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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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2
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Rahman SM, Hauser C, Luebke AE. Loss of calcitonin gene-related peptide (αCGRP) and use of a vestibular challenge highlight balance deficiencies in aging mice. PLoS One 2024; 19:e0303801. [PMID: 38865379 PMCID: PMC11168652 DOI: 10.1371/journal.pone.0303801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2023] [Accepted: 04/30/2024] [Indexed: 06/14/2024] Open
Abstract
Aging impacts the vestibular system and contributes to imbalance. In fact, imbalance precedes changes in cognition in the elderly. However, research is limited in assessing aging mouse models that are deficient in crucial neuromodulators like Calcitonin Gene-Related Peptide (CGRP). We studied the loss of CGRP and its effects in the aging mouse, namely its effect on both static and dynamic imbalances. Postural sway and rotarod testing were performed before and after a vestibular challenge (VC) in the 129S wild type and the αCGRP (-/-) null mice. Four age groups were tested that correspond to young adulthood, late adulthood, middle age, and senescence in humans. Our results suggest wild type mice experience a decline in rotarod ability due to aging after they reach their prime performance at 6-10 months of age, while the αCGRP (-/-) null mice perform poorly on rotarod early in life but improve with age as they get older, potentially due to vestibular compensation. Our postural sway study suggests that a vestibular challenge can lead to significantly reduced CoP ellipse areas (freezing behaviors) in older mice, and this change occurs earlier in the αCGRP (-/-) null but requires future studies to evaluate anxiety effects. These results indicate that αCGRP is an important component of proper balance and that the loss of αCGRP can contribute to balance complications that may compound with aging.
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Affiliation(s)
- Shafaqat M. Rahman
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States of America
| | - Catherine Hauser
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States of America
| | - Anne E. Luebke
- Department of Biomedical Engineering, University of Rochester, Rochester, NY, United States of America
- Department of Neuroscience, Del Monte Institute of Neuroscience, University of Rochester Medical Center, Rochester, NY, United States of America
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Mann Ben Yehuda L, Rachima D, Katz-Leurer M. Anxiety characteristics in benign paroxysmal positional vertigo: first vs. recurrent episodes. Eur Arch Otorhinolaryngol 2024; 281:3245-3251. [PMID: 38573513 PMCID: PMC11065903 DOI: 10.1007/s00405-024-08615-y] [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: 12/30/2023] [Accepted: 03/11/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE To assess the difference in state and trait anxiety levels in patients with Benign Paroxysmal Positional Vertigo (BPPV) at the first episode (FE) versus recurrent episodes (RE), before and after vestibular physiotherapy. A secondary objective was to assess the difference in the prevalence of underlying health conditions between FE and RE BPPV patients. METHODS Fifty-five patients with BPPV, aged 40-70, were recruited. The diagnosis of BPPV was confirmed based on subjective complaints of vertigo and positive results from the Dix-Hallpike and Supine Roll tests. Twenty-four patients were in their FE, and 31 had RE. All patients completed the State-Trait Anxiety Inventory (STAI) questionnaire three times; before, immediately after, and a week after vestibular physiotherapy treatment. RESULTS The RE group demonstrated higher trait anxiety than the FE group in all testing points: before treatment (median value of 38 versus 29, p-value = 0.02), immediately after treatment (median value of 36 versus 28, p-value < 0.01) and a week later (median value of 38 versus 28, p-value < 0.01). State anxiety decreased immediately after treatment in both groups, but at the second session, it was significantly higher in the RE than in the FE group (median value of 38 versus 28.5, p-value = 0.03). Hypothyroidism was significantly more frequent in the RE group (RE 16%, FE 0%, p-value = 0.04). CONCLUSIONS Based on the current study's findings, we recommend assessing anxiety levels in patients with recurrent BPPV and consider referring them for appropriate treatment when necessary.
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Affiliation(s)
- Lotem Mann Ben Yehuda
- Physical Therapy Department, Faculty of Medicine, School of Health Professions, Tel-Aviv University, Tel-Aviv, Israel
- Maccabi Health Care, Kfar Saba, Israel
| | - David Rachima
- Maccabi Health Care, Kfar Saba, Israel
- Maccabi Health Care, Netanya, Israel
| | - Michal Katz-Leurer
- Physical Therapy Department, Faculty of Medicine, School of Health Professions, Tel-Aviv University, Tel-Aviv, Israel.
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Kostelnik EO, Howard LM, Paulson JF. Mental Health Education and Utilization Among Patients with Vestibular Disorders. J Clin Psychol Med Settings 2024:10.1007/s10880-024-10022-8. [PMID: 38762705 DOI: 10.1007/s10880-024-10022-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2024] [Indexed: 05/20/2024]
Abstract
To explore the receipt of mental health education, assessment, and referrals, and mental health service use among individuals with vestibular disorders. Patients with vestibular disorders living in the US, Australia, Canada, and the UK were surveyed through social media forums. Questionnaires assessed demographics, anxiety (Generalized Anxiety Disorder-7), depression (Center for Epidemiological Studies Depression-10), dizziness (Dizziness Handicap Inventory), and type of professional providing mental health education, assessment, referral, and treatment. The 226 participants were largely White (90%), educated (67% holding an associate's degree or higher) women (88%) with an average age of 45 who self-identified as having chronic vestibular symptoms (78%), as opposed to episodic ones (22%). Fifty-two percent reported never receiving verbal education, written education (69%), mental health assessment (54%), or referral (72%). Participants were more likely to receive mental health treatment in the past if they had received verbal resources and/or referrals from clinicians. The majority of patients with vestibular disorders report that medical professionals have not provided education, mental health assessment, or a mental health referral.
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Affiliation(s)
| | - Lindsay M Howard
- Department of Psychology, Augustana University, Madsen Center 131, 2001 S Summit Ave, Sioux Falls, SD, 57197, USA.
| | - James F Paulson
- Department of Psychology, Old Dominion University, Norfolk, VA, USA
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Law JH, Koh HY, Kua A. Optokinetic stimulation in the rehabilitation of visually induced dizziness in people with vestibular disorders: A systematic review. Clin Rehabil 2024:2692155241244932. [PMID: 38584422 DOI: 10.1177/02692155241244932] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/09/2024]
Abstract
OBJECTIVE This systematic review and meta-analysis investigates the effects optokinetic stimulation in people with vestibular disorders, with a specific focus on people with visually induced dizziness. DATA SOURCES A systematic review was conducted using three electronic databases, CINAHL, PubMed and Physiotherapy Evidence Database (PEDro), from 2000 up to February 2024. REVIEW METHODS Randomised controlled trials were included, which compared: (a) adults above 18 years old with vestibular disorders, (b) the study evaluated interventions using optokinetic stimulation, (c) the intervention was compared with usual care; placebo or to no intervention, (d) the study included at least one outcome measure evaluating vestibular symptoms and (e) published in English. The methodological quality of the included studies was assessed using the PEDro scale and PROSPERO's registration number ID: CRD42021273382). RESULTS Eleven randomised control trials, reported in 12 records, fulfilled the inclusion criteria. All of the studies were considered to have 'good' methodological quality according to the PEDro scale. All studies showed significant improvement in vestibular symptoms in both the intervention and control groups. A meta-analysis performed on six of the records found a preference towards the addition of OKS to conventional vestibular rehabilitation helped to further reduce dizziness symptoms for patients, but the results were not statistically significant. CONCLUSION No optimal duration or frequency for OKS has been determined. The addition of OKS to conventional vestibular rehabilitation may be beneficial in further improving vestibular symptoms in patients with dizziness. OKS could help to improve enjoyment and adherence to vestibular rehabilitation.
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Affiliation(s)
- Jessica Hj Law
- Department of Rehabilitation, National University Hospital, Singapore, Singapore
| | - Hui Ying Koh
- Department of Rehabilitation, National University Hospital, Singapore, Singapore
| | - Agnes Kua
- Department of Rehabilitation, National University Hospital, Singapore, Singapore
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Obrero-Gaitán E, Sedeño-Vidal A, Peinado-Rubia AB, Cortés-Pérez I, Ibáñez-Vera AJ, Lomas-Vega R. Optokinetic stimulation for the treatment of vestibular and balance disorders: a systematic review with meta-analysis. Eur Arch Otorhinolaryngol 2024:10.1007/s00405-024-08604-1. [PMID: 38578505 DOI: 10.1007/s00405-024-08604-1] [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: 12/21/2023] [Accepted: 03/05/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES To analyse the effectiveness of optokinetic stimulation (OKS) for improving symptoms and function in patients with vestibular and balance disorders. METHODS PubMed (MEDLINE), SCOPUS, Web of Science (WOS), CINAHL Complete, and PEDro databases were searched to identify randomized controlled trials (RCTs) that included patients with vestibular and balance disorders and compared the effects of OKS versus other interventions or no intervention on subjective or objective functional outcomes. Data were analysed by the standardized mean difference (SMD) and its 95% confidence interval. RESULTS A total of 10 studies were selected including 468 patients, 177 of whom received OKS. There were no significant differences in scores on the Dizziness Handicap Inventory (DHI) (SMD = 0.02; 95% CI - 0.18 to 0.23; p = 0.83) or the visual analogue scale (VAS) for vertigo (SMD = 0.16; 95% CI - 1.25 to 1.58; p = 0.82). However, there were statistically significant differences in the timed up and go (TUG) test, with a large effect (SMD = - 1.13; 95% CI -2 to - 0.28; p = 0.009), and in the sensory organization test (SOT), with a medium effect (SMD = - 0.7; 95% CI - 1.21 to - 0.19; p = 0.007). Subgroup analysis showed significant effects of OKS on VAS (p = 0.017), TUG (p = 0.009) and SOT (p = 0.001) only in patients with balance disorders without vestibular disease (p > 0.05). CONCLUSIONS OKS may improve dizziness intensity measured with VAS or dynamic balance measured whit TUG and SOT in patients with balance disorders not due to vestibular disease. The quality of the evidence was low or very low due to the small number of included studies. PROSPERO REGISTRY NUMBER CRD42023445024.
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Zeitler DM, Prentiss SM, Sydlowski SA, Dunn CC. American Cochlear Implant Alliance Task Force: Recommendations for Determining Cochlear Implant Candidacy in Adults. Laryngoscope 2024; 134 Suppl 3:S1-S14. [PMID: 37435829 PMCID: PMC10914083 DOI: 10.1002/lary.30879] [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: 09/30/2022] [Revised: 05/30/2023] [Accepted: 06/27/2023] [Indexed: 07/13/2023]
Abstract
The indications for cochlear implantation have expanded over time due to evidence demonstrating identification and implantation of appropriate cochlear implant (CI) candidates lead to significant improvements in speech recognition and quality of life (QoL). However, clinical practice is variable, with some providers using outdated criteria and others exceeding current labeled indications. As a results, only a fraction of those persons who could benefit from CI technology receive it. This document summarizes the current evidence for determining appropriate referrals for adults with bilateral hearing loss into CI centers for formal evaluation by stressing the importance of treating each ear individually and a "revised 60/60 rule". By mirroring contemporary clinical practice and available evidence, these recommendations will also provide a standardized testing protocol for CI candidates using a team-based approach that prioritizes individualized patient care. This manuscript was developed by the Adult Cochlear Implantation Candidacy Task Force of the American Cochlear Implant Alliance using review of the existing literature and clinical consensus. LEVEL OF EVIDENCE: N/A Laryngoscope, 134:S1-S14, 2024.
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Affiliation(s)
- Daniel M. Zeitler
- Listen for Life Center, Department of Otolaryngology-Head and Neck Surgery, Virginia Mason Medical Center, Seattle, WA
| | - Sandra M. Prentiss
- Department of Otolaryngology-Head and Neck Surgery, University of Miami, Miami, FL
| | | | - Camille C. Dunn
- The University of Iowa Cochlear Implant Clinical Research Center, Department of Otolaryngology-Head and Neck Surgery, University of Iowa, Iowa City, IA
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Modi AD, Parekh A, Patel ZH. Methods for evaluating gait associated dynamic balance and coordination in rodents. Behav Brain Res 2024; 456:114695. [PMID: 37783346 DOI: 10.1016/j.bbr.2023.114695] [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: 07/12/2023] [Revised: 09/29/2023] [Accepted: 09/30/2023] [Indexed: 10/04/2023]
Abstract
Balance is the dynamic and unconscious control of the body's centre of mass to maintain postural equilibrium. Regulated by the vestibular system, head movement and acceleration are processed by the brain to adjust joints. Several conditions result in a loss of balance, including Alzheimer's Disease, Parkinson's Disease, Menière's Disease and cervical spondylosis, all of which are caused by damage to certain parts of the vestibular pathways. Studies about the impairment of the vestibular system are challenging to carry out in human trials due to smaller study sizes limiting applications of the results and a lacking understanding of the human balance control mechanism. In contrast, more controlled research can be performed in animal studies which have fewer confounding factors than human models and allow specific conditions that affect balance to be replicated. Balance control can be studied using rodent balance-related behavioural tests after spinal or brain lesions, such as the Basso, Beattie and Bresnahan (BBB) Locomotor Scale, Foot Fault Scoring System, Ledged Beam Test, Beam Walking Test, and Ladder Beam Test, which are discussed in this review article along with their advantages and disadvantages. These tests can be performed in preclinical rodent models of femoral nerve injury, stroke, spinal cord injury and neurodegenerative diseases.
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Affiliation(s)
- Akshat D Modi
- Department of Biological Sciences, University of Toronto, Scarborough, Ontario M1C 1A4, Canada; Department of Genetics and Development, Krembil Research Institute, Toronto, Ontario M5T 0S8, Canada.
| | - Anavi Parekh
- Department of Neuroscience, University of Toronto, Toronto, Ontario M5S 1A1, Canada
| | - Zeenal H Patel
- Department of Biological Sciences, University of Toronto, Scarborough, Ontario M1C 1A4, Canada; Department of Biochemistry, University of Toronto, Scarborough, Ontario M1C 1A4, Canada
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9
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Deng W, Chen Y, Xiong H, Ou Y. Tympanostomy tube placement for intractable Meniere's disease in the elderly. Acta Otolaryngol 2024; 144:7-13. [PMID: 38375680 DOI: 10.1080/00016489.2024.2312231] [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: 12/14/2023] [Accepted: 01/25/2024] [Indexed: 02/21/2024]
Abstract
BACKGROUND The treatment of refractory elderly Meniere's disease is a challenge. AIM To investigate the efficacy of tympanostomy tube placement in elderly patients with Meniere's disease. METHODS 31 patients over 60 years old with Meniere's disease who had failed medical treatment and underwent tympanostomy tube placement. Vertigo control, hearing level, tinnitus, and ear fullness were recorded and analyzed preoperatively and postoperatively. RESULTS All patients completed a 6-month follow-up. At 6 months postoperatively,complete control, substantial control and limited control of vertigo were achieved in 10 (32%), 13 (42%), and 6 (19%) patients respectively. Two patients (6%) reported no substantial improvement. Twelve patients completed a 2-year follow-up. At 2 years postoperatively, complete control, substantial control and limited control of vertigo were achieved in 3 (25%), 5 (42%), and 1 (8%) patients respectively. Three (25%) patients showed no significant improvement in vertigo. The majority of patients reported significant improvement in the functional level scale, the Dizziness Handicap Inventory scores, and ear fullness at 6 months and 2 years postoperatively. CONCLUSIONS AND SIGNIFICANCE Tympanostomy tube placement may reduce vertigo attacks and improved the quality of life in elderly patients with Meniere's disease.
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Affiliation(s)
- Wenting Deng
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yuebo Chen
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Hao Xiong
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Yongkang Ou
- Department of Otolaryngology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, China
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10
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Li Q, Xu H, Chen W, Su A, Fu MJ, Walker MF. Short-term learning of the vestibulo-ocular reflex induced by a custom interactive computer game. J Neurophysiol 2024; 131:16-27. [PMID: 37964728 DOI: 10.1152/jn.00130.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2023] [Revised: 10/24/2023] [Accepted: 11/09/2023] [Indexed: 11/16/2023] Open
Abstract
Retinal image slip during head rotation drives motor learning in the rotational vestibulo-ocular reflex (VOR) and forms the basis of gaze-stability exercises that treat vestibular dysfunction. Clinical exercises, however, are unengaging, cannot easily be titrated to the level of impairment, and provide neither direct feedback nor tracking of the patient's adherence, performance, and progress. To address this, we have developed a custom application for VOR training based on an interactive computer game. In this study, we tested the ability of this game to induce VOR learning in individuals with normal vestibular function, and we compared the efficacy of single-step and incremental learning protocols. Eighteen participants played the game twice on different days. All participants tolerated the game and were able to complete both sessions. The game scenario incorporated a series of brief head rotations, similar to active head impulses, that were paired with a dynamic acuity task and with a visual-vestibular mismatch (VVM) intended to increase VOR gain (single-step: 300 successful trials at ×1.5 viewing; incremental: 100 trials each of ×1.13, ×1.33, and ×1.5 viewing). Overall, VOR gain increased by 15 ± 4.7% (mean ± 95% CI, P < 0.001). Gains increased similarly for active and passive head rotations, and, contrary to our hypothesis, there was little effect of the learning strategy. This study shows that an interactive computer game provides robust VOR training and has the potential to deliver effective, engaging, and trackable gaze-stability exercises to patients with a range of vestibular dysfunctions.NEW & NOTEWORTHY This study demonstrates the feasibility and efficacy of a customized computer game to induce motor learning in the high-frequency rotational vestibulo-ocular reflex. It provides a physiological basis for the deployment of this technology to clinical vestibular rehabilitation.
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Affiliation(s)
- Qi Li
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, Ohio, United States
| | - Honglu Xu
- Department of Computer and Data Sciences, Case Western Reserve University, Cleveland, Ohio, United States
| | - Weicong Chen
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, Ohio, United States
| | - Andrew Su
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, Ohio, United States
| | - Michael J Fu
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, Ohio, United States
- Functional Electrical Stimulation Center, VA Northeast Ohio Healthcare System, Cleveland, Ohio, United States
- MetroHealth Rehabilitation Institute, The MetroHealth System, Cleveland, Ohio, United States
| | - Mark F Walker
- Neurology Service, VA Northeast Ohio Healthcare System, Cleveland, Ohio, United States
- Department of Neurology, Case Western Reserve University, Cleveland, Ohio, United States
- Advanced Platform Technology Center, VA Northeast Ohio Healthcare System, Cleveland, Ohio, United States
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Kunelskaya NL, Baybakova EV, Zaoeva ZO, Guseva AL, Chugunova MA, Manaenkova EA, Vinogradova MV. [Rehabilitation in bilateral vestibulopathy: trends and perspectives]. Vestn Otorinolaringol 2024; 89:59-65. [PMID: 38805465 DOI: 10.17116/otorino20248902159] [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: 05/30/2024]
Abstract
A review of the literature on rehabilitation methods for bilateral vestibulopathy is presented using RSCI, Scopus and PubMed databases. The principles and effectiveness of physical vestibular rehabilitation, vestibular implants, galvanic vestibular stimulation, and biofeedback-based sensory substitution and augmentation systems are described. The advantages and disadvantages of each method and perspectives for their improvement are presented.
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Affiliation(s)
- N L Kunelskaya
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - E V Baybakova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - Z O Zaoeva
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - A L Guseva
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - M A Chugunova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - E A Manaenkova
- Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia
| | - M V Vinogradova
- Pirogov Russian National Research Medical University, Moscow, Russia
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Behtani L, Paromov D, Moïn-Darbari K, Houde MS, Bacon BA, Maheu M, Leroux T, Champoux F. Hearing Aid Amplification Improves Postural Control for Older Adults With Hearing Loss When Other Sensory Cues Are Impoverished. Trends Hear 2024; 28:23312165241232219. [PMID: 38356376 PMCID: PMC10868491 DOI: 10.1177/23312165241232219] [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: 09/06/2023] [Revised: 01/17/2024] [Accepted: 01/19/2024] [Indexed: 02/16/2024] Open
Abstract
Recent studies suggest that sound amplification via hearing aids can improve postural control in adults with hearing impairments. Unfortunately, only a few studies used well-defined posturography measures to assess balance in adults with hearing loss with and without their hearing aids. Of these, only two examined postural control specifically in the elderly with hearing loss. The present study examined the impact of hearing aid use on postural control during various sensory perturbations in older adults with age-related hearing loss. Thirty individuals with age-related hearing impairments and using hearing aids bilaterally were tested. Participants were asked to perform a modified clinical sensory integration in balance test on a force platform with and without hearing aids. The experiment was conducted in the presence of a broadband noise ranging from 0.1 to 4 kHz presented through a loudspeaker. As expected, hearing aid use had a beneficial impact on postural control, but only when visual and somatosensory inputs were both reduced. Data also suggest that hearing aid use decreases the dependence on somatosensory input for maintaining postural control. This finding can be of particular importance in older adults considering the reduction of tactile and proprioceptive sensitivity and acuity often associated with aging. These results provide an additional argument for encouraging early hearing aid fitting for people with hearing loss.
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Affiliation(s)
- L. Behtani
- School of Speech Language Pathology and Audiology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche de L’Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC, Canada
| | - D. Paromov
- School of Speech Language Pathology and Audiology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche de L’Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC, Canada
| | - K. Moïn-Darbari
- School of Speech Language Pathology and Audiology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - MS Houde
- School of Speech Language Pathology and Audiology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - BA Bacon
- Department of Psychology, University of British Columbia, Vancouver, BC, Canada
| | - M. Maheu
- School of Speech Language Pathology and Audiology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Institut Universitaire Sur la Réadaptation en Déficience Physique de Montréal (IURDPM), Pavillon Laurier, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, QC, Canada
| | - T. Leroux
- School of Speech Language Pathology and Audiology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
| | - F. Champoux
- School of Speech Language Pathology and Audiology, Faculty of Medicine, Université de Montréal, Montréal, QC, Canada
- Centre de Recherche de L’Institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC, Canada
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Schenberg L, Palou A, Simon F, Bonnard T, Barton CE, Fricker D, Tagliabue M, Llorens J, Beraneck M. Multisensory gaze stabilization in response to subchronic alteration of vestibular type I hair cells. eLife 2023; 12:RP88819. [PMID: 38019267 PMCID: PMC10686621 DOI: 10.7554/elife.88819] [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] [Indexed: 11/30/2023] Open
Abstract
The functional complementarity of the vestibulo-ocular reflex (VOR) and optokinetic reflex (OKR) allows for optimal combined gaze stabilization responses (CGR) in light. While sensory substitution has been reported following complete vestibular loss, the capacity of the central vestibular system to compensate for partial peripheral vestibular loss remains to be determined. Here, we first demonstrate the efficacy of a 6-week subchronic ototoxic protocol in inducing transient and partial vestibular loss which equally affects the canal- and otolith-dependent VORs. Immunostaining of hair cells in the vestibular sensory epithelia revealed that organ-specific alteration of type I, but not type II, hair cells correlates with functional impairments. The decrease in VOR performance is paralleled with an increase in the gain of the OKR occurring in a specific range of frequencies where VOR normally dominates gaze stabilization, compatible with a sensory substitution process. Comparison of unimodal OKR or VOR versus bimodal CGR revealed that visuo-vestibular interactions remain reduced despite a significant recovery in the VOR. Modeling and sweep-based analysis revealed that the differential capacity to optimally combine OKR and VOR correlates with the reproducibility of the VOR responses. Overall, these results shed light on the multisensory reweighting occurring in pathologies with fluctuating peripheral vestibular malfunction.
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Affiliation(s)
- Louise Schenberg
- Université Paris Cité, CNRS UMR 8002, INCC - Integrative Neuroscience and Cognition CenterParisFrance
| | - Aïda Palou
- Departament de Ciències Fisiològiques, Universitat de BarcelonaBarcelonaSpain
- Institut de Neurociènces, Universitat de BarcelonaBarcelonaSpain
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL)l’Hospitalet de LlobregatSpain
| | - François Simon
- Université Paris Cité, CNRS UMR 8002, INCC - Integrative Neuroscience and Cognition CenterParisFrance
- Department of Paediatric Otolaryngology, Hôpital Necker-Enfants MaladesParisFrance
| | - Tess Bonnard
- Université Paris Cité, CNRS UMR 8002, INCC - Integrative Neuroscience and Cognition CenterParisFrance
| | - Charles-Elliot Barton
- Université Paris Cité, CNRS UMR 8002, INCC - Integrative Neuroscience and Cognition CenterParisFrance
| | - Desdemona Fricker
- Université Paris Cité, CNRS UMR 8002, INCC - Integrative Neuroscience and Cognition CenterParisFrance
| | - Michele Tagliabue
- Université Paris Cité, CNRS UMR 8002, INCC - Integrative Neuroscience and Cognition CenterParisFrance
| | - Jordi Llorens
- Departament de Ciències Fisiològiques, Universitat de BarcelonaBarcelonaSpain
- Institut de Neurociènces, Universitat de BarcelonaBarcelonaSpain
- Institut d'Investigació Biomèdica de Bellvitge (IDIBELL)l’Hospitalet de LlobregatSpain
| | - Mathieu Beraneck
- Université Paris Cité, CNRS UMR 8002, INCC - Integrative Neuroscience and Cognition CenterParisFrance
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Behtani L, Paromov D, Moïn-Darbari K, Houde MS, Bacon BA, Maheu M, Leroux T, Champoux F. Sensory Reweighting for Postural Control in Older Adults with Age-Related Hearing Loss. Brain Sci 2023; 13:1623. [PMID: 38137071 PMCID: PMC10741952 DOI: 10.3390/brainsci13121623] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2023] [Revised: 11/15/2023] [Accepted: 11/17/2023] [Indexed: 12/24/2023] Open
Abstract
There is growing evidence linking hearing impairments and the deterioration of postural stability in older adults. To our knowledge, however, no study to date has investigated the effect of age-related hearing loss on the sensory reweighting process during postural control. In the absence of data, much is unknown about the possible mechanisms, both deleterious and compensatory, that could underly the deterioration of postural control following hearing loss in the elderly. The aim of this study was to empirically examine sensory reweighting for postural control in older adults with age-related hearing loss as compared to older adults with normal hearing. The center of pressure of all participants was recorded using a force platform and the modified clinical test of sensory interaction and balance protocol. The results suggest that individuals with age-related hearing loss displayed increased somatosensory reliance relative to normal hearing younger adults. This increased reliance on somatosensory input does not appear to be effective in mitigating the loss of postural control, probably due to the concomitant deterioration of tactile and proprioceptive sensitivity and acuity associated with aging. Beyond helping to further define the role of auditory perception in postural control, these results further the understanding of sensory-related mechanisms associated with postural instability in older adults.
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Affiliation(s)
- Lydia Behtani
- School of Speech Language Pathology and Audiology, Faculty of Medecine, Université de Montréal, Montréal, QC H3T 1J4, Canada; (L.B.); (D.P.); (K.M.-D.); (M.-S.H.); (M.M.); (T.L.)
- Centre de Recherche de L’institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC H3W 1W4, Canada
| | - Daniel Paromov
- School of Speech Language Pathology and Audiology, Faculty of Medecine, Université de Montréal, Montréal, QC H3T 1J4, Canada; (L.B.); (D.P.); (K.M.-D.); (M.-S.H.); (M.M.); (T.L.)
- Centre de Recherche de L’institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC H3W 1W4, Canada
| | - Karina Moïn-Darbari
- School of Speech Language Pathology and Audiology, Faculty of Medecine, Université de Montréal, Montréal, QC H3T 1J4, Canada; (L.B.); (D.P.); (K.M.-D.); (M.-S.H.); (M.M.); (T.L.)
| | - Marie-Soleil Houde
- School of Speech Language Pathology and Audiology, Faculty of Medecine, Université de Montréal, Montréal, QC H3T 1J4, Canada; (L.B.); (D.P.); (K.M.-D.); (M.-S.H.); (M.M.); (T.L.)
| | - Benoit Antoine Bacon
- Department of Psychology, Faculty of Art and Science, University of British Columbia, Vancouver, BC V6T 1Z4, Canada;
| | - Maxime Maheu
- School of Speech Language Pathology and Audiology, Faculty of Medecine, Université de Montréal, Montréal, QC H3T 1J4, Canada; (L.B.); (D.P.); (K.M.-D.); (M.-S.H.); (M.M.); (T.L.)
- Institut Universitaire Sur la Réadaptation en Déficience Physique de Montréal (IURDPM), Pavillon Laurier, CIUSSS du Centre-Sud-de-l’Île-de-Montréal, Montréal, QC H2H 2N8, Canada
| | - Tony Leroux
- School of Speech Language Pathology and Audiology, Faculty of Medecine, Université de Montréal, Montréal, QC H3T 1J4, Canada; (L.B.); (D.P.); (K.M.-D.); (M.-S.H.); (M.M.); (T.L.)
| | - François Champoux
- School of Speech Language Pathology and Audiology, Faculty of Medecine, Université de Montréal, Montréal, QC H3T 1J4, Canada; (L.B.); (D.P.); (K.M.-D.); (M.-S.H.); (M.M.); (T.L.)
- Centre de Recherche de L’institut Universitaire de Gériatrie de Montréal (CRIUGM), Montréal, QC H3W 1W4, Canada
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15
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Smith LJ, Pyke W, Fowler R, Matthes B, de Goederen E, Surenthiran S. Impact and experiences of vestibular disorders and psychological distress: Qualitative findings from patients, family members and healthcare professionals. Health Expect 2023; 27:e13906. [PMID: 37915279 PMCID: PMC10757133 DOI: 10.1111/hex.13906] [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: 08/24/2023] [Revised: 10/04/2023] [Accepted: 10/22/2023] [Indexed: 11/03/2023] Open
Abstract
INTRODUCTION People with vestibular disorders frequently experience reduced quality of life and challenges with activities of daily living. Anxiety, depression and cognitive problems often co-present with vestibular disorders and can aggravate symptoms and prolong clinical recovery. We aimed to gain in-depth insights into the impact of vestibular disorders and the contribution of psychological factors by exploring multistakeholder perspectives. METHODS Semistructured interviews were conducted between October 2021 and March 2022 with 47 participants in the United Kingdom including: 20 patients (age M = 50.45 ± 13.75; 15 females), nine family members (age M = 61.0 ± 14.10; four females), and 18 healthcare professionals. Data were analysed using framework analysis. RESULTS Vestibular disorders impact diverse aspects of patients' lives including work, household chores, socialising, and relationships with family and friends. Being unable to engage in valued activities or fulfil social roles contributes to feelings of grief and frustration, affecting identity, confidence, and autonomy. Anxiety and low mood contribute to negative thought processes, avoidance, and social withdrawal, which can impede clinical recovery through reduced activity levels, and end engagement with treatment. Coping strategies were thought to help empower patients to self-manage their symptoms and regain a sense of control, but these require oversight from healthcare providers. CONCLUSIONS Daily activity limitations, social participation restrictions, and psychological distress can interact to impact quality of life, sense of self, and clinical recovery amongst people with vestibular disorders. Information and resources could aid societal awareness of the impact of vestibular disorders and help patients and families feel understood. An individualised and comprehensive approach that concurrently addresses mental, physical, social, and occupational needs is likely to be beneficial. PATIENT OR PUBLIC CONTRIBUTION Two group meetings were held at the beginning and end of the study with a patient and public involvement network formed of people with vestibular disorders and family members. These individuals commented on the study aims, interview schedule, participant recruitment practices, and interpretation of the themes identified. Two core patient members were involved at all stages of the research. These individuals contributed to the formulation of the interview schedule, development and application of the coding scheme, development and interpretation of themes, and preparation of the final manuscript.
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Affiliation(s)
- Laura J. Smith
- Centre for Preventative Neurology, Wolfson Institute of Population HealthQueen Mary University of LondonLondonUK
- School of Psychology, Keynes CollegeUniversity of KentKentUK
| | - Wesley Pyke
- School of Psychology, Keynes CollegeUniversity of KentKentUK
| | - Rosanna Fowler
- School of Psychology, Keynes CollegeUniversity of KentKentUK
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Casani AP, Gufoni M, Ducci N. Episodic Vertigo: A Narrative Review Based on a Single-Center Clinical Experience. Audiol Res 2023; 13:845-858. [PMID: 37987332 PMCID: PMC10660529 DOI: 10.3390/audiolres13060074] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 10/17/2023] [Accepted: 10/27/2023] [Indexed: 11/22/2023] Open
Abstract
(1) Background: Usually, the majority of patients suffering from vertigo and dizziness can be identified in four major categories: acute spontaneous vertigo, episodic (recurrent) vertigo, recurrent positional vertigo, and chronic imbalance. Our purpose is to retrospectively evaluate the main causes of episodic vertigo and to find indications for a reliable clinical suspicion useful for a definitive diagnosis, comparing patients affected by different presenting symptomatology (acute vertigo, recurrent episodic vertigo, and imbalance). (2) Methods: we retrospectively evaluated the clinical records in a population of 249 consecutive patients observed for vertigo in our tertiary referral center in the period 1 January 2019-31 January 2020. On the basis of the reported clinical history, patients were divided into three groups: patients with their first ever attack of vertigo, patients with recurrent vertigo and dizziness, and patients with chronic imbalance. (3) Results: On the basis of the results of the instrumental examination, we arbitrarily divided (for each type of symptoms) the patients in a group with a normal vestibular instrumental examination and a group of patients in which the clinical-instrumental evaluation showed some pathological results; a highly significant difference (p: 0.157) was found between recurrent and acute vertigo and between recurrent vertigo and imbalance. (4) Conclusions: Patients with recurrent vertigo more frequently exhibit a negative otoneurological examination since they are often examined in the intercritical phase. A precise and in-depth research of the patient's clinical history is the key to suspect or make a diagnosis together with the search for some instrumental or clinical hallmark, especially in cases where the clinical picture does not fully meet the international diagnostic criteria.
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Affiliation(s)
- Augusto Pietro Casani
- ENT Section, Medical, Molecular and Critical Area, Department of Surgical Pathology, Pisa University Hospital, 56122 Pisa, Italy; (M.G.); (N.D.)
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17
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Sayegh MA, Banaag A, Korona-Bailey J, Madsen C, Frank A, Koehlmoos TP. The burden of vestibular disorders among military health system (MHS) beneficiaries, fiscal years 2018-2019. PLoS One 2023; 18:e0286798. [PMID: 37856452 PMCID: PMC10586620 DOI: 10.1371/journal.pone.0286798] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2022] [Accepted: 05/23/2023] [Indexed: 10/21/2023] Open
Abstract
INTRODUCTION Vestibular disorders affect an estimated 33 million adults and 3.5 million children and adolescents in the United States. Previous research relying on self-reported symptoms versus actual diagnosis has limited the ability to provide prevalence estimates for specific vestibular disorders at the population level. This study seeks to describe the burden of vestibular disorders among children and working-age adult beneficiaries in the Military Health System (MHS). MATERIALS AND METHODS Using the MHS Data Repository (MDR), we conducted a cross-sectional study of all TRICARE Prime and Plus MHS beneficiaries aged 0 to 64 years from fiscal years (FY) 2018 to 2019. Study analyses included descriptive statistics of patient demographics and assessing the prevalence of vestibular disorders in pediatric and working-age adult beneficiaries. RESULTS Of the 5,541,932 TRICARE Prime/Prime Plus MHS beneficiaries, 52,878 (0.95%) had a diagnosis of vestibular disorder during fiscal years 2018 to 2019, of which 1,359 were pediatric and adolescents (aged 0 to 17 years) and 51,519 were working-age adults (18 to 64 years). Vertigo was the most common diagnosis in both age-group populations (11.46 per 1,000 working-age adults; 0.52 per 1,000 children and adolescents), with benign vertigo being the most prevalent of the three diagnoses and occurring at a seven times higher rate in adults versus pediatric and adolescents. CONCLUSIONS This study demonstrates the effectiveness of using medical claims data to estimate prevalence compared to self-reported survey data and supports prevalence estimates of vestibular disease in <1% of children overall, but indicate much higher prevalence for adolescents.
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Affiliation(s)
- M. Aaron Sayegh
- Center for Health Services Research, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, United States of America
| | - Amanda Banaag
- Center for Health Services Research, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, United States of America
| | - Jessica Korona-Bailey
- Center for Health Services Research, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, United States of America
| | - Cathaleen Madsen
- Center for Health Services Research, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
- The Henry M. Jackson Foundation for the Advancement of Military Medicine, Inc., Bethesda, Maryland, United States of America
| | - Amanda Frank
- Department of Defense, Hearing Center of Excellence, Defense Health Agency, Joint Base San Antonio, San Antonio, Texas, United States of America
- zCore Business Solutions, Inc., Round Rock, Texas, United States of America
| | - Tracey Pérez Koehlmoos
- Center for Health Services Research, Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, Maryland, United States of America
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Shah S, Chidarala S, Jeong S, Zhang K, Nguyen SA, Wilkinson R, Ward C, Rizk H. Secondary autoimmune immune ear disease (AIED): a systematic review and meta-analysis on vestibular manifestations of systemic autoimmune and inflammatory disorders. Clin Rheumatol 2023; 42:2747-2759. [PMID: 37380912 DOI: 10.1007/s10067-023-06674-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2023] [Revised: 06/07/2023] [Accepted: 06/10/2023] [Indexed: 06/30/2023]
Abstract
Secondary autoimmune inner ear disease (AIED) is often bilateral and asymmetric in patients presenting with audiovestibular symptoms due to a systemic autoimmune disease. This systematic review and meta-analysis are aimed at identifying and highlighting patterns in prevalence of vestibular dysfunction, symptom presentation, and diagnostic methods in extant literature by combining clinical context from case reports with quantitative analyses from cohort studies. Screening of articles by title, abstract, and full text was completed by four reviewers (K.Z., A.L., S.C., and S.J.). In this study, we grouped secondary AIED and systemic autoimmune diseases by pathophysiologic mechanism: (1) connective tissue disease (CTD), (2) vasculitides (VAS), (3) systemic inflammatory disorders (SID), and (4) other immune-mediated disorders (OIMD). The search for AIED disease identified 120 articles (cohorts and case reports) that met the final inclusion criteria. All 120 were included in the qualitative review, and 54 articles were included for meta-analysis. Of these 54 articles, 22 included a control group (CwC). Ninety individual cases or patient presentations from 66 articles were included for analysis in addition to the 54 cohort articles. Secondary AIED does not have a diagnostic algorithm for managing vestibular symptoms. The management of audiovestibular symptoms requires close collaboration between otolaryngologists and rheumatologists to preserve end-organ function of the ear. To improve our ability to understand the impact on the vestibular system, vestibular clinicians need to develop a standardized reporting method. Clinical presentation should frequently be paired with vestibular testing to contextually investigate symptom severity and provide higher quality care.
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Affiliation(s)
- Sunny Shah
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shreya Chidarala
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Seth Jeong
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Kathy Zhang
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Shaun A Nguyen
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Rachel Wilkinson
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA
| | - Celine Ward
- Department of Rheumatology, Medical University of South Carolina, Charleston, SC, USA
| | - Habib Rizk
- Department of Otolaryngology-Head and Neck Surgery, Medical University of South Carolina, Charleston, SC, USA.
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Paplou VG, Schubert NMA, van Tuinen M, Vijayakumar S, Pyott SJ. Functional, Morphological and Molecular Changes Reveal the Mechanisms Associated with Age-Related Vestibular Loss. Biomolecules 2023; 13:1429. [PMID: 37759828 PMCID: PMC10526133 DOI: 10.3390/biom13091429] [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: 08/21/2023] [Revised: 09/08/2023] [Accepted: 09/12/2023] [Indexed: 09/29/2023] Open
Abstract
Age-related loss of vestibular function and hearing are common disorders that arise from the loss of function of the inner ear and significantly decrease quality of life. The underlying pathophysiological mechanisms are poorly understood and difficult to investigate in humans. Therefore, our study examined young (1.5-month-old) and old (24-month-old) C57BL/6 mice, utilizing physiological, histological, and transcriptomic methods. Vestibular sensory-evoked potentials revealed that older mice had reduced wave I amplitudes and delayed wave I latencies, indicating reduced vestibular function. Immunofluorescence and image analysis revealed that older mice exhibited a significant decline in type I sensory hair cell density, particularly in hair cells connected to dimorphic vestibular afferents. An analysis of gene expression in the isolated vestibule revealed the upregulation of immune-related genes and the downregulation of genes associated with ossification and nervous system development. A comparison with the isolated cochlear sensorineural structures showed similar changes in genes related to immune response, chondrocyte differentiation, and myelin formation. These findings suggest that age-related vestibular hypofunction is linked to diminished peripheral vestibular responses, likely due to the loss of a specific subpopulation of hair cells and calyceal afferents. The upregulation of immune- and inflammation-related genes implies that inflammation contributes to these functional and structural changes. Furthermore, the comparison of gene expression between the vestibule and cochlea indicates both shared and distinct mechanisms contributing to age-related vestibular and hearing impairments. Further research is necessary to understand the mechanistic connection between inflammation and age-related balance and hearing disorders and to translate these findings into clinical treatment strategies.
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Affiliation(s)
- Vasiliki Georgia Paplou
- Department of Otorhinolaryngology and Head/Neck Surgery, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (V.G.P.); (N.M.A.S.); (M.v.T.)
| | - Nick M. A. Schubert
- Department of Otorhinolaryngology and Head/Neck Surgery, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (V.G.P.); (N.M.A.S.); (M.v.T.)
- Graduate School of Medical Sciences Research, School of Behavioural and Cognitive Neurosciences, University of Groningen, 9713 AV Groningen, The Netherlands
| | - Marcel van Tuinen
- Department of Otorhinolaryngology and Head/Neck Surgery, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (V.G.P.); (N.M.A.S.); (M.v.T.)
| | - Sarath Vijayakumar
- Department of Biomedical Sciences, School of Medicine, Creighton University, Omaha, NE 68178, USA;
| | - Sonja J. Pyott
- Department of Otorhinolaryngology and Head/Neck Surgery, University Medical Center Groningen, 9713 GZ Groningen, The Netherlands; (V.G.P.); (N.M.A.S.); (M.v.T.)
- Graduate School of Medical Sciences Research, School of Behavioural and Cognitive Neurosciences, University of Groningen, 9713 AV Groningen, The Netherlands
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Gunes-Bayir A, Tandogan Z, Gedik-Toker Ö, Yabaci-Tak A, Dadak A. A Comparison Study of Nutritional Assessment, Diet and Physical Activity Habits, Lifestyle and Socio-Demographic Characteristics in Individuals with and without Dizziness/Vertigo. Nutrients 2023; 15:4055. [PMID: 37764839 PMCID: PMC10534566 DOI: 10.3390/nu15184055] [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: 08/28/2023] [Revised: 09/15/2023] [Accepted: 09/18/2023] [Indexed: 09/29/2023] Open
Abstract
Dizziness and vertigo are growing health problems and have become responsible for increases in health expenditures. In this context, a case-control study has been conducted by nutritional assessment, including dietary and physical activity habits, lifestyle, and socio-demographic characteristics in adults with (patient group) and without (control group) dizziness or vertigo, and the outcomes were compared between these groups. The patient (n = 150) and control (n = 150) groups included 300 participants. The 24-h Dietary Recall and the food frequency questionnaire (FFQ-21) were conducted in order to gain detailed information about foods and beverages consumed by the participants. Additionally, a questionnaire was completed, assessing general socio-demographic (age, gender, etc.) and lifestyle (smoking, alcohol consumption, and obesity) characteristics, anthropometric measurements, and dietary and physical activity habits. The results revealed that there is an association between dizziness/vertigo and female gender and increasing age. Smoking status and alcohol consumption did not differ between the groups, whereas differences in body mass index and obesity were significantly higher in the patient group (65%; n = 98) than the control group (46%; n = 69) (p = 0.001). Skipping meals "everyday" was significantly high (p = 0.044), and lunch was the most skipped meal in the patient group. The three most preferred cooking methods were oven baking, boiling, and frying for both groups. Daily water intake in the patient group was lower than in the control group (p = 0.026). Dietary intake for carotene and vitamin K were significantly lower in the patient group than the control group, but the opposite was true for vitamin D intake (p < 0.05). Daily consumption of bread and dairy products were highest in the patient group (p < 0.05). The physical activity rate was 35% (n = 53) in the control group and 28% (n = 42) in the patient group. Regular walking was the most preferred activity in both groups (p = 0.037). Active monitoring of individual diet and hydration along with supporting professional counseling are advisable. In addition, a healthy lifestyle including weight control and regular physical activity can be helpful to reduce symptoms of dizziness/vertigo.
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Affiliation(s)
- Ayse Gunes-Bayir
- Department of Nutrition and Dietetics, Faculty of Health Sciences, Bezmialem Vakif University, Eyüpsultan, 34065 Istanbul, Turkey
| | - Zelal Tandogan
- Division of Nutrition, Institute of Health Sciences, Istanbul University, Fatih, 34093 Istanbul, Turkey;
| | - Özge Gedik-Toker
- Department of Audiology, Faculty of Health Sciences, Bezmialem Vakif University, Eyüpsultan, 34065 Istanbul, Turkey;
| | - Aysegul Yabaci-Tak
- Department of Biostatistics, Faculty of Medicine, Bezmialem Vakif University, Fatih, 34093 Istanbul, Turkey;
| | - Agnes Dadak
- Institute of Pharmacology and Toxicology, University of Veterinary Medicine Vienna, 1210 Vienna, Austria;
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21
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Youn GM, Shah JP, Agrawal Y, Wei EX. Vestibular Vertigo and Disparities in Healthcare Access Among Adults in the United States. Ear Hear 2023; 44:1029-1035. [PMID: 36920251 PMCID: PMC10440212 DOI: 10.1097/aud.0000000000001344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
OBJECTIVE Vertigo and dizziness have a high lifetime prevalence with significant impacts on daily life. We sought to explore differences in access to and ability to afford care among adults with vestibular vertigo by race/ethnicity, income, and insurance type. DESIGN This is a cross-sectional study using the 2016 National Health Interview Survey. A total of 32,047 adults who completed the 2016 National Health Interview Survey Balance Supplement were analyzed. We used a previously validated definition of vertigo defined as (1) positional vertigo, (2) rotational vertigo, or (3) recurrent dizziness with nausea and either oscillopsia or imbalance. We examined several self-reported measures of healthcare utilization and access. RESULTS Among adults with vestibular vertigo, African Americans had significantly increased odds of delayed care due to lack of transportation; Hispanic ethnicity was associated with decreased odds of skipping medication doses and asking a doctor for a lower-cost medication. Adults with public insurance had significantly lower odds of reporting delayed care due to worry about cost, not receiving medical care due to cost, and delayed filling of a prescription, but had greater odds of reporting delayed care due to lack of transportation. Lack of insurance and lower income were associated with increased odds of delaying and not receiving care due to cost. CONCLUSION These findings demonstrate significant differences in access to care among adults with vestibular vertigo in the United States based on race, income, and health insurance status.
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Affiliation(s)
- Gun Min Youn
- Stanford University School of Medicine, Stanford, California
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Jay P. Shah
- Stanford University School of Medicine, Stanford, California
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
| | - Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | - Eric X. Wei
- Department of Otolaryngology–Head and Neck Surgery, Stanford University School of Medicine, Stanford, California
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22
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Ma X, Shen J, Sun J, Wang L, Wang W, He K, Chen X, Zhang Q, Jin Y, Gao D, Duan M, Yang J, Chen J, He J. P300 Event-Related Potential Predicts Cognitive Dysfunction in Patients with Vestibular Disorders. Biomedicines 2023; 11:2365. [PMID: 37760807 PMCID: PMC10525252 DOI: 10.3390/biomedicines11092365] [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: 08/01/2023] [Revised: 08/13/2023] [Accepted: 08/22/2023] [Indexed: 09/29/2023] Open
Abstract
OBJECTIVE Our aim was to determine the correlation between cognitive impairment and P300 event-related potential (ERP) in older adults with vertigo and imbalance, which further provides a reference for clinical diagnosis and patients' rehabilitation. METHODS A total of 79 older adult patients with vertigo and imbalance in our outpatient department from January 2022 to December 2022 were selected and divided into the mild group (n = 20), moderate group (n = 39), and severe group (n = 20) according to the Dizziness Handicap Inventory (DHI). The auditory P300 component of event-related potentials (ERPs), Generalized Anxiety Disorder Questionnaire-7 (GAD-7), Patient Health Questionnaire-9 (PHQ-9), and Mini-Mental State Examination (MMSE) were used to evaluate depression, anxiety, and cognitive function in these patients, respectively. RESULTS The P300 latencies of the different severity groups were 292 ± 10 ms, 301 ± 8 ms, and 328 ± 5 ms, respectively, and the differences were statistically significant (p = 0.010). The P300 amplitudes of the different severity groups were 14.4 ± 2.6 μV, 3.9 ± 0.8 μV, and 5.1 ± 1.4 μV, respectively, and the differences were also statistically significant (p = 0.004). There was no statistically significant difference in the DHI evaluation or VAS visual simulation scoring between the two groups (p = 0.625, and 0.878, respectively). Compared with the short-course group, the long-course group showed prolonged P300 latency and decreased amplitude, higher scores in PHQ-9 and GAD-7, and lower scores in MMSE, and all the differences were statistically significant (p = 0.013, 0.021, 0.006, 0.004, and 0.018, respectively). CONCLUSION Older patients with more severe symptoms of vertigo and imbalance are at higher risk of developing abnormal cognitive function. The P300 can be used as an objective neurophysiological test for the assessment of cognitive function relevant to elderly patients with vertigo and imbalance.
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Affiliation(s)
- Xiaobao Ma
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; (X.M.); (J.S.); (J.S.); (L.W.); (W.W.); (K.H.); (X.C.); (Q.Z.); (Y.J.); (D.G.); (J.Y.)
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
| | - Jiali Shen
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; (X.M.); (J.S.); (J.S.); (L.W.); (W.W.); (K.H.); (X.C.); (Q.Z.); (Y.J.); (D.G.); (J.Y.)
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
| | - Jin Sun
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; (X.M.); (J.S.); (J.S.); (L.W.); (W.W.); (K.H.); (X.C.); (Q.Z.); (Y.J.); (D.G.); (J.Y.)
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
| | - Lu Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; (X.M.); (J.S.); (J.S.); (L.W.); (W.W.); (K.H.); (X.C.); (Q.Z.); (Y.J.); (D.G.); (J.Y.)
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
| | - Wei Wang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; (X.M.); (J.S.); (J.S.); (L.W.); (W.W.); (K.H.); (X.C.); (Q.Z.); (Y.J.); (D.G.); (J.Y.)
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
| | - Kuan He
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; (X.M.); (J.S.); (J.S.); (L.W.); (W.W.); (K.H.); (X.C.); (Q.Z.); (Y.J.); (D.G.); (J.Y.)
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
| | - Xiangping Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; (X.M.); (J.S.); (J.S.); (L.W.); (W.W.); (K.H.); (X.C.); (Q.Z.); (Y.J.); (D.G.); (J.Y.)
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
| | - Qin Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; (X.M.); (J.S.); (J.S.); (L.W.); (W.W.); (K.H.); (X.C.); (Q.Z.); (Y.J.); (D.G.); (J.Y.)
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
| | - Yulian Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; (X.M.); (J.S.); (J.S.); (L.W.); (W.W.); (K.H.); (X.C.); (Q.Z.); (Y.J.); (D.G.); (J.Y.)
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
| | - Dekun Gao
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; (X.M.); (J.S.); (J.S.); (L.W.); (W.W.); (K.H.); (X.C.); (Q.Z.); (Y.J.); (D.G.); (J.Y.)
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
| | - Maoli Duan
- Ear Nose and Throat Patient Area, Trauma and Reparative Medicine Theme, Karolinska University Hospital, 171 76 Stockholm, Sweden;
- Division of Ear, Nose and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, 171 77 Stockholm, Sweden
| | - Jun Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; (X.M.); (J.S.); (J.S.); (L.W.); (W.W.); (K.H.); (X.C.); (Q.Z.); (Y.J.); (D.G.); (J.Y.)
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
| | - Jianyong Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; (X.M.); (J.S.); (J.S.); (L.W.); (W.W.); (K.H.); (X.C.); (Q.Z.); (Y.J.); (D.G.); (J.Y.)
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
| | - Jingchun He
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China; (X.M.); (J.S.); (J.S.); (L.W.); (W.W.); (K.H.); (X.C.); (Q.Z.); (Y.J.); (D.G.); (J.Y.)
- Ear Institute, Shanghai Jiaotong University School of Medicine, Shanghai 200092, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai 200092, China
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Rahman SM, Hauser C, Luebke AE. Age-Related Balance Problems in Mice Are Sharpened by the Loss of Calcitonin Gene-Related Peptide (CGRP) and a Vestibular Challenge. BIORXIV : THE PREPRINT SERVER FOR BIOLOGY 2023:2023.06.28.546965. [PMID: 37461730 PMCID: PMC10349980 DOI: 10.1101/2023.06.28.546965] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 08/04/2023]
Abstract
Aging impacts the vestibular system and contributes to imbalance. In fact, in the elderly balance deficits often precede changes in cognition. However, imbalance research is limited in assessing aging mouse models that are deficient in neuromodulators like Calcitonin Gene-Related Peptide (CGRP). We studied the loss of CGRP and its effects in the aging mouse, namely its effect on both static and dynamic imbalances. In addition, postural sway and rotarod testing were performed before and after a vestibular challenge (VC) in the 129S wildtype and the αCGRP (-/-) null mice. Four age groups were tested that correspond to young adulthood, late adulthood, middle age, and senescence in humans. Our results suggest wildtype mice experience a decline in rotarod ability with increased age, while the αCGRP (-/-) null mice perform poorly on rotarod early in life and do not improve. Our postural sway study suggests that a vestibular challenge can lead to significantly reduced CoP ellipse areas (freezing behaviors) in older mice, and this change occurs earlier in the αCGRP (-/-) null mouse. These results indicate that αCGRP is an important component of static and dynamic balance; and that the loss of αCGRP can contribute to balance complications that may compound with aging.
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24
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Kavitha Y, Joish UK, Sachin KS, Gund S. Estimation of Normal Semi-circular Canal Dimensions on Computed Tomography. Indian J Otolaryngol Head Neck Surg 2023; 75:176-180. [PMID: 37206736 PMCID: PMC10188744 DOI: 10.1007/s12070-022-03331-7] [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: 01/10/2022] [Accepted: 11/29/2022] [Indexed: 12/23/2022] Open
Abstract
Aims To measure and compare length, width and luminal diameters of semi-circular canals (SCC) on Multiplanar reformatted CT images in individuals without any features of vestibular dysfunction. Materials And Methods A prospective, cross sectional, observational study was conducted in a tertiary care hospital in October - November 2021. Multiplanar reformatted CT temporal bone images of 50 participants without features of vestibular dysfunction were used to measure the curved lengths, widths and luminal diameters of the three semi-circular canals. Unpaired t-test was used to ascertain and compare the values obtained. Results Fifty participants, 27 women and 23 men (mean age 38.5 years) were included in the study. Mean curved lengths of Superior, posterior and Lateral SCCs were 1.37 cm, 1.33 cm and 1.19 cm respectively. Semi-circular width of Superior SCC (4.8 mm) was significantly larger than Posterior SCC (4.17 mm, p = 0.03) which was significantly larger than Lateral SCC (3.65 mm, p = 0.04). No significant difference was found between mean mid luminal diameters of the three SCCs. Mid luminal diameters were significantly smaller than the diameters at either ends of all SCCs. Conclusion The results can potentially serve as reference values for Indians and for further studies on pathophysiology of disequilibrium.
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Affiliation(s)
- Y Kavitha
- Department of ENT, SDM College of Medical Sciences, Dharwad, Karnataka India
- SDM College of Medical Sciences, 580009 Dharwad, Karnataka India
| | - Upendra Kumar Joish
- Department of Radiology, SDM College of Medical Sciences, Dharwad, Karnataka India
| | - KS Sachin
- Department of Anatomy, KVG Medical College and Hospital, Sullia, Karnataka India
| | - Shardul Gund
- Department of Radiology, KVG Medical College and Hospital, Sullia, Karnataka India
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25
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Guy KM, Walker KN, Volsky PG. Dizziness and vestibular disease among hospitalized and outpatients in the U.S. commonwealth of Virginia and the Tidewater region. HEARING, BALANCE AND COMMUNICATION 2023. [DOI: 10.1080/21695717.2023.2188801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/13/2023]
Affiliation(s)
- Kevin M. Guy
- Eastern Virginia Medical School, Norfolk, VA, USA
| | | | - Peter G. Volsky
- Department of Otolaryngology, Eastern Virginia Medical School, Norfolk, VA, USA
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26
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Cobb LH, Bailey VO, Liu YF, Teixido MT, Rizk HG. Relationship of vitamin D levels with clinical presentation and recurrence of BPPV in a Southeastern United States institution. Auris Nasus Larynx 2023; 50:70-80. [PMID: 35659787 DOI: 10.1016/j.anl.2022.05.011] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 05/17/2022] [Accepted: 05/19/2022] [Indexed: 01/28/2023]
Abstract
OBJECTIVE To examine the relationship of 25hydroxyvitamin D serum levels with BPPV incidence and recurrence rates. METHODS A retrospective cross-sectional, case-controlled study with follow-up phone survey was performed on patients diagnosed with BPPV between 05/2017-05/2020, who had available 25hydroxyvitamin D serology. Patients were seen at a multidisciplinary, vestibular-focused, neurotology clinic at a tertiary referral center. Controls consisted of subjects from the National Health and Nutrition Examination Survey (NHANES), and a locoregional age, sex, and race-matched group of patients from our institution. RESULTS Our BPPV cohort consisted of 173 patients (mean age 66.2 ± 11.8 years), who were predominately female (75.7%) and Caucasian (76.3%). Almost all age subgroups (BPPV, NHANES, and locoregional groups) ≤60 years old had insufficient levels of vitamin D. However, the overall BPPV cohort had a significantly higher vitamin D level than the NHANES control (31.4 ± 16.5 v. 26.0 ± 11.2 ng/mL, d=0.474 [0.323, 0.626]). There was no significant difference when compared to the overall locoregional control (31.4 ± 20.5 ng/mL). Migraines were significantly correlated to increased BPPV recurrence rates on univariate (beta=0.927, p=0.037, 95% CI: [0.057, 1.798]) and multiple regression analyses (beta=0.231, 95% CI: [0.024, 2.029], p=0.045). Furthermore, patients with BPPV recurrences had significantly lower levels of vitamin D at initial presentation when compared to patients with no recurrences (29.0 ± 12.0 v. 37.6 ± 18.3 ng/mL, d=0.571[0.139,1.001]). CONCLUSION Many BPPV patients in our cohort had insufficient vitamin D levels, and patients with BPPV recurrences had insufficient and significantly lower vitamin D levels than those without. As a readily available and affordable supplement, vitamin D may be used as an adjunct treatment but prospective studies should be done to confirm if it can prevent or reduce recurrence.
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Affiliation(s)
- Leah H Cobb
- Department of Otolaryngology; Medical University of South Carolina, Charleston, SC, USA
| | - Victoria O Bailey
- Department of Otolaryngology; Medical University of South Carolina, Charleston, SC, USA
| | - Yuan F Liu
- Department of Otolaryngology, Head and Neck Surgery, Loma Linda University Health, Loma Linda, CA, USA
| | - Michael T Teixido
- Department of Otolaryngology, University of Pennsylvania, Philadelphia, PA, USA
| | - Habib G Rizk
- Department of Otolaryngology; Medical University of South Carolina, Charleston, SC, USA.
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27
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Das S, Annam CS, Bakshi SS, Seepana R. Persistent positional perceptual dizziness in clinical practice: a scoping review. Neurol Sci 2023; 44:129-135. [PMID: 35994134 DOI: 10.1007/s10072-022-06353-9] [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: 01/03/2022] [Accepted: 08/15/2022] [Indexed: 01/10/2023]
Abstract
INTRODUCTION Dizziness is an important symptom presenting in routine practice and the life time prevalence ranges from 17 to 30%. Persistent positional perceptual dizziness (PPPD) is a common cause of chronic dizziness and has often been labeled as psychogenic dizziness in the past. DISCUSSION PPPD is diagnosed based on clinical criteria laid down by the Barany society. The vestibular function tests and imaging of the brain and the inner ear are often normal. Most of the patients have an underlying anxiety trait and most cases of PPPD arise following an attack of acute vertigo like Meniere's disease and vestibular neuritis. It is important to differentiate the condition from bilateral vestibulopathy. There is no role of vestibular sedative in the treatment of such condition. Vestibular rehabilitation therapy (VRT), cognitive behavioral therapy (CBT), and selective serotonin reuptake inhibitors (SSRI) like sertraline have shown benefits. However, long-term outcome is not known. CONCLUSION PPPD is a relatively new entity in the ever-expanding field of neurotology that requires a multimodality approach for effective management. The otologists and general physicians must identify the condition so that favorable outcome can be achieved. The long-term effects of treatment with CBT and VRT are not known. It is important to formulate standard guidelines for treatment. Further research is necessary to identify the role of endogenous biomarkers in the outcome of treatment.
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Affiliation(s)
- Soumyajit Das
- Department of ENT, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, 522503, India.
| | - Chandra Sekhar Annam
- Department of ENT, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, 522023, India
| | - Satvinder Singh Bakshi
- Department of ENT, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, 522023, India
| | - Ramesh Seepana
- Department of ENT, All India Institute of Medical Sciences, Mangalagiri, Andhra Pradesh, 522503, India
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28
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Dieterich M, Hergenroeder T, Boegle R, Gerb J, Kierig E, Stöcklein S, Kirsch V. Endolymphatic space is age-dependent. J Neurol 2023; 270:71-81. [PMID: 36197569 PMCID: PMC9813103 DOI: 10.1007/s00415-022-11400-8] [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: 04/25/2022] [Revised: 09/20/2022] [Accepted: 09/23/2022] [Indexed: 01/09/2023]
Abstract
Knowledge of the physiological endolymphatic space (ELS) is necessary to estimate endolymphatic hydrops (ELH) in patients with vestibulocochlear syndromes. Therefore, the current study investigated age-dependent changes in the ELS of participants with normal vestibulocochlear testing. Sixty-four ears of 32 participants with normal vestibulocochlear testing aged between 21 and 75 years (45.8 ± 17.2 years, 20 females, 30 right-handed, two left-handed) were examined by intravenous delayed gadolinium-enhanced magnetic resonance imaging of the inner ear (iMRI). Clinical diagnostics included neuro-otological assessment, video-oculography during caloric stimulation, and head-impulse test. iMRI data analysis provided semi-quantitative visual grading and automatic algorithmic quantitative segmentation of ELS volume (3D, mm3) using a deep learning-based segmentation of the inner ear's total fluid space (TFS) and volumetric local thresholding, as described earlier. As a result, following a 4-point ordinal scale, a mild ELH (grade 1) was found in 21/64 (32.8%) ears uni- or bilaterally in either cochlear, vestibulum, or both. Age and ELS were found to be positively correlated for the inner ear (r(64) = 0.33, p < 0.01), and vestibulum (r(64) = 0.25, p < 0.05). For the cochlea, the values correlated positively without reaching significance (r(64) = 0.21). In conclusion, age-dependent increases of the ELS should be considered when evaluating potential ELH in single subjects and statistical group comparisons.
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Affiliation(s)
- Marianne Dieterich
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Vertigo and Balance Disorders-IFB, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,Graduate School of Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Tatjana Hergenroeder
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Rainer Boegle
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Vertigo and Balance Disorders-IFB, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,Graduate School of Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität, Munich, Germany
| | - Johannes Gerb
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Vertigo and Balance Disorders-IFB, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Emilie Kierig
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany.,German Center for Vertigo and Balance Disorders-IFB, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Sophia Stöcklein
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany
| | - Valerie Kirsch
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany. .,German Center for Vertigo and Balance Disorders-IFB, University Hospital, Ludwig-Maximilians-Universität, Munich, Germany. .,Graduate School of Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität, Munich, Germany.
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Jabri S, Carender W, Wiens J, Sienko KH. Automatic ML-based vestibular gait classification: examining the effects of IMU placement and gait task selection. J Neuroeng Rehabil 2022; 19:132. [PMID: 36456966 PMCID: PMC9713134 DOI: 10.1186/s12984-022-01099-z] [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: 05/03/2022] [Accepted: 10/25/2022] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Vestibular deficits can impair an individual's ability to maintain postural and/or gaze stability. Characterizing gait abnormalities among individuals affected by vestibular deficits could help identify patients at high risk of falling and inform rehabilitation programs. Commonly used gait assessment tools rely on simple measures such as timing and visual observations of path deviations by clinicians. These simple measures may not capture subtle changes in gait kinematics. Therefore, we investigated the use of wearable inertial measurement units (IMUs) and machine learning (ML) approaches to automatically discriminate between gait patterns of individuals with vestibular deficits and age-matched controls. The goal of this study was to examine the effects of IMU placement and gait task selection on the performance of automatic vestibular gait classifiers. METHODS Thirty study participants (15 with vestibular deficits and 15 age-matched controls) participated in a single-session gait study during which they performed seven gait tasks while donning a full-body set of IMUs. Classification performance was reported in terms of area under the receiver operating characteristic curve (AUROC) scores for Random Forest models trained on data from each IMU placement for each gait task. RESULTS Several models were able to classify vestibular gait better than random (AUROC > 0.5), but their performance varied according to IMU placement and gait task selection. Results indicated that a single IMU placed on the left arm when walking with eyes closed resulted in the highest AUROC score for a single IMU (AUROC = 0.88 [0.84, 0.89]). Feature permutation results indicated that participants with vestibular deficits reduced their arm swing compared to age-matched controls while they walked with eyes closed. CONCLUSIONS These findings highlighted differences in upper extremity kinematics during walking with eyes closed that were characteristic of vestibular deficits and showed evidence of the discriminative ability of IMU-based automated screening for vestibular deficits. Further research should explore the mechanisms driving arm swing differences in the vestibular population.
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Affiliation(s)
- Safa Jabri
- grid.214458.e0000000086837370Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109 USA
| | - Wendy Carender
- grid.412590.b0000 0000 9081 2336Department of Otolaryngology, Michigan Medicine, Ann Arbor, MI 48109 USA
| | - Jenna Wiens
- grid.214458.e0000000086837370Department of Electrical Engineering and Computer Science, University of Michigan, Ann Arbor, MI 48109 USA
| | - Kathleen H. Sienko
- grid.214458.e0000000086837370Department of Mechanical Engineering, University of Michigan, Ann Arbor, MI 48109 USA
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30
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Nelson MD, Bennett DM, Lehman ME, Okonji AI. Dizziness, Falls, and Hearing Loss in Adults Living With Sickle Cell Disease. Am J Audiol 2022; 31:1178-1190. [DOI: 10.1044/2022_aja-22-00059] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Objective:
The aim of this study was to assess the prevalence of reported dizziness/imbalance, frequency of falls, and hearing loss in adults with sickle cell disease (SCD) and determine the relationship of these self-reported problems both during and in the absence of an SCD crisis. Also, the impact of educational level and health insurance on seeking treatment services, as well as the relationship of falls to stroke, legal blindness, and other orthopedic problems, was assessed. Interrupted blood flow to shared vestibular and auditory arteries supports the notion of increased likelihood of balance deficits and increased falls in this population.
Design:
A cross-sectional survey study design was used. Adults living with SCD responded to a questionnaire that was distributed online and through traditional mail.
Study Sample:
Adults living with SCD (
N
= 135) participated in the study.
Results:
Responses revealed 70% of participants with SCD experienced dizziness/imbalance and 23% reported hearing loss. Furthermore, 33% of participants reported falling one or more times in the last year. The prevalence of dizziness/imbalance, falling, and hearing loss in the respondents with SCD was much higher than that of the general population of the United States. Additionally, for dizziness and falling, the prevalence was higher not only than the national average but also for persons over 65 years of age. A significant association was demonstrated between dizziness/imbalance and hearing loss as well as dizziness/imbalance and falls for adults living with SCD. In fact, participants with self-reported hearing loss were 5.2 times more likely to also report dizziness/imbalance. They were 4.9 times more likely to fall if they also reported dizziness/imbalance. Numbness of the feet was revealed to significantly impact the likelihood of falling in this disease population and should be further studied. Regarding SCD crisis status, dizziness/imbalance and falls were more likely to occur outside of SCD crisis than during a crisis. Furthermore, pain levels were significantly associated with dizziness/imbalance only when respondents were in crisis and not in the absence of a crisis. In crisis, higher pain levels were reported from respondents who also reported dizziness/imbalance than from those who did not report dizziness. No significant relationship was revealed between hearing loss and falls.
Discussion:
These results provide justification for patient and health care provider education regarding appropriate referrals for vestibular/balance assessments and provision of fall prevention strategies. Future studies on balance and SCD are encouraged.
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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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Ulep AJ, Deshpande AK, Beukes EW, Placette A, Manchaiah V. Social Media Use in Hearing Loss, Tinnitus, and Vestibular Disorders: A Systematic Review. Am J Audiol 2022; 31:1019-1042. [DOI: 10.1044/2022_aja-21-00211] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background:
People are increasingly using social media outlets for gathering health-related information. There has also been considerable interest from researchers and clinicians in understanding how social media is used by the general public, patients, and health professionals to gather health-related information. Interest in the use of social media for audiovestibular disorders has also received attention, although published evidence synthesis of this use is lacking. The objective of this review article was to synthesize existing research studies related to social media use concerning hearing loss, tinnitus, and vestibular disorders.
Method:
Comprehensive searches were performed in multiple databases between October and November 2020 and again in June 2021 and March 2022, with additional reports identified from article citations and unpublished literature. This review article was presented using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines.
Results:
A total of 1,512 articles were identified. Of these, 16 publications met the inclusion criteria. Overall, social media offered people the platform to learn about hearing loss, tinnitus, and vestibular disorders via advice and support seeking, personal experience sharing, general information sharing, and relationship building. Research studies were more common on information and user activities seen on Facebook Pages, Twitter, and YouTube videos. Misinformation was identified across all social media platforms for each of these conditions.
Conclusions:
Online discussions about audiovestibular disorders are evident, although inconsistencies in study procedures make it difficult to compare these discussion groups. Misinformation is a concern needing to be addressed during clinical consultations as well as via other public health means. Uniform guidelines are needed for research regarding the use of social media so that outcomes are comparable. Moreover, clinical studies examining how exposure to and engagement with social media information may impact outcomes (e.g., help seeking, rehabilitation uptake, rehabilitation use, and satisfaction) require exploration.
Supplemental Material:
https://doi.org/10.23641/asha.20667672
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Affiliation(s)
- Alyssa Jade Ulep
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX
- Virtual Hearing Lab, University of Colorado School of Medicine and University of Pretoria, Aurora, CO
| | - Aniruddha K. Deshpande
- The Hear-Ring Lab, Department of Speech-Language-Hearing Sciences, Hofstra University,Hempstead, NY
| | - Eldré W. Beukes
- Virtual Hearing Lab, University of Colorado School of Medicine and University of Pretoria, Aurora, CO
- Vision and Hearing Research Centre, Anglia Ruskin University, Cambridge, United Kingdom
| | - Aubry Placette
- Department of Speech and Hearing Sciences, Lamar University, Beaumont, TX
| | - Vinaya Manchaiah
- Virtual Hearing Lab, University of Colorado School of Medicine and University of Pretoria, Aurora, CO
- Department of Otolaryngology—Head & Neck Surgery, University of Colorado School of Medicine, Aurora
- UCHealth Hearing and Balance Clinic, University of Colorado Hospital, Aurora
- Department of Speech-Language Pathology and Audiology, University of Pretoria, Gauteng, South Africa
- Department of Speech and Hearing, School of Allied Health Sciences, Manipal Academy of Higher Education, Karnataka, India
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Tan MR, Serrador J, Perin J, Gimmon Y, Millar J, Brewer K, Gold D, Schubert MC. Binocular Alignment Changes Between Sitting and Supine Positions in Patients with Dizziness. J Assoc Res Otolaryngol 2022; 23:427-433. [PMID: 35318534 PMCID: PMC9085986 DOI: 10.1007/s10162-022-00845-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2021] [Accepted: 03/07/2022] [Indexed: 12/30/2022] Open
Abstract
Vertical and torsional ocular misalignment can occur from mild traumatic brain injury or inner ear pathology, which may vary depending on head position. Here, we evaluate differences in a behavioral measure of binocular alignment in both upright and supine head position. Ocular perception of vertical and torsional alignment was measured using the torsional and vertical alignment nulling (TAN, VAN) task in N = 52 veterans with dizziness (N = 38 with traumatic brain injury), N = 41 civilians with vestibular schwannoma resection (UVD), and N = 33 healthy controls for both positions. The interquartile range within each group, regardless of head position, was greater for torsional compared to vertical misalignment. We use generalized estimating equations to compare average TAN (torsional) scores and VAN (vertical) scores between groups and test position. Compared to the healthy controls, TAN was significantly increased by + 0.4186° in veterans (P = 0.030) and by + 0.5747° in UVD (P = 0.010), but there was no difference with head position. For VAN, no difference was found between the three groups, but the misalignment did worsen by 0.0888° (P = 0.0070) as the head position moved from upright to supine. Head position had negligible effects on this behavioral measure of vertical and torsional binocular misalignment, and torsional misalignments were worse than controls in both veterans with dizziness and patients with vestibular nerve resection although neither reported torsional diplopia. Our data suggests that the tolerance for roll misalignment may be abnormally large in patients with dizziness. Alternatively, perceptual roll misalignments may be a manifest cause for dizziness, and therefore a useful proxy for distinguishing differences in putative otolith function in veterans with dizziness.
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Affiliation(s)
- Matthew Ryan Tan
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline Street, 6th Floor, Baltimore, MD 21287-0910 USA
| | - Jorge Serrador
- Department of Biomedical Engineering, Rutgers New Jersey Medical School, Newark, NJ USA
- Department of Pharmacology, Physiology and Neuroscience, Rutgers Biomedical Health Sciences, Newark, NJ USA
| | - Jamie Perin
- Bloomberg School of Public Health, Department of International Health, Johns Hopkins University, Baltimore, MD USA
| | - Yoav Gimmon
- Department of Physical Therapy, Faculty of Social Welfare & Health Studies, University of Haifa, Haifa, Israel
- Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel-Hashomer, Israel
| | - Jennifer Millar
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD USA
| | - Kelly Brewer
- Department of Veteran Affairs, War Related Illness and Injury Study Center, Veterans Biomedical Institute, East Orange, NJ USA
| | - Dan Gold
- Department of Neurology, Johns Hopkins University, Baltimore, MD USA
- Department of Ophthalmology, Johns Hopkins University, Baltimore, MD USA
- Department of Neurosurgery, Johns Hopkins University, Baltimore, MD USA
- Department of Emergency Medicine, Johns Hopkins University, Baltimore, MD USA
- Department of Medicine, Johns Hopkins University, Baltimore, MD USA
| | - Michael C. Schubert
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 N. Caroline Street, 6th Floor, Baltimore, MD 21287-0910 USA
- Department of Physical Medicine and Rehabilitation, Johns Hopkins University, Baltimore, MD USA
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Altın B, Aksoy S. Is Inadequate Water Intake a Risk Factor for Vestibular Disorders? J Int Adv Otol 2022; 18:264-268. [PMID: 35608497 PMCID: PMC10682806 DOI: 10.5152/iao.2022.21303] [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: 03/25/2021] [Accepted: 06/18/2021] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Water is a vital nutrient for the human body system and failing to consume enough water could cause health problems. The purpose of this study is to investigate the relationship between water intake and vestibular system disorders. METHODS Data from 93 patients (aged between 20 and 76 years) with vestibular disorders were analyzed in the study. The mean age of the patients was 46.96 ±13.94 years (female: 45.68 ±13.45, male: 49.96 ±14.85), and 69.9% (n=65) were female. Participants were sub-categorized into diagnostic groups as follows: benign paroxysmal positional vertigo, Meniere's disease, vestibular neuritis, vestibular migraine, and persistent postural perceptual dizziness. The water intake information was analyzed for total water, plain water, and caffeinated beverages separately and compared between groups. RESULTS There was a significant difference between vestibular neuritis and benign paroxysmal positional vertigo (P < .001) and also between vestibular neuritis and Meniere's disease (P = .021) in terms of the intake values of plain water and total water. No significant difference was found between groups in caffeinated beverages intake (P = .151), and it was found that there is no statistically significant difference in plain water and total water intake in terms of gender (P > .05). CONCLUSION The most significant result of this study is that inadequate water intake can be a risk factor for some forms of peripheral vestibular disorders. People should be informed about the importance of drinking water and be encouraged to increase their water intake.
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Affiliation(s)
- Büşra Altın
- Department of Audiology, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Songül Aksoy
- Department of Audiology, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
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Wellons RD, Duhe SE, MacDowell SG, Hodge A, Oxborough S, Levitzky EE. Estimating the minimal clinically important difference for balance and gait outcome measures in individuals with vestibular disorders. J Vestib Res 2022; 32:223-233. [PMID: 35147571 DOI: 10.3233/ves-201630] [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: 11/15/2022]
Abstract
BACKGROUND Vestibular Rehabilitation Therapists (VRT) utilize outcome measures to quantify gait and balance abilities in individuals with vestibular disorders (IVD). The minimal clinically important difference (MCID) in gait and balance outcome measures for IVD is unknown. OBJECTIVE The purpose of this study is to estimate the MCID of the Activities-specific Balance Confidence Scale (ABC), Functional Gait Assessment (FGA), and Gait Speed (GS) using distribution and anchor-based methods relative to the Dizziness Handicap Inventory (DHI) in IVD. METHODS Data were collected using a retrospective chart review from two outpatient Vestibular Rehabilitation (VR) clinics. Data included demographic characteristics, diagnosis, VR course, and pre and post outcome measures including DHI, ABC, FGA, and GS. The DHI was used to classify subjects as "responders" or "non-responders" in order to calculate MCID values. RESULTS The total number of subjects analyzed for each outcome measure was 222 for the ABC, 220 for FGA, and 237 for GS. Subjects made statistically significant improvements in ABC, DHI, FGA, and GS (p < 0.001) from pre to post VR. The MCID calculated for ABC, FGA, and GS using the anchor-based approach was 18.1%, 4 points, and 0.09 m/s respectively. The MCIDs calculated using distribution-based approach for the ABC ranged between 7.5-23.5%, FGA ranged between 1.31-4.15 points, and GS ranged between 0.07 m/s-0.22 m/s. CONCLUSIONS The anchor-based calculations of the MCID of 18.1%, 4 points, and 0.09 m/s for ABC, FGA, and GS respectively for IVD should be used over distribution-based calculations. This is due to strength of DHI as the anchor and statistical analysis. VRT and researches can use these values to indicate meaningful changes in gait and balance function in IVD.
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Affiliation(s)
| | - Sydney E Duhe
- Our Lady of the Lake Hearing and Balance Center, USA
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Vanstrum EB, Doherty JK, Sinha UK, Voelker CCJ, Bassett AM. An Exploration of Online Support Community Participation Among Patients With Vestibular Disorders. Laryngoscope 2021; 132:1835-1842. [PMID: 34889460 DOI: 10.1002/lary.29969] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/26/2021] [Revised: 11/03/2021] [Accepted: 11/26/2021] [Indexed: 11/06/2022]
Abstract
OBJECTIVES/HYPOTHESIS To formally document online support community (OSC) use among patients with vestibular symptoms and gain an appreciation for the perceived influence of participation on psychosocial outcomes and the impact on medical decision-making. STUDY DESIGN Self reported internet-based questionnaire. METHODS The Facebook search function was paired with a comprehensive list of vestibular diagnoses to systematically collect publicly available information on vestibular OSCs. Next, a survey was designed to gather clinicodemographic information, OSC characteristics, participation measures, perceived outcomes, and influence on medical decision-making. The anonymous instrument was posted to two OSCs that provide support for patients with general vestibular symptoms. RESULTS Seventy-three OSCs were identified with >250,000 cumulative members and >10,000 posts per month. The survey was completed by 549 participants, a cohort of primarily educated middle-aged (median = 50, interquartile range 40-60), non-Hispanic white (84%), and female (89%) participants. The participants' most cited initial motivation and achieved goal of participants was to hear from others with the same diagnosis (89% and 88%, respectively). Daily users and those who reported seeing ≥5 providers before receiving a diagnosis indicated that OSC utilization significantly influenced their requested medical treatments (72% daily vs. 61% nondaily, P = .012; 61% <5 providers vs. 71% ≥5 providers P = .019, respectively). Most participants agreed that OSC engagement provides emotional support (74%) and helps to develop coping strategies (68%). Membership of ≥1 year was associated with a higher rate of learned coping skills (61% membership <1-year vs. 71% ≥1-year P = .016). CONCLUSIONS The use of OSCs is widespread among vestibular diagnoses. A survey of two OSCs suggests these groups provide a significant source of peer support and can influence users' ability to interface with the medical system. LEVEL OF EVIDENCE N/A Laryngoscope, 2021.
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Affiliation(s)
- Erik B Vanstrum
- Keck School of Medicine, University of Southern California, Los Angeles, California, U.S.A
| | - Joni K Doherty
- Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Uttam K Sinha
- Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Courtney C J Voelker
- Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
| | - Alaina M Bassett
- Caruso Department of Otolaryngology - Head and Neck Surgery, University of Southern California, Los Angeles, California, U.S.A
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Laurent G, Vereeck L, Verbecque E, Herssens N, Casters L, Spildooren J. Effect of age on treatment outcomes in benign paroxysmal positional vertigo: A systematic review. J Am Geriatr Soc 2021; 70:281-293. [PMID: 34698378 DOI: 10.1111/jgs.17485] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Revised: 08/20/2021] [Accepted: 08/28/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND Benign paroxysmal positional vertigo (BPPV) can lead to an increased fall risk in older adults. Therefore, we examined the influence of age on the effectiveness of canalith-repositioning procedures (CRPs) for the treatment of BPPV. METHODS Pubmed, Web of Science, and the bibliographies of selected articles were searched for studies conducted before September 2020 that examined the effectiveness of treatments for BPPV in various age groups. Meta-analyses were performed to compare treatment effectiveness and recurrence rates for younger and older adults. Odds ratios were calculated in a random-effects model. Mean differences were calculated using a fixed-effects model. A significance level of p < 0.05 (95% confidence interval) was set. The risk of bias and the methodological quality of all included articles were examined. RESULTS Forty-five studies were retrieved after full-text screening, of which 29 studies were included for a qualitative review. The remaining 16 studies were eligible for inclusion in the meta-analysis (3267 participants with BPPV). The success rate of a single CRP was higher in the younger group (72.5% vs. 67%, p < 0.001). An average of 1.4 and 1.5 CRPs was needed for complete recovery in the younger and older groups, respectively (p = 0.02). However, global treatment success did not differ between these groups (97.5% vs. 94.6%, p = 0.41). The recurrence rate was higher in the older population (23.2% vs. 18.6%, p = 0.007). CONCLUSIONS Although more CRPs are needed, the rate of complete recovery in older adults is similar to that observed in younger adults.
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Affiliation(s)
- Gwen Laurent
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Luc Vereeck
- Department of Rehabilitation Sciences and Physiotherapy/MOVANT, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Evi Verbecque
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium.,Department of Rehabilitation Sciences and Physiotherapy/MOVANT, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium
| | - Nolan Herssens
- Department of Rehabilitation Sciences and Physiotherapy/MOVANT, Faculty of Medicine and Health Sciences, University of Antwerp, Wilrijk, Belgium.,Department of Rehabilitation Sciences, Gent university, Ghent, Belgium
| | - Laura Casters
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
| | - Joke Spildooren
- REVAL - Rehabilitation Research Center, Faculty of Rehabilitation Sciences, Hasselt University, Diepenbeek, Belgium
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Dillard LK, Wu CZ, Saunders JE, McMahon CM. A scoping review of global aminoglycoside antibiotic overuse: A potential opportunity for primary ototoxicity prevention. Res Social Adm Pharm 2021; 18:3220-3229. [PMID: 34711521 DOI: 10.1016/j.sapharm.2021.10.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Revised: 10/05/2021] [Accepted: 10/19/2021] [Indexed: 01/08/2023]
Abstract
BACKGROUND Aminoglycosides are widely used, broad-spectrum antibiotics with significant potential for ototoxicity. Global efforts to prevent ototoxicity must account for aminoglycoside overuse and non-prescription use. OBJECTIVES The goals of this study were to a) estimate the prevalence of aminoglycoside overuse by synthesizing evidence on self-medication, over the counter (OTC) availability, and household antibiotic storage for later use, and to report the specific aminoglycosides used and the predictors of overuse, and b) leverage this information to comment on potential risk of ototoxicity. METHODS Two systematic search strings were conducted to extract peer-reviewed articles published from 2005 to 2020. The first focused on overuse of aminoglycoside antibiotics. The second focused on potentially ototoxic effects of aminoglycosides related to drug overuse. RESULTS A total of 26 articles were included (first search string: n = 21; second search string: n = 5). The prevalence of aminoglycoside self-medication was high and household storage and OTC availability of aminoglycosides was common. Gentamicin was the most commonly overused aminoglycoside. No studies provided information on antibiotic dosing or resultant toxicities, including ototoxicity. CONCLUSIONS The limited available evidence indicates that antibiotic overuse (self-medication, home storage, and non-prescription availability) is relatively common, especially in low resource settings, and that aminoglycoside antibiotics comprise a variable, but concerning, proportion of non-prescribed antibiotics. Additional evidence is needed to evaluate the relationship between these dispensing patterns and ototoxicity.
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Affiliation(s)
- Lauren K Dillard
- Department of Population Health Sciences, University of Wisconsin-Madison, Madison, WI, USA.
| | - Cecilia Z Wu
- Mass General Brigham Home Care, Department of Staff Education, Waltham, MA, USA
| | - James E Saunders
- Section of Otolaryngology, Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA; Geisel School of Medicine at Dartmouth, Hanover, NH, USA
| | - Catherine M McMahon
- Department of Linguistics, Macquarie University, Sydney, New South Wales, Australia
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Holford KC, Jagodinsky AE, Saripalle R, McAllister P. Leveraging virtual reality for vestibular testing: Clinical outcomes from tests of dynamic visual acuity. J Vestib Res 2021; 32:15-20. [PMID: 34633336 DOI: 10.3233/ves-200782] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Virtual reality (VR) use as a platform for vestibular rehabilitation is widespread. However, the utility of VR based vestibular assessments remains unknown. OBJECTIVE To compare dynamic visual acuity (DVA) scores, perceived balance, and perceived dizziness when using traditional versus VR environments for DVA testing among healthy individuals. METHODS DVA testing occurred for both a traditional clinical protocol and in a VR variant. Horizontal, vertical, and no head motion conditions were conducted for both clinical and VR test protocols. DVA scores, balance ratings, and dizziness ratings were obtained per condition. Two-way ANOVAs with repeated measures were used to assess differences in DVA scores, balance, and dizziness ratings. RESULTS No differences in DVA results, balance or dizziness ratings were observed when comparing traditional clinical protocol versus the VR variant. Differences across head motion conditions were observed, with no motion trials exhibiting significantly higher DVA scores and perceived balance, and lower perceived dizziness compared to vertical and horizontal head motion. Vertical head motion exhibited this same trend compared to horizontal. CONCLUSION DVA testing conducted in VR demonstrated clinical utility for each measure. Effects of head motion were similar across test variants, indicating DVA testing in VR produces similar effects on vestibular function than traditional clinical testing. Additional research should be conducted to assess the feasibility of VR assessment in individuals with vestibular disorder.
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Affiliation(s)
- Kenneth C Holford
- School of Kinesiology and Recreation, Illinois State University, Normal, IL, USA
| | - Adam E Jagodinsky
- School of Kinesiology and Recreation, Illinois State University, Normal, IL, USA
| | - Rishi Saripalle
- School of Information Technology, Illinois State University, Normal, IL, USA
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Kullmann A, Ashmore RC, Braverman A, Mazur C, Snapp H, Williams E, Szczupak M, Murphy S, Marshall K, Crawford J, Balaban CD, Hoffer M, Kiderman A. Normative data for ages 18-45 for ocular motor and vestibular testing using eye tracking. Laryngoscope Investig Otolaryngol 2021; 6:1116-1127. [PMID: 34667856 PMCID: PMC8513422 DOI: 10.1002/lio2.632] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/26/2021] [Accepted: 07/29/2021] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Eye tracking technology has been employed in assessing ocular motor and vestibular function following vestibular and neurologic conditions, including traumatic brain injury (TBI). Assessments include tests that provide visual and motion (rotation) stimuli while recording horizontal, vertical, and torsional eye movements. While some of these tests have shown diagnostic promise in previous studies, their use in clinical practice is limited by the lack of normative data. The goal of this study was to construct normative reference ranges to be used when comparing patients' results. METHODS Optokinetic response, subjective visual horizontal and vertical, and rotation tests were administered to male and female volunteers, ages 18-45, who were free from neurological, vestibular disorders, or other head injuries. Tests were administered using either a rotatory chair or a portable virtual reality-like goggle equipped with video-oculography. RESULTS Reference values for eye movements in response to different patterns of stimuli were analyzed from 290 to 449 participants. Analysis of gender (self-reported) or age when grouped as pediatric (late adolescent; 18-21 years of age) and adult (21-45 years of age) revealed no effects on the test metrics. Data were pooled and presented for each test metric as the 95% reference interval (RI) with 90% confidence intervals (CI) on upper and lower limits of the RI. CONCLUSIONS This normative database can serve as a tool to aid in diagnosis, treatment, and/or rehabilitation protocols for vestibular and neurological conditions, including mild TBI (mTBI). This database has been cleared by the FDA for use in clinical practice (K192186). LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Aura Kullmann
- Neurolign USA LLC, A Subsidiary of Neurolign Technologies Inc. (formerly Neuro Kinetics, Inc.)PittsburghPennsylvaniaUSA
| | - Robin C. Ashmore
- Neurolign USA LLC, A Subsidiary of Neurolign Technologies Inc. (formerly Neuro Kinetics, Inc.)PittsburghPennsylvaniaUSA
| | | | - Christian Mazur
- Neurolign USA LLC, A Subsidiary of Neurolign Technologies Inc. (formerly Neuro Kinetics, Inc.)PittsburghPennsylvaniaUSA
| | - Hillary Snapp
- Department of OtolaryngologyMiller School of Medicine, University of MiamiMiamiFloridaUSA
| | - Erin Williams
- Department of OtolaryngologyMiller School of Medicine, University of MiamiMiamiFloridaUSA
| | - Mikhaylo Szczupak
- Department of OtolaryngologyMiller School of Medicine, University of MiamiMiamiFloridaUSA
| | - Sara Murphy
- Naval Medical CenterSan DiegoCaliforniaUSA
- Department of DefenseHearing Center of ExcellenceSan AntonioTexasUSA
| | - Kathryn Marshall
- Department of DefenseHearing Center of ExcellenceSan AntonioTexasUSA
- Madigan Army Medical CenterTacomaWashingtonUSA
| | | | - Carey D. Balaban
- Department of OtolaryngologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Michael Hoffer
- Department of OtolaryngologyMiller School of Medicine, University of MiamiMiamiFloridaUSA
- Department of Neurological SurgeryMiller School of Medicine, University of MiamiMiamiFloridaUSA
| | - Alexander Kiderman
- Neurolign USA LLC, A Subsidiary of Neurolign Technologies Inc. (formerly Neuro Kinetics, Inc.)PittsburghPennsylvaniaUSA
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Stefani SP, Pastras CJ, Serrador JM, Breen PP, Camp AJ. Stochastic and sinusoidal electrical stimuli increase the irregularity and gain of Type A and B medial vestibular nucleus neurons, in vitro. J Neurosci Res 2021; 99:3066-3083. [PMID: 34510506 DOI: 10.1002/jnr.24957] [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: 05/20/2021] [Revised: 07/30/2021] [Accepted: 08/23/2021] [Indexed: 11/05/2022]
Abstract
Galvanic vestibular stimulation (GVS) has been shown to improve vestibular function potentially via stochastic resonance, however, it remains unknown how central vestibular nuclei process these signals. In vivo work applying electrical stimuli to the vestibular apparatus of animals has shown changes in neuronal discharge at the level of the primary vestibular afferents and hair cells. This study aimed to determine the cellular impacts of stochastic, sinusoidal, and stochastic + sinusoidal stimuli on individual medial vestibular nucleus (MVN) neurons of male and female C57BL/6 mice. All stimuli increased the irregularity of MVN neuronal discharge, while differentially affecting neuronal gain. This suggests that the heterogeneous MVN neuronal population (marked by differential expression of ion channels), may influence the impact of electrical stimuli on neuronal discharge. Neuronal subtypes showed increased variability of neuronal firing, where Type A and B neurons experienced the largest gain changes in response to stochastic and sinusoidal stimuli. Type C neurons were the least affected regarding neuronal firing variability and gain changes. The membrane potential (MP) of neurons was altered by sinusoidal and stochastic + sinusoidal stimuli, with Type B and C neuronal MP significantly affected. These results indicate that GVS-like electrical stimuli impact MVN neuronal discharge differentially, likely as a result of heterogeneous ion channel expression.
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Affiliation(s)
- Sebastian P Stefani
- Department of Physiology, The University of Sydney, Camperdown, New South Wales, Australia
| | - Christopher J Pastras
- Department of Physiology, The University of Sydney, Camperdown, New South Wales, Australia
| | - Jorge M Serrador
- Department of Pharmacology, Physiology & Neuroscience, Rutgers Biomedical and Health Sciences, Newark, New Jersey, USA
| | - Paul P Breen
- The MARCS Institute, Western Sydney University, Penrith, New South Wales, Australia
| | - Aaron J Camp
- Department of Physiology, The University of Sydney, Camperdown, New South Wales, Australia
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Xie D, Welgampola MS, Miller LA, Young AS, D'Souza M, Breen N, Rosengren SM. Subjective Cognitive Dysfunction in Patients with Dizziness and Vertigo. Audiol Neurootol 2021; 27:122-132. [PMID: 34518461 DOI: 10.1159/000518188] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Accepted: 06/28/2021] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION Patients with vestibular disorders sometimes report cognitive difficulties, but there is no consensus about the type or degree of cognitive complaint. We therefore investigated subjective cognitive dysfunction in a well-defined sample of neuro-otology patients and used demographic factors and scores from a measure of depression, anxiety, and stress to control for potential confounding factors. METHODS We asked 126 neuro-otology clinic outpatients whether they experienced difficulties with thinking, memory, or concentration as a result of dizziness or vertigo. They and 42 nonvertiginous control subjects also completed the Neuropsychological Vertigo Inventory (NVI, which measures cognitive, emotional, vision, and motor complaints), the Everyday Memory Questionnaire (EMQ), and Depression, Anxiety, and Stress Scales (DASS). RESULTS In the initial interview questions, 60% of patients reported experiencing cognitive difficulties. Cognitive questionnaire scores were positively correlated with the overall DASS score and to a lesser extent with age and gender. Therefore, we compared patients and controls on the NVI and EMQ, using these mood and demographic variables as covariates. Linear regression analyses revealed that patients scored significantly worse on the total NVI, NVI cognitive composite, and 3 individual NVI cognition subscales (Attention, Space Perception, and Time Perception), but not the EMQ. Patients also scored significantly worse on the NVI Emotion and Motor subscales. CONCLUSIONS Patients with dizziness and vertigo reported high levels of cognitive dysfunction, affecting attention, perceptions of space and time. Although perceptions of cognitive dysfunction were correlated with emotional distress, they were significantly elevated in patients over and above the impact of depression, anxiety, or stress.
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Affiliation(s)
- Danica Xie
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Miriam S Welgampola
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Laurie A Miller
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Allison S Young
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mario D'Souza
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Nora Breen
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Sally M Rosengren
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia.,Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
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Maldonado-Díaz M, Vargas P, Vasquez R, Gonzalez-Seguel F, Rivero B, Hidalgo-Cabalín V, Gutierrez-Panchana T. Teleneurorehabilitation program (virtual reality) for patients with balance disorders: descriptive study. BMC Sports Sci Med Rehabil 2021; 13:83. [PMID: 34340687 PMCID: PMC8330090 DOI: 10.1186/s13102-021-00314-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 07/09/2021] [Indexed: 11/24/2022]
Abstract
Background Balance disorders are common in patients with neurological or vestibular diseases. Telerehabilitation program is a treatment to be as safe as conventional treatment. One of the most used methods to perform telerehabilitation is the incorporation of Virtual Reality. In general, rehabilitation programs train predictive postural control, so the patient does not always acquire the necessary autonomy to react to situations of instability. On the other hand, the objective and systematic supervision and measurement of these programs is limited, making it necessary to create clinical protocols with precise and measurable rehabilitation objectives. This study present the training selection methodology and clinical protocol for patients with balance disorders inserted in a Telerehabilitation Program based on Virtual Reality. Methods Descriptive study where physiotherapists were trained to use RehaMetrics®. To evaluate their level of agreement in the selection of the exercise clusters developed, the Interobserver Reliability was measured through the kappa statistic. Subsequently, the exercises were applied to a group of patients recruited with sedentary trunk control (Berg Balance Scale = 3 points in item 3), mild or normal cognitive level (Montreal Cognitive Assessment> 21 points), and prescribed for tele-rehabilitation by a doctor. Results The agreement among the expert physiotherapists irrespective of the cluster exceeds 80%, which indicates a very good strength of agreement, while the novices reached a level of agreement of 45%, which suggests a moderate strength of agreement. All clinical outcomes showed statistically significant differences between the median times, as did the Maximum Width Left Side (MWLS) (cm). The average number of minutes of training was 485.81 (SD 246.49 min), and the number of sessions performed during the 4 weeks of intervention was 17 (SD 7.15 sessions). Conclusions This analysis what had excellent interobserver reliability with trained physiotherapists. Regarding the second phase of the study, the results show a statistically significant difference between the initial and final evaluation of the clinical tests, which could result in better performance in aspects such as: balance, gait functionality, meter walked and cognition. Telerehabilitation Program based on Virtual Reality is an excellent alternative to provide continuity of treatment to patients with balance disorders. Supplementary Information The online version contains supplementary material available at 10.1186/s13102-021-00314-z.
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Affiliation(s)
- Marcos Maldonado-Díaz
- Clinica Alemana Universidad del Desarrollo, Vitacura 5951. Región Metropolitana, Santiago, Chile.
| | - Patricia Vargas
- Clinica Alemana Universidad del Desarrollo, Vitacura 5951. Región Metropolitana, Santiago, Chile
| | - Ricardo Vasquez
- Clinica Alemana Universidad del Desarrollo, Vitacura 5951. Región Metropolitana, Santiago, Chile
| | - Felipe Gonzalez-Seguel
- Clinica Alemana Universidad del Desarrollo, Vitacura 5951. Región Metropolitana, Santiago, Chile
| | - Betel Rivero
- Clinica Alemana Universidad del Desarrollo, Vitacura 5951. Región Metropolitana, Santiago, Chile
| | - Viviane Hidalgo-Cabalín
- Clinica Alemana Universidad del Desarrollo, Vitacura 5951. Región Metropolitana, Santiago, Chile
| | - Tania Gutierrez-Panchana
- Clinica Alemana Universidad del Desarrollo, Vitacura 5951. Región Metropolitana, Santiago, Chile
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Nimmo ZM, Hwa TP, Naples JG, Shah R, Brant JA, Eliades SJ, Bigelow DC, Ruckenstein MJ. Age-related Patterns of Vestibular Dysfunction in Dizziness and Imbalance: A Review of Vestibular Testing Results Among 1,116 Patients. Otol Neurotol 2021; 42:897-905. [PMID: 34111051 DOI: 10.1097/mao.0000000000003094] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To characterize differences in vestibular testing results among patients presenting with balance-related complaints; to stratify patterns of testing abnormalities by age. STUDY DESIGN Retrospective chart review. SETTING Academic Balance Center at a Tertiary Referral Center. PATIENT POPULATION All patients who underwent vestibular testing in a 1-year period from 2017 to 2018. MAIN OUTCOME MEASURE Balance function test results. RESULTS We reviewed 1,116 patients with age ranging from 11 to 94 years, including 521 patients ≥60 years. Most patients had at least 1 abnormal result, with only 21% of patients ≥60 years and 43% of patients <60 years yielding no test abnormalities (p < 0.001). Among 754 individuals with abnormal testing results, caloric testing did not show any significant difference between age groups. Patients ≥60 years of age were more likely to demonstrate abnormalities on saccadic and horizontal tracking eye movements (p < 0.01; sacc 20.8% vs 6.3%; HT 9.2% vs 4.7%), as well as positional and Dix-Hallpike testing with videonystagmography (p < 0.001; pos 52.3% vs 37.5%, DH 14.4% vs 6.8%). On computerized dynamic posturography, there were significantly more abnormal composite scores in the older group for both sensory organization and motor control testing (p < 0.001; SOT 31.8% vs 8.8%, MCT 7.6% vs 1.8%). CONCLUSION Among patients presenting balance-related complaints, a majority demonstrate at least one abnormality on vestibular testing. While caloric abnormalities occur across the life span, patients ≥60 years of age are more likely to have abnormal results in random saccades, positional, Dix-Hallpike testing, and posturography, with greater effect sizes in tests of central function. While the causes of imbalance and vertigo remain multifactorial, vestibular dysfunction can be considered a major contributor to balance dysfunction in the elderly population and should be thoroughly evaluated.
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Affiliation(s)
- Zachary M Nimmo
- Department of Otolaryngology-Head and Neck Surgery, Hospital of the University of Pennsylvania
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Kim KJ, Gimmon Y, Millar J, Brewer K, Serrador J, Schubert MC. The Instrumented Timed "Up & Go" Test Distinguishes Turning Characteristics in Vestibular Hypofunction. Phys Ther 2021; 101:6189156. [PMID: 33774661 DOI: 10.1093/ptj/pzab103] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2020] [Revised: 01/22/2021] [Accepted: 02/28/2021] [Indexed: 11/13/2022]
Abstract
OBJECTIVE Deficits in vestibular function increase the risk for falls while turning. However, the clinical assessment of turning in patients with vestibular dysfunction is lacking, and evidence is limited that identifies the effectiveness of vestibular physical therapy in improving turning performance. The purpose of this study was to quantify walking and turning performance during the instrumented Timed "Up & Go" (TUG) test using body-worn inertial measurement units (IMUs). Novel instrumented TUG parameters were investigated for ability to distinguish patients with unilateral vestibular deafferentation (UVD) from control groups and discriminate the differences in turning parameters of patients with UVD following vestibular physical therapy. METHODS Thirty-eight individuals were recruited following UVD surgery: 26 age-matched veteran controls with reports of dizziness not from a peripheral vestibular origin, and 12 age-matched healthy controls. Participants were donned with IMUs and given verbal instructions to complete the TUG test as fast as safely possible. The IMU-instrumented and automated assessment of the TUG test provided component-based TUG parameters, including the novel walk:turn ratio. Among the participants with UVD, 19 completed an additional instrumented TUG testing after vestibular physical therapy. RESULTS The walk:turn time ratio showed that turning performance in patients with UVD before rehabilitation is significantly more impaired than both the individuals with nonperipheral conditions and healthy controls. Vestibular rehabilitation significantly improved turning performance and "normalized" their walk:turn time ratio compared with healthy controls. The duration of the straight walking component in individuals with UVD before vestibular physical therapy, however, was not significantly different compared with that component in people after vestibular physical therapy and in healthy controls. CONCLUSION The IMU-instrumented TUG test can be used to distinguish individuals with vestibular deafferentation and to objectively quantify the change in their turning performance after vestibular physical therapy. IMPACT The IMU-based instrumented TUG parameters have the potential to quantify the efficacy of vestibular physical therapy and be adopted in the clinic.
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Affiliation(s)
- Kyoung Jae Kim
- Human Physiology, Performance, Protection and Operation (H-3PO) Laboratory, NASA Johnson Space Center/KBR, Houston, Texas, USA.,Department of Physical Therapy, University of Miami Miller School of Medicine, Coral Gables, Florida, USA
| | - Yoav Gimmon
- Department of Physical Therapy, Faculty of Social Welfare and Health Studies, University of Haifa, Haifa, Israel.,Department of Otolaryngology-Head and Neck Surgery, Sheba Medical Center, Tel-Hashomer, Israel.,Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Jennifer Millar
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
| | - Kelly Brewer
- Department of Veteran Affairs, Veterans Biomedical Institute, War Related Illness and Injury Study Center, East Orange, New Jersey, USA
| | - Jorge Serrador
- Department of Rehabilitation and Movement Sciences, Rutgers School of Health Professions, Newark, New Jersey, USA.,Department of Pharmacology, Physiology and Neuroscience, Rutgers Biomedical Health Sciences, Newark, New Jersey, USA
| | - Michael C Schubert
- Laboratory of Vestibular NeuroAdaptation, Department of Otolaryngology - Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland, USA.,Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA
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Lacroix E, Edwards MG, De Volder A, Noël MP, Rombaux P, Deggouj N. Neuropsychological profiles of children with vestibular loss. J Vestib Res 2021; 30:25-33. [PMID: 32083606 DOI: 10.3233/ves-200689] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The impact of vestibular loss (VL) on cognition has been previously studied in experimental animal, human and adult patient studies showing links between VL, and cognitive impairments in space orientation, working memory, mental rotation and selective attention. However, few studies have been conducted on children with VL. OBJECTIVE We investigated for the first time, the impact of a VL on children's cognition. METHODS 13 children with VL (10 years, 5 months) and 60 average-age matched controls performed a neuropsychological assessment consisting of visuospatial working memory, selective visual attention, mental rotation and space orientation tasks. RESULTS Children with VL recalled smaller sequences for both forward and backward memory subtasks (mean±SD = 6.3±1.9 and 5.3±2.6) than controls (8.2±2.3 and 7.3±2.0), have less accurate mental rotation scores (25.4±6 versus 30.8±5.1) and greater additional distance travelled in the maze task (96.4±66.6 versus 60.4±66.3); all corrected p-values <0.05. Selective visual attention measures do not show significant differences. CONCLUSIONS Children with VL show similar cognitive difficulties that adults with VL, in tasks involving dynamic cognitive processes (higher attentional load) that in tasks requiring static cognitive processes such as visual attention task.
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Affiliation(s)
- Emilie Lacroix
- Oto-Rhino-Laryngology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Institute of Neuroscience (IONS), Université Catholique de Louvain, Louvain-la-Neuve, Belgium.,Institute for Research in Psychological Science (IPSY), Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Martin Gareth Edwards
- Institute of Neuroscience (IONS), Université Catholique de Louvain, Louvain-la-Neuve, Belgium.,Institute for Research in Psychological Science (IPSY), Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Anne De Volder
- Institute of Neuroscience (IONS), Université Catholique de Louvain, Louvain-la-Neuve, Belgium.,Institute for Research in Psychological Science (IPSY), Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Marie-Pascale Noël
- Institute for Research in Psychological Science (IPSY), Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Philippe Rombaux
- Oto-Rhino-Laryngology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Institute for Research in Psychological Science (IPSY), Université Catholique de Louvain, Louvain-la-Neuve, Belgium
| | - Naima Deggouj
- Oto-Rhino-Laryngology Department, Cliniques Universitaires Saint-Luc, Brussels, Belgium.,Institute of Neuroscience (IONS), Université Catholique de Louvain, Louvain-la-Neuve, Belgium.,Institute for Research in Psychological Science (IPSY), Université Catholique de Louvain, Louvain-la-Neuve, Belgium
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Ray A, Spankovich C, Bishop CE, Su D, Min YI, Schweinfurth JM. Association Between Cardiometabolic Factors and Dizziness in African Americans: The Jackson Heart Study. J Am Acad Audiol 2021; 32:186-194. [PMID: 34030194 DOI: 10.1055/s-0041-1722949] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
BACKGROUND Balance dysfunction is a complex, disabling health condition that can present with multiple phenotypes and etiologies. Data regarding prevalence, characterization of dizziness, or associated factors is limited, especially in an African American population. PURPOSE The aim of the study is to characterize balance dysfunction presentation and prevalence in an African American cohort, and balance dysfunction relationship to cardiometabolic factors. RESEARCH DESIGN The study design is descriptive, cross sectional analysis. STUDY SAMPLE The study sample consist of N = 1,314, participants in the Jackson Heart Study (JHS). DATA COLLECTION AND ANALYSIS JHS participants were presented an initial Hearing health screening questionnaire (N = 1,314). Of these, 317 participants reported dizziness and completed a follow-up Dizziness History Questionnaire. Descriptive analysis was used to compare differences in the cohorts' social-demographic characteristics and cardiometabolic variables to the 997 participants who did not report dizziness on the initial screening questionnaire. Based on questionnaire responses, participants were grouped into dizziness profiles (orthostatic, migraine, and vestibular) to further examine differences in cardiometabolic markers as related to different profiles of dizziness. Logistical regression models were adjusted for age, sex, education, reported noise exposure, and hearing sensitivity. RESULTS Participants that reported any dizziness were slightly older and predominantly women. Other significant complaints in the dizzy versus nondizzy cohort included hearing loss, tinnitus, and a history of noise exposure (p < 0.001). Participants that reported any dizziness had significantly higher prevalence of hypertension, blood pressure medication use, and higher body mass index (BMI). Individuals with symptoms alluding to an orthostatic or migraine etiology had significant differences in prevalence of hypertension, blood pressure medication use, and BMI (p < 0.001). Alternatively, cardiometabolic variables were not significantly related to the report of dizziness symptoms consistent with vestibular profiles. CONCLUSION Dizziness among African Americans is comparable to the general population with regards to age and sex distribution, accordingly to previously published estimates. Participants with dizziness symptoms appear to have significant differences in BMI and blood pressure regulation, especially with associated orthostatic or migraine type profiles; this relationship does not appear to be conserved in participants who present with vestibular etiology symptoms.
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Affiliation(s)
- Amrita Ray
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, Mississippi
| | - Christopher Spankovich
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, Mississippi
| | - Charles E Bishop
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, Mississippi
| | - Dan Su
- Department of Data Science, University of Mississippi Medical Center, Jackson, Mississippi
| | - Yuan-I Min
- Department of Medicine, University of Mississippi Medical Center, Jackson, Mississippi
| | - John M Schweinfurth
- Department of Otolaryngology and Communicative Sciences, University of Mississippi Medical Center, Jackson, Mississippi
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Carrillo Muñoz R, Ballve Moreno JL, Villar Balboa I, Rando Matos Y, Cunillera Puertolas O, Almeda Ortega J. A single Epley manoeuvre can improve self-perceptions of disability (quality of life) in patients with pc-BPPV: A randomised controlled trial in primary care. Aten Primaria 2021; 53:102077. [PMID: 33965884 PMCID: PMC8120855 DOI: 10.1016/j.aprim.2021.102077] [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: 02/04/2021] [Revised: 03/08/2021] [Accepted: 03/11/2021] [Indexed: 11/13/2022] Open
Abstract
Posterior canal benign paroxysmal positional vertigo (pc-BPPV) causes physical, functional, and emotional impairment. The treatment is the Epley manoeuvre (EM). Objective The purpose of the study was to compare the impact of the EM and a sham manoeuvre in primary care on self-perceived disability. Design Randomised, double-blind, sham-controlled clinical trial conducted in primary care with a follow-up of 1 year. Participants Patients aged ≥18 years old diagnosed with pc-BPPV according to the Dix–Hallpike test (DHT) were randomised to: Interventions Intervention (EM) group or a control (sham manoeuvre) group. Main measurements The main study covariates were age, sex, history of depression and anxiety, presence of nystagmus in the DHT, patient-perceived disability assessed with the Dizziness Handicap Inventory – screening version (DHI-S). Data were analyzed using bivariate and multivariate mixed Tobit analyses. Results Overall, 134 patients were studied: 66 in the intervention group and 68 in the control group. Median age was 52 years (interquartile range [IQR], 38.25–68.00 years. standard deviation, 16.98) and 76.12% of the patients were women. The DHT triggered nystagmus in 40.30% of patients. The median total DHI-S score for the overall sample at baseline was 16 (IQR, 8.00–22.00); 16 [IQR, 10.5–24.0] vs 10 [6.0–14.0] for women vs men (P < .001). Patients treated with the EM experienced a mean reduction of 2.03 points in DHI-S score over the follow-up period compared with patients in the sham group. Conclusions Pc-BPPV affects the quality of life of primary care patients. A single EM can improve self-perceptions of disability by around 2 points on the DHI-S scale.
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Affiliation(s)
- Ricard Carrillo Muñoz
- Equip d'Atenció Primària Florida Nord, Institut Català de la Salut, L'Hospitalet de Llobregat, Barcelona, Spain
| | - José Luis Ballve Moreno
- Equip d'Atenció Primària Florida Sud, Institut Català de la Salut, L'Hospitalet de Llobregat, Barcelona, Spain; Universitat de Barcelona, Barcelona, Spain.
| | - Iván Villar Balboa
- Equip d'Atenció Primària Florida Nord, Institut Català de la Salut, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Yolanda Rando Matos
- Equip d'Atenció Primària Florida Sud, Institut Català de la Salut, L'Hospitalet de Llobregat, Barcelona, Spain
| | - Oriol Cunillera Puertolas
- Unitat de Suport a la Recerca Metropolitana Sud, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Cornellà, Barcelona, Spain
| | - Jesús Almeda Ortega
- Unitat de Suport a la Recerca Metropolitana Sud, Institut Universitari d'Investigació en Atenció Primària Jordi Gol (IDIAP Jordi Gol), Cornellà, Barcelona, Spain
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Predictive Value of Vestibular Evoked Myogenic Potentials in the Diagnosis of Menière's Disease and Vestibular Migraine. Otol Neurotol 2021; 41:828-835. [PMID: 32271263 DOI: 10.1097/mao.0000000000002636] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To explore the usefulness of vestibular evoked myogenic potentials (VEMPs) in the diagnosis of Menière's disease (MD) and vestibular migraine (VM). STUDY DESIGN Retrospective cohort. SETTING Multidisciplinary neurotology clinic. PATIENTS Definite MD and definite VM patients between January, 2015 and May, 2017, as well as healthy volunteers. INTERVENTIONS Cervical and ocular VEMP (cVEMP and oVEMP) testing. MAIN OUTCOME MEASURES VEMP response, amplitude, and latency. RESULTS Twenty five definite MD, 34 definite VM, and 13 control subjects were analyzed. MD affected ears had significantly lower cVEMP (p = 0.007) and oVEMP (p < 0.001) amplitudes than control ears. VM ears had significantly lower oVEMP (p = 0.001), but not cVEMP (p = 0.198) amplitudes than control ears. MD affected ears, but not VM ears, had significantly more absent cVEMP (25.9% versus 0%, p = 0.005) and oVEMP responses (40.7% versus 0%, p < 0.001) than control ears. oVEMP latency was significantly shorter for both MD affected (p < 0.001) and VM ears (p < 0.001) than control ears. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated using a neurotology clinic MD prevalence of 7.9% in dizzy patients. A present cVEMP or oVEMP both have more than 93% chance of ruling MD out in the tested ear, while a cVEMP amplitude more than 54.9 μV or oVEMP amplitude more than 5.1 μV both have more than 94% of ruling out MD in the tested ear. CONCLUSIONS Despite some overlap in VEMP results between MD and VM, when the diagnosis is uncertain between the two disorders due to symptomatic overlap and nonspecific audiometric data, VEMPs can be helpful in guiding treatment toward one disease entity or the other until more evidence points to a definitive diagnosis.
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Lima Rebêlo F, de Souza Silva LF, Doná F, Sales Barreto A, de Souza Siqueira Quintans J. Immersive virtual reality is effective in the rehabilitation of older adults with balance disorders: A randomized clinical trial. Exp Gerontol 2021; 149:111308. [PMID: 33744393 DOI: 10.1016/j.exger.2021.111308] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 02/22/2021] [Accepted: 03/04/2021] [Indexed: 11/25/2022]
Abstract
QUESTION What are the effects of immersive virtual reality (IVR) training compared to conventional physiotherapy on body balance and risk of falls in older adults with balance disorders? DESIGN A randomized controlled trial with two intervention arms, concealed allocation, per-protocol analysis, and blinded assessment. PARTICIPANTS Thirty-seven older adults with balance disorders and risk of falling. INTERVENTION Participants were randomized into two groups: a control group, which received balance training with conventional physiotherapy using multimodal circuit exercises, and an experimental group, which received balance training using immersive virtual reality. Both groups received 16 individual sessions, twice a week. OUTCOME MEASURES The primary outcome was functional balance. Secondary outcomes were static balance, gait speed, functional range, dizziness symptoms, and fear of falling. Safety was ensured by assessing any adverse events during the intervention. RESULTS After 16 sessions, in the intragroup analysis, the functional balance score in the experimental group increased by 3.00 (95% CI 1.42 to 4.57) and in the control group by 3.88 (95% CI 2.16 to 5.59). Both groups improved in assessments of sensory interaction and anterior reach. Only the experimental group presented increased mobility and reduced dizziness. After two months, there was a maintenance of gains in functional balance and a reduction of the gains in functional reach for both groups. In the intergroup comparison, there was no significant difference. CONCLUSION Immersive Virtual Reality training proved to be effective for balance-related outcomes, although it was not superior to conventional therapy. TRIAL REGISTRATION RBR-3tk7fw.
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Affiliation(s)
- Felipe Lima Rebêlo
- Health Sciences from the Federal University of Alagoas, Physiotherapy Department, State University of Health Sciences of Alagoas and Cesmac University Center, Maceió, Brazil; Health Sciences Graduate Program (PPGCS), Federal University of Sergipe, Aracaju, SE, Brazil; State University of Health Sciences of Alagoas, Maceió, Brazil; Department of Physiotherapy, Cesmac University Center, Maceió, Brazil.
| | | | - Flávia Doná
- Health Sciences, Ibirapuera University, Physiotherapy Department, São Paulo, Brazil
| | - André Sales Barreto
- Health Sciences Graduate Program (PPGCS), Federal University of Sergipe, Aracaju, SE, Brazil; Health Sciences, Federal University of Sergipe, Health Education Department, Aracaju, Brazil
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