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Zborayova K, Barrenäs ML, Granåsen G, Kerber K, Salzer J. Dizziness and vertigo sick leave before and after insurance restrictions - a descriptive Swedish nationwide register linkage study. BMC Public Health 2024; 24:2591. [PMID: 39333959 PMCID: PMC11430563 DOI: 10.1186/s12889-024-20119-2] [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: 07/09/2024] [Accepted: 09/17/2024] [Indexed: 09/30/2024] Open
Abstract
BACKGROUND Vertigo and dizziness can be disabling symptoms that result in sick leave. Research regarding sickness absence due to dizziness has focused on specific vestibular diagnoses rather than the nonspecific vertigo/dizziness diagnoses. Strict sick leave regulations were introduced in Sweden in 2008. The aim of this study was to describe the vertigo/dizziness sick leave prevalence and duration considering both specific and nonspecific diagnoses according to International Classification of diseases 10th revision (ICD-10) on the 3-digit level, including the less specific "R" diagnoses. METHODS Through Swedish nationwide registers we identified individuals aged 16-64 years who during the years 2005-2018 were sickness absent > 14 consecutive days - minimum register threshold - due to vertigo/dizziness diagnoses according to ICD10 codes: specific diagnoses (H81.0, H81.1, H81.2, H81.3, H81.4, G11x) and nonspecific (R42, R26, R27, H81.9). We described the demographic characteristics, prevalence and duration of such sick-leave spells. Data were stratified according to diagnostic groups: ataxias, vestibular and nonspecific. RESULTS We identified 52,179 dizziness/vertigo sick leave episodes > 14 days in 45,353 unique individuals between 2005-2018, which constitutes 0.83% from all sick leave episodes in the given period.The nonspecific diagnoses represented 72% (n = 37741) of sick leave episodes and specific vestibular H-diagnoses 27% (n = 14083). The most common specific vestibular codes was Benign paroxysmal positional vertigo (BPPV) 9.4% (n = 4929). The median duration of sick leave was 31 days (IQR 21-61). Women on sick leave were younger than men (47 vs 51 years, p < 0.05) and had a higher proportion of nonspecific diagnoses compared with men (74% vs 70%, p < 0.05). CONCLUSIONS The vast majority of vertigo/dizziness sick leave episodes were coded as nonspecific diagnoses and occurred in women. BPPV, a curable vestibular condition, was the most common specific diagnosis. This suggests a potential for improved diagnostics. Women on sick leave due to dizziness/vertigo were younger and more often received nonspecific diagnostic codes. Future studies should determine the frequency of use of evidence based therapies and investigate further the gender differences.
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Affiliation(s)
- Katarina Zborayova
- Department of Clinical Sciences, Otorhinolaryngology, Umeå University, Umeå, Sweden.
| | | | - Gabriel Granåsen
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Kevin Kerber
- Department of Neurology, Ohio State University, Columbus, OH, USA
| | - Jonatan Salzer
- Department of Clinical Sciences, Neurosciences, Umeå University, Umeå, Sweden
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Chen SP, Hsu CL, Chen TH, Pan LLH, Wang YF, Ling YH, Chang HC, Chen YM, Fann CSJ, Wang SJ. A genome-wide association study identifies novel loci of vertigo in an Asian population-based cohort. Commun Biol 2024; 7:1034. [PMID: 39174713 PMCID: PMC11341872 DOI: 10.1038/s42003-024-06603-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: 06/23/2023] [Accepted: 07/18/2024] [Indexed: 08/24/2024] Open
Abstract
The contributing genetic factors of vertigo remain poorly characterized, particularly in individuals of non-European ancestries. Here we show the genetic landscape of vertigo in an Asian population-based cohort. In a two-stage genome-wide association study (Ncase = 6199; Ncontrol = 54,587), we identify vertigo-associated genomic loci in DROSHA and ZNF91/LINC01224, with the latter replicating the findings in European ancestries. Gene-based association testing corroborates these findings. Interestingly, both genes are enriched in cerebellum, a key structure receiving sensory input from the vestibular system. Subjects carrying risk alleles from lead SNPs of DROSHA and ZNF91 incur a 1.74-fold risk of vertigo than those without. Moreover, composite clinical-polygenic risk scores allow differentiation between patients and controls, yielding an area under receiver operating characteristic curve of 0.69. This study identified novel genomic loci for vertigo in an Asian population-based cohort, which may help identifying high risk subjects and provide mechanistic insight in understanding the pathogenesis of vertigo.
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Affiliation(s)
- Shih-Pin Chen
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Translational Research, Department of Medical Research, Taipei Veterans General Hospital, Taipei, Taiwan
- Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chia-Lin Hsu
- Institute of Biomedical Sciences, Academia Sinica, Taipei, Taiwan
| | - Ting-Huei Chen
- Department of Mathematics & Statistics, Laval University, Quebec City, QC, Canada
- Cervo Brain Research Centre, Quebec City, QC, Canada
| | - Li-Ling Hope Pan
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yen-Feng Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yu-Hsiang Ling
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsueh-Chen Chang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Yi-Ming Chen
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Division of Translational Research, Department of Medical Research, Taichung Veterans General Hospital, Taipei, Taiwan
| | | | - Shuu-Jiun Wang
- Department of Neurology, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.
- Brain Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.
- School of Medicine, College of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.
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Tønnesen ES, Nielsen JB, Rose K, Wanscher JH, Schmidt JH, Sorensen JR. Labor market effects of rehabilitation for patients diagnosed with dizziness - a Danish nationwide register-based cohort study. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08871-y. [PMID: 39098958 DOI: 10.1007/s00405-024-08871-y] [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: 06/07/2024] [Accepted: 07/24/2024] [Indexed: 08/06/2024]
Abstract
PURPOSE Both vestibular neuronitis (VN) and Meniere's disease (MD) have great impact on quality of life and are associated with a significant number of sick leave days absent from work. The aim was to assess labor market participation rate one year after hospital diagnosis of VN and MD and the use of rehabilitation measures. STUDY DESIGN Nationwide register-based cohort study including patients with VN (n = 1,341) and MD (n = 843) and control persons matched in 1:5 with a VN cohort control (n = 6,683) and MD cohort control (n = 4,209). RESULTS Compared to control persons, VN patients were more likely to be single, have higher income, and a higher Charlson comorbidity index score. MD patients had a higher level of education and a higher Charlson index compared to control persons. One year after patients were diagnosed with VN, no significant difference in labor market participation was observed (p = 0.88). However, MD patients had a 10.4% reduced probability of possessing a full-time job one year after diagnosis compared to matched control persons (58.1 ± 0.5% vs. 68.5 ± 0.5%, p < 0.001). Both VN and MD patients consulted otorhinolaryngologists, general practitioners, and physiotherapists more than control persons both before and after the initial diagnosis (p < 0.01). In addition, MD patients also consulted psychologists more frequently before and after diagnosis of the disease (p < 0.01). CONCLUSION Intrahospital diagnosed MD increases the risk of leaving the labor market in opposition to VN. Both MD and VN are associated with significant expenses to the Danish health care system from the use of public rehabilitation measures and medical consultations.
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Affiliation(s)
- Emil Severin Tønnesen
- Research Unit for ORL-Head & Neck Surgery and Audiology, Odense University Hospital & University of Southern Denmark, J.B. Winsløws vej 4, 5000, Odense C, Denmark
| | - Jesper Bo Nielsen
- Department of Public Health, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Kim Rose
- Department of Public Health, University of Southern Denmark, Campusvej 55, 5230, Odense M, Denmark
| | - Jens Højberg Wanscher
- Research Unit for ORL-Head & Neck Surgery and Audiology, Odense University Hospital & University of Southern Denmark, J.B. Winsløws vej 4, 5000, Odense C, Denmark
| | - Jesper Hvass Schmidt
- Research Unit for ORL-Head & Neck Surgery and Audiology, Odense University Hospital & University of Southern Denmark, J.B. Winsløws vej 4, 5000, Odense C, Denmark
| | - Jesper Roed Sorensen
- Research Unit for ORL-Head & Neck Surgery and Audiology, Odense University Hospital & University of Southern Denmark, J.B. Winsløws vej 4, 5000, Odense C, Denmark.
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Nüesch A, Treleaven J, Ernst MJ. Validation of the Cervical Torsion Test and Head-Neck Differentiation Test in Patients With Peripheral Vestibular Hypofunction. Phys Ther 2024; 104:pzae057. [PMID: 38590288 PMCID: PMC11272218 DOI: 10.1093/ptj/pzae057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 11/28/2023] [Accepted: 02/13/2024] [Indexed: 04/10/2024]
Abstract
OBJECTIVE This study compared adults with peripheral vestibular hypofunction (VH) to healthy controls and assessed the sensitivity and specificity of the Cervical Torsion Test (CTT) and the Head-Neck Differentiation Test (HNDT). This study aimed to determine whether neck problems affected primary outcomes. METHODS This cross-sectional study included adults from a specialist consultation for dizziness. VH had been diagnosed with the video Head Impulse Test. Exclusion criteria were conditions following head or neck trauma and diseases of the central nervous system. The sensitivity and specificity of the index tests were calculated, and regression analyses were performed to test for contributing factors. RESULTS A total of 19 patients with VH and a historical cohort of 19 matched healthy controls were included. Most patients with VH (84.2%) experienced symptoms in at least 1 test component, compared to 5.2% of the control group. Of patients with VH, 78.9% had symptoms during the HNDT "en bloc" (en bloc = head and trunk rotated together), whereas only 26.3% reported symptoms during the CTT en bloc. The best discriminatory validity was found for the HNDT en bloc, with a sensitivity of 0.79 (95% CI = 0.54-0.94), a specificity of 0.86 (95% CI = 0.65-0.97), and a positive likelihood ratio of 5.79 (95% CI = 1.97-17.00). The number of symptoms of CTT "in torsion" (in torsion = trunk rotated actively with fixed head) was increased by a factor of 1.13 (95% CI = 1.01-1.27) for every additional point on the Neck Disability Index. CONCLUSION The CTT and HNDT can serve as non-laboratory tests for patients with dizziness. The HNDT en bloc has the best discriminatory validity, finding those with and those without VH. Symptom reproduction during torsion may help to identify when neck problems may contribute to dizziness. IMPACT The HNDT en bloc may be useful for ruling VH in or out in patients with dizziness. Positive CTT and HNDT in torsion components may verify the likelihood of additional neck involvement.
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Affiliation(s)
- Andrea Nüesch
- Department of Physiotherapy and Occupational Therapy, University Hospital Zürich, Zürich, Switzerland
- School of Health Professions, Institute of Physiotherapy, Zürich University of Applied Sciences, Winterthur, Switzerland
| | - Julia Treleaven
- Division of Physiotherapy, The Neck Pain and Whiplash Research Unit, School of Health and Rehabilitation Sciences, The University of Queensland, Brisbane, Queensland, Australia
| | - Markus J Ernst
- School of Health Professions, Institute of Physiotherapy, Zürich University of Applied Sciences, Winterthur, Switzerland
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Matthews JC, Agrawal Y, Qian ZJ, Wei EX. Healthcare Utilization Among Adults With Vestibular Vertigo in the United States. Ear Hear 2024; 45:945-951. [PMID: 38503724 DOI: 10.1097/aud.0000000000001487] [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: 03/21/2024]
Abstract
OBJECTIVES Vestibular vertigo has been shown to have a high lifetime prevalence. Previous studies have described the increased morbidities associated with vestibular vertigo. DESIGN In this cross-sectional study of the 2016 National Health Interview Study, we sought to explore whether individuals with vestibular vertigo were more likely to utilize healthcare resources compared with those without vestibular vertigo. We characterized utilization of specific healthcare resources including general doctors, specialist doctors, emergency departments, mental health professionals, and others among individuals with vestibular vertigo to better understand how individuals with vertigo interact with the US healthcare system. RESULTS In multivariable analyses, participants with vestibular vertigo had an increased number of nights in the hospital in the last 12 months (mean difference = 0.67 days, 95% confidence interval [CI] = 0.37 to 0.97), increased odds of receiving healthcare 10 or more times in the last 12 months (odds ratio = 2.22, 95% CI = 1.99 to 2.48) and increased number of visits to a healthcare professional in the last 2 weeks (mean difference = 0.17 visits, 95% CI = 0.14 to 0.21). In addition, participants with vestibular vertigo had increased odds of visiting both general doctors, specialist doctors, and other healthcare professionals. CONCLUSIONS These findings characterize how individuals with vestibular vertigo utilize and interact with healthcare resources compared with those without vestibular vertigo.
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Affiliation(s)
- Jacob C Matthews
- Department of Surgery, University of Arizona College of Medicine, Tucson, Arizona, USA
| | - Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Z Jason Qian
- Department of Otolaryngology-Head and Neck Surgery, Stanford Health Care, Palo Alto, California, USA
| | - Eric X Wei
- Department of Otolaryngology-Head and Neck Surgery, Stanford Health Care, Palo Alto, California, USA
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Mohammed A, Li S, Liu X. Exploring the Potentials of Wearable Technologies in Managing Vestibular Hypofunction. Bioengineering (Basel) 2024; 11:641. [PMID: 39061723 PMCID: PMC11274252 DOI: 10.3390/bioengineering11070641] [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: 05/04/2024] [Revised: 05/26/2024] [Accepted: 05/31/2024] [Indexed: 07/28/2024] Open
Abstract
The vestibular system is dedicated to gaze stabilization, postural balance, and spatial orientation; this makes vestibular function crucial for our ability to interact effectively with our environment. Vestibular hypofunction (VH) progresses over time, and it presents differently in its early and advanced stages. In the initial stages of VH, the effects of VH are mitigated using vestibular rehabilitation therapy (VRT), which can be facilitated with the aid of technology. At more advanced stages of VH, novel techniques that use wearable technologies for sensory augmentation and sensory substitution have been applied to manage VH. Despite this, the potential of assistive technologies for VH management remains underexplored over the past decades. Hence, in this review article, we present the state-of-the-art technologies for facilitating early-stage VRT and for managing advanced-stage VH. Also, challenges and strategies on how these technologies can be improved to enable long-term ambulatory and home use are presented.
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Affiliation(s)
- Ameer Mohammed
- School of Information Science and Technology, Fudan University, Shanghai 200433, China; (A.M.); (S.L.)
- State Key Laboratory of Integrated Chips and Systems, Fudan University, Shanghai 201203, China
| | - Shutong Li
- School of Information Science and Technology, Fudan University, Shanghai 200433, China; (A.M.); (S.L.)
- State Key Laboratory of Integrated Chips and Systems, Fudan University, Shanghai 201203, China
| | - Xiao Liu
- School of Information Science and Technology, Fudan University, Shanghai 200433, China; (A.M.); (S.L.)
- State Key Laboratory of Integrated Chips and Systems, Fudan University, Shanghai 201203, China
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Madrigal J, Manzari L, Figueroa JJ, Castillo-Bustamante M. Understanding Benign Paroxysmal Positional Vertigo (BPPV) and Its Impact on Quality of Life: A Systematic Review. Cureus 2024; 16:e63039. [PMID: 39050283 PMCID: PMC11268396 DOI: 10.7759/cureus.63039] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2024] [Indexed: 07/27/2024] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder characterized by brief episodes of vertigo triggered by specific head movements. Despite its short duration, BPPV significantly impacts the quality of life. A comprehensive search of electronic databases, including PubMed, Scopus, and Web of Science, was performed to gather peer-reviewed articles, clinical trials, and review articles published between 2014 and 2024. Keywords used in the search included "benign paroxysmal positional vertigo," "BPPV," "vestibular disorders," "quality of life," "diagnosis," and "treatment." Eleven articles were included in the systematic review. Tools such as the Dizziness Handicap Inventory (DHI) and the 36-Item Short Form Health Survey (SF-36) are reported to assess the impact of BPPV on quality of life. This review includes 11 articles focusing on quality of life outcomes in BPPV patients. This systematic review explores the various dimensions of quality of life affected by BPPV and the tools used to evaluate these effects. BPPV can lead to physical limitations, such as difficulty in performing daily activities, and psychological effects, including anxiety, depression, and emotional distress. Socially, BPPV can cause social withdrawal and isolation due to the fear of experiencing vertigo in public. Occupationally, BPPV can interfere with job-related tasks. Future research should focus on developing personalized treatment approaches and patient-reported outcome measures specific to BPPV. A comprehensive approach to BPPV management is essential for improving the quality of life of affected individuals.
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Affiliation(s)
- Jorge Madrigal
- Otoneurology, Centro de Vértigo y Mareo, Mexico City, MEX
| | | | - Juan J Figueroa
- Medicine, Health Sciences, Pontifical Bolivarian University, Medellín, COL
| | - Melissa Castillo-Bustamante
- Otoneurology, Centro de Vértigo y Mareo, Mexico City, MEX
- Medicine, Health Sciences, Pontifical Bolivarian University, Medellín, COL
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Ross A, Leemeyer AMR, Bruintjes TD, Cals JWL, Bronstein A, van Leeuwen RB, Lissenberg-Witte B, van Vugt VA, Rutgers S, Maarsingh OR. Prospective diagnostic accuracy study of history taking and physical examination for adults with vertigo in general practice: study protocol. BMJ Open 2024; 14:e085715. [PMID: 38569697 PMCID: PMC10989125 DOI: 10.1136/bmjopen-2024-085715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 03/18/2024] [Indexed: 04/05/2024] Open
Abstract
INTRODUCTION Vertigo is a prevalent and burdensome symptom. More than 80% of patients with vertigo are primarily treated by their general practitioner (GP) and are never referred to a medical specialist. Despite this therapeutic responsibility, the GP's diagnostic toolkit has serious limitations. All recommended tests lack empirical evidence, because a diagnostic accuracy study on vestibular disorders ('How well does test x discriminate between patients with or without target condition y?') has never been performed in general practice. The VERtigo DIagnosis study aims to fill this gap. METHODS AND ANALYSIS We will perform a diagnostic accuracy study on vertigo of primary vestibular origin in general practice to assess the discriminative ability of history taking and physical examination. We will compare all index tests with a respective reference standard. We will focus on five target conditions that account for more than 95% of vertigo diagnoses in general practice: (1) benign paroxysmal positional vertigo, (2) vestibular neuritis, (3) Ménière's disease, (4) vestibular migraine (VM) and (5) central causes other than VM. As these five target conditions have a different pathophysiology and lack one generally accepted gold standard, we will use consensus diagnosis as a construct reference standard. Data for each patient, including history, physical examination and additional tests as recommended by experts in an international Delphi procedure, will be recorded on a standardised form and independently reviewed by a neurologist and otorhinolaryngologist. For each patient, the reviewers have to decide about the presence/absence of each target condition. We will calculate sensitivity, specificity, predictive values, likelihood ratios and diagnostic ORs, followed by decision rules for each target condition. ETHICS AND DISSEMINATION The study obtained approval from the Vrije Universiteit Medical Center Medical Ethical Review Committee (reference: 2022.0817-NL83111.029.22). We will publish our findings in peer-reviewed international journals. TRIAL REGISTRATION NUMBER ISRCTN97250704.
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Affiliation(s)
- Andrew Ross
- Department of General Practice, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Anna-Marie Rebecca Leemeyer
- Department of General Practice, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Tjasse D Bruintjes
- Department of Otorhinolaryngology-Head and Neck Surgery, Leiden University Medical Center, Leiden, The Netherlands
- Department of Neurology, Gelre Hospital, Apeldoorn, The Netherlands
| | - Jochen W L Cals
- Department of Family Medicine, Maastricht University Care and Public Health Research Institute, Maastricht, The Netherlands
| | - Adolfo Bronstein
- Neuro-otology Unit, Division of Brain Sciences, Imperial College London, London, UK
| | | | - Birgit Lissenberg-Witte
- Department of Epidemiology and Data Science, Amsterdam UMC Locatie VUmc, Amsterdam, The Netherlands
| | - Vincent Alexander van Vugt
- Department of General Practice, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Sandra Rutgers
- Patient association Hoormij NVVS, Houten, The Netherlands
| | - Otto R Maarsingh
- Department of General Practice, Amsterdam UMC Location VUmc, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Kriz M, Conover S, Cameron N, Conover M, Simon J, Prueter J, Samy R, Backous D. Comparing in-clinic versus telehealth for vestibular physical therapy. J Vestib Res 2024; 34:215-222. [PMID: 38905068 DOI: 10.3233/ves-220094] [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: 06/23/2024]
Abstract
BACKGROUND Vestibular rehabilitation (VR) is a commonly employed treatment method for disorders of dizziness and imbalance. Access to a clinic for rehabilitation appointments can be challenging for a person experiencing dizziness. Telehealth may offer a comparable alternative to clinic-based VR for some patients. OBJECTIVE The objective of this study was to determine the efficacy of telehealth-based VR compared to traditional clinic-based VR, as measured with the Dizziness Handicapped Inventory (DHI) in a retrospective sample of patients with vestibular conditions. METHODS This is a retrospective, multi-institutional review from May 2020 to January 2021. Three study groups were analyzed: a telehealth group, a hybrid group, and a clinic based control group. Treatment efficacy was measured using the DHI. A repeated measures ANCOVA was performed to compare changes between the groups and across timepoints. RESULTS The repeated measures ANCOVA was not significant for the interaction of groups (control, telehealth, and hybrid) by time (pre and post) (p > 0.05). However, there was a significant main effect for time (pre and post) (p < 0.05). Specifically, all groups improved DHI scores from pre to post treatment with mean differences of control: 31.85 points, telehealth: 18.75 points, and hybrid: 21.45 points. CONCLUSION Findings showed that in-clinic, telehealth, and hybrid groups demonstrated a decrease in DHI scores, indicating self-reported improvements in the impact of dizziness on daily life. Continued research is recommended to explore the efficacy of using telehealth in assessing and treating vestibular conditions.
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Affiliation(s)
- Morgan Kriz
- Vestibular Therapy Specialists, Seattle, WA, USA
| | - Sarah Conover
- Sarah Conover and Associates, LLC, Troy, OH, USA
- Xcel Sports Medicine, Vandalia, OH, USA
| | - Nicholas Cameron
- Department of Otolaryngology - Head and Neck Surgery, Kettering Health Dayton, Dayton, OH, USA
| | - Meg Conover
- Doctors Hospital Family Medicine, Columbus, OH, USA
| | - Janet Simon
- College of Applied Health Sciences and Wellness, Ohio University, Athens, OH, USA
| | - James Prueter
- Department of Otolaryngology - Head and Neck Surgery, Southwest Ohio ENT, Dayton, OH, USA
| | - Ravi Samy
- Department of Otolaryngology - Head and Neck Surgery, Lehigh Valley Health Network, Allentown, PA, USA
| | - Douglas Backous
- Department of Otolaryngology - Head and Neck Surgery, Puget Sound ENT, Edmonds, WA, USA
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van Stiphout L, Szmulewicz DJ, Guinand N, Fornos AP, Van Rompaey V, van de Berg R. Bilateral vestibulopathy: a clinical update and proposed diagnostic algorithm. Front Neurol 2023; 14:1308485. [PMID: 38178884 PMCID: PMC10766383 DOI: 10.3389/fneur.2023.1308485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024] Open
Abstract
Bilateral vestibulopathy (BVP) is characterized by its heterogeneous and chronic nature with various clinical presentations and multiple etiologies. This current narrative review reflects on the main insights and developments regarding clinical presentation. In addition, it proposes a new diagnostic algorithm, and describes available and potential future therapeutic modalities.
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Affiliation(s)
- Lisa van Stiphout
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
| | - David J. Szmulewicz
- Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, VIC, Australia
- Bionics Institute, Melbourne, VIC, Australia
| | - Nils Guinand
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Angélica Pérez Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Raymond van de Berg
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
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Hackenberg B, O'Brien K, Döge J, Lackner KJ, Beutel ME, Münzel T, Wild PS, Pfeiffer N, Chalabi J, Matthias C, Bahr‐Hamm K. Vertigo and its burden of disease-Results from a population-based cohort study. Laryngoscope Investig Otolaryngol 2023; 8:1624-1630. [PMID: 38130247 PMCID: PMC10731510 DOI: 10.1002/lio2.1169] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 08/31/2023] [Accepted: 10/06/2023] [Indexed: 12/23/2023] Open
Abstract
Objectives Vertigo describes symptoms of abnormal movement of the environment or the patient's own body. As such, it affects patients' quality of life, prevents them from following their daily activities, and increases healthcare utilization. The Global Burden of Disease Project aims to quantify morbidity and mortality worldwide. In 2013, a separate disability weight for vertigo was introduced. The aim of this study is to estimate the symptom burden of disease caused by vertigo. Methods This study analyzes data from the Gutenberg Health Study (GHS). The GHS is a population-based cohort study representative of the city of Mainz and its district. Participants were asked whether they suffered from vertigo and, if so, how bothered they felt by it, rating their distress on a six-level scale from 1 = little stressful to 6 = extremely stressful. Results Eight thousand five hundred and nineteen participants could be included in the study. The overall prevalence of vertigo was 21.6% (95%-confidence interval [CI] [20.7%; 22.5%]). Vertigo prevalence peaked in the age group of 55-64 years. Vertigo annoyance averaged 2.42 (± 1.28). When an annoyance of 3-6 was considered bothersome, the prevalence of bothersome vertigo was 8.1 % (95%-CI [7.5%; 8.7%]). Age-standardized to the European Standard Population 2013, vertigo caused a burden of 2102 years lived with disability per 100,000 population. Conclusion In this study, it was found that one in five people suffer at least occasionally from vertigo. This result suggests a significant burden of disease. This burden is reported at the symptom level. Future studies are needed to attribute the burden to specific causes. Level of Evidence 2.
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Affiliation(s)
- Berit Hackenberg
- Department of OtorhinolaryngologyUniversity Medical Center MainzMainzGermany
| | - Karoline O'Brien
- Department of OtorhinolaryngologyUniversity Medical Center MainzMainzGermany
| | - Julia Döge
- Department of OtorhinolaryngologyUniversity Medical Center MainzMainzGermany
| | - Karl J. Lackner
- Institute for Clinical Chemistry and Laboratory MedicineUniversity Medical Center MainzMainzGermany
| | - Manfred E. Beutel
- Department of Psychosomatic Medicine and PsychotherapyUniversity Medical Center MainzMainzGermany
| | - Thomas Münzel
- Department of Cardiology—Cardiology IUniversity Medical Center MainzMainzGermany
| | - Philipp S. Wild
- Preventive Cardiology and Preventive Medicine—Department of CardiologyUniversity Medical Center MainzMainzGermany
- Center for Thrombosis and HemostasisUniversity Medical Center MainzMainzGermany
- DZHK (German Center for Cardiovascular Research), Partner Site RhineMainMainzGermany
- Institute of Molecular Biology (IMB)MainzGermany
| | - Norbert Pfeiffer
- Department of OphthalmologyUniversity Medical Center MainzMainzGermany
| | - Julian Chalabi
- Preventive Cardiology and Preventive Medicine—Department of CardiologyUniversity Medical Center MainzMainzGermany
| | - Christoph Matthias
- Department of OtorhinolaryngologyUniversity Medical Center MainzMainzGermany
| | - Katharina Bahr‐Hamm
- Department of OtorhinolaryngologyUniversity Medical Center MainzMainzGermany
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12
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Melliti A, van de Berg M, van de Berg R. Capturing nystagmus during vertigo attacks using a smartphone: adherence, characteristics, pearls and pitfalls. J Neurol 2023; 270:6044-6056. [PMID: 37653139 PMCID: PMC10632223 DOI: 10.1007/s00415-023-11965-y] [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: 05/22/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE To investigate adherence, characteristics, and first clinical experiences of capturing ictal nystagmus at home, which can be performed to complement the diagnostic process in patients with episodic vestibular symptoms. METHODS Patients were recruited at a tertiary referral center in case capturing ictal nystagmus could contribute to the diagnostic process (e.g., to detect or rule out BPPV). They were asked to capture ictal nystagmus with their own smartphone at home, using a smartphone-based adapter (Nystagmocatcher, Balansdiagnos, Stockholm, Sweden). All recordings were analyzed by the last author (RvdB), and the adherence, characteristics, and first clinical experiences were evaluated. RESULTS Seventy patients with vestibular symptoms were asked to participate in this study. Sixty-two (89%) agreed to participate. The median period of participation was 86 days. Fifty-one patients experienced attacks during the study period. Eventually, 51% of them provided eye movement recordings sufficient for analysis. Different types of nystagmus were observed: positional nystagmus related to BPPV, positional nystagmus not related to BPPV, functional eye movements, and the absence of nystagmus or functional eye movements. Capturing ictal nystagmus could contribute to the diagnostic process in several ways, including to detect or rule out BPPV, to detect or rule out vestibular origin of symptoms, to determine the affected side, telemedicine, to monitor attack frequency, and to detect malingering. Furthermore, strict guidance of patients was necessary, which could be time-consuming. CONCLUSION Capturing ictal nystagmus can contribute to the diagnostic process in several ways, which motivates to rethink current clinical workflow in vestibular medicine. However, strict guidance is necessary and not all patients provide ictal recordings. In an outpatient setting, it would be advised to use ictal nystagmus recordings on indication, to complement the diagnostic process.
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Affiliation(s)
- Ali Melliti
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Maurice van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
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Ngo HTN, Maarsingh OR, van de Berg R, Blanker MH, Bruintjes TD, Castien R, Dijkstra R, Rutgers S, Slottje P, Twisk JWR, Yardley L, Bont J, van Vugt VA. Study protocol for a nationwide implementation of internet-based vestibular rehabilitation for patients with chronic vestibular symptoms (I-RECOVER). Implement Sci Commun 2023; 4:147. [PMID: 37993954 PMCID: PMC10666423 DOI: 10.1186/s43058-023-00524-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/01/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Vestibular rehabilitation is a safe and effective exercise-based treatment for patients with chronic vestibular symptoms. However, it is underused in general practice. Internet-based vestibular rehabilitation (Vertigo Training), which has proven to be effective as well, was developed to increase uptake. We now aim to improve the quality of care for patients with vestibular symptoms by carrying out a nationwide implementation of Vertigo Training. We will evaluate the effect of this implementation on primary care. METHODS Our implementation study consists of three successive phases: 1) We will perform a retrospective observational cohort study and a qualitative interview study to evaluate the current management of patients with vestibular symptoms in primary care, in particular anti-vertigo drug prescriptions, and identify areas for improvement. We will use the results of this phase to tailor our implementation strategy to the needs of general practitioners (GPs) and patients. 2) This phase entails the implementation of Vertigo Training using a multicomponent implementation strategy, containing: guideline adaptations; marketing strategy; pharmacotherapeutic audit and feedback meetings; education; clinical decision support; and local champions. 3) In this phase, we will evaluate the effect of the implementation in three ways. a. Interrupted time series. We will use routine primary care data from adult patients with vestibular symptoms to compare the number of GP consultations for vestibular symptoms, referrals for vestibular rehabilitation, prescriptions for anti-vertigo drugs, and referrals to physiotherapy and secondary care before and after implementation. b. Prospective observational cohort study. We will extract data from Vertigo Training to investigate the usage and the characteristics of participants. We will also determine whether these characteristics are associated with successful treatment. c. Qualitative interview study. We will conduct interviews with GPs to explore their experiences with the implementation. DISCUSSION This is one of the first studies to evaluate the effect of a nationwide implementation of an innovative treatment on Dutch primary care. Implementation strategies have been researched before, but it remains unclear which ones are the most effective and under what conditions. We therefore expect to gain relevant insights for future projects that aim to implement innovations in primary care.
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Affiliation(s)
- Hà T N Ngo
- Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Otto R Maarsingh
- Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Raymond van de Berg
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marco H Blanker
- Department of Primary and Long-Term Care, University Medical Centre Groningen, Hanzeplein 1, Groningen, The Netherlands
| | - Tjasse D Bruintjes
- Department of Otorhinolaryngology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Otorhinolaryngology, Gelre Hospital Apeldoorn, Apeldoorn, The Netherlands
| | - René Castien
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Program Musculoskeletal Health, Amsterdam, The Netherlands
| | - Rob Dijkstra
- Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Sandra Rutgers
- Patient Association Hoormij•NVVS, Houten, The Netherlands
| | - Pauline Slottje
- Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Lucy Yardley
- School of Psychology, University of Southampton, Southampton, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Jettie Bont
- Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Vincent A van Vugt
- Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Benjamin T, Gardi A, Sharon JD. Recent Developments in Vestibular Migraine: A Narrative Review. Am J Audiol 2023; 32:739-745. [PMID: 36701806 DOI: 10.1044/2022_aja-22-00120] [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: 01/28/2023] Open
Abstract
PURPOSE The aim of this study was to review current literature regarding the epidemiology of vestibular migraine (VM), patient presentation, pathogenesis, and treatment. RECENT FINDINGS VM is becoming an increasingly recognized condition in the United States, currently affecting 2.7% of people. Patients may experience vestibular symptoms, such as vertigo and imbalance, with or without other migrainous symptoms. Recent evidence has also shown that patients with VM are at higher risk for cochlear dysfunction, such as sudden deafness, sensorineural hearing loss, and tinnitus. The heritability and genetics are not well understood, and the pathogenesis may involve calcitonin gene-related peptide, which is also implicated in migraine headaches. A disease-specific patient reported outcome measure, the Vestibular Migraine Patient Assessment Tool and Handicap Inventory, was recently developed and validated. A limited number of controlled trials have assessed various therapies for VM, including triptans and beta-blockers. More data are needed to understand whether or not currently available migraine treatments are effective for VM. SUMMARY VM is a common etiology of vertigo and dizziness, presenting with a characteristic spectrum of symptoms. Early data suggest that migraine treatments may be helpful in some cases.
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Affiliation(s)
- Tania Benjamin
- Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco
| | - Adam Gardi
- Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco
| | - Jeffrey D Sharon
- Department of Otolaryngology - Head and Neck Surgery, University of California San Francisco
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15
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van Stiphout L, Rolfes J, Waardenburg S, Kimman M, Guinand N, Pérez Fornos A, Van Rompaey V, van de Berg R. Construct validity and reliability of the Bilateral Vestibulopathy Questionnaire (BVQ). Front Neurol 2023; 14:1221037. [PMID: 38020641 PMCID: PMC10646559 DOI: 10.3389/fneur.2023.1221037] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Accepted: 10/06/2023] [Indexed: 12/01/2023] Open
Abstract
Background The Bilateral Vestibulopathy Questionnaire (BVQ) is a recently developed 54-item Patient Reported Outcome Measure (PROM) that evaluates the clinically important symptoms of bilateral vestibulopathy (BVP) and its impact on daily life. This study aimed to assess the construct validity and reliability of the BVQ in a large BVP cohort. Methods Patients diagnosed with BVP were asked to complete a set of questionnaires, including the BVQ, the EuroQol-5D-5L, the Health Utilities Index, the Dizziness Handicap Inventory, the Hospital Anxiety and Depression Scale, and the Oscillopsia Severity Questionnaire. The construct validity of the BVQ was evaluated by confirmatory and exploratory factor analyses (CFA and EFA), followed by hypotheses testing and known groups validity. Structural properties were explored for each individual item. Reliability was assessed by testing the internal consistency of the BVQ constructs (Cronbach's alpha) and test-retest reliability [intraclass correlation coefficients (ICCs)]. Results A total of 148 patients with BVP (50% women, mean age 66 years) completed the set of questionnaires. The CFA did not show a satisfactory model in the original BVQ. However, the EFA showed a four-factor solution with 20 Likert-scale items related to oscillopsia, imbalance, emotion, and cognition. The succeeding CFA provided evidence for construct validity and an acceptable model of fit. Hypothesis testing confirmed that this shortened version validly measures the constructs to be measured. Statistically significant differences in scores between known groups were found, providing further support for good construct validity. The structural properties were acceptable. Cronbach's alpha confirmed good internal consistency for the four constructs, ranging from 0.80 to 0.89. The ICCs of the 20 Likert-scale items and four visual analog scale (VAS) items were interpreted as good (range 0.76-0.93). Conclusion This study showed evidence of good construct validity of the new shortened version of the BVQ, consisting of four constructs with a total of 20 Likert-scale items and four VAS items. The final 24-item BVQ proved to be a reliable and valid multi-item PROM that captures the clinically important symptoms of BVP and evaluates its impact on daily life. Consequently, the BVQ enables the gathering of high-level evidence of treatment effectiveness in a systematic and quantitative manner.
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Affiliation(s)
- Lisa van Stiphout
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
| | - Jeremy Rolfes
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
| | - Sophie Waardenburg
- Department of Clinical Epidemiology and Medical Technology (KEMTA), Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, Maastricht, Netherlands
| | - Merel Kimman
- Department of Clinical Epidemiology and Medical Technology (KEMTA), Care and Public Health Research Institute (CAPHRI), Maastricht University Medical Centre, Maastricht, Netherlands
| | - Nils Guinand
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Angélica Pérez Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
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Harrell RG, Hart R, Jen JC, Whitney SL. Surveying physical therapists' understanding of benign paroxysmal positional vertigo. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1228453. [PMID: 37662546 PMCID: PMC10469676 DOI: 10.3389/fresc.2023.1228453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/24/2023] [Accepted: 08/04/2023] [Indexed: 09/05/2023]
Abstract
Introduction Benign paroxysmal positional vertigo (BPPV) is a common condition with disabling symptoms that is diagnosed and effectively treated at the bedside. Our encounter with patients experiencing prolonged BPPV who may not have received appropriate physical therapy prompted us to explore barriers to the diagnosis and treatment for BPPV among physical therapists, which has not been extensively investigated. We hypothesize that a potential barrier may be a lack of understanding of subtle symptoms of BPPV that deviate from the classical presentation. The gold standard for diagnosing definite BPPV is subjective dizziness or vertigo with nystagmus in response to positional testing. There are variants of BPPV including subjective BPPV (subjective dizziness or vertigo without nystagmus) and vestibular agnosia (nystagmus without subjective dizziness or vertigo) that do not meet the diagnostic criteria for definite BPPV but are equally responsive to the same repositioning maneuvers. The purpose of this project was to survey physical therapists for their understanding of BPPV including subjective BPPV and vestibular agnosia. Methods A panel of experts created a 16-question survey, designed for physical therapists, with three categories: (1), inquiring if they treat persons with BPPV, (2) three clinical vignettes for definite BPPV, subjective BPPV, and BPPV with vestibular agnosia, and (3) demographic information. Data collection occurred at two large physical therapy meetings, one of which was a national professional meeting and the other was a professional continuing medical education course geared towards advancing vestibular rehabilitation skills. Results There were 426 people who completed the survey, 364 of whom treat BPPV in their practice. In the first clinical vignette created to assess the respondents' understanding of definite BPPV, 229 (62%) of respondents would always assess a patient for BPPV based on complaints of a "room spinning" vertigo from head movement. When asked if the complaint was lingering "lightheadedness or feelings of imbalance" from head movement, only 158 (43%) reported they would perform positional testing to reassess. In the BPPV variant vignettes, 187 (51%) identified the patient with subjective BPPV as having BPPV and 305 (85%) identified the patient with vestibular agnosia as having BPPV. Discussion The results of this survey demonstrate gaps in knowledge regarding BPPV across practice settings and experience, with opportunities to bridge these gaps to improve treatment for BPPV.
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Affiliation(s)
- Regan G. Harrell
- Department of Physical Therapy, The University of Pittsburgh, Pittsburgh, PA, United States
| | - Rebecca Hart
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Joanna C. Jen
- Department of Neurology, Icahn School of Medicine at Mount Sinai, New York, NY, United States
| | - Susan L. Whitney
- Department of Physical Therapy, The University of Pittsburgh, Pittsburgh, PA, United States
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Jiam NT, Chern A, Watson J, Naples JG. Lyrical Trends: An Analysis of Music's (Mis) Use of Vertigo. Otol Neurotol 2023; 44:619-625. [PMID: 37254262 DOI: 10.1097/mao.0000000000003912] [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: 06/01/2023]
Abstract
BACKGROUND Popular culture and music have long served as windows into the common attitudes, trends, and issues of the time. The representation of vertigo in music has not been previously explored. The objective of this study was to analyze the portrayal of vertigo in music through content and sentiment analysis of song lyrics. METHODS A large song lyric database was queried to identify English language song titles containing the word "vertigo." A sentiment and content analysis of the lyrics was performed to delineate the most frequently used words, the accuracy of vertigo depictions, and emotional valence (i.e., the ratio of positive to negative references to vertigo). RESULTS Between 1969 and 2022, there were a total of 54 songs specifically titled "Vertigo." Most songs (73%) portrayed vertigo negatively, and the prevalence of negative sentiment within music increased with each decade. The three most common words being used in association with vertigo within music were "feel" (n = 97), "love" (n = 66), and "falling" (n = 57). In early decades, songs using the word vertigo misrepresented the condition and associated perceptions relative to common medical understanding. In more recent decades, vertigo was used in a way more representative of medical interpretations. CONCLUSION The depiction of vertigo in songs has changed over time, and more recently, usage has reflected Bárány Society definitions. Interestingly, the negative sentiment has also increased with time. This work provides a lyrical analysis of vertigo that may improve physician understanding of the cultural usage of this challenging symptom.
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Affiliation(s)
- Nicole T Jiam
- Department of Otolaryngology- Head and Neck Surgery, Massachusetts Eye and Ear, Harvard Medical School, Boston, MA
| | | | - Jowan Watson
- School of Medicine; Harvard Medical School, Boston, MA
| | - James G Naples
- Department of Otolaryngology & Head and Neck Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA
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Du EHY, Tenenbaum MN, Bhadelia RA, Sotman TE, Edlow JA, Selim MH, Chang YM. Major radiological outcomes of CTA head and neck performed for dizziness in a major academic Emergency Department. Neuroradiol J 2023; 36:259-266. [PMID: 36045600 PMCID: PMC10268097 DOI: 10.1177/19714009221124304] [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: 11/17/2022] Open
Abstract
Purpose: Routine head and neck CTAs (CTAhead+neck) performed for dizziness in the Emergency Department (ED) has steadily increased, but its clinical utility is still poorly elucidated. Our purpose was to assess the radiologic outcomes of CTAhead+neck in ED dizziness patients.Methods: ED dizziness patients with CTAhead+neck from January 2010 through November 2019 were retrospectively identified and further stratified into central vertigo (CV), peripheral vertigo (PV), and non-specific dizziness (NSD) groups by final clinical diagnoses. Findings on CTAhead+neck (vessel stenosis >50%, occlusion, dissection, and infarct), and infarct on subsequent MRI if performed, were assessed. Differences in imaging findings were analyzed using chi-square or Fisher's exact tests.Results: Of 867 dizziness patients, 88 were diagnosed with CV, 383 with PV, and 396 with NSD. On CTAhead+neck, 11.4% of all patients had posterior CTA findings, including posterior occlusions (4.2%), dissections (1.2%), and infarcts (2.3%). CV patients had more posterior circulation findings (31.8%) versus PV (9.9%) and NSD (8.3%) patients (both p < 0.01). 21.6% of CV patients had acute infarcts on CT versus none for PV and 0.03% for NSD patients (both p < 0.01). On MRI, 46.6% of CV patients had acute posterior circulation infarcts versus none for PV and 0.3% for NSD patients (p < 0.01).Conclusion: Diagnostic yield for CTAhead+neck for dizziness patients is low except in central vertigo patients which constitute only 1/10th of CTAs performed. Our single institution results support that CTAhead+neck is likely low-yield in patients with high clinical suspicion for PV or NSD and further studies are needed to test this hypothesis.
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Affiliation(s)
- Elizabeth HY Du
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Mary N Tenenbaum
- Department of Radiology, Baystate Medical Center, Springfield, MA, USA
| | - Rafeeque A Bhadelia
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Timothy E Sotman
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Jonathan A Edlow
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Magdy H Selim
- Department of Neurology, Beth Israel Deaconess Medical Center, Boston, MA, USA
| | - Yu-Ming Chang
- Department of Radiology, Beth Israel Deaconess Medical Center, Boston, MA, USA
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Khoujah D, Naples JG, Silva LOJE, Edlow JA, Gerberi DJ, Carpenter CR, Bellolio F. Epley maneuver for benign paroxysmal positional vertigo: Evidence synthesis for guidelines for reasonable and appropriate care in the emergency department. Acad Emerg Med 2023. [PMID: 37186435 DOI: 10.1111/acem.14739] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 04/13/2023] [Accepted: 04/14/2023] [Indexed: 05/17/2023]
Abstract
BACKGROUND Canalith repositioning maneuvers (such as the Epley maneuver) are recommended by specialty guidelines for management of benign paroxysmal positional vertigo (BPPV) yet are frequently underutilized in the emergency department (ED). METHODS We conducted a systematic review of systematic reviews to summarize the evidence of Epley maneuver for the treatment of posterior canal (pc) BPPV in any setting. We included systematic reviews of randomized controlled trials (RCTs) that compared Epley to control in adult patients with pc-BPPV. Titles, abstracts, and full texts were screened in duplicate. The Grading of Recommendations, Assessment, Development and Evaluation (GRADE) assessment was used to rate certainty of evidence. Odds ratios (OR) and 95% confidence intervals (CI) are reported. Meta-analysis of individual studies was conducted with random and fixed effects. RESULTS From 2,228 titles, 7 systematic reviews were selected for quality assessment. One review was of higher methodological quality, included only RCTs, and was the most current and comprehensive. Five of the 11 RCTs of the review, including 312 patients with pc-BPPV diagnosed by Dix-Hallpike, were relevant to our question. Meta-analysis of 4 RCTs (251 patients) showed the use of Epley (as compared to control) was associated with higher complete resolution of vertigo at 1 week (OR 7.19, CI 1.52 to 33.98, moderate certainty). Meta-analysis of 3 RCTs (195 patients) showed the use of Epley was associated with higher conversion to negative Dix-Hallpike at 1 week (OR 6.67, CI 1.52 to 33.98, moderate certainty). The number-needed-to-treat was 3. Meta-analysis of the outcomes at 1 month, and when observational studies were included, showed similar results. No serious adverse effects were reported. CONCLUSIONS Symptoms of pc-BPPV improve with the Epley maneuver. Emergency clinicians should become familiar with performing the Epley for BPPV. Further studies on ED implementation and clinician education of Epley are needed.
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Affiliation(s)
- Danya Khoujah
- Department of Emergency Medicine, University of Maryland School of Medicine, Baltimore, Maryland, USA
- Department of Emergency Medicine, AdventHealth Tampa, Tampa, Florida, USA
| | - James G Naples
- Center, Division of Otolaryngology-Head & Neck Surgery, Beth, Israel Deaconess Medical, Harvard Medical School, Boston, Massachusetts, USA
| | - Lucas Oliveira J E Silva
- Department of Emergency Medicine, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
| | - Jonathan A Edlow
- Department of Emergency Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachusetts, USA
| | | | - Christopher R Carpenter
- Department of Emergency Medicine, Washington University at St. Louis, St. Louis, Missouri, USA
| | - Fernanda Bellolio
- Department of Emergency Medicine, Mayo Clinic, Rochester, Minnesota, USA
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Jáuregui-Renaud K, Velázquez-Ramírez I, Hernández-Tenorio JDJ, Solis-Cruz MDC, Aguilar-Jiménez CM, Morales-Sánchez ODJ, Rincón-Rojas M. Sick Leave Due to Ear Diagnoses, a Nationwide Representative Registry of Mexico. Healthcare (Basel) 2023; 11:healthcare11081112. [PMID: 37107945 PMCID: PMC10137506 DOI: 10.3390/healthcare11081112] [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: 03/08/2023] [Revised: 03/31/2023] [Accepted: 04/10/2023] [Indexed: 04/29/2023] Open
Abstract
Sickness absence from work is a measure of both poor health and social functioning. In order to assess the frequency of sick leave due to ear-related diagnoses, we performed a retrospective analysis on the registry of paid sick leave certificates supplied by the main social security institution in Mexico during the years 2018 and 2019, just prior to the SARS-CoV-2 pandemic. We observed that, in the two years, 22,053 sick leave certificates due to ear-related diagnoses were provided to 18,033 workers. The most frequent ear-related diagnoses were those of vestibular disorders (94.64%); among them, the most common diagnosis was Benign Paroxysmal Positional Vertigo (75.16%), followed by Labrynthitis and Meniere's disease (circa 8% each). A total of 4.63% of the diagnoses were related to external and middle ear disorders, and 0.71% were mainly related to hearing. Consistently, the highest cumulative days of sick leave required were given for the group of diagnoses related to vestibular disorders; although the less frequent diagnoses required the highest cumulative days per case (e.g., ototoxicity). During 2018 and 2019, the most frequent diagnoses of ear-related sick leave were due to vestibular diagnoses (particularly Benign Paroxysmal Positional Vertigo).
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Affiliation(s)
- Kathrine Jáuregui-Renaud
- Unidad de Investigación Médica en Otoneurología, Instituto Mexicano del Seguro Social, Ciudad de México C.P. 06720, Mexico
| | - Ismael Velázquez-Ramírez
- Coordinación de Salud en el Trabajo, Instituto Mexicano del Seguro Social, Ciudad de México C.P. 06720, Mexico
| | | | - María Del Carmen Solis-Cruz
- Coordinación de Salud en el Trabajo, Instituto Mexicano del Seguro Social, Ciudad de México C.P. 06720, Mexico
| | | | | | - Milliteotl Rincón-Rojas
- Coordinación de Salud en el Trabajo, Instituto Mexicano del Seguro Social, Ciudad de México C.P. 06720, Mexico
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21
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Moen U, Knapstad MK, Wilhelmsen KT, Goplen FK, Nordahl SHG, Berge JE, Natvig B, Meldrum D, Magnussen LH. Musculoskeletal pain patterns and association between dizziness symptoms and pain in patients with long term dizziness - a cross-sectional study. BMC Musculoskelet Disord 2023; 24:173. [PMID: 36882720 PMCID: PMC9992911 DOI: 10.1186/s12891-023-06279-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/05/2023] [Accepted: 02/28/2023] [Indexed: 03/09/2023] Open
Abstract
BACKGROUND The impact of long-term dizziness is considerable both on the personal level and in society and may lead to self-imposed restrictions in daily activities and social relations due to fear of triggering the symptoms. Musculoskeletal complaints seem to be common in persons with dizziness, but studies addressing these complaints as a widespread occurrence, are scarce. This study aimed to examine the occurrence of widespread pain in patients with long-term dizziness and investigate the associations between pain and dizziness symptoms. Further, to explore whether diagnostic belonging is related to the occurrence of pain. METHODS This cross-sectional study was conducted in an otorhinolaryngology clinic and included 150 patients with persistent dizziness. The patients were categorized into three groups: episodic vestibular syndromes, chronic vestibular syndromes, and non-vestibular group. The patients completed questionnaires on dizziness symptoms, catastrophic thinking, and musculoskeletal pain when entering the study. Descriptive statistics were used to describe the population, and associations between pain and dizziness were investigated by linear regression. RESULTS Pain was reported by 94.5% of the patients. A significantly higher prevalence of pain was reported in all the ten pain sites examined compared to the general population. Number of pain sites and pain intensity were associated with the dizziness severity. Number of pain sites was also associated with dizziness-related handicap, but not with catastrophic thinking. There was no association between pain intensity and dizziness-related handicap or catastrophic thinking. Pain was equally distributed in the diagnostic groups. CONCLUSION Patients with long-term dizziness have a considerably higher prevalence of pain and number of pain sites than the general population. Pain co-exists with dizziness and is associated with dizziness severity. These findings may indicate that pain should be systematically assessed and treated in patients with persisting dizziness.
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Affiliation(s)
- Unni Moen
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway.
| | - Mari Kalland Knapstad
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway.,Norwegian National Advisory Unit On Vestibular Disorders, Haukeland University Hospital, Bergen, Norway
| | | | - Frederik Kragerud Goplen
- Norwegian National Advisory Unit On Vestibular Disorders, Haukeland University Hospital, Bergen, Norway.,Department of Otorhinolaryngology & Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
| | - Stein Helge Glad Nordahl
- Department of Otorhinolaryngology & Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway.,Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jan Erik Berge
- Norwegian National Advisory Unit On Vestibular Disorders, Haukeland University Hospital, Bergen, Norway.,Department of Otorhinolaryngology & Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
| | - Bård Natvig
- Department of General Practice, University of Oslo, Oslo, Norway
| | - Dara Meldrum
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Liv Heide Magnussen
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
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22
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Gill-Lussier J, Saliba I, Barthélemy D. Proprioceptive Cervicogenic Dizziness Care Trajectories in Patient Subpopulations: A Scoping Review. J Clin Med 2023; 12:jcm12051884. [PMID: 36902670 PMCID: PMC10003866 DOI: 10.3390/jcm12051884] [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: 01/24/2023] [Revised: 02/12/2023] [Accepted: 02/24/2023] [Indexed: 03/08/2023] Open
Abstract
Proprioceptive cervicogenic dizziness (PCGD) is the most prevalent subcategory of cervicogenic dizziness. There is considerable confusion regarding this clinical syndrome's differential diagnosis, evaluation, and treatment strategy. Our objectives were to conduct a systematic search to map out characteristics of the literature and of potential subpopulations of PCGD, and to classify accordingly the knowledge contained in the literature regarding interventions, outcomes and diagnosis. A Joanna Briggs Institute methodology-informed scoping review of the French, English, Spanish, Portuguese and Italian literature from January 2000 to June 2021 was undertaken on PsycInfo, Medline (Ovid), Embase (Ovid), All EBM Reviews (Ovid), CINAHL (Ebsco), Web of Science and Scopus databases. All pertinent randomized control trials, case studies, literature reviews, meta-analyses, and observational studies were retrieved. Evidence-charting methods were executed by two independent researchers at each stage of the scoping review. The search yielded 156 articles. Based on the potential etiology of the clinical syndrome, the analysis identified four main subpopulations of PCGD: chronic cervicalgia, traumatic, degenerative cervical disease, and occupational. The three most commonly occurring differential diagnosis categories are central causes, benign paroxysmal positional vertigo and otologic pathologies. The four most cited measures of change were the dizziness handicap inventory, visual analog scale for neck pain, cervical range of motion, and posturography. Across subpopulations, exercise therapy and manual therapy are the most commonly encountered interventions in the literature. PCGD patients have heterogeneous etiologies which can impact their care trajectory. Adapted care trajectories should be used for the different subpopulations by optimizing differential diagnosis, treatment, and evaluation of outcomes.
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Affiliation(s)
- Joseph Gill-Lussier
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC H3N 1X7, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (IURDPM), CRIR, CIUSSS South-Center, Montreal, QC H3S 1M9, Canada
- Collège d’Études Ostéopathique de Montréal (CEOM), Montréal, QC H3G 1W7, Canada
| | - Issam Saliba
- Division of Otolaryngology, Head and Neck Surgery—Otology and Neurotology, Montreal University Hospital Center (CHUM), University of Montreal, Montreal, QC H2X 3E4, Canada
- Correspondence:
| | - Dorothy Barthélemy
- School of Rehabilitation, Faculty of Medicine, University of Montreal, Montreal, QC H3N 1X7, Canada
- Center for Interdisciplinary Research in Rehabilitation of Greater Montreal (IURDPM), CRIR, CIUSSS South-Center, Montreal, QC H3S 1M9, Canada
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23
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Huang FM, Luo CW, Lee SS, Ho YC, Li YC, Chang YC, Kuan YH. Relationship between periodontal disease and dizziness in Taiwanese adults: A nationwide population-based cohort study. Medicine (Baltimore) 2023; 102:e32961. [PMID: 36827024 PMCID: PMC11309663 DOI: 10.1097/md.0000000000032961] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 01/23/2023] [Accepted: 01/24/2023] [Indexed: 02/25/2023] Open
Abstract
Periodontal disease is often neglected and overlooking its initial symptoms can lead to tooth loss and systemic diseases. Patients with otitis media are at high risk of vestibular and balance dysfunction, consequently, and vertigo. Vertigo and dizziness are conditions with high reported incidences; they worsen with age and can burden health systems. The present study investigated whether periodontal disease causes dizziness. Research data covering 2008 through 2013 were retrieved from the National Health Insurance Research Database of Taiwan. Patients who were newly diagnosed as having periodontal disease or dizziness after at least 1 hospital admission or 3 outpatient visits were enrolled as participants. For our controls, we randomly selected individuals without periodontal disease who were sex- and age-matched with the investigated participants. In total, we enrolled 445 patients with periodontal disease and 1780 controls. The Kaplan-Meier curve indicated that the cumulative incidence of dizziness was significantly higher among the patients with periodontal disease relative to the controls. After adjustment for sex, age, income level, urbanization level, month of onset, and comorbidities, Cox proportional-hazards analysis revealed that patients with periodontal disease had an increased risk of dizziness (hazard ratio [HR]: 1.306, 95% confidence interval (CI): 1.155, 1.475). Compared with the controls, the risk of dizziness among patients with periodontal disease was higher for both female (HR: 1.439, 95%: 1.203, 1.720) and male patients (HR: 1.284, 95%: 1.123, 1.468); this risk was higher even when January (HR: 1.302, 95% CI: 1.145, 1.480), February (HR: 1.337, 95% CI: 1.178, 1.518), or March was excluded (HR: 1.308, 95% CI: 1.151, 1.487) and for patients without Ménière disease. Therefore, periodontal disease is not only a risk factor for dizziness but also an independent risk factor for dizziness. Future studies could clarify the mechanisms linking periodontal disease to dizziness.
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Affiliation(s)
- Fu-Mei Huang
- Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Dentistry, Chung Shan Medical University, Taichung, Taiwan
| | - Ci-Wen Luo
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Pharmacology, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Shiuan-Shinn Lee
- School of Public Health, Chung Shan Medical University, Taichung, Taiwan
| | - Yung-Chuan Ho
- School of Medical Applied Chemistry, Chung Shan Medical University, Taichung, Taiwan
| | - Yi-Ching Li
- Department of Pharmacology, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
| | - Yu-Chao Chang
- Department of Dentistry, Chung Shan Medical University Hospital, Taichung, Taiwan
- School of Dentistry, Chung Shan Medical University, Taichung, Taiwan
| | - Yu-Hsiang Kuan
- Department of Pharmacology, School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Pharmacy, Chung Shan Medical University Hospital, Taichung, Taiwan
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24
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Gawronska A, Rosiak O, Pajor A, Janc M, Kotas R, Kaminski M, Zamyslowska-Szmytke E, Jozefowicz-Korczynska M. Instrumental and Non-Instrumental Measurements in Patients with Peripheral Vestibular Dysfunctions. SENSORS (BASEL, SWITZERLAND) 2023; 23:1994. [PMID: 36850594 PMCID: PMC9963841 DOI: 10.3390/s23041994] [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: 01/01/2023] [Revised: 02/06/2023] [Accepted: 02/08/2023] [Indexed: 06/18/2023]
Abstract
Vestibular dysfunction is a disturbance of the body's balance system. The control of balance and gait has a particular influence on the quality of life. Currently, assessing patients with these problems is mainly subjective. New assessment options using wearables may provide complementary and more objective information. Posturography makes it possible to determine the extent and type of posture dysfunction, which makes it possible to plan and monitor the effectiveness of physical rehabilitation therapy. This study evaluates the effectiveness of non-instrumental clinical tests and the instrumental mobile posturography MediPost device for patients with unilateral vestibular disorders. The study group included 40 patients. A subjective description of the symptoms was evaluated using a questionnaire about the intensity of dizziness using the Dizziness Handicap Inventory (DHI) and Vertigo Syndrome Scale-short form (VSS-sf). The clinical protocol contained clinical tests and MediPost measurements using a Modified Clinical Test of Sensory Interaction on Balance. All patients underwent vestibular rehabilitation therapy (VRT) for four weeks. The non-instrumental measurement results were statistically significant, and the best was in the Timed Up and Go test (TUG). In MediPost, condition 4 was the most valuable. This research demonstrated the possibilities of using an instrumental test (MediPost) as an alternative method to assess balance.
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Affiliation(s)
- Anna Gawronska
- Balance Disorders Unit, Department of Otolaryngology, Medical University of Lodz, The Norbert BarlickMemorial Teaching Hospital, 90-153 Lodz, Poland
| | - Oskar Rosiak
- Department of Otolaryngology, Polish Mother Memorial Hospital Research Institute, 93-338 Lodz, Poland
| | - Anna Pajor
- Balance Disorders Unit, Department of Otolaryngology, Medical University of Lodz, The Norbert BarlickMemorial Teaching Hospital, 90-153 Lodz, Poland
| | - Magdalena Janc
- Audiology and Phoniatrics Clinic, Nofer Institute of Occupational Medicine, 91-348 Lodz, Poland
| | - Rafal Kotas
- Department of Microelectronics and Computer Science, Lodz University of Technology, 90-924 Lodz, Poland
| | - Marek Kaminski
- Department of Microelectronics and Computer Science, Lodz University of Technology, 90-924 Lodz, Poland
| | - Ewa Zamyslowska-Szmytke
- Audiology and Phoniatrics Clinic, Nofer Institute of Occupational Medicine, 91-348 Lodz, Poland
| | - Magdalena Jozefowicz-Korczynska
- Balance Disorders Unit, Department of Otolaryngology, Medical University of Lodz, The Norbert BarlickMemorial Teaching Hospital, 90-153 Lodz, Poland
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25
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Horstmannshoff C, Skudlik S, Petermann J, Kiesel T, Döringer T, Crispin A, Hermsdörfer J, Köberlein-Neu J, Jahn K, Schädler S, Bauer P, Voigt K, Müller M. Effectiveness of an evidence-based care pathway to improve mobility and participation in older patients with vertigo and balance disorders in primary care (MobilE-PHY2): study protocol for a multicentre cluster-randomised controlled trial. Trials 2023; 24:91. [PMID: 36747256 PMCID: PMC9902065 DOI: 10.1186/s13063-022-07017-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Accepted: 12/15/2022] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Vertigo, dizziness or balance disorders (VDB) are common leading symptoms in older people, which can have a negative impact on their mobility and participation in daily live, yet, diagnosis is challenging and specific treatment is often insufficient. An evidence-based, multidisciplinary care pathway (CPW) in primary care was developed and pilot tested in a previous study. The aim of the present study is to evaluate the effectiveness and safety of the CPW in terms of improving mobility and participation in community-dwelling older people with VDB in primary care. METHODS For this multicentre cluster randomised controlled clinic trial, general practitioners (GP) will be recruited in two regions of Germany. A total of 120 patients over 60 years old with VDB will be included. The intervention is an algorithmized CPW. GPs receive a checklist for standardise clinical decision making regarding diagnostic screening and treatment of VDB. Physiotherapists (PT) receive a decision tree for evidence-based physiotherapeutic clinical reasoning and treatment of VDB. Implementation strategies comprises educational trainings as well as a workshop to give a platform for exchange for the GPs and PTs, an information meeting and a pocket card for home care nurses and informal caregivers and telephone peer counselling to give all participants the capability, opportunity and the motivation to apply the intervention. In order to ensure an optimised usual care in the control group, GPs get an information meeting addressing the national guideline. The primary outcome is the impact of VDB on participation and mobility of patients after 6 month follow-up, assessed using the Dizziness Handicap Inventory (DHI) questionnaire. Secondary outcomes are physical activity, static and dynamic balance, falls and fear of falling as well as quality of life. We will also evaluate safety and health economic aspects of the intervention. Behavioural changes of the participants as well as barriers, facilitating factors and mechanisms of impact of the implementation will be investigated with a comprehensive process evaluation in a mixed-methods design. DISCUSSION With our results, we aim to improve evidence-based health care of community-dwelling older people with VDB in primary care. TRIAL REGISTRATION DRKS, DRKS00028524 retrospectively registered on March 24, 2022.
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Affiliation(s)
- Caren Horstmannshoff
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024 Rosenheim, Germany
- Department of Sport and Health Sciences, Chair of Human Movement Science, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992 Munich, Germany
| | - Stefanie Skudlik
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024 Rosenheim, Germany
| | - Jenny Petermann
- Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 1307 Dresden, Germany
| | - Theresia Kiesel
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024 Rosenheim, Germany
| | - Tobias Döringer
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024 Rosenheim, Germany
| | - Alexander Crispin
- Institute for Medical Information Processing, Biometry, and Epidemiology, Ludwig-Maximilian University of Munich, Marchioninistr. 15, 81377 Munich, Germany
| | - Joachim Hermsdörfer
- Department of Sport and Health Sciences, Chair of Human Movement Science, Technical University of Munich, Georg-Brauchle-Ring 60/62, 80992 Munich, Germany
| | - Juliane Köberlein-Neu
- Center for Health Economics and Health Services Research, University of Wuppertal, Rainer-Gruenter-Str. 21, 42119 Wuppertal, Germany
| | - Klaus Jahn
- German Centre for Vertigo and Balance Disorders, Ludwig-Maximilian University of Munich, Marchioninistraße 15, 81377 Munich, Germany
- Schoen Clinic Bad Aibling, Kolbermoorer Str. 72, 83043 Bad Aibling, Germany
| | - Stefan Schädler
- Physiotherapie im Schloss, Schloss 88, 3454, Sumiswald, Switzerland
| | - Petra Bauer
- Faculty of Applied Health and Social Sciences, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024 Rosenheim, Germany
| | - Karen Voigt
- Faculty of Medicine Carl Gustav Carus, Technische Universität Dresden, Fetscherstr. 74, 1307 Dresden, Germany
| | - Martin Müller
- Centre for Research, Development and Technology Transfer, Rosenheim Technical University of Applied Sciences, Hochschulstr. 1, 83024 Rosenheim, Germany
- Department of Primary Care and Health Services Research, Medical Faculty, Heidelberg University, Im Neuenheimer Feld 130.3, 69120 Heidelberg, Germany
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26
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Kim EJ, Song HJ, Lee HI, Kwon E, Jeong SH. One-year prevalence and clinical characteristics in chronic dizziness: The 2019-2020 Korean National Health and Nutrition Examination Survey. Front Neurol 2022; 13:1016718. [PMID: 36530637 PMCID: PMC9751592 DOI: 10.3389/fneur.2022.1016718] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/11/2022] [Accepted: 11/17/2022] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION In this cross-sectional study, we investigated the 1-year prevalence and related factors in the general population with an experience of chronic dizziness. METHODS This study analyzed persons (n = 5,163) who respond to dizziness and nutrition questionnaire from participant of Korean National Health and Nutrition Examination Survey (KNHANES, 2019-2020). RESULTS Of individuals over 40 years, 25.3% of the general population (61.6% females) reported either dizziness or imbalance for the past year. Moreover, 4.8% of the patients reported they suffered from chronic dizziness or imbalance for more than 3 months. In multiple regression analysis, patients with chronic dizziness were older, females, had lower body mass index (BMI), had stress awareness, and had a history of tinnitus within 1 year (>5 min per episode). Relative to normal body weight, both overweight and mild obesity (obesity stages 1 and 2) were associated with a significantly lower risk of chronic dizziness. Overweight, obesity stage 1, and obesity stage 2 had odds ratios of 0.549 [95% confidence interval (CI), 0.332-0.910], 0.445 (95% CI, 0.273-0.727), and 0.234 (95% CI, 0.070-0.779), respectively. CONCLUSIONS In this study, the prevalence of chronic dizziness in the general population was 4.8%. Our study demonstrated that overweight and mild obesity were independently associated with a lower risk of chronic dizziness in adults for the past year. Therefore, the optimal BMI for patients with dizziness should be defined and managed according to an integrated care pathway.
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Affiliation(s)
- Eun Ji Kim
- Department of Neurology, Chungnam National University Hospital, Daejeon, South Korea
| | - Hee-Jung Song
- Department of Neurology, Chungnam National University Sejong Hospital, Sejong, South Korea
- Department of Neurology, Chungnam National University School of Medicine, Daejeon, South Korea
| | - Hak In Lee
- Department of Neurology, Chungnam National University Hospital, Daejeon, South Korea
| | - Eunjin Kwon
- Department of Neurology, Chungnam National University Hospital, Daejeon, South Korea
| | - Seong-Hae Jeong
- Department of Neurology, Chungnam National University Hospital, Daejeon, South Korea
- Department of Neurology, Chungnam National University School of Medicine, Daejeon, South Korea
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27
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Jeong SS, Simpson KN, Johnson JM, Rizk HG. Assessment of the Cost Burden of Episodic Recurrent Vestibular Vertigo in the US. JAMA Otolaryngol Head Neck Surg 2022; 148:2797389. [PMID: 36227614 PMCID: PMC9562102 DOI: 10.1001/jamaoto.2022.3247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/26/2022] [Indexed: 01/25/2023]
Abstract
Importance Understanding of the economic burden of recurrent vestibular causes of vertigo and areas contributing to the cost is needed. Objective To analyze and identify the factors contributing to the direct medical costs associated with Ménière disease (MD), vestibular migraine (VM), and benign paroxysmal positional vertigo (BPPV). Design, Setting, and Participants This economic evaluation used MarketScan Commercial Database claims data from 2018 to identify the non-Medicare patient population with the diagnoses of MD, VM, or BPPV. Data were analyzed January 1 to December 31, 2018. Main Outcomes and Measures The total direct medical costs associated with MD, VM, and BPPV. Results A total of 53 210 patients (mean [SD] age, 47.8 [11.8] years; 67.6% female) were included in this study, with 34 738 normal comparisons. There were 5783 (10.9%) patients with MD, 3526 (6.6%) patients with VM, and 43 901 (82.5%) patients with BPPV in the data set. Mean age and sex were different across the different vestibular disorders. Across the different groups, patients with no comorbidities or with a Charlson Comorbidity Index score of zero ranged from 98.4% to 98.8%. Around 5% of patients were hospitalized with inpatient stay lasting between 4.6 and 5.2 days. After adjusting for age, sex, and comorbidities, there were large differences in mean adjusted annual payments/direct costs across the different groups (MD, $9579; VM, $11 371; and BPPV, $8247). This equated to a total incremental estimated cost of $60 billion compared with the normal population. The number of outpatient brain magnetic resonance imaging or computed tomography scans per patient ranged anywhere from 1 to 20, while the number of inpatient brain magnetic resonance imaging or computed tomography scans per patient ranged anywhere from 1 to 6. A heat map of the total cost expenditure indicated that the costs were concentrated around the Midwest, Lake Michigan, and the East Coast. Conclusions and Relevance In this economic evaluation, the 3 most common causes of recurrent vertigo-MD, VM, and BPPV-had considerable medical costs associated with them. Extraneous imaging orders and vestibular testing are factors to consider for cost reduction. However, further research and widespread education is needed to optimize the diagnosis, treatment, and care of patients presenting with vestibular disorders or dizziness.
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Affiliation(s)
- Seth S. Jeong
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Medical University of South Carolina, Charleston
- Albert Einstein College of Medicine, Bronx, New York
| | - Kit N. Simpson
- Comparative Effectiveness Data Analytic Resource Core, College of Health Professions, Medical University of South Carolina, Charleston
| | - Jada M. Johnson
- Comparative Effectiveness Data Analytic Resource Core, College of Health Professions, Medical University of South Carolina, Charleston
| | - Habib G. Rizk
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Medical University of South Carolina, Charleston
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28
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Patiño JEP, Moreno JLB, Matos YR, Ortega JA, Puértolas OC, Muñoz RC, Balboa IV, Compta XG, Agudelo OLA, Muñoz SC, Rodríguez VM, Cortes AN, Rodríguez EP. Effectiveness of a training intervention to improve the management of vertigo in primary care: a multicentre cluster-randomised trial, VERTAP. Trials 2022; 23:608. [PMID: 35906606 PMCID: PMC9335455 DOI: 10.1186/s13063-022-06548-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2021] [Accepted: 07/14/2022] [Indexed: 01/15/2023] Open
Abstract
Background Benign paroxysmal positional vertigo (BPPV) is the most common type of vertigo. While BPPV is best treated with canalicular repositioning manoeuvres, they are not routinely performed in primary care (PC). Methods To evaluate the effectiveness of blended training (online and face-to-face) on the diagnosis and management of vertigo to improve adherence of family doctors to clinical practice guidelines, we designed a community multicentre cluster-randomised open-label trial with an intervention (IG) and a control (GC) group of 10 primary care teams (PCT) each. Outcome variables will be ICD-10 diagnostic codes (proportion of nonspecific diagnoses such as dizziness and vertigo versus specific diagnoses such as BPPV, vestibular neuritis, and Menière’s disease); number of referrals to ENT or neurology specialists; prescription of antivertigo agents; and duration of sick leave due to vertigo. The baseline comparability of the two study groups will be analysed to ensure homogeneity. A description of all baseline variables will be performed. Student’s t-test will be used to evaluate the differences between the groups. Logistic regression multivariate analysis will be performed to study the relationship between baseline variables of professionals and centres with outcome variables. Discussion With the improvement of the diagnosis and management of vertigo by family doctors after this training, we expect an increase in the proportion of specific diagnoses, a decrease in the prescription of antivertigo agents, a decrease in referrals to ENT or neurology specialists and a reduction in the duration of sick leave due to temporary disability. The blended training will be easily expanded within primary care services, since it is mainly delivered online, with a single face-to-face session to ensure that the manoeuvres have been adequately learned. Trial registration ClinicalTrials.govNCT04929444. Registered June 18, 2021. This protocol has been approved by the Ethics Committee of the Institut Universitari d’Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol) with the code 20/004-P. All patient data will be anonymised in agreement with the 2016/679 European Regulation. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06548-7.
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Affiliation(s)
- Jenniffer Elizabeth Pérez Patiño
- Primary Care Centre Sant Martí de Provençals, Management Area of Barcelona, Catalan Institute of Health, Barcelona, Spain.,Vertigo Approach Research Group in Primary Care (VERTAP), Fundació Institut Universitari per la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - José Lluís Ballvé Moreno
- Vertigo Approach Research Group in Primary Care (VERTAP), Fundació Institut Universitari per la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain. .,Primary Care Centre Florida Nord, Management Area Metropolitana Sud, Catalan Institute of Health, Barcelona, Spain. .,University of Barcelona, Barcelona, Spain.
| | - Yolanda Rando Matos
- Vertigo Approach Research Group in Primary Care (VERTAP), Fundació Institut Universitari per la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Primary Care Centre Florida Nord, Management Area Metropolitana Sud, Catalan Institute of Health, Barcelona, Spain
| | - Jesús Almeda Ortega
- Vertigo Approach Research Group in Primary Care (VERTAP), Fundació Institut Universitari per la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Research Support Unit Metropolitana Sud, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Cornellà de Llobregat, Spain
| | - Oriol Cunillera Puértolas
- Vertigo Approach Research Group in Primary Care (VERTAP), Fundació Institut Universitari per la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Research Support Unit Metropolitana Sud, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Cornellà de Llobregat, Spain
| | - Ricard Carrillo Muñoz
- Vertigo Approach Research Group in Primary Care (VERTAP), Fundació Institut Universitari per la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Primary Care Centre Florida Sud. Management Area Metropolitana Sud, Catalan Institute of Health, Barcelona, Spain
| | - Iván Villar Balboa
- Vertigo Approach Research Group in Primary Care (VERTAP), Fundació Institut Universitari per la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Primary Care Centre Florida Sud. Management Area Metropolitana Sud, Catalan Institute of Health, Barcelona, Spain
| | - Xavier González Compta
- Vertigo Approach Research Group in Primary Care (VERTAP), Fundació Institut Universitari per la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Ear, Nose and Throat Department, University Hospital Bellvitge, Barcelona, Spain.,Management Area Metropolitana Sud, Catalan Institute of Health, Barcelona, Spain
| | - Olga Lucía Arias Agudelo
- Primary Care Centre Sant Martí de Provençals, Management Area of Barcelona, Catalan Institute of Health, Barcelona, Spain.,Vertigo Approach Research Group in Primary Care (VERTAP), Fundació Institut Universitari per la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain
| | - Sebastiá Calero Muñoz
- Vertigo Approach Research Group in Primary Care (VERTAP), Fundació Institut Universitari per la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Primary Care Centre Florida Nord, Management Area Metropolitana Sud, Catalan Institute of Health, Barcelona, Spain.,Primary Care Centre Florida Sud. Management Area Metropolitana Sud, Catalan Institute of Health, Barcelona, Spain
| | - Vanessa Monforte Rodríguez
- Vertigo Approach Research Group in Primary Care (VERTAP), Fundació Institut Universitari per la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Primary Care Centre, Management Area Metropolitana Sud, Catalan Institute of Health, Barcelona, Spain
| | - Anna Navarro Cortes
- Vertigo Approach Research Group in Primary Care (VERTAP), Fundació Institut Universitari per la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,Rehabilitation Centre Viladecans, Management Area Metropolitana Sud, Catalan Institute of Health, Barcelona, Spain
| | - Eva Peguero Rodríguez
- Vertigo Approach Research Group in Primary Care (VERTAP), Fundació Institut Universitari per la Recerca en Atenció Primària de Salut Jordi Gol i Gurina (IDIAPJGol), Barcelona, Spain.,University of Barcelona, Barcelona, Spain.,Primary Care Centre Castelldefels, Management Area Metropolitana Sud, Catalan Institute of Health, Barcelona, Spain
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Maleki M, Maarefvand M, Nazeri AR, Akbarzadeh Baghban AR, Borna A. Audio-Vestibular Profile of COVID-19; Systematic Review and Meta-analysis. IRANIAN JOURNAL OF OTORHINOLARYNGOLOGY 2022; 34:145-155. [PMID: 36035653 PMCID: PMC9393004 DOI: 10.22038/ijorl.2022.60404.3079] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/14/2021] [Accepted: 05/16/2022] [Indexed: 11/06/2022]
Abstract
Introduction After more than a year of the COVID-19 pandemic, audio-vestibular problems have been reported as consequences. Several limited case report studies with different methodologies were published. This study aimed to describe the impact of COVID-19 on the auditory-vestibular system and communication problems in subjects with hearing impairment. Materials and Methods The current systematic review was performed based on the Preferred Reporting Items for Systematic Reviews and Meta-Analysis (PRISMA) guideline. PubMed, Web of Science, and Google Scholar were searched to find relevant articles using combined keywords. Results Out of 26 final studies, 20 studies dealt with the effects of COVID-19 on the auditory and vestibular system, and six articles examined the COVID-19 effects on hearing-impaired people and patients. In these studies, dizziness (17.8%), tinnitus (8.1%), and vertigo (2.8%) were common symptoms. Most studies were case reports (42.30%), and in terms of quality, nine studies (34.61%) were in the suitable quality group. Conclusions COVID-19 might cause auditory-vestibular system problems by directly affecting the structures or functions of the inner ear or by weakening the immune system. The need for taking preventive measures during the COVID-19 pandemic has caused communication and social challenges, particularly for people with hearing loss.
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Affiliation(s)
- Mehri Maleki
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran.
| | - Mohammad Maarefvand
- Department of Audiology, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
| | - Ahmad Reza Nazeri
- Department of Audiology, School of Rehabilitation Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Ali Reza Akbarzadeh Baghban
- Proteomic Research Center Department of Biostatistics, School of Allied Medical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
| | - Azadeh Borna
- Student Research Committee, Iran University of Medical Sciences, Tehran, Iran.,Corresponding Author: School of Rehabilitation Sciences, Iran University of Medical Sciences, Maddadkaran St., Shahid Nazari St., Mother Square, Mirdamad Blvd, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran. E-mail:
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30
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Dietz GP, Bähr M. Editorial: Special issue on inner ear biology. Mol Cell Neurosci 2022; 121:103753. [DOI: 10.1016/j.mcn.2022.103753] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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31
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Surano S, Grip H, Öhberg F, Karlsson M, Faergemann E, Bjurman M, Davidsson H, Ledin T, Lindell E, Mathé J, Tjernström F, Tomanovic T, Granåsen G, Salzer J. Internet-based vestibular rehabilitation versus standard care after acute onset vertigo: a study protocol for a randomized controlled trial. Trials 2022; 23:496. [PMID: 35710448 PMCID: PMC9205069 DOI: 10.1186/s13063-022-06460-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/25/2021] [Accepted: 06/09/2022] [Indexed: 12/02/2022] Open
Abstract
Background Dizziness and vertigo affect around 15% of adults annually and represent common reasons for contacting health services, accounting for around 3% of all emergency department visits worldwide. Vertigo is also associated with excessive use of diagnostic imaging and emergency care and decreased productivity, primarily because of work absenteeism. Vestibular rehabilitation is an evidence-based treatment for chronic dizziness and supervised group exercise therapy has recently been shown to be effective after vestibular neuritis, a common cause of acute onset vertigo. However, such interventions are not readily available and there is a need for more easily accessible tools. The purpose of this study is to investigate the effects on vestibular symptoms of a 6-week online vestibular rehabilitation tool after acute onset vertigo, with the aim of aiding vestibular rehabilitation by presenting a more accessible tool that can help to reduce recovery time. Methods Three hundred twenty individuals diagnosed with acute vestibular syndrome (AVS) will be recruited from multiple hospitals in Sweden and the effects of an online vestibular rehabilitation tool, YrselTräning, on vestibular symptoms after acute onset vertigo will be compared to standard care (written instructions leaflet) in a two-armed, evaluator-blinded, multicenter randomized controlled trial. The primary outcome will be the Vertigo Symptom Scale Short Form (VSS-SF) score at 6 weeks after symptom onset. Secondary outcomes include effects of the intervention on activities of daily living, mood and anxiety, vestibular function recovery, mobility measures, health economic effects, and the reliability of the Swedish VSS-SF translation. Discussion Participants using the online vestibular rehabilitation tool are expected to recover earlier and to a greater extent from their symptoms as compared to standard care. Since up to 50% of people with AVS without treatment develop persistent symptoms, effective treatment of AVS will likely lead to a higher quality of life and help reduce the societal costs associated with dizziness and vertigo. Trial registration Clinicaltrials.gov NCT05056324. Registered on September 24, 2021.
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Affiliation(s)
- Solmaz Surano
- Department of Clinical Sciences, Neurosciences, Umeå University, Umeå, Sweden
| | - Helena Grip
- Department of Radiation Sciences, Umeå University, Umeå, Sweden.,Department of Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Fredrik Öhberg
- Department of Radiation Sciences, Umeå University, Umeå, Sweden.,Department of Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Marcus Karlsson
- Department of Clinical Sciences, Neurosciences, Umeå University, Umeå, Sweden.,Department of Biomedical Engineering, Umeå University, Umeå, Sweden
| | - Erik Faergemann
- Department of Clinical Sciences, Neurosciences, Umeå University, Umeå, Sweden.,Sundsvall Regional Hospital, Sundsvall, Sweden
| | - Maria Bjurman
- Sollefteå Hospital, Region Västernorrland, Sollefteå, Sweden
| | - Hugo Davidsson
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Otorhinolaryngology, Head and Neck Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Torbjörn Ledin
- Department of Biomedical and Clinical Sciences, Linköping University, Linköping, Sweden
| | - Ellen Lindell
- Department of Otorhinolaryngology, Head and Neck Surgery, Institute of Clinical Sciences, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.,Department of Otorhinolaryngology, Region Västra Götaland, Södra Älvsborg Hospital, Borås, Sweden
| | - Jan Mathé
- Department of Clinical Neuroscience, Karolinska Institutet and Capio S:t Görans Hospital, Stockholm, Sweden
| | - Fredrik Tjernström
- Department of Clinical Sciences, Othorhinolaryngology, Lund University, Lund, Sweden
| | - Tatjana Tomanovic
- Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
| | - Gabriel Granåsen
- Department of Public Health and Clinical Medicine, Umeå University, Umeå, Sweden
| | - Jonatan Salzer
- Department of Clinical Sciences, Neurosciences, Umeå University, Umeå, Sweden.
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32
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Filippopulos FM, Strobl R, Belanovic B, Dunker K, Grill E, Brandt T, Zwergal A, Huppert D. Validation of a comprehensive diagnostic algorithm for patients with acute vertigo and dizziness. Eur J Neurol 2022; 29:3092-3101. [PMID: 35708513 DOI: 10.1111/ene.15448] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2022] [Revised: 05/24/2022] [Accepted: 06/09/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND Vertigo and dizziness are common complaints in emergency departments and primary care, which pose major diagnostic challenges due to various underlying etiologies. Most supportive diagnostic algorithms concentrate on either identifying cerebrovascular events or diagnosing specific vestibular disorders or are restricted to specific patient subgroups. METHODS The study was conducted in the scope of the 'PoiSe' project (prevention, online feedback, and interdisciplinary therapy of acute vestibular syndromes by e-health). A three-level algorithm was developed according to international guidelines and scientific evidence addressing both, the detection of cerebrovascular events and the classification to non-vascular vestibular disorders (unilateral vestibulopathy, benign paroxysmal positional vertigo, vestibular paroxysmia, Menière's disease, vestibular migraine, functional dizziness). The algorithm was validated on a prospectively collected dataset of 407 patients with acute vertigo and dizziness presenting to the emergency department at LMU Munich. RESULTS The algorithm assigned 287 of 407 patients to the correct diagnosis, corresponding to an overall accuracy of 71%. Cerebrovascular events were identified with high sensitivity of 94%. The six most common vestibular disorders were classified with high specificity above 95%. Random forest identified the presence of a paresis, sensory loss, central ocular motor and vestibular signs (HINTS), and older age as the most important variables indicating a cerebrovascular event. CONCLUSIONS The proposed diagnostic algorithm can correctly classify the most common vestibular disorders based on a comprehensive set of key questions and clinical examinations. It is easily applied, not limited to subgroups, and might therefore be transferred to broad clinical settings such as primary health care.
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Affiliation(s)
- Filipp M Filippopulos
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Marchioninistr. 15, Munich, Germany.,Department of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, Munich, Germany
| | - Ralf Strobl
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Marchioninistr. 15, Munich, Germany.,Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians-Universität München (LMU), Marchioninistr. 15, Munich, Germany
| | - Bozidar Belanovic
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Marchioninistr. 15, Munich, Germany
| | - Konstanze Dunker
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Marchioninistr. 15, Munich, Germany
| | - Eva Grill
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Marchioninistr. 15, Munich, Germany.,Institute for Medical Information Processing, Biometrics and Epidemiology, Ludwig-Maximilians-Universität München (LMU), Marchioninistr. 15, Munich, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Marchioninistr. 15, Munich, Germany
| | - Andreas Zwergal
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Marchioninistr. 15, Munich, Germany.,Department of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, Munich, Germany
| | - Doreen Huppert
- German Center for Vertigo and Balance Disorders, University Hospital, LMU Munich, Marchioninistr. 15, Munich, Germany.,Department of Neurology, University Hospital, LMU Munich, Marchioninistr. 15, Munich, Germany
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Lu W, Li Z, Li Y, Li J, Chen Z, Feng Y, Wang H, Luo Q, Wang Y, Pan J, Gu L, Yu D, Zhang Y, Shi H, Yin S. A Deep Learning Model for Three-Dimensional Nystagmus Detection and Its Preliminary Application. Front Neurosci 2022; 16:930028. [PMID: 35769696 PMCID: PMC9236194 DOI: 10.3389/fnins.2022.930028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2022] [Accepted: 05/13/2022] [Indexed: 12/02/2022] Open
Abstract
Symptoms of vertigo are frequently reported and are usually accompanied by eye-movements called nystagmus. In this article, we designed a three-dimensional nystagmus recognition model and a benign paroxysmal positional vertigo automatic diagnosis system based on deep neural network architectures (Chinese Clinical Trials Registry ChiCTR-IOR-17010506). An object detection model was constructed to track the movement of the pupil centre. Convolutional neural network-based models were trained to detect nystagmus patterns in three dimensions. Our nystagmus detection models obtained high areas under the curve; 0.982 in horizontal tests, 0.893 in vertical tests, and 0.957 in torsional tests. Moreover, our automatic benign paroxysmal positional vertigo diagnosis system achieved a sensitivity of 0.8848, specificity of 0.8841, accuracy of 0.8845, and an F1 score of 0.8914. Compared with previous studies, our system provides a clinical reference, facilitates nystagmus detection and diagnosis, and it can be applied in real-world medical practices.
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Affiliation(s)
- Wen Lu
- Department of Otolaryngology—Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Zhuangzhuang Li
- Department of Otolaryngology—Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Yini Li
- Department of Otolaryngology—Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Jie Li
- Department of Otolaryngology—Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Zhengnong Chen
- Department of Otolaryngology—Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Yanmei Feng
- Department of Otolaryngology—Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Hui Wang
- Department of Otolaryngology—Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Qiong Luo
- Department of Otolaryngology—Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | | | - Jun Pan
- IceKredit Inc., Shanghai, China
| | | | - Dongzhen Yu
- Department of Otolaryngology—Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Yudong Zhang
- School of Computing and Mathematical Sciences, University of Leicester, Leicester, United Kingdom
| | - Haibo Shi
- Department of Otolaryngology—Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
| | - Shankai Yin
- Department of Otolaryngology—Head and Neck Surgery, Shanghai Jiao Tong University Affiliated Sixth People’s Hospital, Shanghai, China
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Li YN, Lu W, Li J, Li MX, Fang J, Xu T, Yuan TF, Qian D, Shi HB, Yin SK. Electroencephalography Microstate Alterations in Otogenic Vertigo: A Potential Disease Marker. Front Aging Neurosci 2022; 14:914920. [PMID: 35721015 PMCID: PMC9204792 DOI: 10.3389/fnagi.2022.914920] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2022] [Accepted: 05/05/2022] [Indexed: 11/23/2022] Open
Abstract
Objectives A huge population, especially the elderly, suffers from otogenic vertigo. However, the multi-modal vestibular network changes, secondary to periphery vestibular dysfunction, have not been fully elucidated. We aim to identify potential microstate electroencephalography (EEG) signatures for otogenic vertigo in this study. Materials and Methods Patients with recurrent otogenic vertigo and age-matched healthy adults were recruited. We performed 256-channel EEG recording of all participants at resting state. Neuropsychological questionnaires and vestibular function tests were taken as a measurement of patients’ symptoms and severity. We clustered microstates into four classes (A, B, C, and D) and identified their dynamic and syntax alterations of them. These features were further fed into a support vector machine (SVM) classifier to identify microstate signatures for vertigo. Results We compared 40 patients to 45 healthy adults, finding an increase in the duration of Microstate A, and both the occurrence and time coverage of Microstate D. The coverage and occurrence of Microstate C decreased significantly, and the probabilities of non-random transitions between Microstate A and D, as well as Microstate B and C, also changed. To distinguish the patients, the SVM classifier, which is built based on these features, got a balanced accuracy of 0.79 with a sensitivity of 0.78 and a specificity of 0.8. Conclusion There are several temporal dynamic alterations of EEG microstates in patients with otogenic vertigo, especially in Microstate D, reflecting the underlying process of visual-vestibular reorganization and attention redistribution. This neurophysiological signature of microstates could be used to identify patients with vertigo in the future.
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Affiliation(s)
- Yi-Ni Li
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Wen Lu
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Jie Li
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Ming-Xian Li
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Jia Fang
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Tao Xu
- Department of Anesthesiology, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
| | - Ti-Fei Yuan
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- *Correspondence: Ti-Fei Yuan,
| | - Di Qian
- Department of Otolaryngology, People’s Hospital of Longhua, Shenzhen, China
- Di Qian,
| | - Hai-Bo Shi
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
- Hai-Bo Shi,
| | - Shan-Kai Yin
- Department of Otorhinolaryngology Head and Neck Surgery, Shanghai Sixth People’s Hospital Affiliated to Shanghai Jiao Tong University, Shanghai, China
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Bamiou DE, Kikidis D, Bibas T, Koohi N, Macdonald N, Maurer C, Wuyts FL, Ihtijarevic B, Celis L, Mucci V, Maes L, Van Rompaey V, Van de Heyning P, Nazareth I, Exarchos TP, Fotiadis D, Koutsouris D, Luxon LM. Diagnostic accuracy and usability of the EMBalance decision support system for vestibular disorders in primary care: proof of concept randomised controlled study results. J Neurol 2022; 269:2584-2598. [PMID: 34669009 PMCID: PMC8527447 DOI: 10.1007/s00415-021-10829-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Revised: 08/17/2021] [Accepted: 09/28/2021] [Indexed: 11/01/2022]
Abstract
BACKGROUND Dizziness and imbalance are common symptoms that are often inadequately diagnosed or managed, due to a lack of dedicated specialists. Decision Support Systems (DSS) may support first-line physicians to diagnose and manage these patients based on personalised data. AIM To examine the diagnostic accuracy and application of the EMBalance DSS for diagnosis and management of common vestibular disorders in primary care. METHODS Patients with persistent dizziness were recruited from primary care in Germany, Greece, Belgium and the UK and randomised to primary care clinicians assessing the patients with (+ DSS) versus assessment without (- DSS) the EMBalance DSS. Subsequently, specialists in neuro-otology/audiovestibular medicine performed clinical evaluation of each patient in a blinded way to provide the "gold standard" against which the + DSS, - DSS and the DSS as a standalone tool (i.e. without the final decision made by the clinician) were validated. RESULTS One hundred ninety-four participants (age range 25-85, mean = 57.7, SD = 16.7 years) were assigned to the + DSS (N = 100) and to the - DSS group (N = 94). The diagnosis suggested by the + DSS primary care physician agreed with the expert diagnosis in 54%, compared to 41.5% of cases in the - DSS group (odds ratio 1.35). Similar positive trends were observed for management and further referral in the + DSS vs. the - DSS group. The standalone DSS had better diagnostic and management accuracy than the + DSS group. CONCLUSION There were trends for improved vestibular diagnosis and management when using the EMBalance DSS. The tool requires further development to improve its diagnostic accuracy, but holds promise for timely and effective diagnosis and management of dizzy patients in primary care. TRIAL REGISTRATION NUMBER NCT02704819 (clinicaltrials.gov).
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Affiliation(s)
- Doris-Eva Bamiou
- The Ear Institute, University College London, London, WC1X 8EE, UK.
- University College London Hospitals NHS Trust, London, UK.
- NIHR University College London Hospitals Biomedical Research Centre, London, UK.
| | - Dimitris Kikidis
- 1st Department of Otorhinolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippocrateion General Hospital, Athens, Greece
| | - Thanos Bibas
- 1st Department of Otorhinolaryngology, Head and Neck Surgery, National and Kapodistrian University of Athens, Hippocrateion General Hospital, Athens, Greece
| | - Nehzat Koohi
- The Ear Institute, University College London, London, WC1X 8EE, UK
- University College London Hospitals NHS Trust, London, UK
| | - Nora Macdonald
- University College London Hospitals NHS Trust, London, UK
| | - Christoph Maurer
- Clinic of Neurology and Neurophysiology, Medical Center, Faculty of Medicine, University of Freiburg, Freiburg, Germany
| | - Floris L Wuyts
- Antwerp University Research Centre for Equilibrium and Aerospace, University of Antwerp, Antwerp, Belgium
- Laboratory for Equilibrium Investigations and Aerospace, University of Antwerp, Antwerp, Belgium
| | - Berina Ihtijarevic
- Antwerp University Research Centre for Equilibrium and Aerospace, University of Antwerp, Antwerp, Belgium
- Department Otorhinolaryngology-Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Laura Celis
- Antwerp University Research Centre for Equilibrium and Aerospace, University of Antwerp, Antwerp, Belgium
- Department Otorhinolaryngology-Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Viviana Mucci
- Antwerp University Research Centre for Equilibrium and Aerospace, University of Antwerp, Antwerp, Belgium
- School of Science, Western Sydney University, Sydney, NSW, Australia
| | - Leen Maes
- Department of Rehabilitation Sciences, University of Ghent, Ghent, Belgium
| | - Vincent Van Rompaey
- Antwerp University Research Centre for Equilibrium and Aerospace, University of Antwerp, Antwerp, Belgium
- Department Otorhinolaryngology-Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Paul Van de Heyning
- Department Otorhinolaryngology-Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Irwin Nazareth
- Department of Primary Care and Population Health, University College London Medical School, London, UK
| | | | - Dimitrios Fotiadis
- Unit of Medical Technology and Intelligent Information Systems, Department of Materials Science and Engineering, University of Ioannina, Ioannina, Greece
| | - Dimitrios Koutsouris
- Biomedical Engineering Laboratory, National Technical University of Athens, Athens, Greece
| | - Linda M Luxon
- The Ear Institute, University College London, London, WC1X 8EE, UK
- University College London Hospitals NHS Trust, London, UK
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Abstract
VM is a common yet debilitating migraine variant that has taken many monikers in the past. As a relatively new diagnostic entity, public and provider awareness of this disorder can be improved. Symptoms include vertigo episodes in addition to photophobia, phonophobia, nausea, and headache. Diagnosis is primarily based on clinical history as pathognomonic signs via testing are not reliable. Standardized treatment algorithms have yet to be created and current recommendations have been adopted from migraine guidelines.
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Maudoux A, Vitry S, El-Amraoui A. Vestibular Deficits in Deafness: Clinical Presentation, Animal Modeling, and Treatment Solutions. Front Neurol 2022; 13:816534. [PMID: 35444606 PMCID: PMC9013928 DOI: 10.3389/fneur.2022.816534] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2021] [Accepted: 02/23/2022] [Indexed: 11/13/2022] Open
Abstract
The inner ear is responsible for both hearing and balance. These functions are dependent on the correct functioning of mechanosensitive hair cells, which convert sound- and motion-induced stimuli into electrical signals conveyed to the brain. During evolution of the inner ear, the major changes occurred in the hearing organ, whereas the structure of the vestibular organs remained constant in all vertebrates over the same period. Vestibular deficits are highly prevalent in humans, due to multiple intersecting causes: genetics, environmental factors, ototoxic drugs, infections and aging. Studies of deafness genes associated with balance deficits and their corresponding animal models have shed light on the development and function of these two sensory systems. Bilateral vestibular deficits often impair individual postural control, gaze stabilization, locomotion and spatial orientation. The resulting dizziness, vertigo, and/or falls (frequent in elderly populations) greatly affect patient quality of life. In the absence of treatment, prosthetic devices, such as vestibular implants, providing information about the direction, amplitude and velocity of body movements, are being developed and have given promising results in animal models and humans. Novel methods and techniques have led to major progress in gene therapies targeting the inner ear (gene supplementation and gene editing), 3D inner ear organoids and reprograming protocols for generating hair cell-like cells. These rapid advances in multiscale approaches covering basic research, clinical diagnostics and therapies are fostering interdisciplinary research to develop personalized treatments for vestibular disorders.
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Affiliation(s)
- Audrey Maudoux
- Unit Progressive Sensory Disorders, Pathophysiology and Therapy, Institut Pasteur, Institut de l'Audition, Université de Paris, INSERM-UMRS1120, Paris, France
- Center for Balance Evaluation in Children (EFEE), Otolaryngology Department, Assistance Publique des Hôpitaux de Paris, Robert-Debré University Hospital, Paris, France
| | - Sandrine Vitry
- Unit Progressive Sensory Disorders, Pathophysiology and Therapy, Institut Pasteur, Institut de l'Audition, Université de Paris, INSERM-UMRS1120, Paris, France
| | - Aziz El-Amraoui
- Unit Progressive Sensory Disorders, Pathophysiology and Therapy, Institut Pasteur, Institut de l'Audition, Université de Paris, INSERM-UMRS1120, Paris, France
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van Stiphout L, Pleshkov M, Lucieer F, Dobbels B, Mavrodiev V, Guinand N, Pérez Fornos A, Widdershoven J, Strupp M, Van Rompaey V, van de Berg R. Patterns of Vestibular Impairment in Bilateral Vestibulopathy and Its Relation to Etiology. Front Neurol 2022; 13:856472. [PMID: 35386413 PMCID: PMC8979031 DOI: 10.3389/fneur.2022.856472] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2022] [Accepted: 02/17/2022] [Indexed: 11/23/2022] Open
Abstract
Objective This study aimed to investigate (1) the patterns of vestibular impairment in bilateral vestibulopathy (BVP) and subsequently, the implications regarding patient eligibility for vestibular implantation, and (2) whether this pattern and severity of vestibular impairment is etiology dependent. Methods A total of one hundred and seventy-three subjects from three tertiary referral centers in Europe were diagnosed with BVP according to the Bárány Society diagnostic criteria. The subjects underwent vestibular testing such as the caloric test, torsion swing test, video Head Impulse Test (vHIT) in horizontal and vertical planes, and cervical and/or ocular vestibular evoked myogenic potentials (c- and oVEMPs). The etiologies were split into idiopathic, genetic, ototoxicity, infectious, Menière's Disease, (head)trauma, auto-immune, neurodegenerative, congenital, and mixed etiology. Results The caloric test and horizontal vHIT more often indicated horizontal semicircular canal impairment than the torsion swing test. The vHIT results showed significantly higher gains for both anterior canals compared with the horizontal and posterior canals (p < 0.001). The rates of bilaterally absent oVEMP responses were higher compared to the bilaterally absent cVEMP responses (p = 0.010). A total of fifty-four percent of the patients diagnosed with BVP without missing data met all three Bárány Society diagnostic test criteria, whereas 76% of the patients were eligible for implantation according to the vestibular implantation criteria. Regarding etiology, only horizontal vHIT results were significantly lower for trauma, neurodegenerative, and genetic disorders, whereas the horizontal vHIT results were significantly higher for Menière's Disease, infectious and idiopathic BVP. The exploration with hierarchical cluster analysis showed no significant association between etiology and patterns of vestibular impairment. Conclusion This study showed that caloric testing and vHIT seem to be more sensitive for measuring vestibular impairment, whereas the torsion swing test is more suited for measuring residual vestibular function. In addition, no striking patterns of vestibular impairment in relation to etiology were found. Nevertheless, it was demonstrated that although the implantation criteria are stricter compared with the Bárány Society diagnostic criteria, still, 76% of patients with BVP were eligible for implantation based on the vestibular test criteria. It is advised to carefully examine every patient for their overall pattern of vestibular impairment in order to make well-informed and personalized therapeutic decisions.
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Affiliation(s)
- Lisa van Stiphout
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
- *Correspondence: Lisa van Stiphout
| | - Maksim Pleshkov
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
- Faculty of Physics, Tomsk State University, Tomsk, Russia
- Maksim Pleshkov
| | - Florence Lucieer
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
| | - Bieke Dobbels
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Vergil Mavrodiev
- Department of Neurology and German Center for Vertigo, Ludwig-Maximilians University, Munich, Germany
| | - Nils Guinand
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Angelica Pérez Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Josine Widdershoven
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Michael Strupp
- Department of Neurology and German Center for Vertigo, Ludwig-Maximilians University, Munich, Germany
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
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van Stiphout L, Hossein I, Kimman M, Whitney SL, Ayiotis A, Strupp M, Guinand N, Pérez Fornos A, Widdershoven J, Ramos-Macías Á, Van Rompaey V, van de Berg R. Development and Content Validity of the Bilateral Vestibulopathy Questionnaire. Front Neurol 2022; 13:852048. [PMID: 35370880 PMCID: PMC8968143 DOI: 10.3389/fneur.2022.852048] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2022] [Accepted: 02/15/2022] [Indexed: 11/30/2022] Open
Abstract
Background To date, the burden and severity of the full spectrum of bilateral vestibulopathy (BVP) symptoms has not yet been measured in a standardized manner. Since therapeutic interventions aiming to improve BVP symptoms are emerging, the need for a new standardized assessment tool that encompasses the specific aspects of BVP arises. Therefore, the aim of this study was to develop a multi-item Patient Reported Outcome Measure (PROM) that captures the clinically important symptoms of BVP and assesses its impact on daily life. Methods The development of the Bilateral Vestibulopathy Questionnaire (BVQ) consisted of two phases: (I) initial item generation and (II) face and content validity testing. Items were derived from a literature review and individual semi-structured interviews focusing on the full spectrum of reported BVP symptoms (I). Subsequently (IIa), individual patient interviews were conducted using “thinking aloud” and concurrent verbal probing techniques to assess the comprehensibility of the instructions, questions and response options, and the relevance, missing domains, or missing items. Interviews continued until saturation of input was reached. Finally, international experts with experience in the field of the physical, emotional, and cognitive symptoms of BVP participated in an online focus group to assess the relevance and comprehensiveness of the BVQ (IIb). Results The BVQ consisted of two sections. The first section included 50 items scored on a six-point Likert scale arranged into seven constructs (i.e., imbalance, oscillopsia, other physical symptoms, cognitive symptoms, emotional symptoms, limitations and behavioral changes and social life). The second section consisted of four items, scored on a visual analog scale from 0 to 100, to inquire about limitations in daily life, perceived health and expectations regarding future recovery. Interviews with BVP patients [n = 8, 50% female, mean age 56 years (range 24–88 years)] and the expert meeting confirmed face and content validity of the developed BVQ. Conclusion The BVQ, which was developed to assess the spectrum of BVP symptoms and its impact on daily life, proved to have good face and content validity. It can be used to characterize current self-reported symptoms and disability and to evaluate symptom burden before and after therapeutic interventions in future research and clinical practice.
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Affiliation(s)
- Lisa van Stiphout
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, Netherlands
- *Correspondence: Lisa van Stiphout
| | - Israt Hossein
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, Netherlands
| | - Merel Kimman
- Department of Clinical Epidemiology and Medical Technology Assessment (KEMTA), Maastricht University Medical Center, Maastricht, Netherlands
| | - Susan L. Whitney
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Pittsburgh, PA, United States
| | - Andrianna Ayiotis
- Department of Otolaryngology–Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, United States
- Department of Biomedical Engineering, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | - Michael Strupp
- Department of Neurology, German Center for Vertigo, Ludwig-Maximilians University, Munich, Germany
| | - Nils Guinand
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Angélica Pérez Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Josine Widdershoven
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, Netherlands
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Ángel Ramos-Macías
- Department of Otolaryngology, Head and Neck Surgery, Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, Las Palmas, Spain
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head and Neck Surgery, Faculty of Medicine and Health Sciences, Antwerp University Hospital, University of Antwerp, Antwerp, Belgium
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, Netherlands
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Knapstad MK, Ask T, Skouen JS, Goplen FK, Nordahl SHG. Prevalence and consequences of concurrent dizziness on disability and quality of life in patients with long-lasting neck pain. Physiother Theory Pract 2022; 39:1266-1273. [DOI: 10.1080/09593985.2022.2034077] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Mari K. Knapstad
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Tove Ask
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
- Department of Physical Therapy, Haukeland University Hospital, Bergen, Norway
| | - Jan S. Skouen
- Department of Physical Medicine and Rehabilitation, Outpatient Spine Clinic, Haukeland University Hospital, Rådal, Norway
| | - Frederik K. Goplen
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Stein Helge G. Nordahl
- Norwegian National Advisory Unit on Vestibular Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
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A Digital Health Service for Elderly People with Balance Disorders and Risk of Falling: A Design Science Approach. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19031855. [PMID: 35162877 PMCID: PMC8835704 DOI: 10.3390/ijerph19031855] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Revised: 01/25/2022] [Accepted: 02/05/2022] [Indexed: 11/16/2022]
Abstract
In this study, a design science research methodology was used aiming at designing, implementing and evaluating a digital health service to complement the provision of healthcare for elderly people with balance disorders and risk of falling. An explanatory sequential mixed methods study allowed to identify and explore the dissatisfaction with electronic medical records and the opportunity for using digital health solutions. The suggested recommendations helped to elaborate and develop “BALANCE”, a digital service implemented on the METHIS platform, which was recently validated for remote monitoring of chronic patients in primary healthcare. “BALANCE” provides clinical and interactive data, questionnaire pre and post-balance rehabilitation, tutorial videos with balance exercises and patient-recorded videos of the exercises. This digital service was demonstrated, including five elderly patients with clinical recommendations for balance rehabilitation at home. Finally, the authors conducted two focus groups with the participants and their caregivers as well as with physicians. The focus groups aimed at exploring their satisfaction level, needs of adjustment in the “BALANCE” service and strategies for applicability. The digital healthcare service evaluation revealed a significant potential for clinical applicability of this digital solution for elderly people with balance disorders and risk of falling.
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Adams ME, Marmor S. Dizziness Diagnostic Pathways: Factors Impacting Setting, Provider, and Diagnosis at Presentation. Otolaryngol Head Neck Surg 2022; 166:158-166. [PMID: 33845655 PMCID: PMC9258633 DOI: 10.1177/01945998211004245] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
OBJECTIVE Ensuring that patients with dizziness present to the most appropriate level of care and provider are key goals of quality and cost improvement efforts. Using a symptom-defined cohort of adults presenting for dizziness evaluations, we aimed to identify patient factors associated with ambulatory clinic vs emergency department (ED) presentations, evaluating provider specialty, and assigned diagnoses. STUDY DESIGN Cross-sectional study. SETTING OptumLabs Data Warehouse (OLDW), a longitudinal, real-world data asset with deidentified administrative claims. METHODS We performed a cross-sectional analysis of adults (older than 18 years) who received new dizziness diagnoses (2006-2015) and identified factors associated with setting and provider at initial presentation using multivariable regression models. RESULTS Of 805,454 individuals with dizziness (median age 52 years, 62% women, 29% black, Asian, or Hispanic), 23% presented to EDs and 77% to clinics (76% primary care, 7% otolaryngology, 5% cardiology, 3% neurology). Predictors of ED presentation were younger age, male sex, black race, lower education, and medical comorbidity. Predictors of primary care clinic presentation were older age and race/ethnicity other than white. Nonetiologic symptom diagnoses alone were assigned to 51% and were most associated with age older than 75 years (odds ratio, 2.90; 95% CI, 2.86-2.94). CONCLUSION Adults with dizziness often present to a level of care that may be higher than is optimal. Differential care seeking and diagnoses by age, sex, and race/ethnicity reflect influences beyond dizziness presentation acuity. Targeted patient resources, triage systems, provider education, and cross-specialty partnerships are needed to direct dizzy patients to appropriate settings and providers to improve care.
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Affiliation(s)
- Meredith E. Adams
- Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Schelomo Marmor
- Department of Otolaryngology–Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA,Department of Surgery, University of Minnesota, Minneapolis, Minnesota, USA,Center for Clinical Quality and Outcomes Discovery and Evaluation (CQODE), University of Minnesota, Minneapolis, Minnesota, USA
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Bunzen D, Lima F, Figueiredo ME, Fontinele L. Sintomas vestibulares encaminhados ao otorrinolaringologista pela atenção primária da cidade do Recife. REVISTA BRASILEIRA DE MEDICINA DE FAMÍLIA E COMUNIDADE 2021. [DOI: 10.5712/rbmfc16(43)2751] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
Introdução: A Atenção Primária é a “porta de entrada” do usuário ao Sistema Único de Saúde. Caso o médico tenha dificuldade em conduzir o caso, ele encaminha-o a um especialista. A otorrinolaringologia é uma das especialidades que mais recebe referências, com longo tempo de espera em nosso meio. Objetivo: Estimar a frequência das queixas de tontura e suspeita de doença vestibular nos encaminhamentos dos pacientes que aguardam consulta com otorrinolaringologista. Há poucos estudos semelhantes na literatura, e esse levantamento é importante para traçar o perfil desses pacientes e planejar ações de saúde pública. Métodos: Estudo observacional, longitudinal, descritivo, baseado na coleta de dados secundários do Sistema de Regulação da Secretaria de Saúde da Prefeitura do Recife. Foram incluídas as solicitações dos médicos da Estratégia Saúde da Família para o serviço de otorrinolaringologia em outubro-novembro de 2019, que estavam na fila de espera desde junho–julho de 2018. Resultados: A frequência dos encaminhamentos por tontura e suspeita de doença vestibular foi 22,5% de todas as solicitações para otorrinolaringologia. O tempo de espera foi um ano e quatro meses. A maioria era de mulheres (74,7%) e idosos acima de 60 anos (48,3%). Os motivos dos encaminhamentos foram: zumbido (43,2%), labirintite (20%), múltiplos sintomas (17,3%), tontura (11,6%), vertigem (3,9%), labirintopatia (3,6%) e vertigem posicional paroxística benigna (0,6%). Os sintomas aumentam com a idade. Conclusão: A taxa de encaminhamento foi compatível com a literatura. O zumbido é um sintoma muito incômodo, comum tanto nas doenças do labirinto quanto em outras patologias, por isso a alta frequência de solicitação. O termo labirintite nem sempre se refere à neuronite vestibular, mas erroneamente pode ser usado para qualquer síndrome vertiginosa, o que pode justificar a alta taxa de encaminhamento em detrimento de outras vestibulopatias. A educação continuada na Atenção Primária é importante tanto para o diagnóstico correto quanto para a solicitação apropriada da interconsulta. É preciso novas estratégias para diminuir o tempo de espera, como o aumento da oferta de serviços de especialistas, a qualificação da demanda e a otimização do sistema de regulação.
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Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline From the Academy of Neurologic Physical Therapy of the American Physical Therapy Association. J Neurol Phys Ther 2021; 46:118-177. [PMID: 34864777 PMCID: PMC8920012 DOI: 10.1097/npt.0000000000000382] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Uncompensated vestibular hypofunction can result in symptoms of dizziness, imbalance, and/or oscillopsia, gaze and gait instability, and impaired navigation and spatial orientation; thus, may negatively impact an individual's quality of life, ability to perform activities of daily living, drive, and work. It is estimated that one-third of adults in the United States have vestibular dysfunction and the incidence increases with age. There is strong evidence supporting vestibular physical therapy for reducing symptoms, improving gaze and postural stability, and improving function in individuals with vestibular hypofunction. The purpose of this revised clinical practice guideline is to improve quality of care and outcomes for individuals with acute, subacute, and chronic unilateral and bilateral vestibular hypofunction by providing evidence-based recommendations regarding appropriate exercises. Methods: These guidelines are a revision of the 2016 guidelines and involved a systematic review of the literature published since 2015 through June 2020 across 6 databases. Article types included meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case-control series, and case series for human subjects, published in English. Sixty-seven articles were identified as relevant to this clinical practice guideline and critically appraised for level of evidence. Results: Based on strong evidence, clinicians should offer vestibular rehabilitation to adults with unilateral and bilateral vestibular hypofunction who present with impairments, activity limitations, and participation restrictions related to the vestibular deficit. Based on strong evidence and a preponderance of harm over benefit, clinicians should not include voluntary saccadic or smooth-pursuit eye movements in isolation (ie, without head movement) to promote gaze stability. Based on moderate to strong evidence, clinicians may offer specific exercise techniques to target identified activity limitations and participation restrictions, including virtual reality or augmented sensory feedback. Based on strong evidence and in consideration of patient preference, clinicians should offer supervised vestibular rehabilitation. Based on moderate to weak evidence, clinicians may prescribe weekly clinic visits plus a home exercise program of gaze stabilization exercises consisting of a minimum of: (1) 3 times per day for a total of at least 12 minutes daily for individuals with acute/subacute unilateral vestibular hypofunction; (2) 3 to 5 times per day for a total of at least 20 minutes daily for 4 to 6 weeks for individuals with chronic unilateral vestibular hypofunction; (3) 3 to 5 times per day for a total of 20 to 40 minutes daily for approximately 5 to 7 weeks for individuals with bilateral vestibular hypofunction. Based on moderate evidence, clinicians may prescribe static and dynamic balance exercises for a minimum of 20 minutes daily for at least 4 to 6 weeks for individuals with chronic unilateral vestibular hypofunction and, based on expert opinion, for a minimum of 6 to 9 weeks for individuals with bilateral vestibular hypofunction. Based on moderate evidence, clinicians may use achievement of primary goals, resolution of symptoms, normalized balance and vestibular function, or plateau in progress as reasons for stopping therapy. Based on moderate to strong evidence, clinicians may evaluate factors, including time from onset of symptoms, comorbidities, cognitive function, and use of medication that could modify rehabilitation outcomes. Discussion: Recent evidence supports the original recommendations from the 2016 guidelines. There is strong evidence that vestibular physical therapy provides a clear and substantial benefit to individuals with unilateral and bilateral vestibular hypofunction. Limitations: The focus of the guideline was on peripheral vestibular hypofunction; thus, the recommendations of the guideline may not apply to individuals with central vestibular disorders. One criterion for study inclusion was that vestibular hypofunction was determined based on objective vestibular function tests. This guideline may not apply to individuals who report symptoms of dizziness, imbalance, and/or oscillopsia without a diagnosis of vestibular hypofunction. Disclaimer: These recommendations are intended as a guide to optimize rehabilitation outcomes for individuals undergoing vestibular physical therapy. The contents of this guideline were developed with support from the American Physical Therapy Association and the Academy of Neurologic Physical Therapy using a rigorous review process. The authors declared no conflict of interest and maintained editorial independence. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A369).
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van de Berg R, Murdin L, Whitney SL, Holmberg J, Bisdorff A. Curriculum for vestibular medicine (vestmed) proposed by the barany society. J Vestib Res 2021; 32:89-98. [PMID: 34864706 PMCID: PMC9249285 DOI: 10.3233/ves-210095] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This document presents the initiative of the Bárány Society to improve diagnosis and care of patients presenting with vestibular symptoms worldwide. The Vestibular Medicine (VestMed) concept embraces a wide approach to the potential causes of vestibular symptoms, acknowledging that vertigo, dizziness, and unsteadiness are non-specific symptoms that may arise from a broad spectrum of disorders, spanning from the inner ear to the brainstem, cerebellum and supratentorial cerebral networks, to many disorders beyond these structures. The Bárány Society Vestibular Medicine Curriculum (BS-VestMed-Cur) is based on the concept that VestMed is practiced by different physician specialties and non-physician allied health professionals. Each profession has its characteristic disciplinary role and profile, but all work in overlapping areas. Each discipline requires good awareness of the variety of disorders that can present with vestibular symptoms, their underlying mechanisms and etiologies, diagnostic criteria and treatment options. Similarly, all disciplines require an understanding of their own limitations, the contribution to patient care from other professionals and when to involve other members of the VestMed community. Therefore, the BS-VestMed-Cur is the same for all health professionals involved, the overlaps and differences of the various relevant professions being defined by different levels of detail and depth of knowledge and skills. The BS-VestMed-Cur defines a Basic and an Expert Level Curriculum. The Basic Level Curriculum covers the VestMed topics in less detail and depth, yet still conveys the concept of the wide net approach. It is designed for health professionals as an introduction to, and first step toward, VestMed expertise. The Expert Level Curriculum defines a Focused and Broad Expert. It covers the VestMed spectrum in high detail and requires a high level of understanding. In the Basic and Expert Level Curricula, the range of topics is the same and runs from anatomy, physiology and physics of the vestibular system, to vestibular symptoms, history taking, bedside examination, ancillary testing, the various vestibular disorders, their treatment and professional attitudes. Additionally, research topics relevant to clinical practice are included in the Expert Level Curriculum. For Focused Expert proficiency, the Basic Level Curriculum is required to ensure a broad overview and additionally requires an expansion of knowledge and skills in one or a few specific topics related to the focused expertise, e.g. inner ear surgery. Broad Expert proficiency targets professionals who deal with all sorts of patients presenting with vestibular symptoms (e.g. otorhinolaryngologists, neurologists, audiovestibular physicians, physical therapists), requiring a high level of VestMed expertise across the whole spectrum. For the Broad Expert, the Expert Level Curriculum is required in which the minimum attainment targets for all the topics go beyond the Basic Level Curriculum. The minimum requirements regarding knowledge and skills vary between Broad Experts, since they are tuned to the activity profile and underlying specialty of the expert. The BS-VestMed-Cur aims to provide a basis for current and future teaching and training programs for physicians and non-physicians. The Basic Level Curriculum could also serve as a resource for inspiration for teaching VestMed to students, postgraduate generalists such as primary care physicians and undergraduate health professionals, or anybody wishing to enter VestMed. VestMed is considered a set of competences related to an area of practice of established physician specialties and non-physician health professions rather than a separate clinical specialty. This curriculum does not aim to define a new single clinical specialty. The BS-VestMed-Cur should also integrate with, facilitate and encourage translational research in the vestibular field.
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Affiliation(s)
- R van de Berg
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, Netherlands
| | - L Murdin
- Guy's and St Thomas' NHS Foundation Trust, and Ear Institute, UCL, London, United Kingdom
| | - S L Whitney
- Departments of Physical Therapy and Otolaryngology, University of Pittsburgh, Pittsburgh, PA, USA
| | - J Holmberg
- Intermountain Healthcare, Rehabilitation Services, Hearing and Balance Center, Salt Lake City, Utah, USA
| | - A Bisdorff
- Clinique du Vertige, Centre Hospitalier Emile Mayrisch, Esch-sur-Alzette, Luxembourg
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Assessment of Blood Inflamatory Parameters in Elderly Patients With Peripheral Vertigo. JOURNAL OF CONTEMPORARY MEDICINE 2021. [DOI: 10.16899/jcm.976130] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
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Lopes AL, Lemos SMA, Figueiredo PHS, Gonçalves DU, Santos JN. Lian gong as a Therapeutic Treatment Option in Primary Care for Patients with Dizziness: A Randomized Controlled Trial. Int Arch Otorhinolaryngol 2021; 25:e509-e516. [PMID: 34737821 PMCID: PMC8558947 DOI: 10.1055/s-0040-1718956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Accepted: 08/23/2020] [Indexed: 11/08/2022] Open
Abstract
Introduction Dizziness is one of the most common reasons for seeking primary health care. Vestibular rehabilitation (VR) is a conventional treatment method for peripheral balance disorders that effectively decreases symptoms. Lian gong [LG] is believed to benefit patients with dizziness and to reduce the impact of the condition on quality of life by stimulating visual fixation, attention, body balance, and neuroplasticity. Objective The present study aimed to evaluate the effects of LG on the impact of dizziness on quality of life and fear of falling in primary health care patients. Methods This was a two-arm, parallel randomized clinical trial that included 36 patients with dizziness not caused by central changes. After specific medical evaluations and indications for treatment, the participants were randomly assigned to 3 groups: the LG group ( n = 11), the VR group ( n = 11), and the control group ( n = 14). The interventions were conducted collectively over a period of 12 weeks. Results Lian gong reduced the influence of dizziness on quality of life in physical (1.8 points, 95% confidence interval [CI]: 0.2-3.4), functional (4.0 points, 95% CI: 2.1-5.9), and emotional domains of quality of life (4.4 points, 95% CI: 1.7-7.2), with no differences compared with VR. There were similar concerns among the groups about the risk of falling. Conclusion Lian gong was shown to be an effective balance rehabilitation strategy to reduce the impact of dizziness on quality of life, with similar results to those of VR.
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Affiliation(s)
- Aline Lamas Lopes
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Fonoaudiológicas, Belo Horizonte, MG, Brazil
| | - Stela Maris Aguiar Lemos
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Fonoaudiológicas, Belo Horizonte, MG, Brazil
| | - Pedro Henrique Scheidt Figueiredo
- Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Faculdade de Ciências Biológicas e da Saúde, Diamantina, MG, Brazil
| | - Denise Utsch Gonçalves
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Fonoaudiológicas, Belo Horizonte, MG, Brazil
| | - Juliana Nunes Santos
- Universidade Federal de Minas Gerais, Faculdade de Medicina, Programa de Pós-Graduação em Ciências Fonoaudiológicas, Belo Horizonte, MG, Brazil
- Department of Physiotherapy, Universidade Federal dos Vales do Jequitinhonha e Mucuri, Faculdade de Ciências Biológicas e da Saúde, Diamantina, MG, Brazil
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Paplou V, Schubert NMA, Pyott SJ. Age-Related Changes in the Cochlea and Vestibule: Shared Patterns and Processes. Front Neurosci 2021; 15:680856. [PMID: 34539328 PMCID: PMC8446668 DOI: 10.3389/fnins.2021.680856] [Citation(s) in RCA: 26] [Impact Index Per Article: 8.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Accepted: 07/20/2021] [Indexed: 12/16/2022] Open
Abstract
Both age-related hearing loss (ARHL) and age-related loss in vestibular function (ARVL) are prevalent conditions with deleterious consequences on the health and quality of life. Age-related changes in the inner ear are key contributors to both conditions. The auditory and vestibular systems rely on a shared sensory organ - the inner ear - and, like other sensory organs, the inner ear is susceptible to the effects of aging. Despite involvement of the same sensory structure, ARHL and ARVL are often considered separately. Insight essential for the development of improved diagnostics and treatments for both ARHL and ARVL can be gained by careful examination of their shared and unique pathophysiology in the auditory and vestibular end organs of the inner ear. To this end, this review begins by comparing the prevalence patterns of ARHL and ARVL. Next, the normal and age-related changes in the structure and function of the auditory and vestibular end organs are compared. Then, the contributions of various molecular mechanisms, notably inflammaging, oxidative stress, and genetic factors, are evaluated as possible common culprits that interrelate pathophysiology in the cochlea and vestibular end organs as part of ARHL and ARVL. A careful comparison of these changes reveals that the patterns of pathophysiology show similarities but also differences both between the cochlea and vestibular end organs and among the vestibular end organs. Future progress will depend on the development and application of new research strategies and the integrated investigation of ARHL and ARVL using both clinical and animal models.
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Affiliation(s)
- Vasiliki Paplou
- Department of Otorhinolaryngology and Head/Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands
| | - Nick M A Schubert
- Department of Otorhinolaryngology and Head/Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Research School of Behavioural and Cognitive Neurosciences, Graduate School of Medical Sciences, University of Groningen, Groningen, Netherlands
| | - Sonja J Pyott
- Department of Otorhinolaryngology and Head/Neck Surgery, University of Groningen, University Medical Center Groningen, Groningen, Netherlands.,Research School of Behavioural and Cognitive Neurosciences, Graduate School of Medical Sciences, University of Groningen, Groningen, Netherlands
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Xie M, Zhou K, Patro N, Chan T, Levin M, Gupta MK, Archibald J. Virtual Reality for Vestibular Rehabilitation: A Systematic Review. Otol Neurotol 2021; 42:967-977. [PMID: 33782257 DOI: 10.1097/mao.0000000000003155] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
INTRODUCTION Vertigo is a debilitating symptom, leading to increased healthcare utilization and lost patient productivity. Vestibular rehabilitation is used to manage the symptomatic manifestations of vestibular disease. However, vestibular rehabilitation is limited by accessibility and time commitment. Recently, virtual reality has been described as a vestibular rehabilitation tool that may circumvent these barriers to treatment. Despite this, the efficacy of virtual reality for vestibular rehabilitation remains unclear. This study aims to review and summarize the current literature on the effectiveness of virtual reality-based vestibular rehabilitation. METHODS A systematic review of the MEDLINE, EMBASE, and Alternative and Complementary Medicine databases was conducted for prospective studies describing virtual reality-based vestibular rehabilitation. RESULTS Our search identified 382 unique articles. Six randomized controlled trials and four other studies were ultimately included. Study sample sizes ranged from 13 to 70 participants and varied in diagnoses from any unilateral peripheral vertigo to specific pathologies. Different virtual reality interventions were used. Comparator groups ranged from supervised vestibular rehabilitation to independent Cawthorne-Cooksey exercises. Outcomes consisted of validated questionnaires, objective clinical tests, and measurements of balance or reflexes. CONCLUSION The studies reviewed in this study are preliminary evidence to suggest the benefit of virtual reality-based vestibular rehabilitation. However, these studies are limited by their inclusion criteria, heterogeneity, comparator design, and evidence-based clinical outcomes. Further research should address these limitations.
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Affiliation(s)
- Michael Xie
- Division of Otolaryngology-Head and Neck Surgery
| | - Kelvin Zhou
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Nivedh Patro
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Teffran Chan
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
| | - Marc Levin
- Michael G. DeGroote School of Medicine, McMaster University, Hamilton, Ontario, Canada
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Vertigo in Patients with Degenerative Cervical Myelopathy. J Clin Med 2021; 10:jcm10112496. [PMID: 34200086 PMCID: PMC8201049 DOI: 10.3390/jcm10112496] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 05/30/2021] [Accepted: 06/03/2021] [Indexed: 12/14/2022] Open
Abstract
(1) Background: Cervical vertigo (CV) represents a controversial entity, with a prevalence ranging from reported high frequency to negation of CV existence. (2) Objectives: To assess the prevalence and cause of vertigo in patients with a manifest form of severe cervical spondylosis-degenerative cervical myelopathy (DCM) with special focus on CV. (3) Methods: The study included 38 DCM patients. The presence and character of vertigo were explored with a dedicated questionnaire. The cervical torsion test was used to verify the role of neck proprioceptors, and ultrasound examinations of vertebral arteries to assess the role of arteriosclerotic stenotic changes as hypothetical mechanisms of CV. All patients with vertigo underwent a detailed diagnostic work-up to investigate the cause of vertigo. (4) Results: Symptoms of vertigo were described by 18 patients (47%). Causes of vertigo included: orthostatic dizziness in eight (22%), hypertension in five (14%), benign paroxysmal positional vertigo in four (11%) and psychogenic dizziness in one patient (3%). No patient responded positively to the cervical torsion test or showed significant stenosis of vertebral arteries. (5) Conclusions: Despite the high prevalence of vertigo in patients with DCM, the aetiology in all cases could be attributed to causes outside cervical spine and related nerve structures, thus confirming the assumption that CV is over-diagnosed.
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