Health-related quality of life and emotional distress in patients with dizziness: a cross-sectional approach to disentangle their relationship

Risk of Obstructive Sleep Apnea, Chronic Dizziness, and Sleep Duration

BACKGROUND

Although it is recommended that obstructive sleep apnea (OSA) be screened for using a validated self-report questionnaire in patients experiencing dizziness, there is still a lack of research on the relationship between high risk of OSA and chronic dizziness.

OBJECTIVES

The study aimed to examine the relationship between the high risk of OSA and chronic dizziness and investigate how this relationship is affected by sleep duration.

METHODS

This cross-sectional study used data from the 8th Korea National Health and Nutrition Examination Survey (2019-2021). Adults aged 40 years or older were included and divided into two groups using the STOP-Bang Questionnaire (SBQ): a high-risk group for OSA or not. Complex samples logistic regression analyses were performed to examine the odds ratios of chronic dizziness based on the national population estimates.

RESULTS

Our findings showed that individuals in the high-risk group for OSA were significantly more likely to experience chronic dizziness. Specifically, among subgroups based on sleep duration, the high-risk group for OSA with a short sleep duration of ≤5 hours demonstrated the highest odds of chronic dizziness, showing a significantly 2.48-fold increased likelihood compared to the non-high risk for OSA with a sleep duration of 5-9 hours.

DISCUSSION

The SBQ can be beneficial when other causes do not explain chronic dizziness, helping to rule in the possibility of OSA. Educating individuals suspected of having OSA or who have been diagnosed with OSA about the importance of adequate sleep duration may help reduce the risk of chronic dizziness.

Association between screen time and self-reported balance disorders in middle-aged and older adults: national health and nutrition examination survey

BACKGROUND

Balance disorders can give rise to sensations of instability, lightheadedness, vertigo, disequilibrium, or syncope, ultimately leading to grave medical, physical, emotional, and societal ramifications. These conditions are highly prevalent among individuals aged 40 and above. Screen time encompasses activities associated with television viewing, video game playing, and non-work-related computer usage. Prolonged screen exposure may engender a spectrum of health issues and even elevate overall mortality rates. However, the available evidence on the potential link between excessive screen time and balance dysfunction remains limited.

AIMS

The primary aim of this study was to explore the possible association between prolonged screen exposure and impaired balance function.

METHODS

This cross-sectional study utilized data from participants who completed a comprehensive questionnaire in the NHANES database between 1999 and 2002, all of whom were aged over 40 and under 85 years. Participants' screen time was categorized into two groups (< 4 h/d and  ≥4 h/d) for subsequent data analysis. Logistic regression, combined with propensity score matching (PSM), was employed to investigate the correlation between screen time and balance disorders.

RESULTS

A total of 5176 participants were enrolled in this study, comprising 2,586 men and 2,590 women, with a prevalence rate of balance disorders at 25.7% (1331/5176). The incidence of balance disorders was found to be significantly higher among individuals who spent 4 hours or more per day on screen time compared to those with less screen time (P<0.001). Multivariate logistic analysis conducted on the unmatched cohort revealed a significant association between screen time and balance disorders, with an odds ratio (OR) 1.8 (95%CI 1.57 ∼ 2.05). These findings remained consistent even after adjusting for confounding factors, yielding an OR 1.43 (95%CI 1.24 ∼ 1.66). Moreover, the association persisted when employing various multivariate analyses such as propensity score matching adjusted model, standardized mortality ratio weighting model and pairwise algorithmic model; all resulting in ORs ranging from 1.38 to 1.43 and p-values < 0.001.

CONCLUSIONS

After controlling for all covariates, screen time (watching TV, playing video games, and using computers outside of work) was associated with balance dysfunction among middle-aged and older adults. This finding may offer a possible idea for the prevention of dizziness and balance disorders. Nevertheless, additional research is imperative to further validate these results.

Balance performance, falls-efficacy and social participation in patients with type 2 diabetes mellitus with and without vestibular dysfunction

Background

The performance of balance is an important factor to perform activities. The complications of type 2 diabetes mellitus (T2DM), especially vestibular dysfunction (VD), could decrease balance performance and falls-efficacy (FE) which consequently impacts social participation and quality of life (QoL).

Purpose

This study aimed to compare balance performance, FE, social participation and QoL between individuals with T2DM with and without VD.

Methods

The participants comprised 161 T2DM with VD and 161 without VD. Three clinical tests used for confirming VD included the Head Impulse Test (HIT), the Dix Hallpike Test (DHT) and the Supine Roll Test (SRT). The scores of static and dynamic balances, FE, social participation and QoL were compared between groups.

Results

The balance performance, FE, social participation and QoL were lower in the group with VD. The number of patients who had severe social restriction was higher in T2DM with VD than without VD (58.4% vs 48.4%). Moreover, all domains of QoL (physical, psychological, social relationships and environmental) were lower in T2DM with VD than without VD.

Conclusion

The presence of VD in T2DM patients was associated with decreased physical balance performances and increased social and QoL disengagement. Comprehensive management related to balance and FE, as well as the monitoring to support social participation and QoL, should be emphasized in patients with T2DM with VD.

Effectiveness of Telerehabilitation in Dizziness: A Systematic Review with Meta-Analysis

Dizziness can be a debilitating condition with various causes, with at least one episode reported in 17% to 30% of the international adult population. Given the effectiveness of rehabilitation in treating dizziness and the recent advancements in telerehabilitation, this systematic review aims to investigate the effectiveness of telerehabilitation in the treatment of this disorder. The search, conducted across Medline, Cochrane Central Register of Controlled Trials, and PEDro databases, included randomized controlled trials assessing the efficacy of telerehabilitation interventions, delivered synchronously, asynchronously, or via tele-support/monitoring. Primary outcomes focused on dizziness frequency/severity and disability, with secondary outcomes assessing anxiety and depression measures. Seven articles met the eligibility criteria, whereas five articles contributed to the meta-analysis. Significant findings were observed regarding the frequency and severity of dizziness (mean difference of 3.01, p < 0.001), disability (mean difference of -4.25, p < 0.001), and anxiety (standardized mean difference of -0.16, p = 0.02), favoring telerehabilitation. Telerehabilitation shows promise as a treatment for dizziness, aligning with the positive outcomes seen in traditional rehabilitation studies. However, the effectiveness of different telerehabilitation approaches requires further investigation, given the moderate methodological quality and the varied nature of existing methods and programs.

Balance Disorder Trends in US Adults 2008-2016: Epidemiology and Functional Impact

Objective

To quantify the changes in prevalence and impact of dizziness and balance disorders in adults from 2008 to 2016.

Study Design

Epidemiological survey analysis.

Setting

United States.

Methods

The balance modules of the adult 2008 and 2016 National Health Interview Surveys were examined, and persons reporting dizziness or balance problems identified. The prevalence of balance problems was determined and compared over time, adjusting for age and sex. Among those with balance problems, associated symptoms and self-reported functional limitations were quantified and compared over time.

Results

In 2016, 36.8 ± 1.0 million (15.5% ± 0.3%) adults reported a balance problem in the past year, versus 24.2 ± 0.7 million (11.% ± 0.3%) in 2008 (p < .001). After adjustment for age and sex, this percentage increase remained significant (odds ratio 1.435 [1.332-1.546], p < .001). Among those with balance problems, significantly more patients reported specific issues with feeling: off-balance (69.4% vs. 65.4%; p = .005), faint (48.5% vs. 40.3%; p < .001), or vertiginous (45.9% vs. 39.3%; p < .001) in 2016 than 2008. More adults experienced anxiety (29.4% vs. 19.4%; p < .001) and depression (16.3% vs. 12.9%; p = .002) with their balance problems in 2016 than in 2008. In 2016, adults with balance problems were limited in ability to drive motor vehicles (13.0%), exercise (14.4%), or walk downstairs (12.8%). These rates were not significantly different from 2008 (all p > .05).

Conclusion

In this nationally representative analysis, we found a significantly increasing prevalence of balance problems and associated psychiatric symptom burden. This merits attention with respect to present and future health care resource allocation.

Musculoskeletal pain patterns and association between dizziness symptoms and pain in patients with long term dizziness - a cross-sectional study

BACKGROUND

The impact of long-term dizziness is considerable both on the personal level and in society and may lead to self-imposed restrictions in daily activities and social relations due to fear of triggering the symptoms. Musculoskeletal complaints seem to be common in persons with dizziness, but studies addressing these complaints as a widespread occurrence, are scarce. This study aimed to examine the occurrence of widespread pain in patients with long-term dizziness and investigate the associations between pain and dizziness symptoms. Further, to explore whether diagnostic belonging is related to the occurrence of pain.

METHODS

This cross-sectional study was conducted in an otorhinolaryngology clinic and included 150 patients with persistent dizziness. The patients were categorized into three groups: episodic vestibular syndromes, chronic vestibular syndromes, and non-vestibular group. The patients completed questionnaires on dizziness symptoms, catastrophic thinking, and musculoskeletal pain when entering the study. Descriptive statistics were used to describe the population, and associations between pain and dizziness were investigated by linear regression.

RESULTS

Pain was reported by 94.5% of the patients. A significantly higher prevalence of pain was reported in all the ten pain sites examined compared to the general population. Number of pain sites and pain intensity were associated with the dizziness severity. Number of pain sites was also associated with dizziness-related handicap, but not with catastrophic thinking. There was no association between pain intensity and dizziness-related handicap or catastrophic thinking. Pain was equally distributed in the diagnostic groups.

CONCLUSION

Patients with long-term dizziness have a considerably higher prevalence of pain and number of pain sites than the general population. Pain co-exists with dizziness and is associated with dizziness severity. These findings may indicate that pain should be systematically assessed and treated in patients with persisting dizziness.

Dizziness, psychological disorders and cognitive decline

INTRODUCTION

Dizziness is a common disorder, particularly among the elderly population. Aim of this paper was to revise the current concepts surrounding the relationship between dizziness, psychological disorders and cognitive decline.

EVIDENCE ACQUISITION

This is a PRISMA-compliant systematic review, including observational studies in people with dizziness. Database inception, Medline/Cochrane/Embase/Web of Science/Scopus/NHS evidence were searched until October 30, 2019.

EVIDENCE SYNTHESIS

Overall 22 studies, and 65,730 participants were included. Eleven studies were cross-sectional, 7 cross-sectional controlled, 2 prospective case-control, 1 retrospective case series, and 1 cohort study. The persistence of vestibular impairment (for 6 months or more) was correlated to the presence of psychological disorders affecting patient's Quality of Life and causing social anxiety, particularly in some conditions such as Ménière's disease. Interestingly, vestibular loss has been also correlated to cognitive impairment, with certain vestibular dysfunctions reported to be more prevalent in cognitive impaired individuals.

CONCLUSIONS

The current literature suggests that there is an association between vestibular function, psychological disorders and cognitive functions. The findings from this review could be useful in informing on the need for a multidimensional diagnostic and rehabilitative programs for patients with dizziness. More studies could explore the role of counseling or behavioral therapy with an aim to reduce the perceived dizziness-related disability.

The Dizziness Handicap Inventory and sickness absence: a cross-sectional study

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.

Spectrum of Handicap in Unilateral Sensorineural Hearing Loss

Unilateral Sensorineural Hearing Loss (USNHL) can present with varying symptoms apart from hearing loss, such as dizziness and tinnitus. Impaired sound localization, inability to identify speech in noise and decreased temporal summation can significantly impair the daily activities of an individual. This along with dizziness and tinnitus affects the physical, mental and social health as well. The purpose of this study is to assess and correlate the spectrum of handicap faced by USNHL patients. Validated questionnaires were used to evaluate handicap in 42 USNHL patients due to hearing loss (Hearing Handicap Inventory for Adults-HHIA), dizziness (Dizziness Handicap Inventory-DHI) and tinnitus (Tinnitus Handicap Inventory-THI). These handicaps were then correlated with each other using Spearman's correlation coefficient. Statistically significant strong positive correlation of HHIA was seen with DHI (rho = 0.60, p ≤ 0.001) and THI (rho = 0.74, p ≤ 0.001). Similarly, strong positive correlation was seen between emotional subscales of HHIA and DHI (rho = 0.73, p ≤ 0.001). USNHL can lead to significant emotional and social handicap which is compounded in the presence of hearing loss, dizziness and tinnitus. These handicaps are strongly correlated to one another. Hence, a holistic approach is needed for USNHL rehabilitation. There exists a need to develop a comprehensive measure to assess and grade the handicap faced by these patients.

Translation, Cross-Cultural Adaptation, and Validation of the Polish Version of the Dizziness Handicap Inventory

OBJECTIVES

The Dizziness Handicap Inventory (DHI) questionnaire is used to assess the severity of vertigo. In clinical practice, it is a good indicator for understanding the patient's feelings and can be used as a quantitative measure for monitoring ongoing treatment and rehabilitation. This study involved the translation, cultural adaptation, and validation of the Polish DHI questionnaire (DHI-POL).

METHODS

We recruited 127 subjects (mean age 55.1 years) who experienced vertigo, dizziness, and imbalance resulting from a disturbance to their vestibular system that had lasted longer than 1 month and 56 subjects (mean age 51.8 years) without any vestibular symptoms. All subjects performed a posturography Sensory Organization Test and completed the questionnaire twice.

RESULTS

Cronbach's alpha for the overall DHI-POL was α = 0.93. The questions were divided into 3 subgroups (functional [F], emotional [E], and physical [P]) for which the internal consistency was as follows: DHI-F, α = 0.84; DHI-E, α = 0.85; and DHI-P, α = 0.81. Reproducibility, as measured by interclass correlation coefficient for the overall DHI-POL, was 0.91. For each interclass correlation coefficient subgroup, the results were as follows: DHI-F, 0.90; DHI-E, 0.93; and DHI-P, 0.83.

CONCLUSIONS

DHI-POL has a high consistency and repeatability; therefore, it is a fully functional questionnaire that meets all the validation criteria and is a tool ready for use on Polish patients with vertigo.

Clinical characteristics and diagnostic aspects of cervicogenic dizziness in patients with chronic dizziness: A cross-sectional study

BACKGROUND AND OBJECTIVES

Chronic dizziness can significantly affect quality of life, but identifying the underlying cause remains challenging. This study focuses on proprioceptive cervicogenic dizziness (CGD) and aims: (1) to compare clinical test results between patients with CGD, dizzy patients without CGD, and healthy controls; and (2) to evaluate the diagnostic value of the clinical tests for CGD in patients with chronic dizziness.

METHODS

Sixty patients with chronic dizziness (18 with CGD and 42 without CGD), and 43 healthy controls underwent clinical tests evaluating neck function (mobility, proprioception, muscle function and disability), balance control, and the presence of visually induced dizziness. Data were analysed through one-way ANOVA, chi-square, independent samples t-test, and logistic regression analyses.

RESULTS

Patients with CGD had significantly more neck pain-related disability (Neck Bournemouth questionnaire (NBQ), p = 0.006), but better static (Static Balance, p = 0.001) and dynamic balance (Tandem Gait, p = 0.049), compared to dizzy patients without CGD. Univariable analyses revealed that increased NBQ (OR 1.05 [1.01; 1.09], p = 0.017), Joint Position Error (JPE) _{after extension} (OR 1.52 [1.00; 2.32], p = 0.050), and Tandem Gait scores (OR 1.09 [1.01; 1.18], p = 0.046) were individually associated with higher odds of having CGD. Their optimal cut-off level (based on the maximum Youden index) had high sensitivity but low specificity for CGD. The multivariable model, including NBQ and Tandem Gait, had fair discriminative ability (AUC = 0.74, 95% CI [0.61; 0.87]).

CONCLUSION

The combined use of the NBQ and Tandem Gait tests had the highest discriminative ability to detect CGD in patients with chronic dizziness.

Self-Reported Measures Have a Stronger Association With Dizziness-Related Handicap Compared With Physical Tests in Persons With Persistent Dizziness

Background

Associations 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.

Objective

The 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.

Method

Participants 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.

Results

With 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.

Conclusion

There 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.

Investigation of the Relationship between Vestibular Disorders and Sleep Disturbance

Introduction  Vestibular pathologies cause physical and psychological symptoms, as well as cognitive problems.

Objective  To evaluate the deterioration in sleep quality associated with vestibular pathologies.

Methods  The Dizziness Handicap Inventory (DHI), the Beck Depression Inventory (BDI), the Pittsburgh Sleep Quality Index (PSQI), and the Limits of Stability test (LOS) were applied to the participants.

Results  We included 25 patients with Meniere's disease (MD), 22 patients with benign paroxysmal positional vertigo (BPPV), 21 patients with unilateral peripheral vestibular loss (UPVL), 23 patients with vestibular migraine (VM), and 43 controls. The total PSQI scores of the controls were better than those of the MD ( p  = 0.014), VM ( p < 0.001), BPPV ( p  = 0.003), and UPVL ( p  = 0.001) groups. The proportion of poor sleepers in the MD ( p  = 0.005), BPPV ( p  = 0.018), and UPVL ( p < 0.001) groups was significantly higher than that of the controls. The highest total DHI score (45.68 ± 25.76) was found among the MD group, and it was significantly higher than the scores of the BPPV ( p  = 0.007) and control ( p < 0.001) groups. The highest BDI score was obtained in the VM group, and it was significantly higher than the scores of the BPPV ( p  = 0.046) and control ( p < 0.001) groups. Moreover, the BDI scores of the MD ( p = 0.001) and UPVL groups were also significantly worse than the score of the controls ( p = 0.001).

Conclusion  The present study showed thatpatients with vestibular symptoms have physical and functional complaints, as well as increased psychosocial stress and decreased sleep quality. Evaluating multiple parameters of quality of life may contribute to a better understanding of vestibular physiology and symptoms, and may help establish a more effective therapeutic approach.

Vestibulo-ocular dysfunction in mTBI: Utility of the VOMS for evaluation and management – A review

BACKGROUND: Individuals who have suffered a concussion/mild traumatic brain injury (mTBI) frequently report symptoms associated with vestibular and/or oculomotor dysfunction (VOD) like dizziness, nausea, fatigue, brain fog, headache, gait and neurocognitive impairments which are associated with the development of chronic symptoms. The Vestibular/Ocular Motor Screening (VOMS) tool has been established as a reliable and clinically relevant complement to use alongside a battery of post-concussion tests to improve screening and referral for further evaluation and treatment of VOD. OBJECTIVES: This paper will review the pathoanatomy and symptomatology of common vestibular and oculomotor disorders after concussion, as well as the utility of the VOMS to assist in diagnosis, referral, and management. METHODS: Primary articles were identified using a search via PubMed, Google Scholar, OneSearch, and CINAHL. Search key terms were combinations of “mild traumatic brain injury” or “concussion” or “pursuit” or “accommodation” or “vergence” or “convergence insufficiency” or “saccades” or “vestibulo-ocular reflex” or “vestibular ocular motor screen” or “vestibular rehabilitation”, or “vision rehabilitation” including adult and pediatric populations that were published in print or electronically from 1989 to 2021 in English. Classic papers on anatomy of eye movements, vestibular system and pathological changes in mTBI were also included, regardless of publication date. RESULTS: Objective impairments are commonly found during testing of smooth pursuit, saccades, vergence, accommodation, vestibular ocular reflex, and visual motion sensitivity after mTBI. These deficits can be actively treated with vestibular physical therapy and oculomotor/neuro-optometric vision therapy. VOMS is an efficient and reliable tool that can be used by all healthcare and rehabilitation providers to aid in diagnosis of post-concussion VOD, to help facilitate the decision to refer for further evaluation and treatment to expedite symptomatic post-concussion recovery. CONCLUSIONS: VOD is common after concussion in acute, post-acute, and chronic phases. Once areas of impairments are identified through proper assessment, clinicians can maximize recovery by referring to vestibular physical therapy and/or neuro-optometry to design a targeted treatment program to address individual deficits.

Dizziness and health-related quality of life among older adults in an urban population: a cross-sectional study

Background

Dizziness is a common complaint among older adults and may affect quality of life in a negative way. The aim of this study was to assess health-related quality of life (HRQL), sense of coherence (SOC), self-rated health (SRH) and comorbidity in relation to dizziness, among older persons from an urban population.

Methods

The study is part of the Gothenburg H70 Birth Cohort Studies (H70). A cross-sectional population-based sample including 662 79-years-olds (404 women, 258 men, 62% response rate) were surveyed with questions regarding dizziness, imbalance, comorbidities and general health. HRQL was assessed using the 36-item Short Form-36 Health Survey (SF-36) and SOC with the 13-items questionnaire Sense of Coherence (SOC-13).

Results

Half of the participants reported problems with dizziness (54%). Dizziness was negatively associated with HRQL, including after adjusting for comorbidities, especially in the physical domains of SF-36. Having dizziness was also associated with poorer SRH, tiredness and comorbidity among both men and women. SOC (mean total score), however, did not differ between dizzy and non-dizzy participants.

Conclusions

Dizziness was negatively associated with HRQL, also after adjusting for comorbidities. Identification and treatment of dizziness, when possible, are important because reduction of dizziness symptoms may potentially help to enhance overall well-being in this age group.

Dizziness and physical health are associated with pain in dizzy patients-A cross-sectional study

BACKGROUND AND PURPOSE

Associations between dizziness, health-related quality of life, and musculoskeletal pain have not been systematically explored in patients with vestibular disorders. Such knowledge may be important for choice of treatments. The study objectives were to examine the extent and localization of musculoskeletal pain and explore whether pain was associated with dizziness and health-related quality of life.

METHODS

The cross-sectional study investigated anonymized data from an earlier survey on patients with long-lasting dizziness (>3 months) examined in an oto-rhino-laryngological department. The sample includes patient between 18 and 70 years with Ménière's disease, vestibular schwannoma, benign positional paroxysmal vertigo, vestibular neuritis, non-otogenic dizziness, and cervicogenic dizziness. General musculoskeletal, that is, pain in muscles, tendons, and joints was registered by a yes/no question. A pain drawing registered localization of pain. Multiple binary logistic regression models were used to determine the association between pain and vertigo-balance and autonomic-anxiety related dizziness by the short Vertigo Symptom Scale (VSS) and sub-scales (VSS-V, VSS-A), and between pain and health-related quality of life by the SF-36, mental and physical component summary scale (SF-36 MCS, SF-36 PCS).

RESULTS

The sample consisted of 503 patients, 60.2% were women, the median age was 50 years. General musculoskeletal pain was reported by 72.8% of patients, neck pain by 59.2% and widespread pain by 21.9%. Multiple binary logistic regression models demonstrated that all the pain measures were significantly associated with VSS-V and VSS-A and SF-36 PCS, but not SF-36 MCS.

DISCUSSIONS

Musculoskeletal pain is prevalent in patients with long-lasting dizziness. The strong associations between pain, VSS, and SF-36 PCS could result in a self-sustaining complex condition. The findings imply that in addition to assessing and treating the vestibular symptoms, musculoskeletal symptoms and physical health should be addressed.

Interviewing and Counseling the Dizzy Patient with Focus on Quality of Life

When interviewing a patient presenting with dizziness, it is imperative to both diagnosis and treatment for the clinician to identify the impact dizziness has on the patient's productivity, general function level and cognition. and cognition. Psychiatric comorbidities and concurrent sleep disturbances are common in this patient population and identification of these additional factors is important in implementing a holistic, multidisciplinary treatment plan and ultimately improves the patient's outcome.

Exploratory Factor Analysis of the Vestibular Activities Avoidance Instrument

Importance

Fear avoidance is a behavioral response to dizziness that can lead to chronic symptoms and maladaptation of the vestibular system, but there is no valid and reliable clinical measure of fear avoidance for persons with dizziness. Although the Vestibular Activities Avoidance Instrument (VAAI) was developed to identify fear avoidance beliefs in persons with dizziness, it was considered too long for clinical use.

Objective

To continue development of the VAAI for clinical use by reducing its length and by assessing the internal consistency and construct validity through associations with measures of disability, quality of life, and psychological well-being.

Design, Setting, and Participants

This prospective cohort study conducted from February 2018 to December 2019 at a tertiary care balance disorders clinic and in outpatient physical therapy clinics in the United States included 404 adults with dizziness.

Main Outcomes and Measures

Participants completed the 81-item VAAI, the Vestibular Activities and Participation (VAP) measure, the 12-Item Short Form Health Survey (SF-12), and the Hospital Anxiety and Depression Scale (HADS) at baseline. Exploratory factor analysis of the VAAI was conducted to reduce the number of items. Internal consistency of the reduced VAAI was determined by calculating the Cronbach α. Convergent validity was assessed by examining the associations between the reduced VAAI and the VAP, the SF-12, and the HADS using Spearman correlation coefficients.

Results

Data from 404 adults (mean [SD] age, 54.0 [17.0] years; 64.6% women) were included in the analyses. The exploratory factor analysis indicated that 2 factors explained the underlying constructs of the 81-Item VAAI. The first factor was retained and measured the construct of fear avoidance. The VAAI was reduced to 9 items (VAAI-9). The VAAI-9 showed excellent internal consistency (Cronbach α = 0.92) and was positively associated with the VAP (ρ = 0.81) and the HADS anxiety (ρ = 0.47) and depression (ρ = 0.64) subscales, and negatively associated with physical (ρ = -0.76) and mental (ρ = -0.47) health-related quality of life.

Conclusions and Relevance

These findings indicate that the VAAI-9 is a short, internally consistent, valid measure of fear avoidance and is associated with quality of life, activity limitations and participation restrictions, and psychological well-being. The next steps in the development of the VAAI-9 will include validation in an external sample, assessment of test-retest validity, and prospective investigations of its association with future disability.

Benign paroxysmal positional vertigo, dizziness, and health-related quality of life among older adults in a population-based setting

Purpose

Dizziness may affect quality of life in a negative way and contribute to falls. The aim of this study was to investigate and compare 75 years old with dizziness caused by benign paroxysmal positional vertigo (BPPV) to those with general dizziness/impaired balance (non-BPPV related) and to those reporting no dizziness, regarding health-related quality of life (HRQL), falls, tiredness, and walking speed in a population-based setting.

Method

A cross-sectional population-based sample, including 671 75 years old (398 women, 273 men), was investigated for BPPV, dizziness symptoms, falls, and walking speed. HRQL was assessed using the 36-item Short Form-36 Health Survey (SF-36).

Result

A total of 67 persons (10%) had symptoms of BPPV with 11 (1.6%) having nystagmus when tested for BPPV. Having BPPV as well as general dizziness/impaired balance was associated with reduced HRQL, more tiredness, enhanced number of falls, and lower walking speed. Furthermore, the risk of having BPPV increased fourfold if symptoms of dizziness when turning in bed was reported.

Conclusion

Having problems with dizziness is common among senior citizens where BPPV can be an unrecognized cause of dizziness that may impact HRQL and overall well-being. As BPPV is common among older adults, and is potentially curable through reposition maneuvers, it is important to liberally test for, and treat the condition. Information about dizziness when turning in bed can help to pinpoint persons with enhanced risk for BPPV also on a population-based level.

Relation of anxiety and other psychometric measures, balance deficits, impaired quality of life, and perceived state of health to dizziness handicap inventory scores for patients with dizziness

Background

An important question influencing therapy for dizziness is whether the strengths of the relationships of emotional and functional aspects of dizziness to 1) anxiety and other mental states, 2) perceived state of health (SoH) and quality of life (QoL) are different in patients with and without normal balance control. We attempted to answer this question by examining these dimensions’ regression strengths with Dizziness Handicap Inventory (DHI) scores.

Methods

We divided 40 patients receiving group cognitive behavioural therapy (CBT) and vestibular rehabilitation for dizziness, into 2 groups: dizziness only (DO) and normal balance control; dizziness and a quantified balance deficit (QBD). Group-wise, we first performed stepwise multivariate regression analysis relating total DHI scores with Brief Symptom Inventory (BSI) sub-scores obtained pre- and post-therapy. Then, regression analysis was expanded to include SoH, QoL, and balance scores. Finally, we performed regressions with DHI sub-scores.

Results

In both groups, the BSI phobic anxiety state score was selected first in the multivariate regression analysis. In the DO group, obsessiveness/compulsiveness was also selected. The correlation coefficient, R, was 0.74 and 0.55 for the DO and QBD groups, respectively. When QoL and SoH scores were included, R values increased to 0.86 and 0.74, explaining in total 74, and 55% of the DHI variance for DO and QBD groups, respectively. Correlations with balance scores were not significant (R ≤ 0.21). The psychometric scores selected showed the strongest correlations with emotional DHI sub-scores, and perceived QoL and SoH scores with functional DHI sub-scores.

Conclusions

Our findings suggest that reducing phobic anxiety and obsessiveness/compulsiveness during CBT may improve emotional aspects of dizziness and targeting perceived SoH and QoL may improve functional aspects of dizziness for those with and without normal balance control.

Dizziness and its association with walking speed and falls efficacy among older men and women in an urban population

Background

Dizziness is common among older people and falling is a feared complication.

Aim

The purpose of this study was to investigate the presence of dizziness and its association with falls, walking speed and fear of falling, including sex differences, among 79-year-olds. Secondary purposes were to describe the relationship between dizziness and falls to number of medications and diseases.

Method

The study consisted of the fifth cohort of Gothenburg’s H70 birth cohort studies. A sample of 662 79-year-olds (404 women, 258 men) were investigated with questions regarding dizziness, previous falls and falls efficacy [estimated according to the falls efficacy scale Swedish version (FES (S))]. Functional tests included self-selected and maximal walking speed over 20 m.

Results

Dizziness was reported among 51% of the women and by 58% of the men (p = 0.12). Approximately, 40% had fallen during the past 12 months (41% women, 38% of the men, p = 0.48). Dizziness was related to a higher risk of falls among women (OR 2.63 (95% CI 1.67−4.14, p < 0.0001), but not among men (OR 1.07, 95% CI 0.63−1.82, p = 0.8). Dizzy individuals had lower scores on FES (S) (p < 0.01), more medications (p < 0.001) and diseases (p < 0.001) than those without dizziness. Participants who reported dizziness walked 10% slower than participants without dizziness (p < 0.001).

Conclusion

Women with dizziness more often reported falls compared to women without dizziness—a trend that was not seen among men. Persons with dizziness walked slower. Many medications increased risk of falling; hence, number of medications alone might help pinpoint risk groups for falling.

An Experimental Study of Effects of Media Implication on Self-Report Symptoms Related With MP Use

Along with gradually increases in mobile phone (MP) use, the mass media has played a vital role in informing the public regarding the potential health hazards of MP use. These media warnings have prompted public worries about health. The aim of the present study is to investigate the effects of media warnings about the possible health hazards of MP use on self-reported symptoms. Participants were 703 undergraduate students who volunteered to take part in an experimental study between August 2013 and July 2015. After completing baseline questionnaires containing information on demographics, MP usage and possible confounding variables, the participants were randomly clustered assigned to a video treatment group (watching a 5-min video about the possible health hazards of MP use) or a control group. Then, they completed another set of questionnaires containing 6 self-reported physical symptoms and the Beck Depression Inventory (BDI). Chi-squared tests, Mann-Whitney U-tests and logistic regression models were applied in the data analysis. Participants in the video group reported significantly more frequent headache (P = 0.01), fatigue (P = 0.00), memory loss (P = 0.03), inattention (P = 0.00), and higher level of depression (P = 0.05) than those in the control group. Additionally, the prevalence of memory loss (β = 0.071, P = 0.03) and inattention (β = 0.110, P = 0.00) were significantly higher in participants with higher level of depression who watched the video. Media warnings about the possible health hazards of MP use promote people to report physical symptoms and psychological problems. Considering this tendency, more moderate and scientific media information is needed to alleviate public worries about MP use.

Association Between Catastrophizing and Dizziness-Related Disability Assessed With the Dizziness Catastrophizing Scale

Importance

Catastrophizing is a maladaptive thought process that involves irrational fear and worry about anticipated or actual symptoms. Although clinically relevant, the role of catastrophizing in patients with chronic dizziness or imbalance has not yet been explored to our knowledge.

Objectives

To validate a measure of dizziness catastrophizing and to assess its association with dizziness-related disability compared with other negative affect constructs (eg, anxiety and depression).

Design, Setting, and Participants

For this retrospective medical record review, the Dizziness Catastrophizing Scale (DCS), a dizziness-specific catastrophizing assessment tool, was adapted from the previously validated Pain Catastrophizing Scale. Psychometric evaluation of the DCS was performed. In addition, the associations of dizziness catastrophizing and positive and negative affectivity with dizziness-related disability were assessed using structural equation modeling and regression analyses. Data were collected using a retrospective medical record review from April 27, 2010, to June 25, 2014. The dates of analysis were June 3 to August 15, 2017. The setting was the Multidisciplinary Neurotology Clinic at the Toronto General Hospital (Toronto, Ontario, Canada). Participants were 457 adult outpatients with dizziness or imbalance who were referred to the clinic.

Main Outcomes and Measures

Psychometric properties of the DCS and its association with dizziness-related disability, as measured with the Dizziness Handicap Inventory.

Results

Among 457 patients (mean [SD] age, 53.4 [15.4] years; 154 [33.7%] male), the DCS demonstrated good convergent (r = 0.78, P < .001) and discriminant validity (r = -0.40, P < .001) with the negative and positive affectivity, respectively; internal consistency (α = .95); and test-retest reliability (intraclass correlation coefficient, 0.92; P < .001 at the 95% CI). An exploratory dimension reduction analysis revealed a single latent component of the DCS. The results of the structural equation modeling and regression analyses revealed that dizziness catastrophizing, although associated with negative affectivity (eg, symptoms of anxiety and depression), was independently associated with dizziness-related disability (standardized β = 0.378; P < .001). Furthermore, a strong association was found between catastrophizing and dizziness-related disability across different dizziness-related diagnoses (r ≥ 0.6; P < .001).

Conclusions and Relevance

In this study, the DCS was a valid and reliable measure for evaluating catastrophic thinking in patients with dizziness, which was independently associated with dizziness-related disability. Future studies should investigate the influence of alleviating symptoms of catastrophizing on functional outcomes in patients with dizziness or imbalance, the results of which will help guide novel approaches to the clinical care of patients with chronic dizziness.

Orthostatic hypotension and health-related quality of life among community-living older people in Korea

PURPOSE

To investigate the association of orthostatic hypotension (OH) with health-related quality of life (HRQoL) in older people living in the community.

METHODS

A cross-sectional design was used. A total of 217 participants aged 65 and older were classified as having OH if their systolic or diastolic blood pressure showed a drop of ≥ 20 mmHg systolic blood pressure or ≥ 10 mmHg diastolic blood pressure, respectively, within 3 min of standing. Participants provided demographic and medical information and responded to questionnaires about their HRQoL (EuroQoL-5D-3L), as well as depression, anxiety, cognitive function, and recent physical activities.

RESULTS

The number of participants with OH was 117, and those without OH numbered 100. The mean HRQoL levels were 0.56 (SD 0.29) in the OH group and 0.74 (SD 0.25) in the non-OH group (p < .001). Participants with OH were more likely to be older, women, and smokers. These participants had fewer years of education, a greater history of stroke and hypertension, and a greater number of comorbidities. The absence of OH, a higher physical activity level, a lower degree of depression, an absence of stroke history, and younger age were all significant determinants of greater HRQoL.

CONCLUSIONS

The level of HRQoL of older people with OH was significantly lower than that of older people without. The presence of OH was an independent determinant of HRQoL in older adults after adjusting for covariates. This finding suggests that strategies for relieving OH could improve HRQoL in affected older adults.

Patient-reported outcomes measured with and without dizziness associated with non-specific chronic neck pain: implications for primary care

Background

The aim of this study was to compare health-related quality of life (HRQoL) and disability and fear of movement in patients with non-specific chronic neck pain (NSCNP) associated with dizziness with respect to patients with isolated NSCNP in primary care settings.

Methods

A cross-sectional study was carried out in a primary care center. A total of 120 patients were divided into two groups and analyzed in this study. One group of patients reported dizziness combined with NSCNP (n = 60), and the other reported no dizziness with their NSCNP (n = 60). Patient-reported outcome measurements were HRQoL (primary outcome) and disability and kinesiophobia (secondary outcomes) assessed by the EuroQoL Five Dimensions and Five Levels (EQ-5D-5L), neck disability index (NDI) and Tampa Scale of Kinesiophobia (TSK-11), respectively.

Results

Statistically significant differences (P < 0.05) for a 95% confidence interval (CI) with a large effect size (Cohen d) were found between both groups with greater values of disability (mean difference = 6.30 points; 95% CI [3.84-8.75]; d = 0.94) and kinesiophobia (mean difference = 8.36 points; 95% CI [6.07-10.65]; d = 1.33), and an impairment of HRQoL (mean difference = 16.16 points; 95% CI [11.09-21.23]; d = 1.16), for patients with NSCNP associated with dizziness with respect to patients with isolated NSCNP.

Conclusions

Patients with NSCNP in conjunction with dizziness present higher HRQoL impairment and higher disability and kinesiophobia compared to patients with isolated NSCNP.

Investigation of self-reported dizziness in the elderly when lying down or turning over in bed, and possible benign paroxysmal positional vertigo

OBJECTIVES

This study aimed to investigate the rate of dizziness and occurrence of benign paroxysmal positional vertigo in the elderly by physical examination in those reporting dizziness symptoms when lying down or turning over in bed.

METHODS

A total of 498 people, aged 70-85 years, were asked to complete a questionnaire regarding dizziness symptoms. Subjects answering that they became dizzy in bed were asked to participate in a physical examination and diagnostic manoeuvres investigating benign paroxysmal positional vertigo.

RESULTS

A total of 324 participants (65 per cent) completed the questionnaire. More than one-quarter (29 per cent) reported dizziness and 32 (10 per cent) reported dizziness when turning in bed. Of these 32 persons, 22 (69 per cent) underwent a physical examination. Six participants tested positive for benign paroxysmal positional vertigo.

CONCLUSION

Ten per cent of the elderly participants reported positional symptoms, and 6 out of 22 fulfilled diagnostic criteria for benign paroxysmal positional vertigo. Furthermore, benign paroxysmal positional vertigo was established despite a delay between questionnaire completion and investigation, emphasising that this type of dizziness may not be a self-limiting disorder.

Balance problems and dizziness after neck surgery - associations with pain and health-related quality of life

Introduction: Symptoms of dizziness or imbalance are often present in individuals with a variety of neck-disorders. The aims of this study were to determine the prevalence of patient-reported balance problems and dizziness 10-13 years after surgery for cervical degenerative disc disease; evaluate associations with neck pain and health-related quality of life; and investigate how these individuals described dizziness. Material and methods: Sixty-eight individuals, 10 years or more after anterior cervical decompression and fusion surgery, who previously participated in a randomized controlled trial were included. Participants completed questionnaires including ratings of dizziness and balance problems, the Dizziness Handicap Inventory, and an open-ended question regarding their experience of dizziness. Secondary outcomes were neck pain and quality of life. Results: Seventy-two percent experienced occasional or daily symptoms of unsteadiness and/or dizziness. Intensity ratings for dizziness during movement and for balance problems were similar and rather low, but had an impact on quality of life. Ratings of dizziness at rest were even lower. Dizziness ratings were associated with neck pain. Strenuous activities were related to dizziness and dizziness was primarily described as intermittent and non-rotatory. Conclusions: Dizziness or balance problems in the long-term after surgery for cervical degenerative disc disease are common and have an impact on daily life. Ratings of problem frequency and intensity were usually low. Dizziness and balance problems may affect quality of life. Patients' descriptions of these problems are in line with common symptoms of cervicogenic dizziness.

Reducing the burden of dizziness in middle-aged and older people: A multifactorial, tailored, single-blind randomized controlled trial

BACKGROUND

Dizziness is common among older people and is associated with a cascade of debilitating symptoms, such as reduced quality of life, depression, and falls. The multifactorial aetiology of dizziness is a major barrier to establishing a clear diagnosis and offering effective therapeutic interventions. Only a few multidisciplinary interventions of dizziness have been conducted to date, all of a pilot nature and none tailoring the intervention to the specific causes of dizziness. Here, we aimed to test the hypothesis that a multidisciplinary dizziness assessment followed by a tailored multifaceted intervention would reduce dizziness handicap and self-reported dizziness as well as enhance balance and gait in people aged 50 years and over with dizziness symptoms.

METHODS AND FINDINGS

We conducted a 6-month, single-blind, parallel-group randomized controlled trial in community-living people aged 50 years and over who reported dizziness in the past year. We excluded individuals currently receiving treatment for their dizziness, those with degenerative neurological conditions including cognitive impairment, those unable to walk 20 meters, and those identified at baseline assessment with conditions that required urgent treatment. Our team of geriatrician, vestibular neuroscientist, psychologist, exercise physiologist, study coordinator, and baseline assessor held case conferences fortnightly to discuss and recommend appropriate therapy (or therapies) for each participant, based on their multidisciplinary baseline assessments. A total of 305 men and women aged 50 to 92 years (mean [SD] age: 67.8 [8.3] years; 62% women) were randomly assigned to either usual care (control; n = 151) or to a tailored, multifaceted intervention (n = 154) comprising one or more of the following: a physiotherapist-led vestibular rehabilitation programme (35% [n = 54]), an 8-week internet-based cognitive-behavioural therapy (CBT) (19% [n = 29]), a 6-month Otago home-based exercise programme (24% [n = 37]), and/or medical management (40% [n = 62]). We were unable to identify a cause of dizziness in 71 participants (23% of total sample). Primary outcome measures comprised dizziness burden measured with the Dizziness Handicap Inventory (DHI) score, frequency of dizziness episodes recorded with monthly calendars over the 6-month follow-up, choice-stepping reaction time (CSRT), and gait variability. Data from 274 participants (90%; 137 per group) were included in the intention-to-treat analysis. At trial completion, the DHI scores in the intervention group (pre and post mean [SD]: 25.9 [19.2] and 20.4 [17.7], respectively) were significantly reduced compared with the control group (pre and post mean [SD]: 23.0 [15.8] and 21.8 [16.4]), when controlling for baseline scores (mean [95% CI] difference between groups [baseline adjusted]: -3.7 [-6.2 to -1.2]; p = 0.003). There were no significant between-group differences in dizziness episodes (relative risk [RR] [95% CI]: 0.87 [0.65 to 1.17]; p = 0.360), CSRT performance (mean [95% CI] difference between groups [baseline adjusted]: -15 [-40 to 10]; p = 0.246), and step-time variability during gait (mean [95% CI] difference between groups [baseline adjusted]: -0.001 [-0.002 to 0.001]; p = 0.497). No serious intervention-related adverse events occurred. Study limitations included the low initial dizziness severity of the participants and the only fair uptake of the falls clinic (medical management) and the CBT interventions.

CONCLUSIONS

A multifactorial tailored approach for treating dizziness was effective in reducing dizziness handicap in community-living people aged 50 years and older. No difference was seen on the other primary outcomes. Our findings therefore support the implementation of individualized, multifaceted evidence-based therapies to reduce self-perceived disability associated with dizziness in middle-aged and older people.

TRIAL REGISTRATION

Australian New Zealand Clinical Trials Registry ACTRN12612000379819.

Multicenter data banking in management of dizzy patients: first results from the DizzyNet registry project

PURPOSE

Comprehensive phenotypical data across countries is needed to understand the determinants, prognosis and consequences of vestibular disease. The registry is a data repository for the members of the European DizzyNet. We report results from a pilot study using data from Turkey and Germany.

METHODS

The pilot study included a convenience sample of patients aged 18 or above referred to Ege University Medical School Hospital, Dokuz Eylül University Hospital, Izmir, Turkey, and the German Center for German Center for Vertigo and Balance Disorders, University on Munich, Germany, with symptoms of vertigo or dizziness. Health-related quality of life was assessed with the EQ5-D and the Dizziness Handicap Inventory (DHI). To obtain comparable groups we matched data from the two countries for age, sex and diagnosis by propensity score.

RESULTS

We included 80 adult patients, 40 from each country (60% female, mean age 54.1, SD 12.4). Matching was successful. Vestibular migraine (34%) was the most frequent diagnosis, followed by benign paroxysmal positional vertigo (29%) and Menière's disease (12%). Clinical signs and symptoms were comparable in both countries. Patients from Turkey were more likely to report headaches (65 vs. 32%) and to show gait unsteadiness (51 vs. 5%). Patients from Germany reported significantly higher quality of life and lower values of the DHI score.

CONCLUSIONS

Sharing data facilitates research, enhances translation from basic science into clinical applications, and increases transparency. The DizzyNet registry is a first step to data sharing in vestibular research across Europe.

The Longitudinal Effect of Vertigo and Dizziness Symptoms on Psychological Distress: Symptom-Related Fears and Beliefs as Mediators

Despite the frequent observation that vertigo and dizziness (VD) disorders may trigger or exacerbate secondary psychiatric comorbidities, there is limited understanding of the mechanisms underlying this development. To address this gap, we investigated whether symptom-related fears and cognitions as indicated by questionnaire-based measures are mediators of the longitudinal effect of VD symptoms on anxiety and depression after 1 year. We analyzed data from a large study with patients of a treatment center specialized in vertigo (N = 210). Simple and multiple parallel mediation models strengthened our hypothesis that fear of bodily sensations and cognitions about these symptoms play a mediating role in the relationship between VD symptoms and psychopathology at follow-up after baseline scores of the outcome were controlled for. Results are discussed within a cognitive theory framework and point to the potential benefits of interventions that modify symptom-related beliefs and fears via cognitive psychotherapy in this therapeutically underserved population.

Quality of life in the institutionalized elderly with dizziness complaint: a cross-sectional study

ABSTRACT Purpose: to evaluate the quality of life in institutionalized elderly people with dizziness complaint and to relate the results to the characteristics of dizziness and functional capacity. Methods: in this cross-sectional study, one-hundred and nineteen elderly residents in three geriatric long-term care institutions in Natal city, Brazil, were evaluated. Those who had presented dizziness in the former year (30/25.2%) were included in this study. The quality of life was measured by the Dizziness Handicap Inventory. Functional capacity was measured by the Berg Balance Scale, the Functional Reach Test, the Unipedal Stance Test with eyes open and closed, and the Falls Efficacy Scale - International. Results: associations were found between physical, functional and emotional aspects and the duration of dizziness (p=0.002, p=0.041 and p=0.004, respectively); the functional aspects with age (p=0.031), the physical aspects with the presence of falls in the previous year (p=0.039); and the physical, functional and emotional aspects of the Dizziness Handicap Inventory with fear of falling (p=0.004, p<0.001 and p=0.016, respectively). Conclusion: institutionalized elderly with dizziness complaints had a low perception of quality of life, and the duration of dizziness, age, falls and fear of falling negatively influenced their quality of life.

Relationship between sleep quality and dizziness

Objective

Poor sleep quality has a number of significant negative effects on daytime function. However, few studies have examined sleep quality in patients with dizziness. Here, we investigated the potential association between sleep quality and various types of dizziness.

Subjects and methods

We examined dizziness and sleep disturbance in 237 patients experiencing dizziness using Korean versions of the Pittsburgh Sleep Quality Index (PSQI), the Insomnia Severity Index (ISI), and Dizziness Handicap Inventory (DHI). All participants were classified as having benign paroxysmal positional vertigo (BPPV), Ménière’s disease (MD), vestibular neuritis (VN), vestibular migraine (VM), psychogenic dizziness (PD), or Other.

Results

The mean PSQI and ISI scores were highest in the PD group. The rate of sleep disturbance was highest in the Other group when the cut-off score for each questionnaire was set differently, except ISI ≥ 15. The correlation between DHI and sleep disturbance indices was highest in the VM group. Multivariate regression showed that PSQI score and DHI-E score were significantly related to the PD and Other groups, while the Other group was significantly related to the ISI score.

Conclusion

The findings of this study strongly suggest that there are associations between sleep quality and some disease subtypes associated with dizziness. Therefore, it is important to consider sleep disturbance in patients with psychogenic dizziness, such as phobic postural vertigo and chronic subjective dizziness, or nonspecific dizziness.

Role of Emotional Distress in Prolongation of Dizziness: A Cross-Sectional Study

Background and Objectives

Dizziness is a common condition in outpatient clinics. Comorbid conditions such as anxiety and/or depression often complicate a patient’s ability to cope with dizziness. The purpose of the present study was to explore the extent of psychiatric distress using the Hospital Anxiety and Depression Scale (HADS) and to compare the results with the subjective severity of dizziness.

Subjects and Methods

The cross-sectional study included a total of 456 consecutive patients presenting with acute (n=327) and chronic (n=127) dizziness symptoms. The HADS was used to estimate emotional distress and compare between patients with acute and chronic dizziness symptoms. Also, we calculated correlations between subjective dizziness handicap scores and emotional distress using the total and subscale scores of the Dizziness Handicap Inventory (DHI), Disability Scale (DS), and HADS.

Results

The HADS total and subscale scores were significantly increased in patients with chronic dizziness (p<0.01) compared with those with acute symptoms. In patients with symptoms of both acute and chronic dizziness, moderate correlations were evident between the DHI and HADS total scores. When we compared DHI subscale scores with the HADS scores, the emotional DHI subscale scores correlated more highly with the HADS total scores and the scores on the anxiety and depression subscales, than did the functional or physical DHI subscale scores.

Conclusions

Increased levels of distress measured using the HADS in patients with chronic symptoms suggest that emotional status of the patients may contribute to prolongation of dizziness symptoms from the acute phase.

Health-related quality of life and economic burden of vestibular loss in older adults

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.

Impact of osteopathic therapy on proprioceptive balance and quality of life in patients with dizziness

The aim of the study was to evaluate the efficacy of osteopathic manipulative treatment (OMT) in patients with Benign-Paroxysmal-Positional Vertigo (BPPV). Thirty-one patients with BPPV were randomly assigned into two groups: 19 patients received osteopathic treatments (TG) and 12 patients received sham therapy (SG), both in four weekly sessions. Before the first and the last treatment, those patients were evaluated using Dizziness Handicap Inventory (DHI) and stabilometric platform to assess lifestyle modification and balance functions. After the treatment session, TG compared to SG showed an improvement in DHI global (p = 0.02), functional (p = 0.03) and physical (p = 0.03) components, as well as a reduction of swinging area (p = 0.02). An association between swinging area and lifestyle measures (global [r = 0.53; p = 0.02]; functional [r = 0.50; p = 0.03]; physical [r = 0.60; p = 0.01]) changes were found in TG. These findings suggest that OMT could be a useful approach to reduce imbalance symptoms and to improve the quality of life in patients suffering from dizziness.

The effect of sleep disturbance in patients with chronic dizziness

CONCLUSIONS

The comorbidity of sleep disturbance with chronic dizziness in women was related to the intensity of distress and interference with their lives due to dizziness, although it was not related to objective variables of dizziness. In addition, the presence of sleep disturbance was associated with severe anxiety and depression, and low health-related quality-of-life (QoL).

OBJECTIVES

This study investigated the effect of sleep disturbance in patients with chronic dizziness on symptoms of dizziness, handicaps due to dizziness, health-related QoL, and emotional distress.

METHOD

The participants of this study were 252 in-patients with chronic dizziness. Participants completed questionnaires containing the Dizziness Handicap Inventory (DHI, three sub-scales: Physical [DHI-P], Emotional [DHI-E], and Functional [DHI-F] scores), Pittsburgh sleep quality index (PSQI-J), Hospital Anxiety and Depression Scale (HADS), and Medical Outcomes Study 8-items Short Form Health Survey (SF-8, health-related QoL). The participants then underwent gravity center fluctuation measurement as an objective indicator of the severity of dizziness.

RESULTS

The prevalence of sleep disturbance (PSQI-J global score ≧6) was 65.1% in these participants. Two-way ANOVA of the DHI scores showed significant interaction between sleep disturbance and sex in DHI total, DHI-E score, and DHI-F score, indicating that these scores were higher in women with sleep disturbance. Regarding DHI-P score, only the main effect of sex was significant (women > men). Sleep disturbance had no significant effect on objective indicators of severity of dizziness. Patients with sleep disturbance had significantly higher HADS scored and a lower SF-8 scored than patients without sleep disturbance.

Quality of life at 6 months in the Idiopathic Intracranial Hypertension Treatment Trial

OBJECTIVE

To examine the changes in vision-specific and overall health-related quality of life (QOL) at 6 months in participants with idiopathic intracranial hypertension (IIH) and mild visual loss enrolled in the Idiopathic Intracranial Hypertension Treatment Trial (IIHTT) and to determine the signs and symptoms of IIH that mediate the effect of acetazolamide on QOL.

METHODS

We assessed QOL using the National Eye Institute Visual Function Questionnaire-25 (NEI-VFQ-25), the 10-Item NEI-VFQ-25 Neuro-Ophthalmic Supplement, and the 36-Item Short Form Health Survey (SF-36). We examined associations among changes in QOL measures over 6 months, treatment status, and changes in signs and symptoms using linear and structural equation models.

RESULTS

Among the 165 participants with IIH (86 randomized to acetazolamide, 79 to placebo), beneficial effects of acetazolamide were seen on all QOL scales evaluated, as well as on the Near Activities (5.60 points, p = 0.03), Social Functioning (3.85 points, p = 0.04), and Mental Health (9.82, p = 0.04) subscales of the NEI-VFQ-25. Positive acetazolamide-related effects on QOL appeared to be primarily mediated by improvements in visual field, neck pain, pulsatile tinnitus, and dizziness/vertigo that outweighed the side effects of acetazolamide.

CONCLUSIONS

The marked reductions in baseline QOL seen among patients with mild visual loss from IIH are improved by treatment with acetazolamide. When combined with acetazolamide-associated improvements in visual field and other aspects of IIH, our findings with respect to QOL provide further support from the IIHTT in favor of acetazolamide to augment a dietary intervention in the treatment of IIH with mild visual loss (clinicaltrials.gov: NCT01003639).

Prevalence of and factors related to mild and substantial dizziness in community-dwelling older adults: a cross-sectional study

Background

Dizziness is highly prevalent among older people and associated with many health factors. The aim of the study was to determine the prevalence of and factors related to dizziness among community-dwelling older adults in Sweden. In contrast to previous studies, the subjects with dizziness were divided into two groups, mild and substantial dizziness, according to the frequency and intensity of dizziness.

Methods

A sample of 305 older persons between 75 and 90 years of age (mean age 81 years) were interviewed and examined. Subjects with dizziness answered the University of California Los Angeles Dizziness Questionnaire and questions about provoking movements. The groups with substantial, mild, or no dizziness were compared with regard to age, sex, diseases, drugs, blood pressure, physical activity, exercises, falls, fear of falling, quality of life, general health, mobility aids, and physical performance.

Results

In this sample, 79 subjects experienced substantial and 46 mild dizziness. Subjects with substantial dizziness were less physically active, reported more fear of falling, falls, depression/anxiety, diabetes, stroke/TIA, heart disease, a higher total number of drugs and antihypertensive drugs, lower quality of life and general health, and performed worse physically.

Conclusions

There are many and complex associations between dizziness and factors like falls, diseases, drugs, physical performance, and activity. For most of these factors, the associations are stronger in subjects with substantial dizziness compared with subjects with mild or no dizziness; therefore, it is relevant to differ between mild and substantial dizziness symptoms in research and clinical practice in the future.

Impacts of small vestibular schwannoma on community ambulation, postural, and ocular control

OBJECTIVES/HYPOTHESIS

To investigate balance, community mobility, gaze instability, and dizziness handicap and assess falls risk in people who are conservatively managed with small vestibular schwannoma (VS).

STUDY DESIGN

Cross-sectional study with controls.

METHODS

The study involved 18 people (mean age 58.7 ± 12.2 years) diagnosed with VS (<12 mm) and 22 age-matched controls (mean age 56.9 ± 8.0 years). Measures included standing on firm and foam surfaces with feet apart, then together with eyes open and closed, Timed Up and Go (TUG) test and dual TUG test, Dynamic Gait Index, 6-Minute Walk Test, Halmagyi Impulse Test, Dynamic Visual Acuity Test, and the Dizziness Handicap Inventory.

RESULTS

The clinical group failed more trials standing feet together on foam with eyes closed (P < .05); had inferior mobility and walked more slowly with divided attention (P < .05); had more difficulty walking with head movement, negotiating obstacles, and using stairs (P < .01); and walked shorter distances (P < .001) than controls. Reduced gaze stability (P < .01) and higher total (P = .007) and subcategory dizziness handicap scores (P < .05) were revealed compared to age-matched controls.

CONCLUSIONS

Although outcomes for the clinical group are inferior to the control group across all measures and the dizziness impact is higher, the results fall in the low-risk category for falls. Preliminary data (level 4 evidence) support using a suite of clinical measures to monitor people with VS during conservative management.

LEVEL OF EVIDENCE

4 Laryngoscope, 127:1147-1152, 2017.

Tailored care for somatoform vertigo/dizziness: study protocol for a randomised controlled trial evaluating integrative group psychotherapy

Vertigo/dizziness (VD) ranks high in lifetime prevalence and clinical relevance. Nearly half of the complex VD disorders presenting at specialised units for vertigo or otoneurological disorders are not fully explained by an identifiable medical illness, but instead are related to anxiety, depressive, or somatoform disorders. Although there is some evidence that psychotherapy may be effective for these patients, therapeutic options remain unsatisfactory. This report describes the objectives, design and methods of a randomised, controlled clinical trial, evaluating the efficacy of manualised, multimodal group psychotherapy, based on integrative psychotherapy (IPT) and tailored to subgroups of mental disorders in medically unexplained VD. This psychotherapeutic approach will be compared to self-help groups (n = 172; n = 86 per study arm). Improvements with regard to handicap due to VD at 12 months follow-up will serve as primary outcome. Additionally, measures of generic quality of life, severity of vertigo, depression, anxiety, somatisation as well as Head Impulse Test and Computerized Static Posturography will be applied. We will also analyse the cost-effectiveness of this trial. The study aims to improve treatment of this therapeutically underserved population who are often severely impaired in their working and daily lives.

TRIAL REGISTRATION

ClinicalTrials.gov Identifier: NCT02320851.

TRIAL STATUS

This is an on-going study; recruitment for the study is about to start.