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Huang TC, Arshad Q, Kheradmand A. Focused Update on Migraine and Vertigo Comorbidity. Curr Pain Headache Rep 2024; 28:613-620. [PMID: 38635020 DOI: 10.1007/s11916-024-01256-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/04/2024] [Indexed: 04/19/2024]
Abstract
PURPOSE OF REVIEW To provide an update on comorbidity of vestibular symptoms and migraine. RECENT FINDINGS Multisensory processing and integration is a key concept for understanding mixed presentation of migraine and vestibular symptoms. Here, we discuss how vestibular migraine should be distinguished from a secondary migraine phenomenon in which migraine symptoms may coincide with or triggered by another vestibular disorder. We also have some updates on the diagnostic criteria of vestibular migraine, its pathophysiology, and common approaches used for its treatment. As a common clinical presentation of migraine and vestibular symptoms, vestibular migraine should be distinguished from a secondary migraine phenomenon, in which migraine symptoms may be triggered by or coincide with another vestibular disorder. Recent experimental evidence suggests vestibular symptoms in vestibular migraine are linked to multisensory mechanisms that control body motion and orientation in space.
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Affiliation(s)
| | - Qadeer Arshad
- Centre for Vestibular Neurosciences, Department of Brain Sciences, Imperial College London, London, UK
- inAmind Laboratory, College of Life Sciences, University of Leicester, Leicester, UK
| | - Amir Kheradmand
- Department of Neurology, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Neuroscience, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
- Laboratory of Computational Sensing and Robotics (LCSR), Johns Hopkins University School of Medicine, Baltimore, MD, USA
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Murphy CE, Roberts RA, Picou EM, Jacobson GP, Green AP. Probabilities of Isolated and Co-Occurring Vestibular Disorder Symptom Clusters Identified Using the Dizziness Symptom Profile. Ear Hear 2024; 45:878-883. [PMID: 38287481 DOI: 10.1097/aud.0000000000001482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2024]
Abstract
OBJECTIVES Dizziness is among the most common reasons people seek medical care. There are data indicating patients with dizziness, unsteadiness, or vertigo may have multiple underlying vestibular disorders simultaneously contributing to the overall symptoms. Greater awareness of the probability that a patient will present with symptoms of co-occurring vestibular disorders has the potential to improve assessment and management, which could reduce healthcare costs and improve patient quality of life. The purpose of the current investigation was to determine the probabilities that a patient presenting to a clinic for vestibular function testing has symptoms of an isolated vestibular disorder or co-occurring vestibular disorders. DESIGN All patients who are seen for vestibular function testing in our center complete the dizziness symptom profile, a validated self-report measure, before evaluation with the clinician. For this retrospective study, patient scores on the dizziness symptom profile, patient age, and patient gender were extracted from the medical record. The dizziness symptom profile includes symptom clusters specific to six disorders that cause vestibular symptoms, specifically: benign paroxysmal positional vertigo, vestibular migraine, vestibular neuritis, superior canal dehiscence, Meniere disease, and persistent postural perceptual dizziness. For the present study, data were collected from 617 participants (mean age = 56 years, 376 women, and 241 men) presenting with complaints of vertigo, dizziness, or imbalance. Patients were evaluated in a tertiary care dizziness specialty clinic from October 2020 to October 2021. Self-report data were analyzed using a Bayesian framework to determine the probabilities of reporting symptom clusters specific to an isolated disorder and co-occurring vestibular disorders. RESULTS There was a 42% probability of a participant reporting symptoms that were not consistent with any of the six vestibular disorders represented in the dizziness symptom profile. Participants were nearly as likely to report symptom clusters of co-occurring disorders (28%) as they were to report symptom clusters of an isolated disorder (30%). When in isolation, participants were most likely to report symptom clusters consistent with benign paroxysmal positional vertigo and vestibular migraine, with estimated probabilities of 12% and 10%, respectively. The combination of co-occurring disorders with the highest probability was benign paroxysmal positional vertigo + vestibular migraine (~5%). Probabilities decreased as number of symptom clusters on the dizziness symptom profile increased. The probability of endorsing vestibular migraine increased with the number of symptom clusters reported. CONCLUSIONS Many patients reported symptoms of more than one vestibular disorder, suggesting their symptoms were not sufficiently captured by the symptom clusters used to summarize any single vestibular disorder covered by the dizziness symptom profile. Our results indicate that probability of symptom clusters indicated by the dizziness symptom profile is comparable to prior published work on the prevalence of vestibular disorders. These findings support use of this tool by clinicians to assist with identification of symptom clusters consistent with isolated and co-occurring vestibular disorders.
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Affiliation(s)
- Claire E Murphy
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Richard A Roberts
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Erin M Picou
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Gary P Jacobson
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Andrea P Green
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Current Position: Sonova USA, Inc., Aurora, Illinois, USA
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Pajaniappane A. Assessment and management of vestibular migraine within ENT. J Laryngol Otol 2024; 138:S22-S26. [PMID: 38291947 DOI: 10.1017/s0022215123002062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
OBJECTIVE Vestibular migraine is a newly recognised and debilitating condition. This article aims to provide an overview of what is known of vestibular migraine, delineating its diagnostic criteria and presenting some initial management strategies to aid ENT professionals in delivering optimal care when patients first present to the otolaryngology clinic. METHOD Although traditionally underdiagnosed, there are now clearly defined diagnostic criteria to aid accurate diagnosis of vestibular migraine. RESULTS A detailed history and clinical examination are the cornerstone of the diagnostic process, but supportive evidence is required from appropriate audio-vestibular tests and imaging. CONCLUSION This is a unique condition that commonly initially presents to ENT. This article provides a summary of diagnostic and management strategies to facilitate early diagnosis and first-line treatment that can be employed in general ENT settings, which may be particularly useful given the limited availability of specialist audio-vestibular medicine and neuro-otology services.
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Affiliation(s)
- Arun Pajaniappane
- Department of Audiovestibular Medicine, St George's University Hospitals NHS Trust, Tooting, UK
- Harley Street Audiovestibular Clinic, London, UK
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Çakır S, Sahin A, Gedik-Soyuyuce O, Gence Gumus Z, Sertdemir İ, Korkut N, Yalınay Dikmen P. Assessing the impact of migraine on benign paroxysmal positional vertigo symptoms and recovery. BMC Neurol 2024; 24:148. [PMID: 38698310 PMCID: PMC11064330 DOI: 10.1186/s12883-024-03606-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Accepted: 03/18/2024] [Indexed: 05/05/2024] Open
Abstract
BACKGROUND During episodes of benign paroxysmal positional vertigo (BPPV), individuals with migraine, compared with individuals without migraine, may experience more severe vestibular symptoms because of their hyperexcitable brain structures, more adverse effects on quality of life, and worse recovery processes from BPPV. METHODS All patients with BPPV were assigned to the migraine group (MG, n = 64) and without migraine group (BPPV w/o MG, n = 64) and completed the Vertigo Symptom Scale (VSS), Vertigo Dizziness Imbalance Symptom Scale (VDI-SS), VDI Health-Related Quality of Life Scale (VDI-HRQoLS), Beck Anxiety Inventory (BAI), and Beck Depression Inventory (BDI) at the time of BPPV diagnosis (baseline) and on the one-month follow-up. Headache Impact Test-6 and Migraine Disability Assessment Scale were used for an assessment of headache. Motion sickness was evaluated based on the statement of each patient as present or absent. RESULTS Compared with the BPPV w/o MG, the MG had higher VSS scores at baseline [19.5 (10.7) vs. 11.3 (8.5); p < 0.001] and on one-month follow-up [10.9 (9.3) vs. 2.2 (2.7), p < 0.001]; experienced more severe dizziness and imbalance symptoms based on the VDI-SS at baseline (61.9% vs. 77.3%; p < 0.001) and after one month (78.9% vs. 93.7%, p < 0.001); and more significantly impaired quality of life according to the VDI-HRQoLS at baseline (77.4% vs. 91.8%, p < 0.001) and after one month (86.3% vs. 97.6%, p < 0.001). On the one-month follow-up, the subgroups of patients with moderate and severe scores of the BAI were higher in the MG (39.2%, n = 24) than in the BPPV w/o MG (21.8%, n = 14) and the number of patients who had normal scores of the BDI was lower in the MG than in the BPPV w/o MG (67.1% vs. 87.5%, p = 0.038). CONCLUSION Clinicians are advised to inquire about migraine when evaluating patients with BPPV because it may lead to more intricate and severe clinical presentation. Further studies will be elaborated the genuine nature of the causal relationship between migraine and BPPV.
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Affiliation(s)
- Seda Çakır
- Department of Neurology, Acıbadem University School of Medicine, İçerenköy. Kayışdağı Cad. No: 32. Ataşehir, İstanbul, 34752, Turkey
| | - Aysenur Sahin
- Department of Neurology, Acıbadem University School of Medicine, İçerenköy. Kayışdağı Cad. No: 32. Ataşehir, İstanbul, 34752, Turkey
| | | | | | - İbrahim Sertdemir
- Department of Biostatistics and Bioinformatics, Acıbadem University, İstanbul, Turkey
| | - Nazım Korkut
- Department of Otorhinolaryngology, Acıbadem Maslak Hospital, İstanbul, Turkey
| | - Pınar Yalınay Dikmen
- Department of Neurology, Acıbadem University School of Medicine, İçerenköy. Kayışdağı Cad. No: 32. Ataşehir, İstanbul, 34752, Turkey.
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An JB, Kim J, Park SH, Yoon J, Choo OS, Park SK, Chang J. Pediatric Benign Paroxysmal Positional Vertigo: Degree of Nystagmus and Concurrent Dizziness Differs from Adult BPPV. J Clin Med 2024; 13:1997. [PMID: 38610761 PMCID: PMC11012783 DOI: 10.3390/jcm13071997] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 03/22/2024] [Accepted: 03/27/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Benign paroxysmal positional vertigo (BPPV) is characterized by brief, intense episodes of vertigo triggered by abrupt changes in head position. It is generally accepted as being most common in adults, while it is regarded as rare in children. It is necessary to compare the disease between pediatric and adult patients for a better understanding of the disease's characteristics and its natural history. This study aimed to identify the clinical characteristics of BPPV in children and compare them with those of adult BPPV patients. Methods: All children ≤ 18 years old who were diagnosed with BPPV were selected by searching the electronic database of our hospital. Clinical features were identified by medical record review. For adult patients, we collected data from patients > 19 years of age. Results: A total of 30 pediatric (13.65 ± 4.15 years old) and 264 adult patients (60.86 ± 13.74 years old) were included in the study. Among pediatric patients, the lateral canals were involved in 80% and the posterior canals in 16.67%. In adult patients, the lateral and posterior canals were involved similarly (p = 0.007). The degree of nystagmus in pediatric patients was 6.82 ± 12.09, while in adults it was 15.58 ± 20.90 (p < 0.001). The concurrent dizziness disorder was higher in the pediatric group and recurrence was higher in the adult group. In the regression analysis, it was found that adult patients had a stronger nystagmus with a value of 6.206 deg/sec, and the risk of concurrent dizziness disorder was found to be 5.413 times higher in the pediatric group (p < 0.05). Conclusions: BPPV occurs in pediatric patients with lower prevalence, but it cannot be overlooked. In the pediatric group, a relatively high proportion of patients demonstrated lateral canal involvement, weaker nystagmus, and additional dizziness disorder.
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Affiliation(s)
- Jun Beom An
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea
| | - Jisu Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea
| | - Seok Hyun Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea
| | - Joonsung Yoon
- Hallym Medical School, Hallym University College of Medicine, Chuncheon Campus, Chuncheon 24252, Republic of Korea
| | - Oak Sung Choo
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea
| | - Su-Kyoung Park
- PSK99-Ear Nose and Throat Clinic, Seoul 07442, Republic of Korea
| | - Jiwon Chang
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Kangnam Sacred Heart Hospital, Seoul 07441, Republic of Korea
- Department of Otorhinolaryngology-Head & Neck Surgery, Korea University Anam Hospital, 73 Goryeodae-ro, Seongbuk-gu, Seoul 02841, Republic of Korea
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Zach H, Retter D, Schmoeger M, Rommer P, Willinger U, Schwarz FK, Wiest G. Seasonality of benign paroxysmal positional vertigo : A retrospective study from Central Europe. Wien Klin Wochenschr 2024; 136:25-31. [PMID: 37405489 PMCID: PMC10776474 DOI: 10.1007/s00508-023-02237-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 05/30/2023] [Indexed: 07/06/2023]
Abstract
BACKGROUND Although benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in clinical practice, factors influencing the pathophysiology remain not fully understood. OBJECTIVE Here we aim to investigate possible seasonal influences on the occurrence of BPPV in Vienna, a city located in a Central European country with pronounced seasonal fluctuations. METHODS We retrospectively investigated data from 503 patients presenting with BPPV to the outpatient clinics of the Medical University of Vienna between 2007 and 2012. Analyses included age, gender, type of BPPV, seasonal assignment, as well as daylight hours and the temperature in Vienna at symptom onset. RESULTS Out of 503 patients (159 male, 344 female, ratio 1:2.2; mean age 60 ± 15.80 years), most patients presented with posterior (89.7%) and left-sided (43.1%) BPPV. There was a significant seasonal difference (χ2 p = 0.036) with the majority of symptoms occurring in winter seasons (n = 142), followed by springtime (n = 139). Symptom onset did not correlate with the average temperature (p = 0.24) but on the other hand very well with daylight hours (p < 0.05), which ranged from 8.4 h per day in December, to an average of 15.6 h in July. CONCLUSION Our results show a seasonal accumulation of BPPV during winter and springtime, which is in line with previous studies from other climatic zones, suggesting an association of this seasonality with varying vitamin D levels.
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Affiliation(s)
- Heidemarie Zach
- Neurotology Outpatient Clinic, Dept. of Neurology, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria
| | - David Retter
- Neurotology Outpatient Clinic, Dept. of Neurology, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria
| | - Michaela Schmoeger
- Neurotology Outpatient Clinic, Dept. of Neurology, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria
| | - Paulus Rommer
- Neurotology Outpatient Clinic, Dept. of Neurology, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria
| | - Ulrike Willinger
- Neurotology Outpatient Clinic, Dept. of Neurology, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria
| | - Felix K Schwarz
- Neurotology Outpatient Clinic, Dept. of Neurology, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria
| | - Gerald Wiest
- Neurotology Outpatient Clinic, Dept. of Neurology, Medical University of Vienna, Waehringerguertel 18-20, 1090, Vienna, Austria.
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Halmágyi GM, Akdal G, Welgampola MS, Wang C. Neurological update: neuro-otology 2023. J Neurol 2023; 270:6170-6192. [PMID: 37592138 PMCID: PMC10632253 DOI: 10.1007/s00415-023-11922-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/19/2023]
Abstract
Much has changed since our last review of recent advances in neuro-otology 7 years ago. Unfortunately there are still not many practising neuro-otologists, so that most patients with vestibular problems need, in the first instance, to be evaluated and treated by neurologists whose special expertise is not neuro-otology. The areas we consider here are mostly those that almost any neurologist should be able to start managing: acute spontaneous vertigo in the Emergency Room-is it vestibular neuritis or posterior circulation stroke; recurrent spontaneous vertigo in the office-is it vestibular migraine or Meniere's disease and the most common vestibular problem of all-benign positional vertigo. Finally we consider the future: long-term vestibular monitoring and the impact of machine learning on vestibular diagnosis.
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Affiliation(s)
- Gábor M Halmágyi
- Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia.
- Central Clinical School, University of Sydney, Sydney, Australia.
| | - Gülden Akdal
- Neurology Department, Dokuz Eylül University Hospital, Izmir, Turkey
- Neurosciences Department, Dokuz Eylül University Hospital, Izmir, Turkey
| | - Miriam S Welgampola
- Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, University of Sydney, Sydney, Australia
| | - Chao Wang
- Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, University of Sydney, Sydney, Australia
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Saniasiaya J, Kulasegarah J, Narayanan P. Outcome of canalith repositioning manoeuvre in benign paroxysmal positional vertigo in children and adolescents: A systematic review. Clin Otolaryngol 2023; 48:371-380. [PMID: 36640123 DOI: 10.1111/coa.14038] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2022] [Revised: 12/24/2022] [Accepted: 01/07/2023] [Indexed: 01/15/2023]
Abstract
BACKGROUND Benign paroxysmal positional vertigo (BPPV) is a debilitating condition that has been significantly described in adults. Recent data points out that BPPV occurs in children as well. Canalith repositioning manoeuvre (CRM) has shown promising results amongst adult patients with BPPV. OBJECTIVE We reviewed the literature to determine the outcome of CRM in children and adolescents with BPPV. METHODS A literature search was conducted over 1 month (March 2022). The primary outcome was defined as the resolution of positional nystagmus and symptoms, and secondary outcomes were determined by the presence of recurrence and the number of attempts of CRM. RESULTS Ten articles were selected based on our objective and selection criteria. A total of 242 patients were included, with a mean of 10.9 years. BPPV was diagnosed based on history and positional nystagmus in all patients (100%). CRM was performed in 97.9% of patients, whereby 80.5% recovered following a single attempt of CRM. Recurrence of symptoms was identified in 10% of patients with no reported major complications. CONCLUSION CRM has demonstrated promising results in children and adolescents. The quality of evidence is limited until a better-quality study involving randomised controlled studies with a larger sample size is completed.
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Affiliation(s)
- Jeyasakthy Saniasiaya
- Department of Otorhinolaryngology, Faculty of Medicine, Universiti Malaya, Jalan Universiti, Kuala Lumpur, Malaysia
| | - Jeyanthi Kulasegarah
- Department of Otorhinolaryngology, Faculty of Medicine, Universiti Malaya, Jalan Universiti, Kuala Lumpur, Malaysia
| | - Prepageran Narayanan
- Department of Otorhinolaryngology, Faculty of Medicine, Universiti Malaya, Jalan Universiti, Kuala Lumpur, Malaysia
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Wang A, Zhou G, Brodsky JR. Characteristics of Benign Paroxysmal Positional Vertigo in Young Children. Laryngoscope 2023; 133:694-699. [PMID: 35524589 DOI: 10.1002/lary.30172] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Revised: 03/29/2022] [Accepted: 04/19/2022] [Indexed: 11/08/2022]
Abstract
OBJECTIVES This study aimed to determine the clinical characteristics of benign paroxysmal positional vertigo (BPPV) in young children. STUDY DESIGN Retrospective case review. METHODS All children <10 years old that have been diagnosed with BPPV at our pediatric vestibular program between December 2012-July 2021 were selected. Clinical features were identified by medical record review, including demographics, comorbidities, canal involvement, response to treatment, and incidence of recurrence. RESULTS A total of 34 children were diagnosed with BPPV with a mean age of 7.9 years old (SD ± 1/7; range 5-9) at the time of diagnosis and a male:female ratio of 1:1. Involved semicircular canals included posterior in 82% (n = 28), horizontal in 41% (n = 14), and superior in 24% (n = 8) of patients, respectively. Comorbid diagnoses included migraine (n = 14), concussion (n = 10), acute vestibular syndrome (n = 4), and persistent postural perceptual dizziness (n = 6). Recurrence with initially confirmed resolution occurred in 10 patients (29%) with a mean of 2.5 recurrences per patient (SD: 2.2; range 1-8). A family history of vertigo or migraine was identified in 11 and 17 patients, respectively. CONCLUSIONS BPPV is a cause of vertigo in children that may be overlooked. A relatively high proportion of patients demonstrated horizontal or superior canal involvement, recurrence, and additional comorbid causes of dizziness. Thus, providers evaluating young children with dizziness should perform diagnostic maneuvers to evaluate BPPV of all semicircular canals and continue to monitor children after successful treatment for recurrence. LEVEL OF EVIDENCE 4, Case Series Laryngoscope, 133:694-699, 2023.
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Affiliation(s)
- Alicia Wang
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Guangwei Zhou
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Jacob R Brodsky
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Department of Otolaryngology, Harvard Medical School, Boston, Massachusetts, U.S.A
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Shih IA, Hsu CY, Li TC, Wang SJ. Benign Paroxysmal Positional Vertigo Is Associated with an Increased Risk for Migraine Diagnosis: A Nationwide Population-Based Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:3563. [PMID: 36834253 PMCID: PMC9962241 DOI: 10.3390/ijerph20043563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 01/30/2023] [Accepted: 02/11/2023] [Indexed: 06/18/2023]
Abstract
Previous studies reported an increased risk of benign paroxysmal positional vertigo (BPPV) in patients with migraine. Hence, we aimed to assess the risk of migraine in patients with BPPV. This cohort study was conducted using the Taiwan National Health Insurance Research Database. The BPPV cohort consisted of patients aged <45 years with a diagnosis of BPPV between 2000 and 2009. An age- and sex-matched comparison group free from a history of BPPV or migraine was selected. All cases were followed up from 1 January 2000 to 31 December 2010 or until death or a diagnosis of migraine. The baseline demographic characteristics in both groups were compared using Student's t-test and the chi-square test. Cox proportional hazards regression analysis was used to estimate the hazard ratio for migraine in the BPPV cohort compared with the comparison group after adjustment for age, sex, and comorbidities. Notably, 117 of the 1386 participants with BPPV and 146 of the 5544 participants without BPPV developed migraine. After adjustment for age, sex, and comorbidities, BPPV showed an adjusted hazard ratio indicating a 2.96-fold increased risk of migraine (95% confidence interval: 2.30-3.80, p < 0.001). We found that BPPV is associated with an increased risk of a migraine diagnosis.
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Affiliation(s)
- I-An Shih
- Department of Public Health, College of Public Health, China Medical University, Taichung 404327, Taiwan
- Department of Neurology, Ching Chyuan Hospital, Taichung 428433, Taiwan
- Premium Healthcare Center, Chung Shan Medical University Hospital, Taichung 402306, Taiwan
| | - Chung-Y. Hsu
- Graduate Institute of Biomedical Sciences, China Medical University, Taichung 406040, Taiwan
| | - Tsai-Chung Li
- Department of Public Health, College of Public Health, China Medical University, Taichung 404327, Taiwan
- Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung 413305, Taiwan
| | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei 11217, Taiwan
- Department of Neurology, National Yang-Ming Chiao Tung University School of Medicine, Taipei 11217, Taiwan
- Institute of Brain Science, National Yang-Ming Chiao Tung University School of Medicine, Taipei 11217, Taiwan
- Brain Research Center, National Yang-Ming Chiao Tung University School of Medicine, Taipei 11217, Taiwan
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11
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Peterson JD, Brodsky JR. Evaluation and management of paediatric vertigo. Curr Opin Otolaryngol Head Neck Surg 2022; 30:431-437. [PMID: 36165009 DOI: 10.1097/moo.0000000000000849] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW This review summarizes the most current information on cause, evaluation and treatment of dizziness in children. RECENT FINDINGS There has been an increased understanding of the multifactorial cause of dizziness in the paediatric population. Quantitative vestibular testing is increasingly used and valuable as a diagnostic adjunct. Vestibular rehabilitation, migraine hygiene, psychological therapies, pharmaceuticals and/or surgery can be used as well tolerated and effective treatments for vertigo in children and adolescents when tailored to cause. SUMMARY Paediatric vertigo can be effectively evaluated through careful history taking and physical examination along with adjunctive tests, such as vestibular testing and audiometry, when appropriate. Options for treatment of vestibular disorders in children and adolescents have greatly expanded in recent years allowing for the effective management of nearly all cases of paediatric vertigo, though a multimodal and/or multidisciplinary approach is often needed.
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Affiliation(s)
- Joseph D Peterson
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital
| | - Jacob R Brodsky
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital
- Harvard Medical School, Boston, Massachusetts, USA
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12
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Kim EK, Pasquesi L, Sharon JD. Examining Migraine as a Predictor of Benign Paroxysmal Positional Vertigo Onset, Severity, Recurrence, and Associated Falls. Cureus 2022; 14:e28278. [PMID: 36168362 PMCID: PMC9505626 DOI: 10.7759/cureus.28278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/22/2022] [Indexed: 11/05/2022] Open
Abstract
Introduction: The comorbidity of migraine and benign paroxysmal positional vertigo (BPPV) is well-established, yet the impact of migraine on the BPPV phenotype remains understudied. Methods: A retrospective analysis of patients at a tertiary dizziness/vertigo clinic diagnosed with BPPV from 2015 and 2020 was conducted. The study's primary outcomes were the age of BPPV onset, Dizziness Handicap Index (DHI), BPPV recurrence, and dizziness-related falls. Results: In our cohort of 255 BPPV patients, 44.7% had a history of migraine. Those with migraine had an earlier age of BPPV onset than individuals without migraine (60.2 vs. 65.4, p = 0.0018). Migraineurs and non-migraineurs did not differ in their DHI (44.7 vs. 41.6, p= 0.44), recurrence rates (48.3% vs. 40.4%, p= 0.21), and falls (32.5% vs. 37.6%, p = 0.39). Among individuals with horizontal canal BPPV, a higher proportion of migraineurs experienced falls than non-migraineurs (50.0% vs. 6.3%, p = 0.02). Conclusions: Migraineurs experience BPPV at a younger age than those without migraine. This finding suggests that migraine, which has been shown to cause inner ear damage, predisposes individuals to developing BPPV earlier. Migraine was also associated with a higher rate of falls among patients with horizontal canal BPPV, indicating that a migraine history may impact the phenotype of BPPV.
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Analysis of Bone Mineral Density and Bithermal Caloric Test Results in Unilateral Idiopathic Benign Paroxysmal Positional Vertigo Patients. Otol Neurotol 2022; 43:e780-e786. [PMID: 35763493 DOI: 10.1097/mao.0000000000003565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE Benign paroxysmal positional vertigo (BPPV) is the most frequently diagnosed type of peripheral vestibular vertigo. Studies have reported a possible association between BPPV and osteoporosis; however, there is still a lack of evidence. This study aimed to investigate the characteristics of bone mineral density (BMD) and bithermal caloric test results in patients with unilateral posterior canal idiopathic benign paroxysmal positional vertigo (pc-iBPPV). METHODS BMD was measured in 65pc-iBPPV menopausal female patients and 65 healthy controls using dual-energy xray absorptiometry and then compared the T-score of BMD between the two groups. The bithermal caloric test was also performed with video nystagmography and the relationship between canal paresis, directional preponderance, T-score, and recurrence were analyzed. RESULTS Lower T-scores were observed in pc-iBPPV patients compared with the normal subjects. Among 65 pc-iBPPV patients, free recurrence was observed in 38 (58.5%), single recurrence was noted in 14 (21.5%), and multiple recurrences were seen in 13 (20%) patients. The proportion of positive T-score and CP value increased with the pc-BPPV recurrence frequency. Statistically, a significant difference was found only in T-score, indicating that recurrence was raised with a decrement of T-score. The proportion of positive CP values tended to increase as BMD decreased. CONCLUSION The decrement of BMD might be one of the pathogeneses in patients with unilateral pc-iBPPV and associated with multiple recurrences. Moreover, positive CP value cannot be regarded as a predictive factor for recurrence; however, there is a clear association between CP and BMD.
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A Predictive Model of Bilateral Sensorineural Hearing Loss in Meniere Disease Using Clinical Data. Ear Hear 2021; 43:1079-1085. [PMID: 34799494 DOI: 10.1097/aud.0000000000001169] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Meniere disease (MD) is defined by a clinical syndrome of recurrent attacks of spontaneous vertigo associated with tinnitus, aural fullness, and sensorineural hearing loss (SNHL). Most patients have unilateral SNHL, but some of them will develop contralateral SNHL during the course of the disease. Several studies have reported a frequency of 2 to 73% SNHL in the second ear, according to the duration of disease and the period of follow-up. We hypothesize that unilateral and bilateral MD are different conditions, the first would initially involve the apical turn of the cochlea, while bilateral MD would affect the entire length of the cochlea. The aim of the study is to search for clinical predictors of bilateral SNHL in MD to build a predictive model of bilateral involvement. DESIGN A retrospective, longitudinal study including two cohorts with a total of 400 patients with definite MD was carried out. The inception cohort consisted of 150 patients with MD and the validation cohort included 250 cases. All of the cases were diagnosed of unilateral MD according to their hearing loss thresholds. The following variables were assessed as predictors of bilateral SNHL for the two cohorts: sex, age of onset, familiar history of MD, migraine and high-frequency hearing loss (HFHL, defined if hearing threshold >20 dB in two or more consecutive frequencies from 2 to 8 KHz). A descriptive analysis was carried out according to the presence of HFHL in the first audiogram for the main variables. By using multiple logistic regression, we built-up several predictive models for the inception cohort and validated it with the replication cohort and merged dataset. RESULTS Twenty-three (19.3%) and 78 (41%) of patients with HFHL developed contralateral SNHL during the follow-up, in the inception and validation cohorts, respectively. In the inception cohort, the best predictive model included HFHL in the first audiogram (OR = 6.985, p = 0.063) and the absence of migraine (OR = 0.215, p = 0.144) as clinical predictors for bilateral SNHL [area under the curve (AUC) = 0.641, p = 0.002]. The model was validated in the second cohort (AUC = 0.621, p < 0.001). Finally, we merged both datasets to improve the precision of the model including HFHL in the first audiogram (OR = 3.168, p = 0.001), migraine (OR = 0.482, p = 0.036) and age of onset >35 years old (OR = 2.422, p = 0.006) as clinical predictors (AUC = 0.639, p < 0.001). CONCLUSIONS A predictive model including the age of onset, HFHL in the first audiogram and migraine can help to assess the risk of bilateral SNHL in MD. This model may have significant implications for clinical management of patients with MD.
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Increased Risk of Neurodegenerative Dementia after Benign Paroxysmal Positional Vertigo. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph181910553. [PMID: 34639856 PMCID: PMC8507776 DOI: 10.3390/ijerph181910553] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Revised: 10/05/2021] [Accepted: 10/05/2021] [Indexed: 11/25/2022]
Abstract
The aim of the present study was to estimate the risk of dementia in patients with benign paroxysmal positional vertigo (BPPV), using a population cohort. Data from the Korean National Health Insurance Service-National Sample Cohort for the population ≥60 years of age from 2002 to 2013 were collected. A total of 11,432 individuals with dementia were matched for age, sex, income, region of residence, hypertension, diabetes, and dyslipidemia with 45,728 individuals comprising the control group. The crude (simple) and adjusted odds ratios (ORs) of dementia in BPPV patients were analyzed using non-conditional logistic regression analyses. Subgroup analyses were conducted according to age and sex. A history of BPPV characterized 5.3% (609/11,432) of the dementia group and 2.6% (1,194/45,728) of the control group (p < 0.001). The adjusted OR of dementia for BPPV was 1.14 (95% CI = 1.03–1.26, p = 0.009). In subgroup analyses according to age and sex, males had higher ORs of dementia for BPPV. BPPV increases the risk of dementia in the 60 years of age or older population.
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Teggi R, Guidetti R, Gatti O, Guidetti G. Recurrence of benign paroxysmal positional vertigo: experience in 3042 patients. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2021; 41:461-466. [PMID: 34734582 PMCID: PMC8569667 DOI: 10.14639/0392-100x-n1233] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 05/10/2021] [Indexed: 12/20/2022]
Abstract
OBJECTIVES Benign paroxysmal positional vertigo (BPPV) is a disorder of the inner ear with a high rate of recurrence. Vascular disorders, migraine and autoimmune disorders have been considered facilitating factors for relapsing episodes. Our aim was to assess the role of vascular disorders, migraine and anti-thyroid antibodies in patients with recurrences. METHODS We retrospectively analysed records of 3042 patients treated for BPPV without other lifetime vertigo. Clinical data included previous vascular disorders of the central nervous system, heart disorders, migraine and recent head trauma. The presence of anti-thyroid autoantibodies was assessed in all patients. RESULTS Mean age of the first BPPV was 52.8 ± 14.5 years; there were 2339 females (76.9%), while 2048 (67.3%) of patients presented recurrences within two years of follow-up. Previous disorders of the central nervous system, presence of anti-thyroid antibodies, head trauma and migraine showed an association with recurrences. Above all, in subjects having the first BPPV while aged between 40 and 60 years, anti-thyroid antibodies were predictive for recurrences. CONCLUSIONS Our data are consistent with the hypothesis that anti-thyroid autoantibodies may play a role in recurrences in subjects with initial manifestations between 40 and 60 years.
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Affiliation(s)
- Roberto Teggi
- Division of Otolaryngology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | | | - Omar Gatti
- Division of Otolaryngology, IRCCS San Raffaele Scientific Institute, Milan, Italy
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Hilton DB, Luryi AL, Bojrab DI, Babu SC, Hong RS, Bojrab DI, Santiago Rivera OJ, Schutt CA. Comparison of associated comorbid conditions in patients with benign paroxysmal positional vertigo with or without migraine history: A large single institution study. Am J Otolaryngol 2020; 41:102650. [PMID: 32702572 DOI: 10.1016/j.amjoto.2020.102650] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/24/2020] [Accepted: 06/30/2020] [Indexed: 11/19/2022]
Abstract
PURPOSE In the largest reported United States (U.S.) cohort of benign paroxysmal positional vertigo (BPPV), does the presence or absence of migraine correlate with increased associations of other factors? MATERIALS & METHODS A retrospective chart review from a single U.S. neurotology center. Adult patients with BPPV from 2003 to 2017 classified into two groups: 1) with migraine; 2) without migraine. RESULTS The prevalence of self-reported migraine history in a BPPV-positive population (n = 1481) was 25.8% (n = 382). Among those with BPPV and migraine, 88.5% were female, 8.1% had diabetes, 22.5% had prior history of BPPV, 8.9% had Meniere's disease and recurrence rate was 38.3%. No statistically significant differences between recurrence or resolution rates between the two groups were demonstrated (p > 0.05). Adjusted logistic regression model found that women and those with a prior history of BPPV had significantly higher odds of having both BPPV and migraine conditions compared to their counterparts. In contrast, older age and diabetes were associated with significantly lower odds of concomitant BPPV and migraine. CONCLUSIONS The prevalence of migraine among the study sample was 25.8%. Female gender, prior history of BPPV, younger age, and lack of diabetes were independently associated with the concurrent comorbidity of BPPV and migraine. These data further substantiate previously reported rates (from smaller studies); and, demonstrate that recurrence and resolution rates are not worse in those with BPPV and migraine compared to the general BPPV population. Findings support an association between migraine and BPPV and enhances one's ability to accurately counsel patients regarding these diseases.
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Affiliation(s)
- Daniel B Hilton
- Department of Surgery, McLaren Health Care/Oakland - Michigan State University, Pontiac, MI, United States
| | - Alexander L Luryi
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Farmington, MI, United States.
| | - Dennis I Bojrab
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Farmington, MI, United States.
| | - Seilesh C Babu
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Farmington, MI, United States
| | - Robert S Hong
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Farmington, MI, United States
| | - Dennis I Bojrab
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Farmington, MI, United States
| | - Olga J Santiago Rivera
- Research Faculty, McLaren Health Care/Oakland - Michigan State University, Pontiac, MI, United States.
| | - Christopher A Schutt
- Department of Neurotology, Michigan Ear Institute, St. John Providence Hospital and Medical Centers, Farmington, MI, United States.
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Comolli L, Goeldlin M, Gaschen J, Kammer C, Sauter TC, Caversaccio MD, Kalla R, Fischer U, Mantokoudis G. [Dizziness and vertigo in a tertiary ENT emergency department]. HNO 2020; 68:763-772. [PMID: 32221628 DOI: 10.1007/s00106-020-00857-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Although vestibular symptoms are amongst the most frequent reasons for seeking emergency medical help, many patients remain undiagnosed. OBJECTIVE In this cross-sectional study, we investigated the spectrum of vertigo and dizziness in a tertiary ear, nose, and throat (ENT) emergency department (ED). Furthermore, we investigated the attendant symptoms, clinical signs, and the diagnostic tests performed. METHODS We screened all ED reports from 01/2013 to 12/2013 for adult patients with vestibular symptoms referred to the ENT department. RESULTS In total, we found 2596 cases with reported vestibular symptoms in the ED as a main or accompanying complaint. Of these, 286 were referred to the ENT specialist directly (n = 98) or via other major medical specialties (n = 188). Benign paroxysmal positional vertigo (BPPV) was the most frequent diagnosis in our study (n = 46, 16.1%), followed by vestibular neuritis (n = 44, 15.4%), otitis media (n = 20, 7%), and 9 patients (3.1%) had an ischemic stroke or a transient ischemic attack. In 70 (24.5%) cases, dizziness was not further specified. CONCLUSION BPPV is the most frequent diagnosis seen in the ED; however, physicians need to document nystagmus more precisely and perform diagnostic tests systematically, in order to make an accurate diagnosis. To avoid misdiagnoses, ED physicians and ENT specialists should be able to recognize central signs in patients with an acute vestibular syndrome. Every fourth patient does not receive a definitive diagnosis. Diagnostic ED workup for patients with dizziness needs further improvement.
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Affiliation(s)
- L Comolli
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Schweiz
| | - M Goeldlin
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Schweiz
| | - J Gaschen
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Schweiz
| | - C Kammer
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Schweiz
| | - T C Sauter
- Department of Emergency Medicine, Inselspital, Bern University Hospital, University of Bern, Bern, Schweiz
| | - M D Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Schweiz
| | - R Kalla
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Schweiz
| | - U Fischer
- Department of Neurology, Inselspital, University Hospital Bern, University of Bern, Bern, Schweiz
| | - G Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern, University of Bern, Bern, Schweiz.
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Wang A, Zhou G, Lipson S, Kawai K, Corcoran M, Brodsky JR. Multifactorial Characteristics of Pediatric Dizziness and Imbalance. Laryngoscope 2020; 131:E1308-E1314. [PMID: 32809223 DOI: 10.1002/lary.29024] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/26/2020] [Accepted: 07/21/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To examine the relative prevalence of individual diagnoses in children and adolescents presenting with dizziness and/or imbalance, and to assess the proportion of patients assigned multiple contributing diagnoses. STUDY DESIGN Retrospective cohort study. METHODS We retrospectively reviewed our internal database of all patients seen at our pediatric vestibular program between January 2012 and March 2019 to determine the incidence of common diagnoses and groups of diagnoses for patients ages 21 or younger. RESULTS One thousand twenty-one patients were included with a mean age of 12.5 ± 4.9 years (range: 9 months-21 years). Of this total, 624 patients were female and 397 were male. Common diagnoses included vestibular migraine (VM; 35.0%), benign paroxysmal positional vertigo (BPPV; 21.6%), primary dysautonomia (15.7%), anxiety disorder (13.5%), and persistent postural perceptual dizziness (PPPD; 11.2%). A high proportion of patients (44.4%) received multiple contributing diagnoses. VM was frequently diagnosed with BPPV or PPPD, and 22 patients were diagnosed with all three concurrently. CONCLUSION The causes of dizziness and imbalance in the pediatric population are diverse, and many patients have multiple diagnoses that are often interrelated. It is important that providers recognize that the causes of vestibular symptoms in children and adolescents may be multifactorial and may span across multiple specialties. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1308-E1314, 2021.
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Affiliation(s)
- Alicia Wang
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Guangwei Zhou
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Sophie Lipson
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Tufts School of Medicine, Boston, Massachusetts, U.S.A
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Meghan Corcoran
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Jacob R Brodsky
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
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Dornhoffer JR, Liu YF, Donaldson L, Rizk HG. Factors implicated in response to treatment/prognosis of vestibular migraine. Eur Arch Otorhinolaryngol 2020; 278:57-66. [DOI: 10.1007/s00405-020-06061-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2020] [Accepted: 05/14/2020] [Indexed: 10/24/2022]
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Vestibular Lab Testing: Interpreting the Results in the Headache Patient with Dizziness. Curr Neurol Neurosci Rep 2020; 20:16. [PMID: 32430768 DOI: 10.1007/s11910-020-01036-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE OF REVIEW To provide an overview of vestibular lab testing and to familiarize the reader with common results observed in headache patients with dizziness. RECENT FINDINGS The latest research indicates variable levels of both peripheral and central vestibular dysfunction in headache populations with dizziness. Mechanisms may include vestibulocerebellar loss of inhibition, central vestibular network misfiring, and peripheral pathology aggravating central hypersensitization. Headache patients are commonly affected by dizziness stemming from various etiologies. Although history is still the gold standard in diagnosis, vestibular lab testing can identify the integrity of vestibular function. Research is emerging and future directions are encouraging.
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Kim SK, Hong SM, Park IS, Choi HG. Association Between Migraine and Benign Paroxysmal Positional Vertigo Among Adults in South Korea. JAMA Otolaryngol Head Neck Surg 2020; 145:307-312. [PMID: 30676633 DOI: 10.1001/jamaoto.2018.4016] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Importance Patients with migraine often experience various types of vertigo, and several studies have suggested an epidemiologic and physiologic association of migraine and vertigo with vestibule. However, few researchers have investigated the association between migraine and benign paroxysmal positional vertigo (BPPV). Objective To determine the incidence of BPPV in individuals with migraine in a large national population-based sample. Design, Setting, and Participants This cohort study obtained data from the Korean Health Insurance Review and Assessment Service covering the period January 1, 2002, through December 31, 2013. These data included personal information, health insurance claim codes, diagnostic codes, death records, socioeconomic data, and medical examination data for each individual in the database. A 1:4 matching method was used to select individuals for the migraine group (n = 40 682) and the control group (n = 162 728). Individuals who had a history of BPPV before the index date, for whom a match could not be identified, and who received a migraine diagnosis before age 20 years were excluded from the analysis. Data analysis was conducted from September 1, 2015, to December 31, 2017. Main Outcomes and Measures The crude and adjusted (by age, sex, income, region of residence, and medical history [hypertension, diabetes, or dyslipidemia]) hazard ratios for migraine and BPPV were analyzed using the Cox proportional hazards regression model. Results Of the 40 682 individuals in the migraine group, 10 381 (25.5%) were male and 30 301 (74.5%) were female. Of the 162 728 controls, 41 524 (25.5%) were male and 121 204 (74.5%) were female. The incidence of BPPV was statistically significantly higher in the migraine group than in the control group (2431 [6.0%] vs 3677 [2.3%]). Migraine increased the risk of BPPV (adjusted hazard ratio, 2.54; 95% CI, 2.41-2.68). In a subgroup analysis, the incidence of BPPV in all age groups and in both men and women was statistically significantly higher in the migraine group than in the control group. The incidence of BPPV was the highest in men younger than 40 years (adjusted hazard ratio, 4.49; 95% CI, 3.05-6.62), and the HR decreased in both men and women as age increased. Conclusions and Relevance Migraine appeared to be statistically significantly associated with higher incidence of BPPV; future studies are needed to determine the association between BPPV and specific factors related to migraine.
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Affiliation(s)
- Sung Kyun Kim
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Dongtan, South Korea
| | - Seok Min Hong
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Dongtan, South Korea
| | - Il-Seok Park
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Dongtan, South Korea
| | - Hyo Geun Choi
- Department of Otorhinolaryngology-Head & Neck Surgery, Hallym University College of Medicine, Anyang, South Korea
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Can a Chronic BPPV With a History of Trauma be the Trigger of Symptoms in Vestibular Migraine, Myalgic Encephalomyelitis/Chronic Fatigue Syndrome (ME/CFS), and Whiplash Associated Disorders (WAD)? A Retrospective Cohort Study. Otol Neurotol 2020; 40:96-102. [PMID: 30303941 DOI: 10.1097/mao.0000000000002020] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
BACKGROUND In patients with chronic benign paroxysmal positional vertigo (BPPV), i.e., chronic vestibular multicanalicular canalithiasis (CVMCC), abnormal signals are transmitted from diseased labyrinths via the healthy vestibular nuclei complex to their end organs. The vestibulo-thalamo-cortical reflex as proposed in vestibular migraine is just one of these reflexes. In a group of patients diagnosed with CVMCC otolith repositioning maneuvers specific for each semicircular canal (SCC) ameliorated pain and other symptoms in 90%. Increased awareness of CVMCC may reduce suffering and continuous medication. OBJECTIVE To evaluate if CVMCC can be the trigger of symptoms in vestibular migraine, myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS), and whiplash associated disorders (WAD). STUDY DESIGN Retrospective consecutive observational cohort study. SETTING Ambulatory at a private Otoneurology Centre. PATIENTS One hundred sixty-three patients with CVMCC and a history of trauma. INTERVENTION Based on the symptoms (structured symptom questionnaire), the patients are post hoc sub grouped according to the criteria of the different diagnoses. MAIN OUTCOME MEASURE Frequency of patients with CVMCC who fulfill the criteria of the different diagnoses. RESULTS 98% of all patients with CVMCC fulfill the Barany Society criteria of a probable vestibular migraine; 17% fulfill the International Classification of Headache Disorders defined vestibular migraine criteria; 63% fulfill the Fukuda criteria of ME/CFS; 100% of the patients with WAD suffer from CVMCC. CONCLUSION This survey supports the hypothesis that CVMCC can be the trigger of symptoms in vestibular migraine, ME/CFS, and WAD. The actual diagnosis the patient receives is often in accordance with the patient's dominant symptom.
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Baker BJ, May C. Meniere’s Disease and Concurrent BPPV in an Older Adult: A Case Report. PHYSICAL & OCCUPATIONAL THERAPY IN GERIATRICS 2020. [DOI: 10.1080/02703181.2019.1667471] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Affiliation(s)
- Barbara J. Baker
- Physical Therapy Department, Grand Valley State University, Calvin College Rehabilitation Services, Grand Rapids, MI, USA
| | - Christopher May
- Physical Therapy Department, Grand Valley State University, Calvin College Rehabilitation Services, Grand Rapids, MI, USA
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Han K, Yun YM, Moon SG, Kim CH. Bone mineral density and serum 25-hydroxyvitamin D in subtypes of idiopathic benign paroxysmal positional vertigo. Am J Otolaryngol 2020; 41:102313. [PMID: 31732302 DOI: 10.1016/j.amjoto.2019.102313] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2019] [Accepted: 10/01/2019] [Indexed: 11/28/2022]
Abstract
Although the etiology of benign paroxysmal positional vertigo (BPPV) is idiopathic in most cases, the association of osteoporosis or vitamin D deficiency with BPPV has attracted much interest recently. While it is generally accepted that osteoporosis or vitamin D deficiency is related to the occurrence and/or recurrence of BPPV, the difference in serum vitamin D level and bone mineral density (BMD) among different subtypes of BPPV has not been investigated. We aimed to compare T-score of BMD score and serum 25-hydroxyvitamin D level among idiopathic BPPV patients with a different subtype. This study included 117 consecutive patients with idiopathic BPPV (26 men and 91 women; mean age, 55 ± 11 years; age range, 25 to 78 years) who underwent blood sampling for serum 25-hydroxyvitamin D level measurement and bone mineral densitometry of the anterior-posterior lumbar spine and femur between April 2018 and February 2019. Among 117 patients, 49 were diagnosed with posterior semicircular canal (PSCC) BPPV, 24 were diagnosed with lateral semicircular canal (LSCC) canalolithiasis, and 44 were diagnosed with LSCC cupulolithiasis. The mean T-score of BMD was -1.5 ± 0.9 in PSCC BPPV, -1.5 ± 1.3 in LSCC canalolithiasis, and -1.5 ± 1.1 in LSCC cupulolithiasis, which was not significantly different (p = 0.998, One-way ANOVA test). The mean level of 25-hydroxyvitamin D was 22.5 ± 10.6 ng/ml in PSCC BPPV, 26.8 ± 16.0 ng/ml in LSCC canalolithiasis, and 25.4 ± 9.6 ng/ml in LSCC cupulolithiasis, which was not significantly different (p = 0.262, One-way ANOVA test). The proportion of osteoporosis/osteopenia or vitamin D deficiency/insufficiency did not show significant difference among idiopathic BPPV patients with different subtypes, and findings of this study indicate that either serum level of vitamin D or T-score of BMD is not a distinguishable characteristic among different subtypes of BPPV.
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Affiliation(s)
- Kyujin Han
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Yeo-Min Yun
- Department of Laboratory Medicine, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Sung Gyu Moon
- Department of Radiology, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea
| | - Chang-Hee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Research Institute of Medical Science, Konkuk University School of Medicine, Seoul, Republic of Korea.
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26
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Abstract
The pathophysiological mechanism underlying benign paroxysmal positional vertigo (BPPV) is related to free-floating debris/otoliths in the semicircular canal (canalolithiasis) or debris/otoliths attached to the cupula (cupulolithiasis). These debris/otoliths are considered to originally accumulate after detachment from the neuroepithelium of the utricular macula secondary to a type of degeneration. An idiopathic form, which is assumed to occur spontaneously, is diagnosed when the causative pathology is obscure. However, an association between various other systemic or inner ear conditions and BPPV has been reported, indicating the existence of secondary BPPV. This study was performed to present the first review of the pathology underlying BPPV following a complete PubMed/Medline search. In total, 1932 articles published from 1975 to 2018 were reviewed. The articles were classified according to 17 potentially causative factors (aging; migraine; Meniere's disease; infection; trauma; idiopathic sudden sensorineural hearing loss; sleeping habits; osteoporosis and vitamin D insufficiency; hyperglycemia and diabetes mellitus; chronic head and neck pain; vestibule or semicircular canal pathology; pigmentation disorders; estrogen deficiency; neurological disorders; autoimmune, inflammatory, or rheumatologic disorders; familial or genetic predisposition; and allergy). A discussion of the underlying cause of BPPV for each factor is presented.
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Affiliation(s)
- Sertac Yetiser
- Department of Otolaryngology-Head and Neck Surgery, Anadolu Medical Center, Gebze, Kocaeli, Turkey
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Kutlubaev MA, Zamergrad MV. [A role of vascular risk factors in the development of peripheral vestibulopathy]. Zh Nevrol Psikhiatr Im S S Korsakova 2019; 119:85-89. [PMID: 31825395 DOI: 10.17116/jnevro201911909285] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The development of peripheral vestibular disorders are often thought to be associated with vascular mechanisms, taking into account terminal type of inner ear blood supply and other predisposing factors. A number of studies indicates a high frequency of vascular risk factors in the patients with vestibular neuronitis and benign paroxysmal positional vertigo (BPPV). According to other results, migraine is widely spread among patients with Meniere's disease and BPPV. However currently there is no evidence for casual relationship between vascular factors and development of peripheral vestibulopathy. The only exclusion is labyrinthine infarction, which develops as a result of posterior circulation disorder. More research is needed in this area.
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Affiliation(s)
- M A Kutlubaev
- Kuvatov Republican Clinical Hospital, Ufa, Russia; Bashkir State Medical University, Ufa, Russia
| | - M V Zamergrad
- Russian Medical Aacademy for Contuning Postgraduate Education, Moscow, Russia
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28
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Britt CJ, Ward BK, Owusu Y, Friedland D, Russell JO, Weinreich HM. Assessment of a Statistical Algorithm for the Prediction of Benign Paroxysmal Positional Vertigo. JAMA Otolaryngol Head Neck Surg 2019; 144:883-886. [PMID: 30178063 DOI: 10.1001/jamaoto.2018.1657] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
Importance Benign paroxysmal positional vertigo (BPPV) is an otologic pathologic condition defined as a sensation of spinning triggered by changes in head position relative to gravity and caused by an entrapment of fragmented endolymph debris most commonly in the posterior semicircular canal. Confirmation of diagnosis requires experience with procedures that are poorly known by those other than practitioners with advanced otologic training. The complexity in the diagnosis of BPPV inspired the design of a questionnaire-based algorithm that would be useful for determining a vestibular diagnosis and treatment options. Objective To assess a statistical algorithm for the diagnosis of BPPV in a busy tertiary care setting, with the long-term goal of implementing a clinical pathway to efficiently diagnose and treat patients with dizziness. Design, Setting, and Participants In this retrospective case series, 200 patients who visited the Department of Otolaryngology-Head and Neck Surgery at Johns Hopkins University School of Medicine for their initial vertigo symptoms from September 1, 2016, to December 31, 2016, were assessed. Interventions Use of a validated patient questionnaire as a tool to differentiate patients with dizziness in an electronic medical record review. Main Outcomes and Measures Linear predictor (LP) value based on the questionnaire for the diagnosis of BPPV. Results Of the 200 patient visits reviewed (132 [66%] female), 106 (53.0%; 68 [64%] female) had the information necessary to calculate the LP value and had a confirmed final diagnosis. On the basis of an LP value of 0.2 or greater, the sensitivity for a diagnosis of BPPV was 0.75 and the specificity was 1.0. The positive predictive value was 1.0, whereas the negative predictive value was 0.96. Patients with BPPV had a statistically significantly different LP value (odds ratio, 5.92; 95% CI, 2.73-12.83) than did patients without BPPV. Conclusions and Relevance The findings of this study suggest that the algorithm is efficient for the diagnosis of BPPV in a clinical care setting.
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Affiliation(s)
| | - Bryan K Ward
- Department of Otolaryngology, Johns Hopkins University, Baltimore, Maryland
| | - Yaw Owusu
- Department of Otolaryngology, Johns Hopkins University, Baltimore, Maryland
| | - David Friedland
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin, Milwaukee
| | - Jonathon O Russell
- Department of Otolaryngology, Johns Hopkins University, Baltimore, Maryland
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Benign Paroxysmal Positional Vertigo (BPPV) in Children and Adolescents: Clinical Features and Response to Therapy in 110 Pediatric Patients. Otol Neurotol 2019; 39:344-350. [PMID: 29287036 DOI: 10.1097/mao.0000000000001673] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE This study aimed to characterize the clinical features and outcomes of benign paroxysmal positional vertigo (BPPV) in the pediatric population. STUDY DESIGN Retrospective case review. SETTING Tertiary care center. PATIENTS One hundred ten patients, aged 5 to 19 years old, diagnosed with BPPV. MAIN OUTCOME MEASURES Patient demographics, comorbidities, canal involvement, response to treatment, and incidence of recurrence. RESULTS BPPV was diagnosed in 19.8% of patients seen for dizziness during the study period. Patient age ranged 5 to 19 years old (mean =13.4 ± 3.4 yr). Female:male ratio was 3:2. The most prevalent comorbidities were concussion (n = 42, 38.2%) and migraine disorders (n = 33, 30.0%). Average time to diagnosis from symptom onset was 178.2 ± 190.8 days. The posterior canal was most frequently affected (n = 80, 72.7%), followed by the lateral canal (n = 37, 33.6%) and superior canal (n = 21, 19.1%), and 36.4% (n = 40) of patients had multiple canals affected. Treatment requiring more than or equal to five maneuvers to achieve resolution was observed in 11.8% of cases (n = 13). Recurrence was observed in 18.2% of cases. A logistic regression analysis demonstrated that patients with vestibular migraine or benign paroxysmal vertigo of childhood had five times higher odds of recurrence of BPPV, p = 0.003, 95% [1.735, 15.342], than those who did not have either. CONCLUSIONS BPPV is a relatively common cause of dizziness in the pediatric population. Children and adolescents with BPPV can be successfully treated with repositioning maneuvers but may be at risk for treatment resistance and recurrence. Increased awareness of BPPV in pediatric patients may reduce delays in identification and treatment.
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30
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Association between bone mineral density and benign paroxysmal positional vertigo: a meta-analysis. Eur Arch Otorhinolaryngol 2019; 276:1561-1571. [DOI: 10.1007/s00405-019-05345-4] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2018] [Accepted: 02/12/2019] [Indexed: 12/22/2022]
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31
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Bernetti L, Pellegrino C, Corbelli I, Caproni S, Eusebi P, Faralli M, Ricci G, Calabresi P, Sarchielli P. Subclinical vestibular dysfunction in migraineurs without vertigo: A Clinical study. Acta Neurol Scand 2018; 138:270-277. [PMID: 29658983 DOI: 10.1111/ane.12941] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/21/2018] [Indexed: 01/03/2023]
Abstract
OBJECTIVES This observational study aimed to investigate the presence of potential vestibular system subclinical dysfunction among migraineurs without a history of vertigo and dizziness compared with healthy controls. METHODS Patients diagnosed with episodic migraine with and without aura were enrolled. All patients and healthy controls underwent vestibular examination using the following conventional tests: sitting position, Pagnini-McClure's, Dix-Hallpike's, head hanging, video head impulse, subjective visual vertical, Romberg, Fukuda, and caloric vestibular stimulation by Fitzgerald-Hallpike's tests. Nystagmus and angular velocity of the slow phase during culmination phase was analyzed by video-nystagmography. RESULTS Overall, 33 patients (76% female, 7 with aura and 26 without aura; mean age (mean ± SD): 29.1 ± 4.3 years) and 22 controls (33% female, mean age: 30.8 ± 9.4 years) were enrolled. There were no statistically significant differences in demographic features between patients and controls. Caloric vestibular stimulation test results were found to differ among patients and controls. In particular, right and left angular velocity (AV) were highly correlated one another (r = 0.88, P < .001). Right AV (53.0 ± 6.7 vs 44.0 ± 9.6) and left AV (54.3 ± 5.3 vs 43.3 ± 9.0) were statistically higher in migraineurs as compared to controls (P < .001). Also right V-HIT (1.1 ± 0.1 vs 0.8 ± 0.4) and left V-HIT (1.1 ± 0.1 vs 0.7 ± 0.2) were statistically higher in migraineurs compared to controls (P < .001). CONCLUSION Our findings suggest a subclinical alteration of vestibular pathway in migraineurs who have never complained vertigo or postural imbalance. This finding supports the hypothesis of a vestibular-cerebellar dysfunction in migraineurs, particularly among those with aura.
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Affiliation(s)
- L. Bernetti
- Department of Medicine; Neurologic Clinic, Headache Centre; University of Perugia; Perugia Italy
| | - C. Pellegrino
- Department of Medicine; Otolaryngology and Head-Neck Surgery Clinic; University of Perugia; Perugia Italy
| | - I. Corbelli
- Department of Medicine; Neurologic Clinic, Headache Centre; University of Perugia; Perugia Italy
| | - S. Caproni
- Neuroscience Department; Neurologic Clinic; S. Maria Hospital of Terni; Terni Italy
| | - P. Eusebi
- Department of Medicine; Neurologic Clinic, Headache Centre; University of Perugia; Perugia Italy
| | - M. Faralli
- Department of Medicine; Otolaryngology and Head-Neck Surgery Clinic; University of Perugia; Perugia Italy
| | - G. Ricci
- Department of Medicine; Otolaryngology and Head-Neck Surgery Clinic; University of Perugia; Perugia Italy
| | - P. Calabresi
- Department of Medicine; Neurologic Clinic, Headache Centre; University of Perugia; Perugia Italy
- IRCCS, Santa Lucia Foundation; European Brain Research Institute; Rome Italy
| | - P. Sarchielli
- Department of Medicine; Neurologic Clinic, Headache Centre; University of Perugia; Perugia Italy
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32
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Gupta SK, Upadhyay A, Mundra RK. Role of Electronystagmography in Diagnosis of Secondary BPPV in Elderly Patients with Vertigo: A Retrospective Study. Indian J Otolaryngol Head Neck Surg 2018; 70:428-433. [PMID: 30211103 PMCID: PMC6127064 DOI: 10.1007/s12070-018-1449-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2018] [Accepted: 07/05/2018] [Indexed: 10/28/2022] Open
Abstract
Elderly population is frequently affected by vertigo which affects their mobility and makes them vulnerable to fall and other morbidities. Often these patient visit neurologist and are often subjected to CT scan, MRI brain etc. to rule out a central cause of vertigo; whereas majority of these patients suffer from vestibular cause of vertigo. A schematic approach by detailed history, simple tests for vestibular functions like Dix Hallpike, supine roll and head impulse test give important clue to diagnosis. Often the diagnosis is benign paroxysmal positional vertigo (BPPV) which is treated by repositioning maneuver. There are often other vestibular causes which may be diagnosed by Electronystagmography (ENG), electrocochleography and other tests. This study was undertaken to study occurrence of secondary BPPV utilizing various parameters of ENG. The study group comprised of 131 patients from the neuro-otology proforma data base at ENT centre and vertigo clinic from January 2015 to December 2017. Inclusion criterion was male and female aged 51 years and above presenting with dizziness, imbalance, rotational vertigo, unsteadiness as the chief complaint. Exclusion criterion was BPPV relieved after Epley's maneuver, Otitis externa, acute Otitis media, Suppurative Otitis media, pre existing neurological condition and history of ear surgery. Neuro-otology Data obtained and the ENG findings were tabulated in the master chart and the observations interpreted and transferred to Claussen's butterfly chart. The study group comprised of 58 male (44.27%) and 73 female (55.73%) with a male female ratio of 1:1.25. ENG exhibited 36 patients (27.49) to have recurrent BPPV, 53 (40.45%) were found to have unilateral/bilateral canal paresis. Meniere's disease was diagnosed in 39 (29.77%) patients and brain stem pathology identified in 3 (2.29%) cases.
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Affiliation(s)
- Sanjay Kumar Gupta
- Department of ENT, Index Medical College Hospital and Research Centre, Indore, M.P. India
| | | | - R. K. Mundra
- Department of ENT, MGM Medical College and MY Hospital, Indore, M.P. India
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33
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Pan Q, Zhang Y, Long T, He W, Zhang S, Fan Y, Zhou J. Diagnosis of Vertigo and Dizziness Syndromes in a Neurological Outpatient Clinic. Eur Neurol 2018; 79:287-294. [PMID: 29794430 DOI: 10.1159/000489639] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Accepted: 04/22/2018] [Indexed: 11/19/2022]
Abstract
BACKGROUND Dizziness and vertigo are frequent complaints of outpatients in the neurological department. Our objective was to explore the epidemiological category and clinical features of patients with dizziness or vertigo in the neurological outpatient department of a tertiary hospital. METHODS We consecutively recruited all patients with dizziness and/or vertigo visiting the neurological outpatient clinic of the First Affiliated Hospital of Chongqing Medical University from January 2016 to June 2017. All patients were interviewed by 4 neurologists and they completed self-administered questionnaires. General physical and standardized neuro-otology bedside examinations were performed in all participants. Instrumental examinations and other related examinations were prescribed as needed. RESULTS A total of 392 patients, 272 female and 120 male, were enrolled and the ratio of males to females was 1: 2.27. The mean age was 52.39 ± 13.87 years (range 11-90). Elderly patients (≥60 years) accounted for about one-third of the patients. Peripheral vestibular disorders accounted for 54.6% of patients, central vestibular disorders (including vestibular migraine [VM]) accounted for 22.4% of patients, psychogenic vertigo in 64 (16.3%), other reasons in 9 (2.3%) and unknown in 17 (4.3%). Benign paroxysmal positional vertigo (BPPV; 30.8%), psychiatric dizziness (20.5%), and VM (14.4%) were the 3 major vestibular diseases in patients under 60 years of age; however, BPPV (27.9%), central vertigo (21.7%), and Meniere's disease (11.7%) were more common in patients over 60 years of age. CONCLUSIONS This study provided a classification and clinical features of vestibular disorders in a neurological outpatient department of a tertiary hospital in China. The spectrum of vertigo or dizziness is different between different age groups and clinicians should pay attention to this difference in clinical reasoning.
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34
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Wei W, Sayyid ZN, Ma X, Wang T, Dong Y. Presence of Anxiety and Depression Symptoms Affects the First Time Treatment Efficacy and Recurrence of Benign Paroxysmal Positional Vertigo. Front Neurol 2018; 9:178. [PMID: 29619005 PMCID: PMC5871662 DOI: 10.3389/fneur.2018.00178] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2017] [Accepted: 03/07/2018] [Indexed: 01/30/2023] Open
Abstract
Objectives To investigate the possible effects of anxiety and/or depression symptoms on the treatment outcomes and recurrence of benign paroxysmal positional vertigo (BPPV). Methods This is a retrospective study conducted at a single institution. 142 consecutive patients diagnosed with idiopathic BPPV at the Department of Otology in Shengjing Hospital of China Medical University between October 2016 and July 2017 were retrospectively reviewed. 127 patients were finally included in this study. Zung self-rating anxiety scale (SAS) and Zung self-rating depression scale (SDS) were used to evaluate the presence of anxiety and/or depression, respectively, in our BPPV patients. A significant score (at or above 50 for SAS and 53 for SDS) represents the presence of clinically significant symptoms. Two-tailed Student’s t-test, χ2 test, and logistic regression analysis were used as appropriate. A p value less than 0.05 was considered statistically significant. Results The prevalence of anxiety and/or depression symptoms in BPPV patients in the present study was 49.61%. The effectiveness of the first time canalith repositioning maneuver (CRM) was 70.08%. With weekly follow-up treatments of CRM, the success rate increased to 97.64% by 1 month. The total recurrence rate at 6-month follow-up post-cure was 14.17%. Holding all other variables constant, patients with psychiatric symptoms (Relative-risk ratio: 3.160; p = 0.027) and patients with non-posterior semicircular canal (PSC) involvement (Relative-risk ratio: 7.828, p = 0.013) were more likely to experience residual dizziness (RD) even after effective CRM treatment. Psychiatric symptoms (Relative-risk ratio: 6.543; p = 0.001) and female gender (Relative-risk ratio: 4.563; p = 0.010) are risk factors for the failure of first time CRM. In addition, BPPV patients with psychiatric symptoms (Odds ratio: 9.184, p = 0.008) were significantly more likely to experience recurrences within the first 6 months after a successful maneuver. Conclusion Anxiety-depression status significantly reduced the efficacy of the first time CRM and increased the risk for recurrence. Other factors, such as female gender and non-PSC involvement are also susceptible risk factors for BPPV patients to require multiple treatments and experience delayed recovery. A screening for psychiatric symptoms in BPPV patients and active treatment of these symptoms would benefit both physicians and patients in understanding and improving the prognosis of the disease and treatment options.
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Affiliation(s)
- Wei Wei
- Department of Otology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Zahra N Sayyid
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, United States
| | - Xiulan Ma
- Department of Otology, Shengjing Hospital of China Medical University, Shenyang, China
| | - Tian Wang
- Department of Otolaryngology-Head and Neck Surgery, Second Xiangya Hospital of Central South University, Changsha, China
| | - Yaodong Dong
- Department of Otology, Shengjing Hospital of China Medical University, Shenyang, China
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35
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Abstract
Migraine is one of the most common neurological disorders. In addition to severe headaches, non-headache symptoms associated with migraine attacks as well as co-morbid disorders frequently aggravate the disabling of migraine patients. Some of these symptoms are related to poor outcomes. In this review, we update the advances of studies on certain non-headache symptoms, including visual disturbance, gastrointestinal symptoms, allodynia, vestibular symptoms, and symptoms of co-morbid restless legs syndrome and psychiatric disorders.
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Affiliation(s)
- Ping-Kun Chen
- School of Medicine, China Medical University, Taichung, Taiwan.,Bo-Zhi Neurology Clinic, Taichung, Taiwan.,Department of Neurology, China Medical University Hospital, Taichung, Taiwan
| | - Shuu-Jiun Wang
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Brain Research Center, National Yang-Ming University, Taipei, Taiwan.,Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
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36
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Chan KC, Tsai YT, Yang YH, Chen PC, Chang PH. Osteoporosis is associated with increased risk for benign paroxysmal positional vertigo: a nationwide population-based study. Arch Osteoporos 2017; 12:106. [PMID: 29177633 DOI: 10.1007/s11657-017-0403-7] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Accepted: 11/06/2017] [Indexed: 02/03/2023]
Abstract
UNLABELLED Recent evidence has indicated that osteoporosis is a risk factor for benign paroxysmal positional vertigo (BPPV). This large population-based study demonstrated that patients with osteoporosis had a 1.82-fold higher risk of developing BPPV than those without osteoporosis through the use of the Taiwan National Health Insurance Research Database. PURPOSE Benign paroxysmal positional vertigo (BPPV) is one of the most frequent causes of vertigo. Osteoporosis reflects a homeostatic imbalance in the rate of bone turnover, with the rate of bone resorption exceeding that of bone formation. Recent evidence has indicated that osteoporosis is a risk factor for BPPV. We aimed to validate the risk of BPPV in osteoporotic patients through a nationwide, population-based, cohort study. METHODS Patients treated for osteoporosis were identified from entries made in the Taiwan National Health Insurance Research Database (NHIRD) between 2000 and 2013. Each osteoporosis patient was age- and sex-matched with four randomly selected subjects without osteoporosis. We compared the incidence rates of BPPV in the two cohorts (with and without osteoporosis) and identified risk factors. RESULTS We identified 6649 osteoporosis patients and 26,596 match controls. According to the incidence of BPPV among the two groups, patients with osteoporosis were found to have a 1.82-fold higher risk of developing BPPV than those without osteoporosis. The incidence rate ratio (IRR) between osteoporotic patients and the control cohort was 2.0 (p < 0.001). CONCLUSIONS This large population-based study demonstrated that patients with osteoporosis were associated with an increased risk for BPPV. The results of this study provide some insight into the management of BPPV.
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Affiliation(s)
- Kai-Chieh Chan
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, No 5, Fu Hsing Street, Kwei-Shan, Taoyuan, 333, Taiwan.,School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Kwei-Shan, Taoyuan, Taiwan
| | - Yao-Te Tsai
- School of Medicine, Chang Gung University, Taoyuan, Taiwan.,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Kwei-Shan, Taoyuan, Taiwan.,Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, Chiayi, Taiwan
| | - Yao-Hsu Yang
- Department of Traditional Chinese Medicine, Chiayi Chang Gung Memorial Hospital, Chiayi, Taiwan.,Health Information and Epidemiology Laboratory of Chang Gung Memorial Hospital, Chiayi, Taiwan.,School of Traditional Chinese Medicine, College of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Pau-Chung Chen
- Institute of Occupational Medicine and Industrial Hygiene, National Taiwan University College of Public Health, Taipei, Taiwan.,Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Po-Hung Chang
- Department of Otolaryngology-Head and Neck Surgery, Chang Gung Memorial Hospital, No 5, Fu Hsing Street, Kwei-Shan, Taoyuan, 333, Taiwan. .,School of Medicine, Chang Gung University, Taoyuan, Taiwan. .,Graduate Institute of Clinical Medical Sciences, Chang Gung University, Kwei-Shan, Taoyuan, Taiwan.
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37
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Epidemiology of Dizzy Patient Population in a Neurotology Clinic and Predictors of Peripheral Etiology. Otol Neurotol 2017; 38:870-875. [DOI: 10.1097/mao.0000000000001429] [Citation(s) in RCA: 37] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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38
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Li J, Tian S, Zou S. Efficacy of the Li maneuver in treating posterior canal benign paroxysmal positional vertigo. Acta Otolaryngol 2017; 137:588-592. [PMID: 27921448 DOI: 10.1080/00016489.2016.1258731] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
CONCLUSION The Li maneuver is a safe, effective, and simple repositioning method for the treatment of BPPV. It is simple to master and exerts an exact effect. As a rapid repositioning method, the Li maneuver can result in reduced treatment times and increased treatment efficacy, and is, therefore, especially suitable for patients with limited cervical spine movement. OBJECTIVE To compare the short-term efficacies of the Li and Epley maneuvers in treating posterior canal benign paroxysmal positional vertigo (PC-BPPV). METHODS A total of 120 patients with PC-BPPV were randomly treated by either the Li or Epley maneuvers at our department between May 5, 2014 and July 30, 2015. Follow-up examinations were performed 3 days and 1 week after the first repositioning. RESULTS Of the 120 patients initially enrolled, 113 (72 females; 41 males; average age = 52 years; Li and Epley maneuver groups, 56 and 57 cases, respectively) satisfied the inclusion and exclusion criteria of this study. There were no statistically significant differences between the two groups of patients in terms of the success rates of treatment at either the 3-day or 1-week follow-ups (p = .756 and .520, respectively).
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Affiliation(s)
- Jinrang Li
- Department of Otolaryngology Head Neck Surgery, Navy General Hospital, Beijing, PR China
| | - Shiyu Tian
- Department of Otolaryngology Head Neck Surgery, Navy General Hospital, Beijing, PR China
| | - Shizhen Zou
- Department of Otolaryngology Head Neck Surgery, Navy General Hospital, Beijing, PR China
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O’Connell Ferster AP, Priesol AJ, Isildak H. The clinical manifestations of vestibular migraine: A review. Auris Nasus Larynx 2017; 44:249-252. [DOI: 10.1016/j.anl.2017.01.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2016] [Revised: 01/13/2017] [Accepted: 01/30/2017] [Indexed: 12/25/2022]
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40
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Welgampola MS, Akdal G, Halmagyi GM. Neuro-otology- some recent clinical advances. J Neurol 2016; 264:188-203. [PMID: 27632181 PMCID: PMC5225204 DOI: 10.1007/s00415-016-8266-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2016] [Revised: 07/25/2016] [Accepted: 08/09/2016] [Indexed: 11/26/2022]
Abstract
Vestibular disorders manifesting as vertigo, chronic dizziness and imbalance are common problems in neurological practice. Here, we review some recent interesting and important advances in diagnosis of vestibular disorders using the video head impulse test and in the management of benign positional vertigo and migrainous vertigo.
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Affiliation(s)
| | - Gülden Akdal
- Neurology Department, Dokuz Eylül University Hospital, Izmir, Turkey
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41
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Wu CH, Zhang ZH, Wu MK, Wang CH, Lu YY, Lin CL. Increased migraine risk in osteoporosis patients: a nationwide population-based study. SPRINGERPLUS 2016; 5:1378. [PMID: 27610297 PMCID: PMC4993742 DOI: 10.1186/s40064-016-3090-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/12/2016] [Accepted: 08/17/2016] [Indexed: 02/10/2023]
Abstract
BACKGROUND Osteoporosis and migraine are both important public health problems and may have overlapping pathophysiological mechanisms. The aim of this study was to use a Taiwanese population-based dataset to assess migraine risk in osteoporosis patients. METHODS The Taiwan National Health Insurance Research Database was used to analyse data for 40,672 patients aged ≥20 years who had been diagnosed with osteoporosis during 1996-2010. An additional 40,672 age-matched patients without osteoporosis were randomly selected as the non-osteoporosis group. The relationship between osteoporosis and migraine risk was estimated using Cox proportional hazard regression models. RESULTS During the follow-up period, 1110 patients with osteoporosis and 750 patients without osteoporosis developed migraine. After controlling for covariates, the overall incidence of migraine was 1.37-fold higher in the osteoporosis group than in the non-osteoporosis group (3.72 vs. 1.24 per 1000 person-years, respectively). Migraine risk factors included high Charlson Comorbidity Index score, female gender, hypertension, depression, asthma, allergic rhinitis, obesity, and tobacco use disorder. CONCLUSIONS Our results indicate that patients with a history of osteoporosis had a higher risk of migraine.
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Affiliation(s)
- Chieh-Hsin Wu
- Graduate Institute of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan.,Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100 Tzyou 1st Road, Kaohsiung, 80708 Taiwan
| | - Zi-Hao Zhang
- Department of Neurosurgery, The No. 7 People's Hospital of Hebei Province, Dingzhou, 073000 Hebei People's Republic of China
| | - Ming-Kung Wu
- Department of Psychiatry, Kaohsiung Chang Gung Memorial Hospital and Chang Gung University College of Medicine, Kaohsiung, 807 Taiwan
| | - Chiu-Huan Wang
- Department of Nursing, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100 Tzyou 1st Road, Kaohsiung, 80708 Taiwan
| | - Ying-Yi Lu
- Department of Dermatology, Kaohsiung Veterans General Hospital, No. 386 Dazhong 1st Rd, Kaohsiung, 81362 Taiwan.,Cosmetic Applications and Management Department, Yuh-Ing Junior College of Health Care and Management, Kaohsiung, Taiwan
| | - Chih-Lung Lin
- Department of Neurosurgery, Kaohsiung Medical University Hospital, Kaohsiung Medical University, No. 100 Tzyou 1st Road, Kaohsiung, 80708 Taiwan.,Department of Neurosurgery, Faculty of Medicine, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan
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Saeed BMN, Omari AF. Climatic variations and benign paroxysmal positional vertigo. J Otol 2016; 11:33-37. [PMID: 29937808 PMCID: PMC6002593 DOI: 10.1016/j.joto.2016.03.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2016] [Revised: 03/03/2016] [Accepted: 03/04/2016] [Indexed: 11/30/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is probably the most common diagnosis at vertigo clinics. Seasonal cycles of several human illnesses could be attributed variously to changes in atmospheric or weather conditions. In this retrospective study, patients with BPPV from January 2010 to December 2012 were studied, and their charts were reviewed. Statistical analysis revealed a statistically significant difference in patients' numbers among different months of the year. Also there is a significant statistical correlation between the numbers of patients with climatic variations especially the temperature. The present paper discusses the possible explanations for these results which confirms the seasonal variations in BPPV, together with a review of literature to view the possible associations with other disorders that causes such seasonality.
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Affiliation(s)
- Basil M N Saeed
- Department of Surgery, College of Medicine, Mosul University, Duhok, Kurdistan, Iraq
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Kunelskaya NL, Melnikov OA, Guseva AL, Baybakova EV. The etiology, pathophysiology and differential diagnosis of benign paroxysmal positional vertigo. Zh Nevrol Psikhiatr Im S S Korsakova 2016; 116:79-84. [DOI: 10.17116/jnevro20161164179-84] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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