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Castillo-Bustamante M, Çelebisoy N, Echavarria LG, Franco I, Valencia S, Gonzalez S, García A. Balance in Transition: Unraveling the Link Between Menopause and Vertigo. Cureus 2024; 16:e59277. [PMID: 38813338 PMCID: PMC11135238 DOI: 10.7759/cureus.59277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 05/31/2024] Open
Abstract
The onset of menopause, marked by hormonal fluctuations and a decline in estrogen levels, is suggested to be linked to increased susceptibility to vestibular disturbances. Estrogen, beyond its established association with reproductive physiology, plays modulatory roles in various physiological systems, including neurosensory function. The vestibular system, crucial for balance and spatial orientation, is influenced by hormonal changes during menopause, potentially contributing to the emergence of vertigo symptoms. This interplay between hormones and the vestibular system is a burgeoning area of research with clinical implications, offering insights into novel diagnostic and therapeutic approaches for managing postmenopausal women with vestibular disorders. The article reviews current scientific literature, delves into the hormonal intricacies of menopause, and investigates potential mechanisms underlying the connection between hormonal fluctuations and vertigo symptoms.
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Affiliation(s)
- Melissa Castillo-Bustamante
- Otoneurology, Centro de Vértigo y Mareo, Mexico City, MEX
- Medicine, Universidad Pontificia Bolivariana, Medellín, COL
| | | | - Luis G Echavarria
- Obstetrics and Gynecology, Clinica Universitaria Bolivariana, Medellín, COL
| | - Isabela Franco
- Otolaryngology, Universidad Pontificia Bolivariana, Medellín, COL
| | | | - Sara Gonzalez
- Otolaryngology, Universidad Pontificia Bolivariana, Medellin, COL
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Katzenberger B, Fuchs S, Schwettmann L, Strobl R, Hauser A, Koller D, Grill E. Association of self-efficacy, risk attitudes, and time preferences with functioning in older patients with vertigo, dizziness, and balance disorders in a tertiary care setting-Results from the MobilE-TRA2 cohort. Front Neurol 2023; 14:1316081. [PMID: 38162444 PMCID: PMC10755024 DOI: 10.3389/fneur.2023.1316081] [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: 10/10/2023] [Accepted: 11/20/2023] [Indexed: 01/03/2024] Open
Abstract
Introduction The functional burden of vertigo, dizziness, and balance problems (VDB) might depend on the personality traits of the patients affected. The aim of this study thus was to investigate the impact of self-efficacy, risk attitudes, and time preferences on functioning in older patients with VDB before and after treatment in a specialized tertiary care center. Methods Data for this study was obtained from the MobilE-TRA2 cohort study, conducted at a specialized tertiary care center in Germany. Patients aged 60 and older were assessed during their initial stay at the care center and 3 months later, using self-administered questionnaires. Self-efficacy was measured on a scale from 1 (very low) to 5 (very high). Health-related risk attitudes were inquired using an 11-point scale. Time preferences were measured by evaluating patients' willingness to postpone a reward in favor of a greater benefit on an 11-point Likert scale. Functioning was evaluated using the Dizziness Handicap Inventory, representing functional, emotional, and physical aspects of functional disability caused by VDB. Mixed-effects regression models were used to analyze the association between the selected personality traits and functioning over time. Interaction terms with time were incorporated for each personality trait, enabling the assessment of their influence on functioning 3 months following the initial observation period. Results An overall of 337 patients (53% women, median age at baseline = 70 years) were included. Patients with higher self-efficacy (Beta = -3.82, 95%-CI [-6.56; -1.08]) and higher willingness to take risks (Beta = -1.31, 95%-CI [-2.31; -0.31]) reported better functioning during their initial visit at the care center. Self-efficacy significantly predicted functioning after 3 months for overall functioning (Beta = -4.21, 95%-CI [-6.57; -1.84]) and all three domains. Conclusion Our findings suggest that patients with high self-efficacy and high willingness to take risks may exhibit better coping mechanisms when faced with the challenges of VDB. Promoting self-efficacy may help patients to better manage the duties accompanying their treatment, leading to improved functioning. These insights may inform the development of personalized treatment aimed at reducing the functional burden of VDB in older patients.
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Affiliation(s)
- Benedict Katzenberger
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
| | - Sebastian Fuchs
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
- Pettenkofer School of Public Health, Munich, Germany
- Department of Orthopaedics and Trauma Surgery, LMU University Hospital, LMU Munich, Munich, Germany
| | - Lars Schwettmann
- Department of Health Services Research, School of Medicine and Health Sciences, Carl Von Ossietzky University of Oldenburg, Oldenburg, Germany
- Institute of Health Economics and Health Care Management (IGM), Helmholtz Zentrum München (GmbH) – German Research Center for Environmental Health, Neuherberg, Germany
| | - Ralf Strobl
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
- German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Munich, Munich, Germany
| | - Ari Hauser
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
| | - Daniela Koller
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
| | - Eva Grill
- Institute for Medical Information Processing, Biometry and Epidemiology (IBE), Faculty of Medicine, LMU Munich, Munich, Germany
- German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Munich, Munich, Germany
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Hung SH, Xirasagar S, Dang LH, Chen YC, Cheng YF, Lin HC, Chen CS. Trends in the incidence of peripheral vestibular disorders: a Nationwide population-based study. Front Neurol 2023; 14:1322199. [PMID: 38192578 PMCID: PMC10773773 DOI: 10.3389/fneur.2023.1322199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2023] [Accepted: 11/28/2023] [Indexed: 01/10/2024] Open
Abstract
Purpose This study aimed to examines the long-term trend of incidence of peripheral vestibular disorders between 2010 and 2018 in Taiwan. Methods Study-eligible patients were identified from Taiwan's Longitudinal Health Insurance Database 2005 maintained by the Ministry of Health and Welfare in Taiwan. We retrieved 230,566 patients with a first-time diagnosis of peripheral vestibular disorders between 2010 and 2018. We calculated annual incidence rates of peripheral vestibular disorders per 100,000 population. We used the annual percent change (APC) to test the trend of peripheral vestibular disorders over time. Results The mean annual incidence rate of peripheral vestibular disorders during the study period was 1489.6 per 100,000 population. Incidence showed a statistically significant steady decrease from 2010 to 2018 with a mean APC of -6.15% (95% CI = -6.97% ~ -5.32%). The decline was led by Meniere's disease (APC = -9.83, 95% CI = -10.66% ~ -8.99%), followed by benign paroxysmal positional vertigo (APC = -3.69, 95% CI = -4.53% ~ -3.03%), vestibular neuritis (APC = -7.85, 95% CI = -8.96 ~ -6.73), and other peripheral vestibular dizziness (APC = -5.56, 95% CI = -6.69% ~ -4.43%). Conclusion The incidence of peripheral vestibular disorders, overall, and the four major subgroups, benign paroxysmal positional vertigo, Meniere's disease, vestibular neuritis, and other peripheral vestibular dizziness, all decreased substantially, year by year within the 2010-2018 period.
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Affiliation(s)
- Shih-Han Hung
- Department of Otolaryngology, School of Medicine, Taipei Medical University, Taipei, Taiwan
- Department of Otolaryngology, Wan Fang Hospital, Taipei, Taiwan
- International Ph.D. Program in Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Sudha Xirasagar
- Department of Health Services Policy and Management, University of South Carolina, Arnold School of Public Health, Columbia, SC, United States
| | - Luong Huu Dang
- Department of Otolaryngology, Wan Fang Hospital, Taipei, Taiwan
- Department of Otolaryngology, Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
| | - Yen-Chun Chen
- Department of Otolaryngology, School of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yen-Fu Cheng
- Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Otolaryngology-Head and Neck Surgery, Taipei Veterans General Hospital, Taipei, Taiwan
- Department of Otolaryngology-Head and Neck Surgery, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Research Center of Data Science on Healthcare Industry, College of Management, Taipei Medical University, Taipei, Taiwan
| | - Herng-Ching Lin
- School of Health Care Administration, College of Management, Taipei Medical University, Taipei, Taiwan
- Research Center of Sleep Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Chin-Shyan Chen
- Research Center of Data Science on Healthcare Industry, College of Management, Taipei Medical University, Taipei, Taiwan
- Department of Economics, National Taipei University, New Taipei City, Taiwan
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Wang L, Zhang L, Roe E, Decker S, Howard G, Luth A, Marks K, Whitman B. The Perceived Knowledge of Fall Prevention in Nurses Working in Acute Care Hospitals in China and the United States. J Patient Saf 2022; 18:e580-e584. [PMID: 34320533 PMCID: PMC8855948 DOI: 10.1097/pts.0000000000000873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of the study was to investigate the perceived knowledge of fall prevention in nurses working in hospitals in China and the United States. METHODS A cross-sectional survey with 17 items was used to measure perceived knowledge of fall prevention of nurses working in hospitals in China and the United States. RESULTS A total of 1442 nurses at 2 hospitals completed the survey in China (90% return rate), and 260 nurses in 2 hospitals in the United States (42% return rate) for a total sample size of 1702. Six items had means less than 4, indicating less familiarity with these factors. These items included assessment of vertigo and vestibular dysfunction, vision, foot problems, balance and activity, cognitive changes, and medications. In both countries, there was a difference in 2 units worked, with those working in maternal-child having a lower perception of knowledge of fall prevention than those employed on medical-surgical units. Of the 17 items, 11 were significantly different between China and the United States, all with the United States having higher perceived knowledge. CONCLUSIONS For both the United States and China, the perception of knowledge of fall prevention was high. However, nurses from both countries were less familiar with the items not commonly included on fall risk tools, such as vertigo and vestibular dysfunction, vision, foot problems, balance, and cognitive changes. The findings have implications for practice and education and suggest a need to include important factors related to falls in education and intervention in both countries.
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Affiliation(s)
- Lin Wang
- From the Departments of Transitional Care
| | - Li Zhang
- First Class Ward, The First Affiliated Hospital, Jinan University, Guangzhou, China
| | - Elizabeth Roe
- Crystal M. Lange College Health and Human Service, Saginaw Valley State University
| | - Sally Decker
- Crystal M. Lange College Health and Human Service, Saginaw Valley State University
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Jilla AM, Arnold ML, Miller EL. U.S. Policy Considerations for Telehealth Provision in Audiology. Semin Hear 2021; 42:165-174. [PMID: 34381300 PMCID: PMC8328556 DOI: 10.1055/s-0041-1731697] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Abstract
The demand for telehealth services will continue to grow alongside an increased need for audiology services among both children and adults. Insurance coverage policies for audiologic services are specific to each payer and vary widely in the level of coverage provided for both in-person and telehealth-based audiology services. While benefits for children are fairly comprehensive, coverage for audiology services for adults is generally poor. Traditional Medicare does not cover hearing aids or other rehabilitative audiologic services, and other payer policies vary widely. Lack of benefits for hearing and balance services is inconsistent with the evidence base and leaves many beneficiaries without access to meaningful care for hearing and balance disorders, which are highly prevalent among and disproportionately affect Medicare beneficiaries. The purpose of this article is to discuss regulatory and reimbursement considerations for telehealth provision in audiology and elucidate opportunities to influence related health policy at both state and federal levels.
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Affiliation(s)
- Anna Marie Jilla
- Department of Otorhinolaryngology – Head and Neck Surgery, University of Texas Health Science Center at Houston, Houston, Texas
| | - Michelle L. Arnold
- Department of Communication Sciences and Disorders, University of South Florida Sarasota-Manatee Campus, Sarasota, Florida
| | - Erin L. Miller
- School of Speech-Language Pathology and Audiology, The University of Akron, Akron, Ohio
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Ruthberg JS, Rasendran C, Kocharyan A, Mowry SE, Otteson TD. The economic burden of vertigo and dizziness in the United States. J Vestib Res 2021; 31:81-90. [PMID: 33285661 DOI: 10.3233/ves-201531] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Vertigo and dizziness are extremely common conditions in the adult population and therefore place a significant social and economic burden on both patients and the healthcare system. However, limited information is available for the economic burden of vertigo and dizziness across various health care settings. OBJECTIVE Estimate the economic burden of vertigo and dizziness, controlling for demographic, socioeconomic, and clinical comorbidities. METHODS A retrospective analysis of data from the Medical Expenditures Panel Survey (2007-2015) was performed to analyze individuals with vertigo or dizziness from a nationally representative sample of the United States. Participants were included via self-reported data and International Classification of Diseases, 9th Revision Clinical Modification codes. A cross-validated 2-component generalized linear model was utilized to assess vertigo and dizziness expenditures across demographic, socioeconomic and clinical characteristics while controlling for covariates. Costs and utilization across various health care service sectors, including inpatient, outpatient, emergency department, home health, and prescription medications were evaluated. RESULTS Of 221,273 patients over 18 years, 5,275 (66% female, 34% male) reported either vertigo or dizziness during 2007-2015. More patients with vertigo or dizziness were female, older, non-Hispanic Caucasian, publicly insured, and had significant clinical comorbidities compared to patients without either condition. Furthermore, each of these demographic, socioeconomic, and clinical characteristics lead to significantly elevated costs due to having these conditions for patients. Significantly higher medical expenditures and utilization across various healthcare sectors were associated with vertigo or dizziness (p < 0.001). The mean incremental annual healthcare expenditure directly associated with vertigo or dizziness was $2,658.73 (95% CI: 1868.79, 3385.66) after controlling for socioeconomic and demographic characteristics. Total annual medical expenditures for patients with dizziness or vertigo was $48.1 billion. CONCLUSION Vertigo and dizziness lead to substantial expenses for patients across various healthcare settings. Determining how to limit costs and improve the delivery of care for these patients is of the utmost importance given the severe morbidity, disruption to daily living, and major socioeconomic burden associated with these conditions.
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Affiliation(s)
- Jeremy S Ruthberg
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Armine Kocharyan
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sarah E Mowry
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Todd D Otteson
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
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Aratani MC, Ricci NA, Caovilla HH, Ganança FF. Benefits of vestibular rehabilitation on patient-reported outcomes in older adults with vestibular disorders: a randomized clinical trial. Braz J Phys Ther 2020; 24:550-559. [PMID: 31952916 PMCID: PMC7779949 DOI: 10.1016/j.bjpt.2019.12.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Revised: 11/05/2019] [Accepted: 12/20/2019] [Indexed: 10/25/2022] Open
Abstract
BACKGROUND Chronic dizziness has a negative impact on emotional aspects, functional capacity, and quality of life of older people. OBJECTIVE To compare the effects of the conventional Cawthorne & Cooksey and the multimodal Cawthorne & Cooksey protocols on patient-reported outcomes in older adults with vestibular disorders. METHODS This is a single-blind, randomized controlled trial with three-months' follow-up. Older adults with chronic dizziness were randomly assigned to conventional or multimodal protocols. The protocols were performed in individual 50-minute sessions, twice weekly, for two months. The primary outcome was the Dizziness Handicap Inventory (DHI) and the secondary outcomes were the Visual Analogue Scale, the Vestibular Disorders Activities of Daily Living Scale, the Geriatric Depression Scale, and the Activities-specific Balance Confidence Scale. Outcomes were collected at baseline, post-treatment and three-month follow-up; and analyzed on an intention-to-treat approach. RESULTS Eighty-two patients were randomized into the conventional (n = 40) or multimodal (n = 42) protocols. There was no between-group difference on DHI at post-treatment (Mean Difference (MD): -0.7; 95% CI: -9.2, 7.8) and at three-month follow-up (MD: -1.6; 95% CI: -9.5, 6.2). No between-group difference was found for the secondary outcomes. All patient-reported outcomes in the within-group analysis showed significant improvement between baseline and post-treatment, and changes were maintained between post-treatment and follow-up. Following treatment, 55% of patients in the conventional and 57% in the multimodal protocol reached DHI clinical improvement (decrease ≥18). CONCLUSIONS The addition of multimodal exercises to the conventional Cawthorne & Cooksey protocol did not promote extra benefits on patient-reported outcomes in older adults with chronic dizziness. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry-ANZCTR (ACTRN12610000018011), the trial was registered January 7, 2010 and the first participant was enrolled April 15, 2010. URL of the registry: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=334985.
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Affiliation(s)
- Mayra Cristina Aratani
- Department of Otorhinolaryngology and Head & Neck Surgery, Otoneurology Discipline, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Natalia Aquaroni Ricci
- Department of Otorhinolaryngology and Head & Neck Surgery, Otoneurology Discipline, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil; Master's and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo (UNICID), São Paulo, Brazil.
| | - Heloísa Helena Caovilla
- Department of Otorhinolaryngology and Head & Neck Surgery, Otoneurology Discipline, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
| | - Fernando Freitas Ganança
- Department of Otorhinolaryngology and Head & Neck Surgery, Otoneurology Discipline, Universidade Federal de São Paulo (UNIFESP), São Paulo, Brazil
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Müller M, Goeldlin MB, Gaschen J, Sauter TC, Stock S, Wagner F, Exadaktylos AK, Fischer U, Kalla R, Mantokoudis G. Characteristics and resource needs in patients with vestibular symptoms: a comparison of patients with symptoms of unknown versus determined origin. BMC Emerg Med 2020; 20:70. [PMID: 32867677 PMCID: PMC7460761 DOI: 10.1186/s12873-020-00361-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2020] [Accepted: 08/17/2020] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Vestibular symptoms are a frequent reason for presenting at the emergency department (ED). Underlying conditions range in severity from life-threatening to benign, but often remain undiagnosed despite extensive investigations. We aimed to identify clinical characteristics that are associated with ED consultations by patients with vestibular symptoms of unknown origin (VUO) and to quantify the ED resources consumed during the investigations. METHODS This retrospective one-year, single-centre, cross-sectional study assessed ED consultations with patients whose chief complaint was 'vestibular symptoms'. Data on risk factors, clinical characteristics, management and ED resources were extracted from the administrative database and medical records. Consultations were grouped according to the discharge diagnosis as either VUO or non-VUO. We determined clinical factors associated with VUO and compared ED resource consumption by the two patient groups using multivariable analysis. RESULTS A total of 1599 ED consultations were eligible. Of these, 14.3% (n = 229) were consultations with patients with VUO. Clinical characteristics included in the final multivariable model to determine associations with VUO were sensory disorders, aural fullness, improvement at rest, absence of situational provocation, pre-existing neurological conditions, and age < 65 years. Patients with VUO had higher total ED resource consumption in terms of physicians' work and radiology resources, as a result of more use of computed tomography and magnetic resonance imaging. CONCLUSION One in seven emergency patients with vestibular symptoms is dismissed without a diagnosis. Clinical characteristics of VUO patients are distinct from patients in whom a diagnosis was made in the ED. VUO triggers higher ED resource consumption, which can be justified if appropriately indicated.
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Affiliation(s)
- Martin Müller
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
- Institute of Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany
| | - Martina B. Goeldlin
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Janika Gaschen
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Freiburgstrasse, 3010 Bern, Switzerland
- Children’s Hospital of Aarau, Aarau, Switzerland
| | - Thomas C. Sauter
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
- Medical Skills Lab, Charité Medical School Berlin, Berlin, Germany
| | - Stephanie Stock
- Institute of Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany
| | - Franca Wagner
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Aristomenis K. Exadaktylos
- Department of Emergency Medicine, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
| | - Urs Fischer
- Institute of Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany
| | - Roger Kalla
- Institute of Health Economics and Clinical Epidemiology, Cologne University Hospital, Cologne, Germany
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Switzerland
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Powell G, Derry-Sumner H, Shelton K, Rushton S, Hedge C, Rajenderkumar D, Sumner P. Visually-induced dizziness is associated with sensitivity and avoidance across all senses. J Neurol 2020; 267:2260-2271. [PMID: 32306170 PMCID: PMC7359147 DOI: 10.1007/s00415-020-09817-0] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2020] [Revised: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Persistent postural perceptual dizziness (PPPD) is a common chronic condition presenting in neurology and neuro-otology clinics. Symptoms lie on a spectrum in the general population. The cause is unknown and thought to involve interactions between visual and vestibular systems, but symptoms also correlate with anxiety and migraine. OBJECTIVE To test whether PDDD symptoms are associated with reported differences in other senses (touch, hearing, smell and taste); to investigate possible mediation via anxiety or migraine; to discover the proportion of variance accountable to these non-vestibular factors. METHODS We measured self-report multisensory sensitivity, anxiety, visual difficulties, visual discomfort and migraine in patients with PPPD (N = 29) and a large general population cohort (N > 1100). We used structural equation modelling to examine relationships between the factors using a step-wise approach. RESULTS We found increased self-reported over-sensitivity in sensory domains beyond vision and balance in both patients with PPPD and non-clinical participants with more PPPD symptoms. SEM analysis revealed that anxiety partly, but not wholly, mediated this relationship. Adding visual difficulties and visual discomfort to the model allowed it to explain 50% of PPPD symptom variance. Most of the path coefficients and mediation effects in our model were unchanged between participants with and without migraine. CONCLUSIONS Our findings support the idea that PPPD is a complex neurological condition that includes broad perceptual factors, and may suggest that some brains are predisposed to generalised cross-modal sensory-overload. This may give rise to vulnerability to severe PPPD should a vestibular insult occur.
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Affiliation(s)
- Georgina Powell
- School of Psychology, Cardiff University, Tower building, Park Place, Cardiff, UK.
| | - Hannah Derry-Sumner
- Department of Audiovestibular Medicine, University Hospital of Wales, Cardiff, UK
| | - Katherine Shelton
- School of Psychology, Cardiff University, Tower building, Park Place, Cardiff, UK
| | - Simon Rushton
- School of Psychology, Cardiff University, Tower building, Park Place, Cardiff, UK
| | - Craig Hedge
- School of Psychology, Cardiff University, Tower building, Park Place, Cardiff, UK
| | - Deepak Rajenderkumar
- Department of Audiovestibular Medicine, University Hospital of Wales, Cardiff, UK
| | - Petroc Sumner
- School of Psychology, Cardiff University, Tower building, Park Place, Cardiff, UK
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Wolf J, Sattel H, Limburg K, Lahmann C. From illness perceptions to illness reality? Perceived consequences and emotional representations relate to handicap in patients with vertigo and dizziness. J Psychosom Res 2020; 130:109934. [PMID: 31972479 DOI: 10.1016/j.jpsychores.2020.109934] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Revised: 01/11/2020] [Accepted: 01/11/2020] [Indexed: 12/19/2022]
Abstract
OBJECTIVE Vertigo and dizziness (VD) are frequent symptoms that can occur due to various structural pathologies or due to functional impairment. Independent of their aetiology, the symptoms are often associated with physical and psychological burden which manifests in severe handicap in more than half of the patients. It is suggested that illness perceptions, the patients' cognitive and emotional concept of their disease, most likely impact the degree of handicap. For patients with VD, however, this relation of illness perceptions and handicap is so far not well understood. This study aimed to investigate the relation of illness perceptions and handicap for patients with VD. METHODS In a cross-sectional study design, n = 419 patients with VD were examined (53.7% female, age 53.5 ± 15.5 years). Participants underwent neurological and psychiatric examinations as well as a comprehensive assessment using self-report questionnaires. RESULTS Illness perceptions, specifically perceived consequences and emotional representations showed a moderate correlation with VD related handicap (r(419) = 0.62, p < .001). Our regression model including symptom severity, psychiatric comorbidity, and aspects of cognitive and emotional illness perceptions accounted for 52% of the variance in VD related handicap. In a moderation analysis, this relation did not differ significantly in patients with functional VD symptoms. CONCLUSION Findings of the present study provide evidence for the relevance of illness perceptions to handicap in patients with VD symptoms.
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Affiliation(s)
- Johannes Wolf
- Department of Psychosomatic Medicine and Psychotherapy, Albert-Ludwigs-Universität Freiburg, Hauptstraße 8, 79104 Freiburg, Germany.
| | - Heribert Sattel
- Department of Psychosomatic Medicine and Psychotherapy, Klinikum rechts der Isar, Technische Universität München, Munich, Germany
| | - Karina Limburg
- Department of Psychology, Ludwig-Maximilians-Universität München, Munich, Germany
| | - Claas Lahmann
- Department of Psychosomatic Medicine and Psychotherapy, Albert-Ludwigs-Universität Freiburg, Hauptstraße 8, 79104 Freiburg, Germany
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Sezier AEI, Saywell N, Terry G, Taylor D, Kayes N. Working-age adults' perspectives on living with persistent postural-perceptual dizziness: a qualitative exploratory study. BMJ Open 2019; 9:e024326. [PMID: 30940754 PMCID: PMC6500355 DOI: 10.1136/bmjopen-2018-024326] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To (a) explore the experiences of persistent postural-perceptual dizziness (PPPD), formerly chronic subjective dizziness on the personal, work and social lives of working-age adults; (b) enhance current understandings of the condition and its impact on the lives of working-age adults and (c) highlight points for consideration and importance to clinical practice. METHODS This qualitative exploratory study drew on interpretive descriptive methodology. Working-age adults (n=8) diagnosed with PPPD were recruited from a single New Zealand community-based specialist clinic. Data from interviews (n=8) and postinterview reflections (n=2) were analysed using thematic analysis. RESULTS Three themes were constructed: (1) It sounds like I'm crazy-referring to the lack of medical, social and self-validation associated with PPPD; (2) I'm a shadow of my former self-representing the impact of the condition on sense of self and life trajectory and (3) How will I survive?- highlighting individual coping processes. CONCLUSION This study contributed to the existing body of knowledge by highlighting the complexity and fluidity of experiencing PPPD. It also drew attention to the tension between the acute illness framework that forms the basis of many therapeutic interactions and the enduring psychosocial support needs of the person experiencing PPPD. The findings highlighted that contextual factors need to be taken into account and that a person-centred and biopsychosocial approach, rather than a condition-specific biomedical approach, is needed for care to be perceived as meaningful and satisfactory.
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Affiliation(s)
| | - Nicola Saywell
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Gareth Terry
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
| | - Denise Taylor
- Health and Rehabilitation Research Institute, Auckland University of Technology, Auckland, New Zealand
| | - Nicola Kayes
- Centre for Person Centred Research, Auckland University of Technology, Auckland, New Zealand
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Evangelista ASDL, Cordeiro ESG, Nascimento GFFD, Gazzola JM, Araújo ES, Mantello EB. Speech-Language-Hearing intervention in vestibular rehabilitation with the use of technologies: an integrative literature review. REVISTA CEFAC 2019. [DOI: 10.1590/1982-0216/20192162219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
ABSTRACT Purpose: to perform an integrative literature review regarding the Speech-Language-Hearing intervention in vestibular rehabilitation with the use of technologies, presenting the most applied ones, as well as their effectiveness and possible biases. Methods: a search was performed on the PubMed/MEDLINE, LILACS, Scopus and SciELO databases, using as search strategy, the keywords: dizziness OR postural balance AND vestibular rehabilitation. Studies carried out by at least one audiologists and which addressed vestibular rehabilitation with the use of technologies as the study object, were included. The publication period set was from 2008 to 2018. During the evaluation of these articles, a quantitative analysis, a characterization of the included studies and an evaluation of their level of evidence and results were performed. Results: six articles, published between 2013 and 2018, were chosen. Most studies (n=4) applied Nintendo WiiTM versions during interventions. Among the authors, nine were audiologists. Three studies were clinical trials, two were observational studies without a control group and one was a case study. Conclusion: it was verified that the Speech-Language-Hearing Therapy has been applying technologies in vestibular rehabilitation interventions. However, publications regarding this modality of therapy are scarce in the literature and still lack robust scientific evidence.
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Jilla AM, Roberts RA, Johnson CE. Teaching Patient-Centered Counseling Skills for Assessment, Diagnosis, and Management of Benign Paroxysmal Positional Vertigo. Semin Hear 2018; 39:52-66. [PMID: 29422713 PMCID: PMC5802993 DOI: 10.1055/s-0037-1613705] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022] Open
Abstract
Audiologists are an integral part of the management of those with dizziness and vestibular disorders. However, little research has been performed on counseling approaches for patients who present with dizziness as a primary concern. Accordingly, it is important that audiology students are provided with didactic and experiential learning opportunities for the assessment, diagnosis, and management of this population. Benign paroxysmal positional vertigo is the most common vestibular disorder among adults. Doctor of Audiology students, at a minimum, should be provided with learning opportunities for counseling patients with this particular disorder. Implementation of patient-centered counseling is applied across various parts of the patient encounter from initial intake to treatment and patient education. The purpose of this article is to present the available evidence and to apply widely accepted theories and techniques to counseling those with benign paroxysmal positional vertigo. Didactic resources and experiential learning activities are provided for use in coursework or as a supplement to clinical education.
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Affiliation(s)
- Anna Marie Jilla
- Hearing Evaluation, Rehabilitation, and Outcomes (HERO) Laboratory, Department of Communication Sciences and Disorders, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
| | - Richard A. Roberts
- Department of Hearing and Speech Sciences Vanderbilt University Medical Center, Nashville, Tennessee
| | - Carole E. Johnson
- Hearing Evaluation, Rehabilitation, and Outcomes (HERO) Laboratory, Department of Communication Sciences and Disorders, University of Oklahoma Health Sciences Center, Oklahoma City, Oklahoma
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14
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Faag C, Bergenius J, Forsberg C, Langius-Eklöf A. Feasibility and Effects of a Nursing Intervention for Patients with Peripheral Vestibular Disorders. Rehabil Nurs 2017; 42:274-281. [PMID: 29244042 DOI: 10.1002/rnj.261] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE To explore the feasibility and possible outcomes of a nursing intervention in patients with peripheral vestibular disorders. DESIGN A randomized controlled trial (RCT). METHODS Thirty-six patients participated in the study: the intervention group (n = 18), who received the intervention, and patients in a control group (n = 18), who received standard care. The intervention includes patient education and individualized nursing support during a 6-month rehabilitation period. Outcomes were symptoms, well-being, sense of coherence, and self-care measured at baseline before randomization and at 6 and 9 months later. FINDINGS At the 9-month follow up, the patients who received the intervention rated significantly fewer vertigo-related symptoms and a higher sense of coherence than the control group. CONCLUSION The intervention was feasible and seems to support the patients to manage symptoms, but confirmative studies are warranted. CLINICAL RELEVANCE Patient education in combination with individual support may be beneficial to help patients with peripheral disorders during their rehabilitation.
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Affiliation(s)
- Carina Faag
- 1 School of Health and Medical Sciences, Örebro University, Stockholm, Sweden2 Red Cross University College, Stockholm, Sweden3 Department of Clinical Neuroscience, Karolinska Institutet and Hospital, Stockholm, Sweden4 Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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15
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Agrawal Y, Pineault KG, Semenov YR. Health-related quality of life and economic burden of vestibular loss in older adults. Laryngoscope Investig Otolaryngol 2017; 3:8-15. [PMID: 29492463 PMCID: PMC5824117 DOI: 10.1002/lio2.129] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2017] [Revised: 10/12/2017] [Accepted: 11/10/2017] [Indexed: 01/05/2023] Open
Abstract
Objectives Vestibular loss is a debilitating condition, and despite its high prevalence in older adults, the quality of life (QoL) burden of vestibular loss in older individuals has not been well-studied. This report quantifies the impact on overall QoL and identifies domains of health most affected. We hypothesize vestibular loss will be associated with impairment in diverse domains of health-related QoL. Study Design Prospective, case-control study. Methods A convenience sample of 27 patients age ≥60 years with vestibular physiologic loss was recruited from an academic neurotology clinic. The patients did not have any identifiable cause of their vestibular loss other than aging. The convenience sample was compared to an age-matched cross-sectional sample of the general US population (n = 1266). The main outcome was QoL measured by the Ontario Health Utilities Index Mark III (HUI3). Results Compared to the general population, patients with vestibular loss had significantly lower overall unadjusted HUI3 scores (-0.32, p < 0.001). Multivariate regression analysis showed vestibular loss was significantly associated with poorer performance in vision (-0.11 p < 0.0001), speech (-0.15, p < 0.0001), dexterity (-0.13, p < 0.0001), and emotion (-0.07, p = 0.0065). Adjusted aggregate HUI3 was also significantly lower for vestibular loss (-0.15, p = 0.0105). These QoL decrements resulted in an average loss of 1.30 Quality-Adjusted Life Years (QALYs). When using a $50,000/QALY willingness-to-pay threshold, vestibular loss was associated with a $64,929 lifetime economic burden per affected older adult, resulting in a total lifetime societal burden of $227 billion for the US population ≥60 years of age. Conclusions Loss of vestibular function with aging significantly decreases quality of life across multiple domains of well-being. These QoL reductions are responsible for heavy societal economic burdens of vestibular loss, which reveal potential benefits of prompt diagnosis and treatment of this condition. Level of Evidence 3.
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Affiliation(s)
- Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD U.S.A
| | - Kevin G Pineault
- Department of Otolaryngology-Head and Neck Surgery Johns Hopkins University School of Medicine Baltimore MD U.S.A
| | - Yevgeniy R Semenov
- Division of Dermatology Washington University School of Medicine Saint Louis MO U.S.A
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Khoza-Shangase K. VESTIBULAR FUNCTION IN A GROUP OF ADULTS WITH HIV/AIDS ON HAART. Afr J Infect Dis 2017; 12:7-14. [PMID: 29302644 PMCID: PMC5733256 DOI: 10.21010/ajid.v12i1.2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 04/21/2017] [Accepted: 04/24/2017] [Indexed: 11/23/2022] Open
Abstract
Background: The high prevalence of HIV/AIDS and the established otological manifestations of the disease have important implications for research into vestibular function in this population. Materials and Methods: The main aim of the current study was to investigate and monitor the vestibular status in a group of adult patients with AIDS receiving Highly Active Antiretroviral Therapy (HAART) and other therapies in a hospital outpatient clinic in Gauteng, South Africa. The study was exploratory and observational in nature, with repeated measures in the form of pre- and post-treatment survey; and a control group. The measures were taken before commencement of antiretroviral therapy (ARVs), three months after initiation of treatment and six months into therapy. A comparison of results of the control group and treatment group was done for all objectives. A total of 150 (104 in the treatment group and 46 in the control group) participants who were recruited through a nonprobability convenience sampling technique were included in the study. All participants were at stage three of HIV/AIDS according to their CD4+ T-cell counts at baseline. Data were analysed through descriptive statistics. Results: Findings from the current study revealed occurrence of acute vertigo which spontaneously resolved in adults with AIDS on HAART over a monitoring period of six months; with this occurrence being higher in participants on HAART than in the control group. The symptoms occurred after diagnosis with HIV and mostly after HAART initiation; and participants who experienced vertigo did not report this to their attending doctor. Furthermore, there was a lack of a relationship between the increasing occurrences of hearing loss in the group to the presentation of vertigo over the six months of monitoring. Conclusion: Findings from the present study which revealed occurrence of possible acute vertigo that spontaneously resolves in adults with AIDS on HAART, over a monitoring period of six months, add to the existing literature on vestibular function in this population. These findings raise important research as well as clinical assessment and management implications in this population.
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Affiliation(s)
- Katijah Khoza-Shangase
- Department of Speech Pathology and Audiology, School of Human and Community Development, University of the Witwatersrand, Johannesburg, South Africa
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17
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The impact of opioid medications on subsequent fractures in discharged emergency department patients with peripheral vertigo. CAN J EMERG MED 2017. [PMID: 28631577 DOI: 10.1017/cem.2017.37] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
BACKGROUND Vertigo is common in the emergency department (ED). Most aetiologies are peripheral and do not require hospitalization, but many patients still fear falling. Some patients may be taking opioid analgesic medications (for other reasons); the risk of falls leading to fractures among patients with vertigo could be potentiated by the simultaneous use of opioids. OBJECTIVES To examine the risk of fractures in discharged ED patients with peripheral vertigo who were being prescribed opioids during the same time period. METHODS Linked administrative databases from Ontario were used to compare discharged ED patients aged ≥65 with peripheral vertigo to patients with urinary tract infection (UTI) from 2006 to 2011. We used Cox regression analysis with an interaction term to estimate the modifying effect of an opioid prescription on the hazard of fracture within 90 days. RESULTS There were 13,012 patients with a peripheral vertigo syndrome and 76,885 with a UTI. Thirteen percent of the vertigo cohort and 25% of the UTI cohort had access to a filled opioid prescription. Compared to vertigo patients who did not fill an opioid prescription, the adjusted hazard of fracture among vertigo patients who did fill a prescription was 3.59 (95% CI 1.97-6.13). Among UTI patients who filled an opioid prescription the hazard ratio was 1.68 (95% CI 1.43-1.97) compared to UTI patients who did not. CONCLUSIONS Patients discharged from the ED with peripheral vertigo who were also being prescribed opioids had a higher hazard of subsequent fracture compared to those who were not, and the effect was much greater than among UTI patients. These results suggest that in the acutely vertiginous older patient, opioid analgesic medications should be modified, where possible.
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Effects of Vestibular Rehabilitation on Balance Control in Older People with Chronic Dizziness: A Randomized Clinical Trial. Am J Phys Med Rehabil 2016; 95:256-69. [PMID: 26368833 DOI: 10.1097/phm.0000000000000370] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE The aim of this study was to compare the effects of vestibular rehabilitation protocols on balance control in elderly with dizziness. DESIGN This is a randomized clinical trial with 3-mo follow-up period. The sample was composed of 82 older individuals with chronic dizziness from vestibular disorders. The control group was treated according to the Conventional Cawthorne & Cooksey protocol (n = 40), and the experimental group was submitted to a Multimodal Cawthorne & Cooksey protocol (n = 42). Measures included Dynamic Gait Index, fall history, hand grip strength, Time Up-and-Go Test, sit-to-stand test, multidirectional reach, and static balance tests. RESULTS With the exception of history of falls, Forward Functional Reach, Unipedal Right and Left Leg Eyes Closed, and Sensorial Romberg Eyes Open, all outcomes improved after treatments. Such results persisted at follow-up period, with the exception of the Tandem Eyes Open and the Timed Up-and-Go manual. The between-group differences for Sensorial Romberg Eyes Closed (4.27 secs) and Unipedal Left Leg Eyes Open (4.08 secs) were significant after treatment, favoring the Multimodal protocol. CONCLUSIONS Both protocols resulted in improvement on elderly's balance control, which was maintained during a short-term period. The multimodal protocol presented better performance on specific static balance tests.
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Armstrong D, Charlesworth E, Alderson AJ, Elliott DB. Is there a link between dizziness and vision? A systematic review. Ophthalmic Physiol Opt 2016; 36:477-86. [PMID: 27255594 DOI: 10.1111/opo.12299] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2015] [Accepted: 03/03/2016] [Indexed: 12/11/2022]
Abstract
PURPOSE The aim of this study was to systematically review the literature to investigate the link (if any) between vision and dizziness. METHODS Medline, CINAHL, AMED, Web of Science and The Cochrane Library were searched with keywords chosen to find articles which investigated the causes of dizziness and considered vision as a possible trigger. Citation chaining of all included papers was performed in addition to the hand searching of all reference lists. Unpublished literature was identified using www.opengrey.eu. The review considered studies involving adults which link, measure or attempt to improve any aspect of vision in relation to dizziness. RESULTS Nine thousand six hundred and eighty one possible references were found, and the abstracts were screened independently by two reviewers to determine if they should be included in the study. Thirteen papers were found which investigated whether dizziness was linked to an assessment of vision. Visual impairment measures were crude and typically self-report, or Snellen visual acuity with little or no measurement details. Five studies found an independent link between dizziness and vision, five found a weak association (typically finding a link when univariate analyses were used, but not when multivariate analyses were used), and three found no association. Studies finding a strong link were usually cross-sectional with a large study population whereas those finding a weak association had relatively small numbers of participants. Studies which did not find an association used a broad definition of dizziness that included the term light-headedness, an unreliable Rosenbaum near visual acuity chart or an unusual categorisation of visual acuity. CONCLUSIONS This review suggests that dizziness (although likely not 'light-headedness') is linked with poor vision although further studies using more appropriate measures of vision are recommended.
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Affiliation(s)
- Deborah Armstrong
- Bradford School of Optometry and Vision Science, University of Bradford, Bradford, UK
| | - Emily Charlesworth
- Bradford School of Optometry and Vision Science, University of Bradford, Bradford, UK
| | - Alison J Alderson
- Bradford School of Optometry and Vision Science, University of Bradford, Bradford, UK
| | - David B Elliott
- Bradford School of Optometry and Vision Science, University of Bradford, Bradford, UK
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Vestibular rehabilitation with visual stimuli in peripheral vestibular disorders. Braz J Otorhinolaryngol 2016; 82:232-41. [PMID: 26832632 PMCID: PMC9449018 DOI: 10.1016/j.bjorl.2015.05.019] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/08/2014] [Revised: 05/05/2015] [Accepted: 05/19/2015] [Indexed: 11/21/2022] Open
Abstract
Introduction Visual stimuli can induce vestibular adaptation and recovery of body balance. Objective To verify the effect of visual stimuli by digital images on vestibular and body balance rehabilitation of peripheral vestibular disorders. Methods Clinical, randomized, prospective study. Forty patients aged between 23 and 63 years with chronic peripheral vestibular disorders underwent 12 sessions of rehabilitation with visual stimuli using digital video disk (DVD) (experimental group) or Cawthorne-Cooksey exercises (control group). The Dizziness Handicap Inventory (DHI), dizziness analog scale, and the sensitized Romberg static balance and one-leg stance tests were applied before and after the intervention. Results Before and after the intervention, there was no difference between the experimental and control groups (p > 0.005) regarding the findings of DHI, dizziness analog scale, and static balance tests. After the intervention, the experimental and control groups showed lower values (p < 0.05) in the DHI and the dizziness analog scale, and higher values (p < 0.05) in the static balance tests in some of the assessed conditions. Conclusion The inclusion of visual stimuli by digital images on vestibular and body balance rehabilitation is effective in reducing dizziness and improving quality of life and postural control in individuals with peripheral vestibular disorders.
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Pereira AB, Almeida LAF, Pereira NG, Menezes PAFD, Felipe L, Volpe FM. Seasonality of dizziness and vertigo in a tropical region. Chronobiol Int 2015; 32:585-90. [PMID: 25839995 DOI: 10.3109/07420528.2015.1014094] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Vertigo and dizziness are among the most common medical complaints in the emergency room, and are associated with a considerable personal and health care burden. Scarce and conflicting reports indicate those symptoms may present a seasonal distribution. This study aimed at investigating the existence of a seasonal distribution of vertigo/dizziness in a tropical region, and the correlations of these findings with climatic variables. The charts of all patients consecutively admitted between 2009 and 2012 in the emergency room of a Brazilian general hospital were reviewed. A total of 4920 cases containing these terms were sorted from a sample of 276,076 emergency records. Seasonality was assessed using Cosinor Analysis. Pearson's correlations were performed between the incidence of consultations, considering separately dizziness and vertigo and each of the predictor climatic variables of that index month. Significant seasonal patterns were observed for dizziness and vertigo in the emergency room. Vertigo was more frequent in late winter-spring, negatively correlating to humidity (r = -0.374; p = 0.013) and rainfall (r = -0.334; p = 0.020). Dizziness peaked on summer months, and positively correlated to average temperatures (r = 0.520; p < 0.001) and rainfall (r = 0.297; p = 0.040), but negatively to atmospheric pressure (r = -0.424; p = 0.003). The different seasonal patterns evidenced for dizziness and vertigo indicate possible distinct underlying mechanisms of how seasons may influence the occurrence of those symptoms.
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Affiliation(s)
- Alcione Botelho Pereira
- Hospital Foundation of Minas Gerais, Teaching and Research Management , Belo Horizonte , Brazil
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22
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Howell Collie MJ, Ramsey AR. Differentiating Benign Paroxysmal Positional Vertigo From Other Causes of Dizziness. J Nurse Pract 2014. [DOI: 10.1016/j.nurpra.2014.03.008] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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Mueller M, Schuster E, Strobl R, Grill E. Identification of aspects of functioning, disability and health relevant to patients experiencing vertigo: a qualitative study using the international classification of functioning, disability and health. Health Qual Life Outcomes 2012; 10:75. [PMID: 22738067 PMCID: PMC3464694 DOI: 10.1186/1477-7525-10-75] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2011] [Accepted: 06/27/2012] [Indexed: 02/06/2023] Open
Abstract
Purpose Aims of this study were to identify aspects of functioning and health relevant to patients with vertigo expressed by ICF categories and to explore the potential of the ICF to describe the patient perspective in vertigo. Methods We conducted a series of qualitative semi-structured face-to-face interviews using a descriptive approach. Data was analyzed using the meaning condensation procedure and then linked to categories of the International Classification of Functioning, Disability and Health (ICF). Results From May to July 2010 12 interviews were carried out until saturation was reached. Four hundred and seventy-one single concepts were extracted which were linked to 142 different ICF categories. 40 of those belonged to the component body functions, 62 to the component activity and participation, and 40 to the component environmental factors. Besides the most prominent aspect “dizziness” most participants reported problems within “Emotional functions (b152), problems related to mobility and carrying out the daily routine. Almost all participants reported “Immediate family (e310)” as a relevant modifying environmental factor. Conclusions From the patients’ perspective, vertigo has impact on multifaceted aspects of functioning and disability, mainly body functions and activities and participation. Modifying contextual factors have to be taken into account to cover the complex interaction between the health condition of vertigo on the individuals’ daily life. The results of this study will contribute to developing standards for the measurement of functioning, disability and health relevant for patients suffering from vertigo.
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Affiliation(s)
- Martin Mueller
- Institute for Medical Informatics, Biometry and Epidemiology, Ludwig-Maximilians-Universität München, Munich, Germany.
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Chaibi A, Tuchin PJ. Chiropractic spinal manipulative treatment of cervicogenic dizziness using Gonstead method: a case study. J Chiropr Med 2011; 10:194-8. [PMID: 22014910 DOI: 10.1016/j.jcm.2011.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2011] [Revised: 05/07/2011] [Accepted: 06/20/2011] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE The purpose of this case report is to present the response of a patient with chronic nonresponsive cervicogenic dizziness to chiropractic care. CASE REPORT A 29-year-old man had a 10-year history of progressive cervicogenic dizziness with symptoms including a sensation of excessive motion, imbalance, and spinning associated with neck pain and stiffness. After treatment, he reported a reduction in pain and dizziness and an improved quality of life following Gonstead method of chiropractic spinal manipulative therapy. CONCLUSION This case study suggests that a patient with nonresponsive cervicogenic dizziness might respond to chiropractic spinal manipulative therapy approach using Gonstead method.
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Affiliation(s)
- Aleksander Chaibi
- Chiropractor & Physiotherapist, Atlasklinikken, Fridtjof Nansens plass 8, 0160 Oslo, Norway
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