with vestibular disorders and prospectively evaluate their relationship with patient-reported outcome measures. STUDY DESIGN Prospective cohort study. SETTING Tertiary care neurotology vestibular disorders clinic. PATIENTS Adult patients with various vestibular disorders. INTERVENTIONS Patients were given the Dizziness Handicap Inventory (DHI) and the Dizziness Catastrophizing Scale (DCS) at a baseline visit and follow-up visit after treatment. MAIN OUTCOME MEASURES Correlation studies were used to determine the relationships between DHI and DCS. Multivariable linear regression was performed to determine the relationship between DCS and DHI change with treatment, accounting for demographic variables. RESULTS Forty-six subjects completed both the DHI and the DCS before and after treatment. Patients with higher baseline DCS scores had higher baseline DHI scores ( p < 0.001). There was a significant improvement in both DHI score ( p < 0.001) and DCS ( p < 0.001) at follow-up. Patients who had reduction in DCS scores during were more likely to show reduction in DHI scores ( p < 0.001). A subset of patients had a mindfulness-based stress reduction program included in their treatment. These patients had a greater reduction in both DCS and DHI scores at follow-up compared with those who received other treatments. CONCLUSIONS Catastrophizing is associated with higher pretreatment DHI scores and worse treatment outcomes. Addressing dizziness catastrophizing may help improve vestibular outcomes.
Collapse
Affiliation(s)
- Danielle M Gillard
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Maxwell Hum
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| | - Adam Gardi
- Drexel University College of Medicine, Philadelphia, Pennsylvania
| | - Linda Centore
- Department of Behavioral Sciences, University of California San Francisco School of Dentistry, San Francisco, California
| | - Jeffrey D Sharon
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California
| |
Collapse
|
4
|
Rizk HG, Velozo C, Shah S, Hum M, Sharon JD, Mcrackan TR. Item Level Psychometrics of the Dizziness Handicap Inventory in Vestibular Migraine and Meniere's Disease. Ear Hear 2024; 45:106-114. [PMID: 37415269 DOI: 10.1097/aud.0000000000001405] [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: 07/08/2023]
Abstract
OBJECTIVES Evaluate the measurement properties of the Dizziness Handicap Inventory (DHI) using item response theory in patients diagnosed with vestibular migraine (VM) and Meniere's disease (MD). DESIGN One hundred twenty-five patients diagnosed with VM and 169 patients diagnosed with MD by a vestibular neurotologist according to the Bárány Society criteria in two tertiary multidisciplinary vestibular clinics and who completed the DHI at their initial visit, were included in the study. The DHI (total score and individual items) was analyzed using the Rasch Rating Scale model for patients in each subgroup, VM and MD, and as a whole group. The following categories were assessed: rating-scale structure, unidimensionality, item and person fit, item difficulty hierarchy, person-item match, and separation index, standard error of measurement, and minimal detectable change (MDC). RESULTS Patients were predominantly female (80% of the VM subgroup and 68% of the MD subgroup) with a mean age of 49.9 ± 16.5 years and 54.1 ± 14.2 years, respectively. The mean total DHI score for the VM group was 51.9 ± 22.3 and for the MD group was 48.5 ± 26.6 ( p > 0.05). While neither all items nor the separate constructs met all criteria for unidimensionality (i.e., items measuring a single construct), post hoc analysis showed that the all-item analysis supported a single construct. All analyses met the criterion for showing a sound rating scale and acceptable Cronbach's alpha (≥0.69). The all-item analysis showed the most precision, separating the samples into three to four significant strata. The separate-construct analyses (physical, emotional, and functional) showed the least precision, separated the samples into less than three significant strata. Regarding MDC, the MDC remained consistent across the analyses of the different samples; approximately 18 points for the full analyses and approximately 10 points for the separate construct (physical, emotional, and functional). CONCLUSIONS Our evaluation of the DHI using item response theory shows that the instrument is psychometrically sound and reliable. The all-item instrument fulfills criteria for essential unidimensionality but does seem to measure multiple latent constructs in patients with VM and MD, which has been reported in other balance and mobility instruments. The current subscales did not show acceptable psychometrics, which is in line with multiple recent studies favoring the use of the total score. The study also shows that the DHI is adaptable to episodic recurrent vestibulopathies. The total score shows better precision and separation of subjects in up to four strata compared to the separate construct that separate subjects into less than three strata. The measurement error smallest detectable change was found in our analysis to be 18 points, which means any change in the DHI of less than 18 points is not likely to be clinically significant. The minimal clinically important difference remains indeterminate.
Collapse
Affiliation(s)
- Habib G Rizk
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Craig Velozo
- Division of Occupational Therapy, College of Health Professions, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Sunny Shah
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Maxwell Hum
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Jeffrey D Sharon
- Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, San Francisco, California, USA
| | - Theodore R Mcrackan
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, South Carolina, USA
| |
Collapse
|
5
|
Leong S, Teh BM, Duong T, Hu D, Chui A, Chen JS, Sisti MB, Wang TJ, Zanotto D, Lalwani AK. Instrumented insoles for assessment of gait in patients with vestibular schwannoma. WEARABLE TECHNOLOGIES 2023; 4:e14. [PMID: 38487773 PMCID: PMC10936291 DOI: 10.1017/wtc.2023.11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/24/2022] [Revised: 03/22/2023] [Accepted: 04/13/2023] [Indexed: 03/17/2024]
Abstract
Background Imbalance and gait disturbances are common in patients with vestibular schwannoma (VS) and can result in significant morbidity. Current methods for quantitative gait analysis are cumbersome and difficult to implement. Here, we use custom-engineered instrumented insoles to evaluate the gait of patients diagnosed with VS. Methods Twenty patients with VS were recruited from otology, neurosurgery, and radiation oncology clinics at a tertiary referral center. Functional gait assessment (FGA), 2-minute walk test (2MWT), and uneven surface walk test (USWT) were performed. Custom-engineered instrumented insoles, equipped with an 8-cell force sensitive resistor (FSR) and a 9-degree-of-freedom inertial measurement unit (IMU), were used to collect stride-by-stride spatiotemporal gait parameters, from which mean values and coefficients of variation (CV) were determined for each patient. Results FGA scores were significantly correlated with gait metrics obtained from the 2MWT and USWT, including stride length, stride velocity, normalized stride length, normalized stride velocity, stride length CV, and stride velocity CV. Tumor diameter was negatively associated with stride time and swing time on the 2MWT; no such association existed between tumor diameter and FGA or DHI. Conclusions Instrumented insoles may unveil associations between VS tumor size and gait dysfunction that cannot be captured by standardized clinical assessments and self-reported questionnaires.
Collapse
Affiliation(s)
- Stephen Leong
- Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Bing M. Teh
- Department of Otolaryngology—Head & Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
- Department of Otolaryngology—Head & Neck Surgery, Monash Health; Faculty of Medicine, Nursing and Health Sciences, Monash University, Clayton, VC, Australia
| | - Ton Duong
- Department of Mechanical Engineering, Stevens Institute of Technology, Hoboken, NJ, USA
| | - Diane Hu
- Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY, USA
| | - Alexander Chui
- Department of Biological Sciences, Columbia University, New York, NY, USA
| | - Jocelyn S. Chen
- Department of Biomedical Engineering, Columbia University, New York, NY, USA
| | - Michael B. Sisti
- Department of Otolaryngology—Head & Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
- Department of Neurological Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
- Department of Radiation Oncology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Tony J.C. Wang
- Department of Neurological Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
- Department of Radiation Oncology, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
| | - Damiano Zanotto
- Department of Mechanical Engineering, Stevens Institute of Technology, Hoboken, NJ, USA
| | - Anil K. Lalwani
- Vagelos College of Physicians & Surgeons, Columbia University Irving Medical Center, New York, NY, USA
- Department of Otolaryngology—Head & Neck Surgery, NewYork-Presbyterian/Columbia University Irving Medical Center, New York, NY, USA
- Department of Mechanical Engineering, Columbia University, New York, NY, USA
| |
Collapse
|
6
|
Wu J, Jiang CY, Bai YX, Xu Q, Sun XH, Pan H, Shu L, Liu JR, Chen W. Effect of the serum 25-hydroxyvitamin D level on risk for short-term residual dizziness after successful repositioning in benign paroxysmal positional vertigo stratified by sex and onset age. Front Neurol 2023; 14:1144958. [PMID: 37064183 PMCID: PMC10102369 DOI: 10.3389/fneur.2023.1144958] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/15/2023] [Accepted: 03/08/2023] [Indexed: 04/03/2023] Open
Abstract
ObjectiveA low serum 25-hydroxyvitamin D (25(OH)D) level is relevant to both the occurrence and recurrence of benign paroxysmal positional vertigo (BPPV). However, whether it also contributes to residual dizziness (RD) after successful repositioning maneuvers is unknown. Therefore, this study aimed to explore the correlation between the serum 25(OH)D level and short-term RD severity in patients with BPPV after successful repositioning maneuvers.MethodsIn total, 251 patients with BPPV after successful repositioning were enrolled and prospectively followed up for 1 week (W1). Serum 25(OH)D values were detected by chemiluminescence immunoassay at enrollment (W0). In addition, we explored the relationship between 25(OH)D values at baseline and RD severity at W1 in different subgroups stratified by sex and onset age (early-onset, ≤50 years; late-onset, >50 years).ResultsThe serum 25(OH)D level of female patients was significantly lower than that of male patients (15.9 ± 6.8 vs. 19.8 ± 6.6 ng/ml, p < 0.001). Its level also decreased in early-onset patients compared to late-onset ones (15.3 ± 5.9 vs. 18.0 ± 7.3 ng/ml, p = 0.003). In addition, early-onset female patients had lower 25(OH)D values than late-onset female patients (14.0 ± 5.5 vs. 17.1 ± 7.2 ng/ml, p = 0.004). However, this difference was not observed between early- and late-onset male patients. Among early-onset female patients, the 25(OH)D values of the moderate-to-severe RD group were lower than those of the minor or no RD group (10.9 ± 3.3 vs. 14.7 ± 5.7 vs. 15.0 ± 5.9 ng/ml, p = 0.046). Multivariate analysis found that decreased 25(OH)D values were related to the occurrence of moderate-to-severe RD in early-onset female patients (OR = 0.801; p = 0.022). This effect did not exist in late-onset female or male patients with BPPV.ConclusionsAge and sex differences in serum 25(OH)D levels exist in patients with BPPV. A decreased 25(OH)D level in early-onset female patients may increase the odds of moderate-to-severe RD 1 week after successful repositioning maneuvers.
Collapse
Affiliation(s)
- Jing Wu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chun-Yan Jiang
- Department of Neurology, Huangpu Branch, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Ying-Xia Bai
- Department of Neurology, Huangpu Branch, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Qian Xu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xu-Hong Sun
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hui Pan
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Liang Shu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jian-Ren Liu
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Jian-Ren Liu
| | - Wei Chen
- Department of Neurology, Shanghai Ninth People's Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Wei Chen
| |
Collapse
|
7
|
Keshner EA, Mallinson AI, Longridge NS, Sinno S, Petersen H, Perrin P. Evolution of postural control assessment: From dynamic posturography to virtual reality. Front Neurol 2023; 13:1054346. [PMID: 36712454 PMCID: PMC9874684 DOI: 10.3389/fneur.2022.1054346] [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: 09/26/2022] [Accepted: 12/13/2022] [Indexed: 01/12/2023] Open
Abstract
During the early years of spaceflight it was documented that astronauts were impaired and incapacitated upon return to earth. Computerized Dynamic Posturography (CDP) was devised to investigate and quantify this deficit, and eventually progressed into a clinical assessment tool. The current sprouting of virtual reality (VR) technologies has allowed for the development of an alternative approach that could be more informative. Many low-cost VR systems (including desktop gaming programs designed for rehabilitation) are now available. Continued improvements in this technology indicate a high probability that VR will become an integral component of posturography by replacing present mechanical CDP techniques. We researched the relevant literature to evaluate the strengths and weaknesses of CDP using the Equitest (Neurocom International; Clackamas USA), and the added benefits of incorporating VR to help clinicians assess the complex task of balance maintenance. VR is capable of manipulating task and environmental demands in order to assess functional postural behavior. VR is also a useful tool for clinical testing of postural disorders resulting from sensory mismatch. Although posturography is still a useful clinical tool, VR provides an inherent conflict between the visual and vestibular senses and can elevate the effectiveness of CDP for both assessment and intervention. We conclude that, when initially developed, CDP was innovative and ahead of its time. However, with the advent of VR, we have a chance to modernize CDP and enhance its value as a clinical instrument.
Collapse
Affiliation(s)
- Emily A. Keshner
- Department of Health and Rehabilitation Sciences, Temple University, Philadelphia, PA, United States,*Correspondence: Emily A. Keshner ✉
| | - Arthur I. Mallinson
- Division of Otolaryngology, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Neil S. Longridge
- Division of Otolaryngology, Department of Surgery, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada
| | - Solara Sinno
- Research Unit EA 3450 DevAH–Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, Nancy, France,Laboratory for the Analysis of Posture, Equilibrium and Motor Function (LAPEM), University Hospital of Nancy, Nancy, France
| | - Hannes Petersen
- Department of Otorhinolaryngology, University of Iceland, Reykjavík, Iceland,Department of Anatomy, Faculty of Medicine, University of Iceland, Reykjavik, Iceland
| | - Philippe Perrin
- Research Unit EA 3450 DevAH–Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, Nancy, France,Laboratory for the Analysis of Posture, Equilibrium and Motor Function (LAPEM), University Hospital of Nancy, Nancy, France
| |
Collapse
|
8
|
Knapstad MK, Goplen FK, Nordahl SHG, Berge JE. The Dizziness Handicap Inventory and sickness absence: a cross-sectional study. Disabil Rehabil 2023; 45:286-290. [PMID: 34978234 DOI: 10.1080/09638288.2021.2022786] [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] [Indexed: 01/12/2023]
Abstract
PURPOSE The aim of this study was to examine the association between the Dizziness Handicap Inventory (DHI) and sickness absence from work in patients with dizziness. MATERIAL AND METHODS This was a cross-sectional study conducted at an otolaryngology clinic with 238 patients referred for a suspected vestibular disorder during a 1-year period. The association between sickness absence over the last 30 days and DHI was examined with binary and ordinal logistic regression. The Hospital Anxiety and Depression scale (HADS), health-related quality of life (RAND-12), duration of dizziness, diagnosis, age and gender were used as adjustments variables. RESULTS The adjusted analysis showed that a 10-point increase on DHI was associated with an increased risk of sickness absence (yes/no) (OR: 1.50, 95% CI: 1.25-1.90, p < 0.001). In addition, a 10-point increase in DHI-score was associated with a higher degree of sickness absence (OR: 1.50, 95% CI: 1.25-1.80, p < 0.001). CONCLUSION A higher DHI-score was associated with sickness absence in addition to the duration of absence the previous month. These results indicate the relevance and clinical usefulness of the DHI as a possible indicator of sickness absence from work in patients with dizziness regardless of diagnosis.IMPLICATIONS FOR REHABILITATIONApproximately half of patients referred to a dizziness clinic have sickness absence.A higher score on The Dizziness Handicap Inventory is associated with longer duration of sickness absence.A vestibular diagnosis was not associated with sickness absence.The results indicate that the Dizziness Handicap Inventory may be a clinically useful tool for identifying patients with a high risk of sickness absence.
Collapse
Affiliation(s)
- Mari Kalland Knapstad
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Frederik Kragerud Goplen
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Stein Helge Glad Nordahl
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jan Erik Berge
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| |
Collapse
|
9
|
Kristiansen L, Magnussen LH, Wilhelmsen KT, Maeland S, Nordahl SHG, Hovland A, Clendaniel R, Boyle E, Juul-Kristensen B. Self-Reported Measures Have a Stronger Association With Dizziness-Related Handicap Compared With Physical Tests in Persons With Persistent Dizziness. Front Neurol 2022; 13:850986. [PMID: 35911903 PMCID: PMC9334819 DOI: 10.3389/fneur.2022.850986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2022] [Accepted: 06/03/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundAssociations between dizziness-related handicap and a variety of self-reported measures have been reported. However, research regarding associations between dizziness-related handicap and aspects of functioning that includes both physical tests and self-reported measures is scarce.ObjectiveThe purpose of the study was to describe the variations in signs and symptoms in people with persistent dizziness using physical tests and self-reported outcomes across three severity levels of the Dizziness Handicap Inventory (DHI) and investigate their associations with the DHI.MethodParticipants with persistent dizziness (n = 107) were included in this cross-sectional study. The participants underwent (1) physical tests (gait tests, grip strength, body flexibility, and movement-induced dizziness) and completed questionnaires regarding (2) psychological measures (Mobility Inventory of Agoraphobia, Body Sensation Questionnaire, Agoraphobic Cognitions Questionnaire, and Hospital Depression and Anxiety Questionnaire), and (3) fatigue, dizziness severity, and quality of life (Chalders Fatigue Scale, Vertigo Symptom Scale-Short Form, and EQ visual analog scale), in addition to the DHI. Data were presented by descriptive statistics for three DHI severity levels (mild, moderate, and severe). A multiple linear backward regression analysis was conducted for each group of measures in relation to the DHI total score, with additional analyses adjusting for age and sex. Based on these results, significant associations were tested in a final regression model.ResultsWith increasing severity levels of DHI, the participants demonstrated worse performance on most of the physical tests (preferred and fast gait velocity, dizziness intensity after head movements), presented with worse scores on the self-reported measures (avoidance behavior, fear of bodily sensation, fear of fear itself, psychological distress, fatigue, dizziness severity, quality of life). After adjusting for age and sex, significant associations were found between total DHI and avoidance behavior, psychological distress, dizziness severity, and quality of life, but not with any of the physical tests, explaining almost 56% of the variance of the DHI total score.ConclusionThere was a trend toward worse scores on physical tests and self-reported measurements with increasing DHI severity level. The DHI seems to be a valuable tool in relation to several self-reported outcomes; however, several signs and symptoms may not be detected by the DHI, and thus, a combination of outcomes should be utilized when examining patients with persistent dizziness.
Collapse
Affiliation(s)
- Lene Kristiansen
- Department of Health and Function, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngol and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
- *Correspondence: Lene Kristiansen
| | - Liv H. Magnussen
- Department of Health and Function, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Kjersti T. Wilhelmsen
- Department of Health and Function, Faculty of Health and Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway
| | - Silje Maeland
- Department of Global Public Health and Primary Care, Faculty of Medicine, University of Bergen, Bergen, Norway
- Research Unit for General Practice in Bergen, The Norwegian Research Center, Bergen, Norway
| | - Stein Helge G. Nordahl
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngol and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Anders Hovland
- Department of Clinical Psychology, University of Bergen, Bergen, Norway
- Solli District Psychiatric Centre, Bergen, Norway
| | - Richard Clendaniel
- Physical Therapy Division, Department of Orthopaedics and Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, NC, United States
| | - Eleanor Boyle
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| | - Birgit Juul-Kristensen
- Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark
| |
Collapse
|
10
|
Formeister EJ, Baum RT, Sharon JD. Supervised machine learning models for classifying common causes of dizziness. Am J Otolaryngol 2022; 43:103402. [PMID: 35221115 DOI: 10.1016/j.amjoto.2022.103402] [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: 01/18/2022] [Accepted: 02/13/2022] [Indexed: 11/25/2022]
Abstract
PURPOSE The objective of this study was to use a supervised machine learning (ML) platform and a national dataset to identify factors important in classifying common types of dizziness. METHODS Using established clinical criteria and responses to the balance and dizziness supplement from the 2016 National health Interview Survey (n = 33,028), case definitions for vestibular migraine (VM), benign paroxysmal positional vertigo (BPPV) Ménière's disease (MD), persistent postural-perceptual dizziness (PPPD), superior canal dehiscence (SCD), and bilateral vestibular hypofunction (BVH) were generated. One hundred thirty-six variables consisting of sociodemographic characteristics and medical comorbidities were used to develop decision tree models to predict these common types of dizziness. RESULTS The one-year prevalence of dizziness in the U.S. was 16.8% (5562 respondents). VM was highly prevalent, representing 4.0% of the overall respondents (n = 1327). ML decision tree models were able to correctly classify all 6 dizziness subtypes with high accuracy (sensitivity range, 70-92%; specificity range, 89-99%) using responses to questions about functional limitations due to dizziness, such as falls due to dizziness and modification of social activities due to dizziness. CONCLUSIONS In a large population-based dataset, supervised ML models accurately predicted dizziness subtypes according to responses to questions that do not pertain to dizziness symptoms alone.
Collapse
|
11
|
Herdman D, Picariello F, Moss-Morris R. Validity of the Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) in Patients With Dizziness. Otol Neurotol 2022; 43:e361-e367. [PMID: 34999617 DOI: 10.1097/mao.0000000000003460] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HYPOTHESIS The Patient Health Questionnaire Anxiety and Depression Scale (PHQ-ADS) will be a valid and reliable combined measure of depression and anxiety in people with vertigo and dizziness. BACKGROUND Co-occurrence of depressive, anxiety, and somatic symptoms are common. The Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder Scale-7 (GAD-7) measure symptoms of depression and anxiety respectively, although measuring them separately may be suboptimal in people who have illness-related distress. There is some evidence that these scales can be combined in long-term conditions resulting in the PHQ-ADS, but validity is yet to be determined in people with vertigo and dizziness. METHODS Two separate datasets from a tertiary vestibular clinic were analyzed where the PHQ-ADS was completed at initial clinical assessment (n = 624) and while on a waiting list (n = 185). A cross-sectional design was used to examine the factor structure (confirmatory factor analysis), internal consistency (omega index), and construct validity (Pearson correlation coefficient) of the PHQ-ADS. Construct validity was determined against the dizziness handicap inventory (DHI). RESULTS A bi-factor PHQ-ADS model had good fit to the data (χ2 = 397.163, 249.763; comparative fit index [CFI] = 0.954, 0.919; Tucker-Lewis index [TLI] = 0.938, 0.892; root mean squared error of approximation [RMSEA] = 0.076, 0.098). The general distress factor explained 81 to 85% of the common variance between items. There were moderate to large significant positive correlations between the PHQ-ADS and DHI. CONCLUSION The PHQ-ADS appears to have good structural validity in patients with vertigo and dizziness. Clinicians and researchers can use this scale where a composite psychological measure is desired.
Collapse
Affiliation(s)
- David Herdman
- Health Psychology Section, Institute of Psychiatry Psychology and Neuroscience, King's College London
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - Federica Picariello
- Health Psychology Section, Institute of Psychiatry Psychology and Neuroscience, King's College London
| | - Rona Moss-Morris
- Health Psychology Section, Institute of Psychiatry Psychology and Neuroscience, King's College London
| |
Collapse
|
12
|
|
13
|
Ellsperman SE, Telian SA, Kileny PR, Welch CM. Intraoperative Electrocochleography Correlates to Outcomes in Transmastoid and Middle Cranial Fossa Superior Semicircular Canal Dehiscence Repair. Otol Neurotol 2022; 43:120-127. [PMID: 34510121 DOI: 10.1097/mao.0000000000003350] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine the degree to which electrocochleography (ECoG) correlates with auditory and vestibular outcomes after repair of superior semicircular canal dehiscence (SSCD) via transmastoid (TM) and middle cranial fossa (MCF) approaches. STUDY DESIGN Retrospective review. SETTING Academic tertiary referral center. PATIENTS Adults with SSCD who underwent repair between 2005 and 2019. INTERVENTION Pre-, intra-, and postoperative ECoG. MAIN OUTCOME MEASURES Patient-reported vestibular and auditory symptoms; pre-, intra-, and postoperative ECoG measures, dizziness handicap inventory (DHI) scores. RESULTS Forty-six patients underwent SSCD repair (40 unilateral, six bilateral) between 2005 and 2019, including 24 MCF and 28 TM approaches. There were no differences in preoperative, intraoperative, or postrepair ECoG SP/AP values between the MCF and TM groups (p 0.12, 0.77, 0.58). Patients had subjective improvement in vestibular symptoms (or stable vestibular function in patients operated for predominantly auditory manifestations) with both approaches (MCF: 87.5%; TM: 92.3%; p 0.64). A successful outcome correlated with intraoperative SP/AP ratio normalization (p 0.0005). Similarly, DHI scores were similar in both groups preoperatively (p 0.66) and returned to their preoperative baseline postoperatively with both (p 0.52). Reported vestibular symptoms persisted or worsened more often in patients with migraine (66.6% vs. 28.9%, p 0.03), and with persistently abnormal ECoG measures, though the latter was not statistically significant in this population (38% vs. 15%, p 0.10). Patients had subjective improvement or stability in auditory symptoms using either approach (MCF: 96%; TM: 100%; p 0.62), also correlating with SP/AP ratio normalization (p 0.008). CONCLUSIONS Correction of abnormal preoperative ECoG reliably correlates to patient symptom improvement after SSCD repair. No significant differences in postoperative outcomes were noted between patients undergoing TM versus MCF repair. Circumspection regarding the likelihood of an ideal outcome after SSCD repair should be exercised when counseling patients with concomitant migraine. DEFINE PROFESSIONAL PRACTICE GAP AND EDUCATIONAL NEED It is not certain whether outcomes differ between the two dominant approaches for SSCD repair. Surgeons and patients would benefit from an intraoperative metric that reflects satisfactory plugging of SSCD. LEARNING OBJECTIVE To highlight the reliability and unique utility of intraoperative ECoG and demonstrate the correlation between ECoG correction and symptom improvement for SSCD repair. DESIRED RESULT To report subjective and objective outcomes following SSCD repair and encourage adoption of intraoperative ECoG monitoring. LEVEL OF EVIDENCE Level V. INDICATE IRB OR IACUC IRB review considers this study exempt (HUM00169949).
Collapse
Affiliation(s)
- Susan E Ellsperman
- University of Michigan Department of Otolaryngology - Head and Neck Surgery
| | | | | | | |
Collapse
|
14
|
Silveira RMG, Nascimento GFFD, Diniz Junior J, Mantello EB. Relationship between physical activity, feelings of disability, and quality of life in patients with peripheral vestibular dysfunction. REVISTA CEFAC 2022. [DOI: 10.1590/1982-0216/202224412221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
ABSTRACT Purpose: to verify the association of self-reported feelings of disability and physical activity with the impact of vestibular symptoms on the quality of life of patients with vestibular dysfunction. Methods: a retrospective, cross-sectional, analytical, documentary study approved by the Research Ethics Committee (evaluation report no. 4.462.519), with 50 selected medical records of patients diagnosed with peripheral vestibular dysfunction, including a survey of their medical history and results of the Dizziness Handicap Inventory (DHI). Results: the sample’s mean age was 55.38 years, and the majority were females (70%). The DHI revealed a moderate impact of dizziness. Physically active patients perceived less impact of the disease (p-value = 0.0167), while patients with feelings of disability, due to vestibular symptoms, had a greater damage of their quality of life (p-value = 0.0468). Conclusion: physical activity was associated with less damage of dizziness to the quality of life; also, a greater impact on the quality of life was associated with feelings of disability related to vestibular complaints.
Collapse
Affiliation(s)
| | | | | | - Erika Barioni Mantello
- Universidade Federal do Rio Grande do Norte, Brazil; Universidade Federal do Rio Grande do Norte, Brazil
| |
Collapse
|
15
|
Silveira RMG, Nascimento GFFD, Diniz Junior J, Mantello EB. Relação entre atividade física, sentimento de incapacidade e qualidade de vida em pacientes com disfunção vestibular periférica. REVISTA CEFAC 2022. [DOI: 10.1590/1982-0216/202224412221s] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
RESUMO Objetivo: verificar a associação entre o sentimento de incapacidade autorrelatada e a prática de atividade física com o impacto dos sintomas vestibulares sobre a qualidade de vida em pacientes com disfunção vestibular. Métodos: estudo documental, analítico, transversal e retrospectivo, aprovado pelo Comitê de Ética em Pesquisa (parecer 4.462.519), no qual foram selecionados 50 prontuários de pacientes diagnosticados com disfunção vestibular periférica, analisada anamnese e os resultados do questionário Dizziness Handicap Inventory (DHI). Resultados: a amostra obteve média de idade de 55.38 anos e predomínio do sexo feminino (70%). O DHI evidenciou impacto moderado da tontura. Os pacientes que praticavam atividade física perceberam um menor impacto da doença (p-valor=0.0167) e, os pacientes que apresentavam sentimento de incapacidade, devido aos sintomas vestibulares, tiveram maior prejuízo na qualidade de vida (p-valor=0.0468). Conclusão: houve associação entre a prática de atividade física com o menor prejuízo da tontura na qualidade de vida e associação entre um maior impacto na qualidade de vida dos indivíduos que apresentavam sentimento de incapacidade relacionado às queixas vestibulares.
Collapse
Affiliation(s)
| | | | | | - Erika Barioni Mantello
- Universidade Federal do Rio Grande do Norte, Brazil; Universidade Federal do Rio Grande do Norte, Brazil
| |
Collapse
|
16
|
Formeister EJ, Chae R, Wong E, Chiao W, Pasquesi L, Sharon JD. Episodic versus Chronic Dizziness: An Analysis of Predictive Factors. Ann Otol Rhinol Laryngol 2021; 131:403-411. [PMID: 34121469 DOI: 10.1177/00034894211025416] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To elucidate differences in demographic and clinical characteristics between patients with episodic and chronic dizziness. METHODS A cross-sectional, observational study of 217 adults referred for dizziness at 1 tertiary center was undertaken. Subjects were split into a chronic dizziness group (>15 dizzy days per month) and an episodic dizziness group (<15 dizzy days per month). RESULTS 217 adults (average age, 53.7 years; 56.7% female) participated. One-third (n = 74) met criteria for chronic dizziness. Dizziness handicap inventory (DHI) scores were significantly higher in those with chronic dizziness compared to those with episodic dizziness (53.9 vs 40.7; P < .001). Comorbid depression and anxiety were more prevalent in those with chronic dizziness (44.6% and 47.3% vs 37.8% and 35.7%, respectively; P > .05). Abnormal vestibular testing and abnormal imaging studies did not differ significantly between the 2 groups. Ménière's disease and BPPV were significantly more common among those with episodic dizziness, while the prevalence of vestibular migraine did not differ according to chronicity of symptoms. A multivariate regression that included age, sex, DHI, history of anxiety and/or depression, associated symptoms, and dizziness triggers was able to account for 15% of the variance in the chronicity of dizziness (pseudo-R2 = 0.15; P < .001). CONCLUSIONS Those who suffer from chronic dizziness have significantly higher DHI and high comorbid rates of depression and anxiety than those with episodic dizziness. Our findings show that factors other than diagnosis alone are important in the chronification of dizziness, an observation that could help improve on multimodal treatment options for this group of patients.
Collapse
Affiliation(s)
- Eric J Formeister
- Institution where work was performed, Department of Otolaryngology, Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco, CA, USA.,Current location, Department of Otolaryngology, Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Ricky Chae
- Institution where work was performed, Department of Otolaryngology, Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Emily Wong
- Institution where work was performed, Department of Otolaryngology, Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Whitney Chiao
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota School of Medicine, Minneapolis, MN, USA
| | - Lauren Pasquesi
- Institution where work was performed, Department of Otolaryngology, Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| | - Jeffrey D Sharon
- Institution where work was performed, Department of Otolaryngology, Head and Neck Surgery, University of California, San Francisco School of Medicine, San Francisco, CA, USA
| |
Collapse
|
17
|
[Quality of primary care and quality of life from the point of view of older patients with dizziness. Results oft the cohort study MobilE-TRA]. MMW Fortschr Med 2021; 163:11-18. [PMID: 33844180 DOI: 10.1007/s15006-021-9703-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/04/2023]
Abstract
BACKGROUND The treatment of elderly patients with dizziness/vertigo/balance disorders (VDB) can be challenging for their general practitioner. Patient-centered care with a focus on self-management support could be a possible approach. Primary objective of this study was to investigate the correlations between quality of primary care and health-related quality of life (HRQOL) from the patient's perspective. METHOD Data had been collected in the area of Munich and in the area of Dresden between 2017 and 2019. Questionnaires of n = 157 elderly patients from primary care practices in Munich and Dresden were evaluated. Multiple linear regression was used to analyse quality of care, physical activity, depression, and their correlations with HRQOL. RESULTS In this cohort of patients aged 65 to 94 no significant correlation between quality of care and HRQOL could be detected. Depression correlated negatively with HRQOL, whereas physical activity showed a positive correlation with HRQOL. CONCLUSIONS Physical activity can be beneficial for elderly dizzy patients' HRQOL. Additionally, a potential depression should be taken into account when treating patients with dizziness to improve their HRQOL. The results can be well transferred to elderly patients with VDB. Analysing more patients however, could increase the significance of the results.
Collapse
|
18
|
Graham MK, Staab JP, Lohse CM, McCaslin DL. A Comparison of Dizziness Handicap Inventory Scores by Categories of Vestibular Diagnoses. Otol Neurotol 2021; 42:129-136. [PMID: 33229883 DOI: 10.1097/mao.0000000000002890] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The Dizziness Handicap Inventory (DHI) is a 25-item self-report quantifying dizziness-related physical and emotional symptoms and restrictions in daily activities. DHI scores do not correlate with severity of structural vestibular deficits; thus, high DHI scores may reflect other causes of morbidity. This study investigated the relationship between total DHI scores and the presence of structural, functional, and psychiatric disorders in tertiary neurotology patients. STUDY DESIGN Retrospective. SETTING Tertiary center. PATIENTS Eighty-five patients who underwent multidisciplinary neurotologic evaluations. INTERVENTION Diagnostic. MAIN OUTCOME MEASURE(S) Active illnesses identified by a multidisciplinary neurotology team were abstracted from medical records, cataloged as structural, functional, or psychiatric disorders, and used to group patients into diagnostic categories: structural (structural disorders only), functional (functional disorders with/without structural disorders), and psychiatric (psychiatric disorders with/without other conditions). DHI scores were compared across diagnostic categories. Sensitivities and specificities of DHI scores for identifying structural versus functional or psychiatric disorders were calculated. RESULTS Mean DHI scores differed significantly by diagnostic category (structural 35 ± 18, functional 64 ± 15, and psychiatric 65 ± 19), before and after adjusting for age and sex (p < 0.001, Hedges' g>1.62 for structural versus functional and psychiatric categories). DHI≤30 (mild handicap) had specificity = 0.98 for structural disorders alone, whereas DHI>60 (severe handicap) had specificity = 0.88 for functional or psychiatric disorders. CONCLUSIONS In this tertiary cohort, categories of illnesses had large effects on total DHI scores. Patients with scores ≤30 were likely to have structural disorders alone, whereas those with scores >60 were likely to have functional or psychiatric disorders, with or without coexisting structural conditions.
Collapse
Affiliation(s)
| | - Jeffrey P Staab
- Department of Otolaryngology-Head and Neck Surgery
- Department of Psychiatry and Psychology
| | - Christine M Lohse
- Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota
| | | |
Collapse
|