1
|
Ma YM, Zhang DP, Zhang HL, Cao FZ, Zhou Y, Wu B, Wang LZ, Xu B. Why is vestibular migraine associated with many comorbidities? J Neurol 2024:10.1007/s00415-024-12692-8. [PMID: 39302416 DOI: 10.1007/s00415-024-12692-8] [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: 06/27/2024] [Revised: 09/09/2024] [Accepted: 09/10/2024] [Indexed: 09/22/2024]
Abstract
Vestibular migraine (VM) is a usual trigger of episodic vertigo. Patients with VM often experience spinning, shaking, or unsteady sensations, which are usually also accompanied by photophobia, phonophobia, motor intolerance, and more. VM is often associated with a number of comorbidities. Recurrent episodes of VM can affect the patient's emotions, sleep, and cognitive functioning to varying degrees. Patients with VM may be accompanied by adverse moods such as anxiety, fear, and depression, which can gradually develop into anxiety disorders or depressive disorders. Sleep disorders are also a common concomitant symptom of VM, which significantly lower patients' quality of life. The influence of anxiety disorders and sleep disorders may reduce cognitive functions of VM, such as visuospatial ability, attention, and memory decline. Clinically, it is also common to see VM comorbid with other vestibular disorders, making the diagnosis more difficult. VM episodes are relieved but lingering, in which case VM may coexist with persistent postural-perceptual dizziness (PPPD). Anxiety may be an important bridge between recurrent VM and PPPD. The clinical manifestations of VM and Meniere's disease (MD) overlap considerably, and those who meet the diagnostic criteria for both can be said to have VM/MD comorbidity. VM can also present with positional vertigo, and some patients with VM present with typical benign paroxysmal positional vertigo (BPPV) nystagmus on positional testing. In this paper, we synthesize and analyze the pathomechanisms of VM comorbidity by reviewing the literature. The results show that it may be related to the extensive connectivity of the vestibular system with different brain regions and the close connection of the trigeminovascular system with the periphery of the vestibule. Therefore, it is necessary to pay attention to the diagnosis of comorbidities in VM, synthesize its pathogenesis, and give comprehensive treatment to patients.
Collapse
Affiliation(s)
- Yan-Min Ma
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou City, China
| | - Dao-Pei Zhang
- The First Affiliated Hospital of Henan University of Chinese Medicine, Henan Province, Zhengzhou City, China
| | - Huai-Liang Zhang
- The First Affiliated Hospital of Henan University of Chinese Medicine, Henan Province, Zhengzhou City, China
| | - Fang-Zheng Cao
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou City, China
| | - Yu Zhou
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou City, China
| | - Bin Wu
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou City, China
| | - Ling-Zhe Wang
- The Second School of Clinical Medicine, Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou City, China
| | - Bin Xu
- Department of Neurology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Zhejiang Province, Hangzhou City, 310053, China.
| |
Collapse
|
2
|
Kirsch V, Boegle R, Gerb J, Kierig E, Ertl-Wagner BB, Becker-Bense S, Brandt T, Dieterich M. Imaging endolymphatic space of the inner ear in vestibular migraine. J Neurol Neurosurg Psychiatry 2024:jnnp-2024-334419. [PMID: 39271244 DOI: 10.1136/jnnp-2024-334419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2024] [Accepted: 07/29/2024] [Indexed: 09/15/2024]
Abstract
BACKGROUND Vestibular migraine (VM), the most frequent episodic vertigo, is difficult to distinguish from Ménière's disease (MD) because reliable biomarkers are missing. The classical proof of MD was an endolymphatic hydrops (EH). However, a few intravenous gadolinium-enhanced MRI studies of the inner ear (iMRI) also revealed an EH in VM. The major questions were the frequency and distribution characteristics of EH in VM for diagnostic use. METHODS In a prospective case-control study of 200 participants, 75 patients with VM (49 females; mean age 46 years) and 75 with MD (36 females; mean age 55 years), according to the Bárány and International Headache Society, and 50 age-matched participants with normal vestibulocochlear testing (HP), were enrolled. Analyses of iMRI of the endolymphatic space included volumetric quantification, stepwise regression, correlation with neurotological parameters and support vector machine classification. RESULTS EH was maximal in MD (80%), less in VM (32%) and minimal in HP (22%). EH was milder in VM (mean grade 0.3) compared with MD (mean grade 1.3). The intralabyrinthine distribution was preferably found in the vestibulum in VM, but mainly in the cochlea in MD. There was no interaural lateralisation of EH in VM but in the affected ear in MD. The grade of EH in the vestibulum was correlated in both conditions with the frequency and duration of the attacks. CONCLUSION Three features of the iMRI evaluation were most supportive for the diagnosis of VM at group and individual levels: (1) the bilateral manifestation, (2) the low-grade EH and (3) the intraaural distribution.
Collapse
Affiliation(s)
- Valerie Kirsch
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Munich, Germany
- Graduate School of Systemic Neuroscience, Ludwig-Maximilians-University, Munich, Germany
| | - Rainer Boegle
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Munich, Germany
- Graduate School of Systemic Neuroscience, Ludwig-Maximilians-University, Munich, Germany
| | - Johannes Gerb
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Munich, Germany
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
| | - Emilie Kierig
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Munich, Germany
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
| | | | - Sandra Becker-Bense
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Munich, Germany
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
| | - Thomas Brandt
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Munich, Germany
- Graduate School of Systemic Neuroscience, Ludwig-Maximilians-University, Munich, Germany
| | - Marianne Dieterich
- German Center for Vertigo and Balance Disorders, Ludwig-Maximilians-University, Munich, Germany
- Graduate School of Systemic Neuroscience, Ludwig-Maximilians-University, Munich, Germany
- Department of Neurology, Ludwig-Maximilians-University, Munich, Germany
- SyNergy, Munich Cluster of Systems Neurology, Munich, Germany
| |
Collapse
|
3
|
Guo X, Xiao H, Huang G, Lin C, Lin J, Cai H, Ke X, Lu Y, Ye S. Differentiating Definite and Probable Ménière Disease: A Comprehensive Evaluation of Audio-Vestibular Function Testing Combined with Inner Ear MRI. Otol Neurotol 2024; 45:925-931. [PMID: 39142314 DOI: 10.1097/mao.0000000000004282] [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: 08/16/2024]
Abstract
OBJECTIVES To evaluate the differences between audio-vestibular function testing and inner ear gadolinium magnetic resonance imaging (MRI) in distinguishing definite Ménière disease (DMD) and probable Ménière disease (PMD), and to provide a reference for early clinical diagnosis and intervention. METHODS A total of 116 patients diagnosed with DMD (n = 80) and PMD (n = 36) were enrolled. The differences in the results of pure tone audiometry, caloric test, and tympanic injection of gadolinium for contrast-enhanced MRI between the two groups were compared and analyzed. Parameters that could differentiate between the two conditions were identified, and the sensitivity and specificity and the area under the curve (AUC) of individual and combined indices in the differential diagnosis of DMD and PMD were evaluated. RESULTS The hearing threshold and hearing asymmetry rate of the DMD group were significantly higher than those of the PMD group (p < 0.001), 98.8% and 30.6%, respectively. The abnormal rates of canal paresis (CP) and severity of endolymphatic hydrops in the DMD group were higher than those in the PMD group (p < 0.05). When combined with high-frequency hearing thresholds, hearing asymmetry, hearing curve type, endolymphatic hydrops, and abnormal CP, the diagnostic accuracy of DMD was improved compared to using high-frequency alone (p < 0.05). CONCLUSION This study showed that PMD and DMD may represent two different stages in the development of MD disease. The comprehensive assessment of audio-vestibular function testing and inner ear MRI proves beneficial for early diagnosis, potentially contributing to the preservation of inner ear function.
Collapse
|
4
|
Mavrodiev V, Strupp M, Vinck AS, van de Berg R, Lehner L. The dissociation between pathological caloric testing and a normal video head impulse test helps differentiate between Menière's disease, vestibular migraine, and other vestibular disorders: a confirmatory study in a large cohort of 2,101 patients. Front Neurol 2024; 15:1449261. [PMID: 39206283 PMCID: PMC11350975 DOI: 10.3389/fneur.2024.1449261] [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: 06/14/2024] [Accepted: 07/29/2024] [Indexed: 09/04/2024] Open
Abstract
Vestibular migraine (VM) and Menière's disease (MD) are characterized by episodes of vertigo of similar duration. It is well known that differentiation between both diseases is not always possible based only on the patient history, physical examination, and audiological testing. In addition, the quantification of the vestibular function can also be helpful since, among patients with MD, there is often a dissociation between a normal/pseudo-normal video head impulse test (vHIT) and reduced caloric testing. The goal of this confirmatory study was to determine the sensitivity, specificity, and positive and negative predictive values (PPV and NPV) of this dissociation to differentiate between MD and VM as well as between MD and other vestibular diseases. We performed a retrospective analysis of 2,101 patients. The examination group consisted of 1,100 patients; of these, 627 (57%) had MD according to the diagnostic criteria of the Bárány Society and 473 (43%) had VM. The comparison group consisted of 1,001 patients with other peripheral, central, or functional vestibular disorders. Statistical analysis revealed the following findings for the dissociation: MD vs. VM: specificity: 83.5%, sensitivity: 58.9%, PPV: 82.6%, and NPV: 60.5%, and MD vs. all other vestibular disorders (VM plus others): specificity: 83.5%, sensitivity: 58.9%, PPV: 60.3%, and NPV: 82.7%. The dissociation between a normal vHIT and a reduced caloric response is due to the high specificity and PPV suited for the differentiation between MD and VM. This part of the study confirms previous findings in a large cohort of patients. When it comes to differentiating between MD and all observed vestibular disorders, if there is no dissociation, the diagnosis of MD is unlikely.
Collapse
Affiliation(s)
- Vergil Mavrodiev
- Department of Neurology, LMU University Hospital, Munich, Germany
- German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Munich, Munich, Germany
| | - Michael Strupp
- Department of Neurology, LMU University Hospital, Munich, Germany
- German Center for Vertigo and Balance Disorders, LMU University Hospital, LMU Munich, Munich, Germany
| | | | - Raymond van de Berg
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Vestibular Disorders, Maastricht University Medical Center, Maastricht, Netherlands
| | - Louisa Lehner
- Department of Neurology, LMU University Hospital, Munich, Germany
| |
Collapse
|
5
|
Kouga T, Miwa T, Sunami K, Itoh Y. Effectiveness of Anti-Calcitonin Gene-Related Peptide Medication in Vestibular Migraine: A Retrospective Cohort Study in an Asian Population. CNS Drugs 2024; 38:637-648. [PMID: 38809343 DOI: 10.1007/s40263-024-01094-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/30/2024] [Indexed: 05/30/2024]
Abstract
BACKGROUND Migraine and dizziness often coexist, with vestibular migraine (VM) presenting with vestibular symptoms and headaches. Calcitonin gene-related peptide (CGRP) may be involved in motion-induced symptoms; however, studies on the use of anti-CGRP monoclonal antibodies (mAbs) for the treatment of VM have yielded conflicting results. This study aimed to clarify the effectiveness of anti-CGRP mAbs in VM treatment. METHODS This retrospective observational cohort study, conducted between 1 January 2021 and 31 March 2023, assessed 12 Japanese patients with VM who were treated with anti-CGRP mAbs (CGRP group) for 6 months and 11 Japanese patients who received standard of care for VM and served as controls. Clinical questionnaires and equilibrium tests were administered, with primary outcomes including changes in Dizziness Handicap Inventory (DHI) scores compared with baseline values. Objective variables included the DHI score and explanatory variables included demographic data, balance test results, head-up tilt (HUT) test results, vestibular test results and questionnaire survey results. Analysis of variance was used to assess the treatment effects of anti-CGRP mAbs, and multivariate regression analysis was performed to identify mAb responders. RESULTS After 6 months, the CGRP group showed significant improvements in DHI scores [0 versus 6 months, odds ratio (95% confidence interval): 22.01 (0.13-43.88)] and number of vertigo/dizziness attacks per month [0 versus 6 months: 10.28 (2.80-17.76)]. No significant difference was observed in the control group [DHI scores, 0 versus 6 months: 0.65 (-26.84 to 28.14); number of vertigo/dizziness attacks per month, 0 versus 6 months: - 8.07 (- 23.77 to 7.62)]. Multivariate regression analysis showed that autonomic function at baseline was associated with mAb response in patients [β estimates (95% confidence interval): 3.63 (0.21-7.06)]. CONCLUSIONS Treatment with anti-CGRP mAbs was more effective than conventional treatment in preventing migraine in patients with VM. While the identified factors associated with treatment responsiveness offer valuable insights into personalised treatment approaches, further prospective studies are warranted to validate the findings due to our study's retrospective design and limited sample size.
Collapse
Affiliation(s)
- Teppei Kouga
- Department of Otolaryngology, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Toru Miwa
- Department of Otolaryngology, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan.
- Department of Otolaryngology-Head and Neck Surgery, Graduate of School of Medicine, Kyoto University, 54 Shogoin Kawahara-cho, Sakyo-ku, Kyoto, 606-8507, Japan.
| | - Kishiko Sunami
- Department of Otolaryngology, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| | - Yoshiaki Itoh
- Department of Neurology, Osaka Metropolitan University, 1-4-3 Asahi-machi, Abeno-ku, Osaka, 545-8585, Japan
| |
Collapse
|
6
|
Hac NEF, Gold DR. Advances in diagnosis and treatment of vestibular migraine and the vestibular disorders it mimics. Neurotherapeutics 2024; 21:e00381. [PMID: 38845250 PMCID: PMC11284549 DOI: 10.1016/j.neurot.2024.e00381] [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: 03/10/2024] [Revised: 05/26/2024] [Accepted: 05/27/2024] [Indexed: 07/15/2024] Open
Abstract
Dizziness is one of the most common chief complaints in both the ambulatory care setting and the emergency department. These symptoms may be representative of a broad range of entities. Therefore, any attempt at treatment must first start with determining the etiology. In this current perspective, we focus specifically on the diagnosis of and treatment of vestibular migraine, which is common and overlaps clinically with a variety of other diagnoses. We discuss the traditional treatments for vestibular migraine in addition to the recent explosion of novel migraine therapeutics. Because vestibular migraine can mimic, or co-exist with, a variety of other vestibular diseases, we discuss several of these disorders including persistent postural-perceptual dizziness, benign paroxysmal positional vertigo, post-concussive syndrome, Ménière's disease, and cerebrovascular etiologies. We discuss the diagnosis of each, as well as overlapping and distinguishing clinical features of which the reader should be aware. Finally, we conclude with evidence based as well as expert commentary on management, with a particular emphasis on vestibular migraine.
Collapse
|
7
|
Pajaniappane A. Assessment and management of vestibular migraine within ENT. J Laryngol Otol 2024; 138:S22-S26. [PMID: 38291947 DOI: 10.1017/s0022215123002062] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
OBJECTIVE Vestibular migraine is a newly recognised and debilitating condition. This article aims to provide an overview of what is known of vestibular migraine, delineating its diagnostic criteria and presenting some initial management strategies to aid ENT professionals in delivering optimal care when patients first present to the otolaryngology clinic. METHOD Although traditionally underdiagnosed, there are now clearly defined diagnostic criteria to aid accurate diagnosis of vestibular migraine. RESULTS A detailed history and clinical examination are the cornerstone of the diagnostic process, but supportive evidence is required from appropriate audio-vestibular tests and imaging. CONCLUSION This is a unique condition that commonly initially presents to ENT. This article provides a summary of diagnostic and management strategies to facilitate early diagnosis and first-line treatment that can be employed in general ENT settings, which may be particularly useful given the limited availability of specialist audio-vestibular medicine and neuro-otology services.
Collapse
Affiliation(s)
- Arun Pajaniappane
- Department of Audiovestibular Medicine, St George's University Hospitals NHS Trust, Tooting, UK
- Harley Street Audiovestibular Clinic, London, UK
| |
Collapse
|
8
|
Halmágyi GM, Akdal G, Welgampola MS, Wang C. Neurological update: neuro-otology 2023. J Neurol 2023; 270:6170-6192. [PMID: 37592138 PMCID: PMC10632253 DOI: 10.1007/s00415-023-11922-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2023] [Accepted: 08/01/2023] [Indexed: 08/19/2023]
Abstract
Much has changed since our last review of recent advances in neuro-otology 7 years ago. Unfortunately there are still not many practising neuro-otologists, so that most patients with vestibular problems need, in the first instance, to be evaluated and treated by neurologists whose special expertise is not neuro-otology. The areas we consider here are mostly those that almost any neurologist should be able to start managing: acute spontaneous vertigo in the Emergency Room-is it vestibular neuritis or posterior circulation stroke; recurrent spontaneous vertigo in the office-is it vestibular migraine or Meniere's disease and the most common vestibular problem of all-benign positional vertigo. Finally we consider the future: long-term vestibular monitoring and the impact of machine learning on vestibular diagnosis.
Collapse
Affiliation(s)
- Gábor M Halmágyi
- Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia.
- Central Clinical School, University of Sydney, Sydney, Australia.
| | - Gülden Akdal
- Neurology Department, Dokuz Eylül University Hospital, Izmir, Turkey
- Neurosciences Department, Dokuz Eylül University Hospital, Izmir, Turkey
| | - Miriam S Welgampola
- Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, University of Sydney, Sydney, Australia
| | - Chao Wang
- Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia
- Central Clinical School, University of Sydney, Sydney, Australia
| |
Collapse
|
9
|
Frank M, Abouzari M, Djalilian HR. Meniere's disease is a manifestation of migraine. Curr Opin Otolaryngol Head Neck Surg 2023; 31:313-319. [PMID: 37266702 PMCID: PMC10527226 DOI: 10.1097/moo.0000000000000908] [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: 06/03/2023]
Abstract
PURPOSE OF REVIEW To discuss the theory that Meniere's disease (MD) is a variation of otologic migraine rather than an isolated inner ear condition. RECENT FINDINGS In contrast to the approximately 12% of the general population suffering from migraine headaches, 51-60% of patients with MD experience migraine headaches. While pathognomonic for MD, endolymphatic hydrops has also been identified in patients with vestibular migraine. Treatment with the integrative neurosensory rehabilitation approach (diet and lifestyle changes, magnesium and riboflavin supplementation, and when needed, prophylactic medication) to treat the underlying migraine process has been highly effective in patients with MD. SUMMARY MD can be understood as a manifestation of migraine such that patients with MD can be effectively treated with migraine therapies.
Collapse
Affiliation(s)
- Madelyn Frank
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Mehdi Abouzari
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
| | - Hamid R. Djalilian
- Department of Otolaryngology–Head and Neck Surgery, University of California, Irvine, USA
- Department of Biomedical Engineering, University of California, Irvine, USA
| |
Collapse
|
10
|
Murofushi T, Monobe H, Ushio M. Isolated bilateral posterior semicircular canal hypofunction: comparison with bilateral vestibulopathy. Acta Otolaryngol 2023; 143:687-691. [PMID: 37682576 DOI: 10.1080/00016489.2023.2253270] [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: 07/07/2023] [Accepted: 08/21/2023] [Indexed: 09/09/2023]
Abstract
BACKGROUND Chronic unsteadiness is a common complaint at vestibular clinics. Bilateral vestibulopathy (BVP) is a major cause of chronic unsteadiness but is often overlooked. Although diagnostic criteria for BVP have been established by the Barany Society, isolated vertical canal hypofunction can remain undiagnosed. Recently, the video head-impulse test has enabled clinicians to assess vertical semicircular canal function at clinics. OBJECTIVE This study aimed to compare the features of isolated bilateral posterior semicircular canal hypofunction (IBPH) with those of BVP diagnosed based on the Barany criteria. METHODS The clinical data of 8 IBPH patients that had been diagnosed using our diagnostic criteria (sex, age, subjective symptoms, questionnaire, video head-impulse test and stabilometry) were analyzed and compared with those of 6 BVP patients diagnosed using the Barany criteria. RESULTS The IBPH patients were all aged >70 years, while the age range of the BVP patients was wider. While the BVP patients complained of both oscillopsia during body movement and unsteadiness in darkness, the IBPH patients complained of unsteadiness in darkness without oscillopsia during body movement. The IBPH patients exhibited milder clinical findings than the BVP patients. CONCLUSION IBPH can cause mild unsteadiness in the elderly. SIGNIFICANCE Clinicians should be aware that IBPH can cause unsteadiness in the elderly.
Collapse
Affiliation(s)
- Toshihisa Murofushi
- Department of Otolaryngology, Teikyo University School of Medicine Mizonokuchi Hospital, Kasasaki, Japan
| | - Hiroko Monobe
- Department of Otolaryngology, Japan Red Cross Medical Center, Tokyo, Japan
| | - Munetaka Ushio
- Department of Otolaryngology, Toho University School of Medicine Sakura Medical Center, Sakura, Japan
| |
Collapse
|
11
|
Azami M, Fushiki H, Tsunoda R, Kamo T, Ogihara H, Tanaka R, Kato T. Clinical features of persistent postural-perceptual dizziness with isolated otolith dysfunction as revealed by VEMP and vHIT findings. Front Neurol 2023; 14:1129569. [PMID: 37006499 PMCID: PMC10060848 DOI: 10.3389/fneur.2023.1129569] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Accepted: 02/27/2023] [Indexed: 03/18/2023] Open
Abstract
BackgroundPersistent postural-perceptual dizziness (PPPD) is a relatively new disease entity, with diagnostic criteria published by the Bárány Society. PPPD is often preceded by a peripheral or central vestibular disorder. It is not clear how coexisting deficits due to preceding vestibular disorders affect PPPD symptoms.ObjectiveThis study aimed to characterize the clinical features of PPPD with or without isolated otolith dysfunction using vestibular function tests.MethodsThe study included 43 patients (12 males and 31 females) who were diagnosed with PPPD and completed oculomotor-vestibular function tests. The Dizziness Handicap Inventory (DHI), Hospital Anxiety and Depression Scale (HADS), Niigata PPPD Questionnaire (NPQ), and Romberg test for stabilometry were examined. The 43 patients with PPPD were classified into four categories based on vestibular evoked myogenic potential (VEMP) and video head impulse test (vHIT) results: normal function for both semicircular canals and otoliths (normal), isolated otolith dysfunction (iOtoDys), isolated semicircular canal dysfunction (iCanalDys), and dysfunction of both otoliths and semicircular canals (OtoCanalDys).ResultsAmong the 43 patients with PPPD, the iOtoDys group was the largest (44.2%), followed by the normal group (37.2%), iCanalDys group (9.3%), and OtoCanalDys group (9.3%). Eight of the 19 iOtoDys patients showed both abnormal cVEMP and oVEMP responses unilaterally or bilaterally (both sacculus and utriculus damage type), whereas 11 showed either an abnormal cVEMP or an abnormal oVEMP response (either sacculus or utriculus damage type). In a three-group comparison of the both sacculus and utriculus damage type, the either sacculus or utriculus damage type, and the normal group, the mean total, functional, and emotional DHI scores were significantly higher for the both sacculus and utriculus damage type than for the either sacculus or utriculus damage type. The Romberg ratio, a measure of stabilometry, was significantly higher for the normal group than for the both sacculus and utriculus damage type and the sacculus or utriculus damage type in the iOtoDys group.ConclusionsThe coexistence of sacculus and utriculus damage may exacerbate dizziness symptoms in patients with PPPD. Determining the presence and extent of otolith damage in PPPD may provide useful information on the pathophysiology and treatment strategies of PPPD.
Collapse
Affiliation(s)
- Masato Azami
- Otolaryngology, Mejiro University Ear Institute Clinic, Saitama, Japan
- Department of Physical Therapy, Faculty of Health Sciences, Japan University of Health Sciences, Satte, Japan
| | - Hiroaki Fushiki
- Otolaryngology, Mejiro University Ear Institute Clinic, Saitama, Japan
- *Correspondence: Hiroaki Fushiki
| | - Reiko Tsunoda
- Otolaryngology, Mejiro University Ear Institute Clinic, Saitama, Japan
| | - Tomohiko Kamo
- Otolaryngology, Mejiro University Ear Institute Clinic, Saitama, Japan
- Department of Physical Therapy, Faculty of Rehabilitation, Gunma Paz University, Takasaki, Japan
| | - Hirofumi Ogihara
- Otolaryngology, Mejiro University Ear Institute Clinic, Saitama, Japan
- Division of Physical Therapy, Department of Rehabilitation, Faculty of Health Sciences, Nagano University of Health and Medicine, Nagano, Japan
| | - Ryozo Tanaka
- Otolaryngology, Mejiro University Ear Institute Clinic, Saitama, Japan
- Department of Physical Therapy, Faculty of Health Sciences, Mejiro University, Saitama, Japan
| | - Takumi Kato
- Otolaryngology, Mejiro University Ear Institute Clinic, Saitama, Japan
| |
Collapse
|
12
|
Zhang J, Zhao Y, Jing Y, Han L, Ma X, Yu L, Diao T. The plasma fibrinogen levels in the nitroglycerin-induced chronic migraine rat model and its association between migraine-associated vestibular dysfunction. Front Neurol 2023; 14:980543. [PMID: 37034073 PMCID: PMC10079898 DOI: 10.3389/fneur.2023.980543] [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: 06/28/2022] [Accepted: 03/10/2023] [Indexed: 04/11/2023] Open
Abstract
The purpose of this study was to measure the vestibular function and plasma fibrinogen level in the nitroglycerin (NTG)-induced chronic migraine rats, and explore the effect of defibrinogenation on migraine and associated vestibular dysfunction. The chronic migraine rat model was built by recurrent NTG injection. Batroxobin was administrated as a defibrinogenating drug. We measured the mechanical withdrawal threshold, vestibular function, and fibrinogen level of the rats 30 min before and 2 h following the model establishment, as well as 1 h after batroxobin administration. The results showed that vestibular function was impaired in NTG-induced chronic migraine rats. The fibrinogen levels were increased following repeated NTG injections. However, defibrinogenation did not affect either aggravating or alleviating mechanical hyperalgesia or vestibular dysfunction in the migraine model rats. These findings suggest that the NTG-induced chronic migraine rat model can be used for research on migraine-associated vestibular symptoms. Albeit the association between elevated fibrinogen levels and migraine attacks can be observed, the role of excessive fibrinogen in the pathogenesis of chronic migraine is yet to be determined.
Collapse
|
13
|
Inui T, Kuriyama T, Moriyama K, Shirai T, Sudo T, Ayani Y, Ozaki A, Inaka Y, Araki M, Haginomori SI, Kawata R. Saccular functions differ for Meniere's disease with and without coexisting headaches. Front Neurol 2023; 14:1141388. [PMID: 37122301 PMCID: PMC10140342 DOI: 10.3389/fneur.2023.1141388] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2023] [Accepted: 03/21/2023] [Indexed: 05/02/2023] Open
Abstract
Objectives To elucidate the differences between the cases of Meniere's disease (MD) with and without coexisting headaches, especially migraine. The clinical characteristics and vestibular functions are compared. Subjects Fifteen patients with definite unilateral MD without headaches (MD/H-; 10 males and 5 females; mean age of 55.8 years), and 20 patients with definite unilateral MD with headaches (MD/H+; 3 males and 17 females; mean age of 54.4 years; 15 cases of migraine without aura and 5 cases of suspected migraine or tension-type headache) were enrolled. Methods The medical records, caloric test results, and cervical vestibular evoked myogenic potential (cVEMP) of the patients were reviewed. A monothermal caloric test by injection of cold water was performed, and canal paresis was assessed. cVEMP was recorded using 500 Hz short tone bursts, and the asymmetry ratio using the corrected amplitude of p13-n23 was determined. Results The patients in the MD/H- group were predominantly male, whereas more female patients were seen in MD/H+ group (p = 0.004). In the MD/H+ group, the frequency of vertigo and the dizziness handicap inventory (DHI) values were significantly higher than those in the MD/H- group (p = 0.045, <0.001, respectively). There was no statistical difference in the ages, duration of illness, or the hearing levels between both groups. The caloric testing results were abnormal for 10 of the 13 MD/H- cases, and 14 of the 16 MD/H+ cases, which revealed no significant difference between both groups. The cVEMP results revealed positive saccular dysfunction based on the asymmetry ratio of 4 of the 15 MD/H- cases, and 14 of the 20 MD/H+ cases; it was significantly more prevalent in the MD/H+ group than in the MD/H- group (p = 0.018). Multivariate analysis of sex, frequency of vertigo, DHI, and cVEMP results showed significant differences only in the cVEMP results (p = 0.049). Conclusion The present study revealed differences in patients with MD depending on the presence or absence of headaches. MD without headaches showed a significant male preponderance. MD with coexisting headaches was more associated with severe saccular dysfunctions than MD without headaches. Concomitant headache may affect the manifestations of the vestibular function, especially in the sacculus, in MD cases.
Collapse
|
14
|
Thomas L, Lepcha A, Reka K, Augustine AM, Alex A, Philip A, Mammen MD. Comparing Intratympanic Gentamicin with Methylprednisolone in Meniere's Disease with Non-Serviceable Hearing. Indian J Otolaryngol Head Neck Surg 2022; 74:3738-3745. [PMID: 36742746 PMCID: PMC9895489 DOI: 10.1007/s12070-021-02528-6] [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: 02/12/2021] [Accepted: 03/22/2021] [Indexed: 02/07/2023] Open
Abstract
Abstract To compare the effectiveness of high dose fixed alternate day intratympanic gentamicin with methylprednisolone in the treatment of patients with unilateral, intractable Meniere's disease with poor hearing. Randomized single blind prospective parallel group trial in a tertiary referral centre. Twenty-two patients with definite unilateral Meniere's disease with average pure tone thresholds worse than 50 dB in the affected ear were enrolled. Eleven patients were treated with intratympanic buffered gentamicin and the other eleven were administered intratympanic methylprednisolone (both 4 injections, 40 mg/ml, on alternate days). Patients were assessed pre-intervention, 3 months post intervention and subsequently followed up for 2-4 years. Both groups of patients had significant control of vertigo, DHI scores and THI scores after treatment while the functional scores in the methylprednisolone group was not better than the pre- treatment scores in the long-term follow-up. 9 of 11(82%) patients in gentamicin group and 3 of 11(27%) patients in the methylprednisolone group achieved Class A vertigo control. The gentamicin group had better post intervention DHI scores (p = 0.016, 3 months and p = 0.046, long term) and Functional score (p = 0.014, 3 months and p = 0.05, long term). The hearing in both groups and THI scores, post intervention was similar between both groups. In patients with unilateral intractable MD with non-serviceable hearing, high fixed doses of both intratympanic gentamicin and methylprednisolone are effective in alleviating disease symptoms in long term follow-up. However, intratympanic gentamicin resulted in better control of vertigo, total DHI score and functional level scores than intratympanic methylprednisolone with no significant difference in hearing levels. Trail Registration Number Clinical Trials Registry of India (CTRI- REF/2016/10/012363).
Collapse
Affiliation(s)
- Leah Thomas
- Christian Medical College Vellore, Chittoor Campus, Chittoor, Andhra Pradesh India
| | - Anjali Lepcha
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - K. Reka
- Department of Biostatistics, Christian Medical College, Vellore, Tamil Nadu 632 002 India
| | - Ann Mary Augustine
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Anu Alex
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Ajay Philip
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu 632004 India
| | - Manju Deena Mammen
- Department of ENT, Christian Medical College, Vellore, Tamil Nadu 632004 India
| |
Collapse
|
15
|
Gambacorta V, D’Orazio A, Pugliese V, Di Giovanni A, Ricci G, Faralli M. Persistent Postural Perceptual Dizziness in Episodic Vestibular Disorders. Audiol Res 2022; 12:589-595. [PMID: 36412653 PMCID: PMC9680392 DOI: 10.3390/audiolres12060058] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2022] [Revised: 10/06/2022] [Accepted: 10/11/2022] [Indexed: 12/14/2022] Open
Abstract
Benign Paroxysmal Positional Vertigo (BPPV), Vestibular Migraine (VM), and Meniere Disease (MD) are among the most common episodic vestibulopathies. Persistent Postural Perceptual Dizziness (PPPD) is a chronic functional vestibular disorder that can arise in patients suffering from one or more of these conditions. We analyzed the role of these vestibular disorders as single or multiple associated comorbidities and as a precipitating condition for PPPD. A total of 376 patients suffering from dizziness with a known history of single or multiple vestibular disorders were preliminarily evaluated. We conducted a careful anamnesis to determine whether the reported dizziness could meet the diagnostic criteria for PPPD. PPPD was diagnosed in 24 cases; its incidence in patients with history of a single comorbidity or multiple vestibular comorbidities was 3.9% and 22.4%, respectively. BPPV, VM, and MD were identified as a precipitating condition in 2.34%, 16.45%, and 3.92%, respectively. BPPV constituted a precipitating condition mainly at the first episode. We observed that the presence of multiple vestibular comorbidities (BPPV, VM, and MD) in patients' clinical history increased the risk of PPPD. VM plays a significant role in representing a precipitating condition for PPPD, both when present individually or in association with the other vestibular disorders.
Collapse
Affiliation(s)
- Valeria Gambacorta
- Department of Surgical and Biomedical Sciences, Section of Otorhinolaryngology, University of Perugia, 06129 Perugia, Italy
| | | | | | | | | | | |
Collapse
|
16
|
Development and Validation of the Predictive Model for the Differentiation between Vestibular Migraine and Meniere's Disease. J Clin Med 2022; 11:jcm11164745. [PMID: 36012984 PMCID: PMC9410183 DOI: 10.3390/jcm11164745] [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: 07/20/2022] [Revised: 08/11/2022] [Accepted: 08/12/2022] [Indexed: 11/29/2022] Open
Abstract
(1) Background: Vestibular migraine (VM) and Meniere’s disease (MD) share multiple features in terms of clinical presentations and auditory-vestibular dysfunctions, e.g., vertigo, hearing loss, and headache. Therefore, differentiation between VM and MD is of great significance. (2) Methods: We retrospectively analyzed the medical records of 110 patients with VM and 110 patients with MD. We at first established a regression equation by using logistic regression analysis. Furthermore, sensitivity, specificity, accuracy, positive predicted value (PV), and negative PV of screened parameters were assessed and intuitively displayed by receiver operating characteristic curve (ROC curve). Then, two visualization tools, i.e., nomograph and applet, were established for convenience of clinicians. Furthermore, other patients with VM or MD were recruited to validate the power of the equation by ROC curve and the Gruppo Italiano per la Valutazione degli Interventi in Terapia Intensiva (GiViTI) calibration belt. (3) Results: The clinical manifestations and auditory-vestibular functions could help differentiate VM from MD, including attack frequency (X5), phonophobia (X13), electrocochleogram (ECochG) (X18), head-shaking test (HST) (X23), ocular vestibular evoked myogenic potential (o-VEMP) (X27), and horizontal gain of vestibular autorotation test (VAT) (X30). On the basis of statistically significant parameters screened by Chi-square test and multivariable double logistic regression analysis, we established a regression equation: P = 1/[1 + e−(−2.269× X5 − 2.395× X13 + 2.141× X18 + 3.949 × X23 + 2.798× X27 − 4.275× X30(1) − 5.811× X30(2) + 0.873)] (P, predictive value; e, natural logarithm). Nomographs and applets were used to visualize our result. After validation, the prediction model showed good discriminative power and calibrating power. (4) Conclusions: Our study suggested that a diagnostic algorithm based on available clinical features and an auditory-vestibular function regression equation is clinically effective and feasible as a differentiating tool and could improve the differential diagnosis between VM and MD.
Collapse
|
17
|
Murofushi T, Nishimura K, Tsubota M. Isolated Otolith Dysfunction in Persistent Postural-Perceptual Dizziness. Front Neurol 2022; 13:872892. [PMID: 35481262 PMCID: PMC9038172 DOI: 10.3389/fneur.2022.872892] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2022] [Accepted: 03/21/2022] [Indexed: 11/13/2022] Open
Abstract
The aims of this study were to investigate otolith dysfunction, especially isolated otolith dysfunction (with preserved semicircular canal function) in persistent postural-perceptual dizziness (PPPD) patients. Twenty-one patients who had been diagnosed with PPPD were enrolled in this study. The subjects filled out questionnaires [the Dizziness Handicap Inventory (DHI) and the Niigata PPPD Questionnaire (NPQ)] and underwent vestibular evoked myogenic potential (VEMP) tests, video head-impulse tests (vHIT), and stabilometry. Among the 21 subjects with PPPD, 9 showed isolated otolith dysfunction, 4 exhibited both otolith dysfunction and semicircular canal dysfunction, and 2 demonstrated isolated semicircular canal dysfunction. Six subjects exhibited normal VEMP and vHIT results. Concerning the subjects' questionnaire scores and stabilometric parameters, there were no significant differences among subgroups when the subjects were classified according to their VEMP and vHIT results while stabilometric parameters obtained in PPPD subjects were significantly increased than published data of healthy subjects. As precipitating conditions for PPPD, vestibular neuritis was the most frequent and the second most was idiopathic otolithic vertigo. In conclusion, the majority of PPPD patients had otolith dysfunction, and most of them showed isolated otolith dysfunction. Idiopathic otolithic vertigo can be a precipitating factor of PPPD. While otolith dysfunction may be associated with initiation of PPPD symptoms, PPPD symptoms are also considered to be associated with other dysfunctions of the sensory processing system.
Collapse
Affiliation(s)
- Toshihisa Murofushi
- Department of Otolaryngology, Teikyo University School of Medicine, Mizonokuchi Hospital, Kawasaki, Japan
- *Correspondence: Toshihisa Murofushi
| | - Koji Nishimura
- Department of Otolaryngology, Teikyo University School of Medicine, Mizonokuchi Hospital, Kawasaki, Japan
| | - Masahito Tsubota
- Department of Otolaryngology, Teikyo University School of Medicine, Mizonokuchi Hospital, Kawasaki, Japan
- Department of Otolaryngology, Kanazawa Medical University, Himi Municipal Hospital, Himi, Japan
| |
Collapse
|
18
|
Kısabay Ak A, Çelebisoy N, Özdemir HN, Gökçay F, Saruhan Durmaz G, Top Kartı D, Ertaşoğlu Toydemir H, Yayla V, Çolpak Işıkay Aİ, Erkent İ, Özçelik P, Akdal G, Ataç C, Bıçakcı Ş, Ozaydın-Göksu E, Güleç Uyaroğlu F. Factors determining the response to treatment in patients with vestibular migraine. Neurol Res 2022; 44:847-854. [PMID: 35348034 DOI: 10.1080/01616412.2022.2056341] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
PURPOSE To find out clinical features associated with poor response to treatment in vestibular migraine (VM). METHODS VM patients treated with drugs recommended in migraine prophylaxis were included in this multicenter study. Migraine features including type, age of onset of headache and vertigo attacks, attack frequency, intensity, associated symptoms, triggering factors, presence of interictal dizziness/imbalance, anxiety, depression, history of motion sickness, and family history of migraine were noted. Amitriptyline, flunarizine, propranolol, topiramate and venlafaxine were chosen depending on patients' individual requirements. Maximum dose of each drug was tried for 2 months to decide its efficacy. In the case of inefficacy, it was changed with another preventive drug of different class. If there was still no improvement, two drugs of different classes were combined. ≥ 50% reduction in attack frequency and severity in patients using one drug and a combination of two drugs was compared, with patients showing <50% reduction despite combination therapy, regarding their clinical features. RESULTS The results of 430 VM patients, 65 men and 365 women with a mean age of 42.2 ± 12.2 years (range: 17-74 years), were analyzed. CONCLUSION Cutaneous allodynia frequently associated with female sex, comorbid anxiety and depression and interictal dizziness/imbalance enhanced with comorbid anxiety were risk factors for reduced treatment response. Aural fullness might be the clue of impending concomitant Meniere's disease not responding to migraine preventives.
Collapse
Affiliation(s)
| | | | | | - Figen Gökçay
- Department of Neurology, Ege University, Izmir, Turkey
| | | | - Dilek Top Kartı
- Department of Neurology, University of Health Sciences Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Hülya Ertaşoğlu Toydemir
- Department of Neurology, University of Health Sciences Istanbul Bakırköy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | - Vildan Yayla
- Department of Neurology, University of Health Sciences Istanbul Bakırköy Dr. Sadi Konuk Education and Research Hospital, Istanbul, Turkey
| | | | - İrem Erkent
- Department of Neurology, Hacettepe University, Ankara, Turkey
| | - Pınar Özçelik
- Department of Neurology, Dokuz Eylül University, Izmir, Turkey
| | - Gülden Akdal
- Department of Neurology, Dokuz Eylül University, Izmir, Turkey
| | - Ceyla Ataç
- Department of Neurology, University of Health Sciences Izmir Bozyaka Education and Research Hospital, Izmir, Turkey
| | - Şebnem Bıçakcı
- Department Of Neurology, Çukurova University, Adana, Turkey
| | - Eylem Ozaydın-Göksu
- Department of Neurology, University of Health Sciences Antalya Education and Research Hospital, Antalya, Turkey
| | - Feray Güleç Uyaroğlu
- Department of Neurology, University of Health Sciences Izmir Tepecik Education and Research Hospital, Izmir, Turkey
| |
Collapse
|
19
|
VESTIBULAR MIGRAINE, DEMOGRAPHIC AND CLINICAL FEATURES OF 415 PATIENTS: A MULTICENTER STUDY. Clin Neurol Neurosurg 2022; 215:107201. [DOI: 10.1016/j.clineuro.2022.107201] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2021] [Revised: 02/27/2022] [Accepted: 03/05/2022] [Indexed: 11/22/2022]
|
20
|
Abstract
PURPOSE OF REVIEW This article reviews recent developments in Ménière's disease including etiologic, diagnostic, and therapeutic investigations that have changed the landscape for medical providers. These updates shed light onto the complex nature of Ménière's disease and generate additional means to provide optimal care to patients. RECENT FINDINGS Given the multifactorial cause of Ménière's disease, five subtypes of Ménière's disease have recently been proposed. A knowledge of these subtypes will aid in the development of an appropriate treatment algorithm. Although newer treatments have not been developed, stepwise treatment algorithms have been proposed and can improve patient care. New MRI modalities and serum testing hold promise as clinical clues and biomarkers. SUMMARY As these updated diagnostic criteria are used, Ménière's disease can be identified and treated more precisely. This will in turn allow for future randomized controlled studies to improve the quality of treatment options available. Future imaging, vestibular testing, and the potential for serum biomarkers may illuminate additional diagnostic criteria, only furthering the improvement in clinical care.
Collapse
Affiliation(s)
- Justin L Hoskin
- Department of Neurology, Barrow Neurological Institute, Phoenix, Arizona, USA
| |
Collapse
|
21
|
Risk of Vestibulocochlear Disorders in Patients with Migraine or Non-Migraine Headache. J Pers Med 2021; 11:jpm11121331. [PMID: 34945803 PMCID: PMC8707905 DOI: 10.3390/jpm11121331] [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: 11/05/2021] [Revised: 12/03/2021] [Accepted: 12/07/2021] [Indexed: 11/23/2022] Open
Abstract
Headaches, especially migraines, have been associated with various vestibular symptoms and syndromes. Tinnitus and hearing loss have also been reported to be more prevalent among migraineurs. However, whether headaches, including migraine or non-migraine headaches (nMH), are associated with vestibular and cochlear disorders remains unclear. Thus, we sought to investigate possible associations between headache and vestibulocochlear disorders. We analyzed 10 years of data from the Smart Clinical Data Warehouse. In patients with migraines and nMH, meniere’s disease (MD), BPPV, vestibular neuronitis (VN) and cochlear disorders, such as sensorineural hearing loss (SNHL) and tinnitus, were collected and compared to clinical data from controls who had health check-ups without headache. Participants included 15,128 with migraines, 76,773 patients with nMH and controls were identified based on propensity score matching (PSM). After PSM, the odds ratios (OR) in subjects with migraine versus controls were 2.59 for MD, 2.05 for BPPV, 2.98 for VN, 1.74 for SNHL, and 1.97 for tinnitus, respectively (p < 0.001). The OR for MD (1.77), BPPV (1.73), VN (2.05), SNHL (1.40), and tinnitus (1.70) in patients with nMH was also high after matching (p < 0.001). Our findings suggest that migraines and nMH are associated with an increased risk of cochlear disorders in addition to vestibular disorders.
Collapse
|
22
|
A Family with a High Incidence of Migraine and Vestibular Migraine and a Case of Menière's Disease. Case Rep Med 2021; 2021:9984047. [PMID: 34512765 PMCID: PMC8433000 DOI: 10.1155/2021/9984047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2021] [Accepted: 08/19/2021] [Indexed: 11/22/2022] Open
Abstract
Vestibular migraine (VM) and Menière's disease (MD) are common neurotological disorders causing episodic vertigo. Sometimes, VM is accompanied by cochlear symptoms suggestive for MD. Therefore, in those cases, the differential diagnosis between the two disorders can be difficult. Moreover, a comorbidity with migraine in MD patients is widely reported, up to the hypothesis of a possible MD-VM overlapping syndrome. In this brief case report, we consider the clinical history of a family presenting high incidence of subjects fulfilling the diagnostic criteria of VM and single case fulfilling criteria for definite MD. The relationship between VM and MD is still under debate; anyway, it can be speculated that commonly shared genetic mutations could play a role as predisposing factors in both disorders. A congenital nystagmus in the family was present too, but its correlation with the other conditions is still not clear. Future goal of our work will be to assess genetics in this family.
Collapse
|
23
|
Dispenza F, Immordino A, Priola R, Salvago P, Montalbano C, Martines F. Evolution of migraine vertigo in overlapping syndrome with Ménière's disease: prognostic role of instrumental examination. ACTA ACUST UNITED AC 2021; 41:180-184. [PMID: 34028464 PMCID: PMC8142731 DOI: 10.14639/0392-100x-n0752] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2020] [Accepted: 10/31/2020] [Indexed: 11/23/2022]
Abstract
Introduction Migraine vertigo (MV) and Ménière’s disease (MD) share several signs and symptoms such as tinnitus, fullness, photophobia, phonophobia, headache and vertigo spells lasting hours. Objective The aim of the present study was to prospectively observe patients with MV with a sporadic audiological symptom evaluated with clinical examination, Vestibular Evoked Myogenic Potentials (VEMPs), ECochG and v-HIT. Results The finding of VEMP asymmetry, according to our cut-off of 33% of difference between sides, resulted in 20 cases, of which 6 had asymmetry of both c-VEMPs and o-VEMPS, all with development of fluctuating hearing during follow-up. ECochG was positive for endolymphatic hydrops in 12 patients. Conclusions The evolution of MV may have a variable course in which some patients may develop symptoms typical of MD. The two diseases may be contextually present at the same time configuring an overlapping syndrome, and asymmetric VEMPs might predict development of fluctuating hearing.
Collapse
Affiliation(s)
- Francesco Dispenza
- U.O.C. Otorinolaringoiatria, A.U.O. Policlinico P. Giaccone, Palermo, Italy.,Istituto Euro-Mediterraneo di Scienza e Tecnologia - IEMEST, Palermo, Italy
| | - Angelo Immordino
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Italy
| | - Roberta Priola
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Italy
| | - Pietro Salvago
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Italy
| | - Calogero Montalbano
- Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Italy
| | - Francesco Martines
- Istituto Euro-Mediterraneo di Scienza e Tecnologia - IEMEST, Palermo, Italy.,Dipartimento di Biomedicina, Neuroscienze e Diagnostica Avanzata, Università degli Studi di Palermo, Italy
| |
Collapse
|
24
|
Weckel A, Gallois Y. Clinical management of Menière's disease: Clinician perspective in 2020. J Vestib Res 2021; 31:323-325. [PMID: 33325419 DOI: 10.3233/ves-200794] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Menière's disease (MD) still presents both diagnostic and therapeutic difficulties. Today, this pathology is diagnosed only on clinical criteria. The development of high resolution magnetic resonance imaging of the inner is very promising to improve diagnostic criteria in MD. MD treatment depending on the practitioner and the clinical center, is mainly based on conservative therapies, and if this fails, non-ablative or ablative therapies. MD therefore always exposes clinicians to diagnostic uncertainties, but also to therapeutic difficulties which still lead to destructive treatments, in the absence of targeted, curative treatments, acting on the cause and not on the consequence of the pathology.
Collapse
Affiliation(s)
- A Weckel
- Department of otology and neurotology, Purpan University Hospital, Pierre Paul Riquet Building, Toulouse, France
| | - Y Gallois
- Department of otology and neurotology, Purpan University Hospital, Pierre Paul Riquet Building, Toulouse, France
| |
Collapse
|
25
|
Subjective Cognitive Symptoms and Dizziness Handicap Inventory (DHI) Performance in Patients With Vestibular Migraine and Menière's Disease. Otol Neurotol 2021; 42:883-889. [PMID: 33606474 DOI: 10.1097/mao.0000000000003081] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Cognitive symptoms in patients with vestibular disorders are far from rare, but identification of patients at risk for cognitive impairment remains poor. The Dizziness Handicap Inventory (DHI) is a widely used patient-reported outcome questionnaire for dizzy patients with several questions that address cognitive function. However, the relationship between subjective cognitive symptomatology in patients with vestibular disorders and performance on DHI is poorly characterized. STUDY DESIGN Retrospective cohort study. SETTING Tertiary care vestibular clinic. SUBJECTS Individuals with diagnoses of vestibular migraine (VM), Menière's disease (MD), and concomitant vestibular migraine and Menière's disease (VMMD) presenting to clinic between January 2007 and December 2019. RESULTS Of 761 subjects, 365 had VM, 311 had MD, and 85 had VMMD. Symptoms of brain fog and chronic fatigue occurred more frequently in the VM and VMMD groups compared with the MD group (χ2 (df = 2, n = 761) = 67.8, 20.9, respectively, p < 0.0001). DHI scores were significantly higher in patients with VM and VMMD compared with those with MD (F[2,758] = 63.5, p < 0.001). A DHI score ≥ 13 suggested that the patient suffered from brain fog (sensitivity = 47.4%, specificity = 72.3%), whereas a score ≥ 15 indicated that the patient complained of chronic fatigue (sensitivity = 81.5%, specificity = 57.7%). CONCLUSION Our results indicate a high prevalence of interictal cognitive symptoms in patients with episodic vestibular disorders. The DHI cannot be reliably used to differentiate between vestibular disorders nor detect cognitive impairment in these patient populations. Alternative methods must be used to identify vestibulopathic patients with cognitive symptoms to initiate strategies for prevention and treatment.
Collapse
|
26
|
Martines F, Dispenza F, Montalbano C, Priola R, Torrente A, La Gumina R, Brighina F, Galletti F, Salvago P. Comparison of Electrocochleography and Video Head Impulse Test findings in Vestibular Migraine and Ménière Disease: A Preliminary Study. J Int Adv Otol 2021; 16:183-189. [PMID: 32784155 DOI: 10.5152/iao.2020.8165] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
OBJECTIVES To evaluate electrophysiological findings among patients with vestibular migraine (VM) and to compare them with those of patients suffering from definite Ménière disease (MD) without migraine. MATERIALS AND METHODS Twenty-one consecutive patients suffering from VM were enrolled; all subjects were selected according to the criteria proposed by the Bàràny Society for Neuro-otology. Each patient underwent a careful otological and neurotological examination. After completing a questionnaire regarding migraine and vertigo complaints, they were assessed by audiometric testing, video head impulse test (vHIT), and electrocochleography (EcochG). Data were compared with those of 21 patients who fulfilled the criteria for definite MD. RESULTS 52.38% of the patients with VM suffered from at least two episodes of migraine per week, with 42.85% of the subjects complaining of migraines lasting ≥24 hours. 57.14% of the patients reported at least four episodes of vertigo per month, whereas 61.9% suffered from symptoms of chronic unsteadiness. No significant difference (p=0.76) resulted from the comparison of vHIT gain between patients with VM and MD. Eleven out of 21 patients (52.38%) with definite MD presented at least one ear with SP/AP >0.4, differently from patients with VM who exhibited SP/AP values suggestive of endolymphatic hydrops (EH) in only three cases (14.28%). CONCLUSION The present study found a higher proportion of abnormal EcochG in MD than in VM (p=0.02) without any significant difference in the vHIT gain. On the basis of our findings, the identification of EH in some patients with VM cannot be definitely related to the same pathway that triggers MD symptoms. Future research may help in better understanding whether abnormal EcochG findings can predict the occurrence of MD among patients with VM.
Collapse
Affiliation(s)
- Francesco Martines
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Francesco Dispenza
- U.O.C. Otorinolaringoiatria, Policlinico "P. Giaccone" University Hospital, Palermo, Italy
| | - Calogero Montalbano
- U.O.C. Otorinolaringoiatria, Policlinico "P. Giaccone" University Hospital, Palermo, Italy
| | - Roberta Priola
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Angelo Torrente
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Rosario La Gumina
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Filippo Brighina
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| | - Francesco Galletti
- Department of Human Pathology of Adults and Children ''G. Barresi'', University of Messina, Messina, Italy
| | - Pietro Salvago
- Department of Biomedicine, Neuroscience and Advanced Diagnostics (BiND), University of Palermo, Palermo, Italy
| |
Collapse
|
27
|
杨 丽, 丁 伟, 吴 梅. [Anxiety and depression state among patients with different type of vertigo and dizziness]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2021; 35:440-443. [PMID: 34304471 PMCID: PMC10128482 DOI: 10.13201/j.issn.2096-7993.2021.05.013] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 01/14/2021] [Indexed: 11/12/2022]
Abstract
Objective:To assess the status of anxiety and depression among patients with different type of vertigo and dizziness, and to figure out the possible reason. Methods:The data of the patients with vertigo from November 2017 to June 2020 were reviewed, and their status of anxiety and depression were assessed using self-rating anxiety scale(SAS) and self-rating depression scale(SDS). Results:A total of 559 patients with vertigo were enrolled, including 94 cases for vestibular migraine (VM), 86 cases for Meniere disease (MD), 78 cases for benign paroxysmal positional vertigo (BPPV), 77 cases for sudden hearing loss(SHL) with vertigo, 74 cases for no definite diagnosis, 58 cases for vestibular neuritis (VN), 57 cases for benign recurrent vertigo (BRV) and 35 cases for persistent postural-perceptual dizziness (PPPD).The incidence of anxiety is 43.11%(no definite diagnosis=64.86%, VM=63.83%, MD=55.81%, PPPD=48.57%, BRV=47.37%), and the incidence of depression is 11.27% (no definite diagnosis=25.68%, PPPD=17.14%, VM=14.89%, BRV=14.04%, MD=12.79%). Kruskal-Wallis test was used to analyze SAS and SDS scores of patients with vertigo. The results showed that there were significant differences in each group. All patients were divided into 3 groups according to the duration of vertigo. The anxiety incidence of >2 years group was highest(58.56%), and the second one was 2 months to 2 years group(54.75%). There was no statistically significant difference between 2 groups by χ²test(P>0.05). But both of them were significantly higher than the <2 months group(17.30%). The depression incidence of >2 years group was highest(32.43%), the second one was 2 months to 2 years group(10.27%), and the lowest one was <2 months group(0%). χ² test(P<0.01) showed statistically significant differences among these three groups. Conclusion:Anxiety is more common among patients with vertigo than depression, and the patients who suffer from VM,MD,PPPD or BRV have significantly higher rates of psychiatric comorbidity.
Collapse
Affiliation(s)
- 丽 杨
- 新疆维吾尔自治区人民医院耳鼻咽喉科(乌鲁木齐,830001)Department of Otorhinolaryngology Head and Neck Surgery, the People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China
| | - 伟 丁
- 新疆维吾尔自治区人民医院耳鼻咽喉科(乌鲁木齐,830001)Department of Otorhinolaryngology Head and Neck Surgery, the People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China
| | - 梅 吴
- 新疆维吾尔自治区人民医院耳鼻咽喉科(乌鲁木齐,830001)Department of Otorhinolaryngology Head and Neck Surgery, the People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China
| |
Collapse
|
28
|
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.
Collapse
|
29
|
Perez-Carpena P, Lopez-Escamez JA. Do we need to reconsider the classification of vestibular migraine? Expert Rev Neurother 2021; 21:503-516. [PMID: 33755502 DOI: 10.1080/14737175.2021.1908129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Introduction: Vestibular migraine (VM) is a complex disease characterized by recurrent episodes of migraine associated with vertigo attacks that are observed in 1-3% of the general population. Given its high prevalence and the impact on the health system, it is important to characterize these patients, in order to offer an accurate diagnosis and a proper treatment. As the diagnosis of VM is based on clinical features, the study of potential biomarkers has gained more interest in the last years, to improve the precision in the diagnosis of this disease. The aim of this review is to summarize the main tests available for the diagnosis of VM, including the accuracy of biomarkers for the diagnosis of VM.Areas covered: This review summarizes the main information on VM, including all diagnosis records published in the field in the last 10 years, and focusing on candidate biomarkers for the diagnosis of VM patients.Expert opinion: There is a limited knowledge in the pathophysiology of VM. The search of biomarkers for diagnosis of VM is needed to improve the precision in the diagnosis promoting clinical and translational research. The potential reclassification of VM will depend upon the discovery and validation of these biomarkers.
Collapse
Affiliation(s)
- Patricia Perez-Carpena
- Otology & Neurotology Group CTS495, Department of Genomic Medicine, GENYO-Centre for Genomics and Oncological Research - Pfizer/University of Granada/Junta De Andalucía, Granada, PTS, Spain.,Department of Otolaryngology, Instituto De Investigación Biosanitaria ibs.GRANADA, Hospital Universitario Virgen De Las Nieves, Granada, Spain
| | - Jose A Lopez-Escamez
- Otology & Neurotology Group CTS495, Department of Genomic Medicine, GENYO-Centre for Genomics and Oncological Research - Pfizer/University of Granada/Junta De Andalucía, Granada, PTS, Spain.,Department of Otolaryngology, Instituto De Investigación Biosanitaria ibs.GRANADA, Hospital Universitario Virgen De Las Nieves, Granada, Spain.,Department of Surgery, Division of Otolaryngology, Universidad De Granada, Granada, Spain
| |
Collapse
|
30
|
Teggi R, Familiari M, Gatti O, Bussi M. Vertigo without cochlear symptoms: vestibular migraine or Menière disease? Neurol Sci 2021; 42:5071-5076. [PMID: 33768434 DOI: 10.1007/s10072-021-05215-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2021] [Accepted: 03/22/2021] [Indexed: 11/30/2022]
Abstract
BACKGROUND Menière's disease (MD) is an inner ear disorder due to raised endolymphatic pressure (hydrops), characterized by cochlear symptoms associated with episodic vertigo. In delayed hydrops, vertigo attacks begin long after the onset of a hearing loss. Few were published on MD in which the onset of vertigo precedes cochlear symptoms by several months. Vestibular migraine (VM) is also a cause of episodic vertigo and an association between migraine and MD was proposed. Purpose of our retrospective work was to assess clinical features associated with MD in which vertigo precedes by months cochlear symptoms. METHODS Our sample was composed by 28 subjects reporting episodic vertigo accompanied by migrainous headache or photo-phonophobia, without cochlear symptoms at onset; during follow-up, all patients developed cochlear symptoms leading to a diagnosis of MD. Results of bedside examination were compared with those of 48 VM subjects with diagnosis of VM confirmed in the follow-up. All subjects performed a bedside examination, including head-shaking, positional, and skull vibration test (SVIN). RESULTS SVIN was more frequent in MD, while positive positional test in VM. In the entire group of 72 subjects, migrainous headache during vertigo and positive positional test were correlated with a final diagnosis of VM. CONCLUSIONS Our data are not inconsistent with the hypothesis that in patients reporting only photo-phonophobia during vertigo attacks and with a positive SVIN, the clinical manifestations may be predictive for evolution toward a MD, while migrainous headache and positive positional tests more frequently are correlated to VM.
Collapse
Affiliation(s)
- Roberto Teggi
- Department of Otolaryngology Head & Neck Surgery, IRCCS San Raffaele Scientific Institute, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy.
| | - Marco Familiari
- Department of Otolaryngology Head & Neck Surgery, IRCCS San Raffaele Scientific Institute, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
| | - Omar Gatti
- Department of Otolaryngology Head & Neck Surgery, IRCCS San Raffaele Scientific Institute, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
| | - Mario Bussi
- Department of Otolaryngology Head & Neck Surgery, IRCCS San Raffaele Scientific Institute, San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
| |
Collapse
|
31
|
Kutlubaev MA, Pal'chun VT, Guseva AL, Zamergrad MV. [Various types of vertigo and balance disorders in patients with Meniere's disease]. Vestn Otorinolaringol 2021; 86:90-95. [PMID: 33720659 DOI: 10.17116/otorino20218601190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Vertigo and balance disorders in Meniere's disease (MD) may have various etiology. The aim of the review is discussing pathogenetic mechanisms of the typical vertiginous paroxysms in MD, resulting from endolymphatic hydrops as well as analysis of etiology, pathogenesis, clinical course and basic treatment of paroxysmal and permanent forms of vertigo and balance disorders, caused by other conditions, associated with MD. We discussed the course of MD complicated by vestibular migraine, benign positional paroxysmal vertigo, functional dizziness, bilateral vestibulopathy and vestibular drop-attacks.
Collapse
Affiliation(s)
| | - V T Pal'chun
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - A L Guseva
- Pirogov Russian National Research Medical University, Moscow, Russia
| | - M V Zamergrad
- Russian Medical Academy of Continuous Professional Education, Moscow, Russia
| |
Collapse
|
32
|
Oh SY, Dieterich M, Lee BN, Boegle R, Kang JJ, Lee NR, Gerb J, Hwang SB, Kirsch V. Endolymphatic Hydrops in Patients With Vestibular Migraine and Concurrent Meniere's Disease. Front Neurol 2021; 12:594481. [PMID: 33776877 PMCID: PMC7991602 DOI: 10.3389/fneur.2021.594481] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Accepted: 02/09/2021] [Indexed: 12/17/2022] Open
Abstract
Objective: Intravenous contrast agent enhanced, high-resolution magnetic resonance imaging of the inner ear (iMRI) confirmed that patients with Menière's disease (MD) and vestibular migraine (VM) could present with endolymphatic hydrops (EH). The present study aimed to investigate EH characteristics and their interrelation to neurotologic testing in patients with VM, MD, or VM with concurrent MD (VM-MD). Methods: Sixty–two patients (45 females, aged 23–81 years) with definite or probable VM (n = 25, 19 definite), MD (n = 29, 17 definite), or showing characteristics of both diseases (n = 8) were included in this study. Diagnostic workup included neurotologic assessments including video-oculography (VOG) during caloric stimulation and head-impulse test (HIT), ocular and cervical vestibular evoked myogenic potentials (o/cVEMP), pure tone audiometry (PTA), as well as iMRI. EH's degree was assessed visually and via volumetric quantification using a probabilistic atlas-based segmentation of the bony labyrinth and volumetric local thresholding (VOLT). Results: Although a relevant number of VM patients reported varying auditory symptoms (13 of 25, 52.0%), EH in VM was only observed twice. In contrast, EH in VM-MD was prevalent (2/8, 25%) and in MD frequent [23/29, 79.3%; χ2(2) = 29.1, p < 0.001, φ = 0.7]. Location and laterality of EH and neurophysiological testing classifications were highly associated (Fisher exact test, p < 0.005). In MD, visual semi-quantitative grading and volumetric quantification correlated highly to each other (rS = 0.8, p < 0.005, two-sided) and to side differences in VOG during caloric irrigation (vestibular EH ipsilateral: rS = 0.6, p < 0.05, two-sided). In VM, correlations were less pronounced. VM-MD assumed an intermediate position between VM and MD. Conclusion: Cochlear and vestibular hydrops can occur in MD and VM patients with auditory symptoms; this suggests inner ear damage irrespective of the diagnosis of MD or VM. The EH grades often correlated with auditory symptoms such as hearing impairment and tinnitus. Further research is required to uncover whether migraine is one causative factor of EH or whether EH in VM patients with auditory symptoms suggests an additional pathology due to MD.
Collapse
Affiliation(s)
- Sun-Young Oh
- Department of Neurology, School of Medicine, Jeonbuk National University, Jeonju, South Korea.,Research Institute of Clinical Medicine, Jeonbuk National University Hospital-Biomedical Research Institute, Jeonbuk National University, Jeonju, South Korea
| | - 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.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - Bit Na Lee
- Department of Neurology, School of Medicine, Jeonbuk National University, Jeonju, South Korea
| | - 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
| | - Jin-Ju Kang
- Department of Neurology, School of Medicine, Jeonbuk National University, Jeonju, South Korea
| | - Na-Ri Lee
- Research Institute of Clinical Medicine, Jeonbuk National University Hospital-Biomedical Research Institute, Jeonbuk National University, Jeonju, South Korea.,Division of Oncology and Hematology, Department of Internal Medicine, Jeonbuk National University Hospital and School of Medicine, Jeonju, South Korea
| | - 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
| | - Seung-Bae Hwang
- Research Institute of Clinical Medicine, Jeonbuk National University Hospital-Biomedical Research Institute, Jeonbuk National University, Jeonju, South Korea.,Department of Radiology, Jeonbuk National University Hospital and School of Medicine, Jeonju, South Korea
| | - 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
| |
Collapse
|
33
|
Teggi R, Colombo B, Zagato L, Filippi M. Could ionic regulation disorders explain the overlap between meniere's disease and migraine? J Vestib Res 2021; 31:297-301. [PMID: 33579883 DOI: 10.3233/ves-200788] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Ménière's disease (MD) is an inner ear disorder characterized by a burden of symptoms and comorbidities, including migraine. In both disorders, ionic dysregulation may play a role as a predisposing factor. In recent years. aquaporins have been widely investigated, but the results are far from conclusive. We recently studied the genetics of ionic transporters and the hormone endogenous ouabain as predisposing factors for development of MD. In particular, we found two genetic polymorphisms associated with MD: 1) rs3746951, a missense variant (Gly180Ser) in the salt-inducible kinase-1 (SIK1) gene encoding a Na+, K+ ATPase; 2) rs487119, an intronic variant of gene SLC8A1 coding for a Na+, Ca++ exchanger (NCX-1). Ionic concentration in the brain also plays a role in the pathophysiology of migraine. In this brief review we summarize what has been published on MD and migraine.
Collapse
Affiliation(s)
- Roberto Teggi
- Division of Otolaryngology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Bruno Colombo
- Units of Neurology and Neurophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Laura Zagato
- Genomics of Renal Diseases and Hypertension Unit, IRCCS San Raffaele Scientific Institute, Milan, Italy
| | - Massimo Filippi
- Units of Neurology and Neurophysiology, IRCCS San Raffaele Scientific Institute, Milan, Italy.,Neuroimaging Research Unit, INSPE, Division of Neuroscience, IRCCS San Raffaele Scientific Institute, Milan, Italy; Vita-SaluteSan Raffaele University, Milan, Italy
| |
Collapse
|
34
|
Fujimoto C, Kawahara T, Yagi M, Murofushi T. Association between vestibular dysfunction and findings of horizontal head-shaking and vibration-induced nystagmus. J Vestib Res 2020; 30:319-327. [PMID: 33164966 DOI: 10.3233/ves-200721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The association between vestibular function and findings of horizontal head-shaking nystagmus (HHSN) and vibration-induced nystagmus (VIN) tests is not well understood. OBJECTIVE To investigate the association between function in the five distinct vestibular end organs and findings of these nystagmus tests. METHODS We retrospectively reviewed the medical records of 50 patients with vestibular diseases who underwent HHSN testing, VIN testing, video head impulse testing (vHIT), cervical vestibular evoked myogenic potential testing to air-conducted sound (ACS cVEMP) and ocular VEMP testing to ACS (ACS oVEMP). We performed mixed-effects logistic regression analyses to see whether age, sex or the presence of nystagmus in HHSN or VIN have an association with the presence of peripheral vestibular dysfunction on the opposite side to the direction of nystagmus. RESULTS The presence of HHSN had a significant association with abnormal vHIT in the lateral semicircular canal (LSCC) on the opposite side to the direction of nystagmus. The presence of VIN had a significant association with abnormal vHIT in all the SCCs and abnormal ACS oVEMP on the opposite side to the direction of nystagmus. CONCLUSIONS HHSN had an association with LSCC dysfunction alone. VIN had an association with dysfunction in all the SCCs and the utricle.
Collapse
Affiliation(s)
- Chisato Fujimoto
- Department of Otolaryngology, Tokyo Teishin Hospital, Tokyo, Japan.,Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takuya Kawahara
- Biostatistics Division, Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Masato Yagi
- Department of Otolaryngology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Toshihisa Murofushi
- Department of Otolaryngology, Tokyo Teishin Hospital, Tokyo, Japan.,Department of Otolaryngology, Teikyo University School of Medicine Mizonokuchi Hospital, Kawasaki, Japan
| |
Collapse
|
35
|
杨 丽, 吴 梅, 唐 亮. [Etiological analysis of 1027 patients with vertigo in Xinjiang Autonomous Region]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2020; 34:1024-1026. [PMID: 33254324 PMCID: PMC10133128 DOI: 10.13201/j.issn.2096-7993.2020.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/22/2020] [Indexed: 06/12/2023]
Abstract
Objective:To analysis the etiological characteristics of patients with vertigo in Xinjiang Uygur Autonomous Region. Method:The data of 1027 patients with vertigo and dizziness were collected and the etiology was analyzed. Result:The patients aged 51-60 years accounted for 27.95% of the total, followed by those aged 61-70 years accounted for 20.16% and those aged 41-50 years accounted for 17.33% s. There were 363 males and 664 females with a ratio of 1∶1.8. Benign paroxysmal positional vertigo (BPPV) was the most common cause in 233 cases (22.69%), followed by vestibular migraine (VM) in 184 cases (17.92%), Meniere's disease (MD) in 139 cases (13.53%), sudden deafness with vertigo in 132 cases (12.85%), and unknown cause in 114 cases (11.10%). Conclusion:Among vertigo patients, women are significantly more than men. BPPV, VM, MD, and SHL are the most common vertigo causes. There are still some patients haven't received definite diagnosis.
Collapse
Affiliation(s)
- 丽 杨
- 新疆维吾尔自治区人民医院耳鼻咽喉科(乌鲁木齐,830001)Department of Otorhinolaryngology, the People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China
| | - 梅 吴
- 新疆维吾尔自治区人民医院耳鼻咽喉科(乌鲁木齐,830001)Department of Otorhinolaryngology, the People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China
| | - 亮 唐
- 新疆维吾尔自治区人民医院耳鼻咽喉科(乌鲁木齐,830001)Department of Otorhinolaryngology, the People's Hospital of Xinjiang Uygur Autonomous Region, Urumqi, 830001, China
| |
Collapse
|
36
|
Oh EH, Shin JH, Cho JW, Choi SY, Choi KD, Choi JH. TRPM7 as a Candidate Gene for Vestibular Migraine. Front Neurol 2020; 11:595042. [PMID: 33193064 PMCID: PMC7649787 DOI: 10.3389/fneur.2020.595042] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Accepted: 09/29/2020] [Indexed: 12/14/2022] Open
Abstract
Objectives: Vestibular migraine (VM) is a common vestibular disorder, and familial aggregation of VM with autosomal-dominant inheritance has been described, which supports a genetic background. This study aimed to describe the clinical phenotype of a family with VM, and identify a candidate gene for VM. Methods: We recruited six individuals (four affected and two unaffected) from three consecutive generations of a Korean family with VM, and performed whole-exome sequencing to search for candidate genes. Results: All affected individuals presented with recurrent vertigo, headache, and nausea/vomiting that fulfilled the diagnostic criteria of VM. Two individuals also experienced transient hemiparesis or dysarthria during the episodes. The symptoms were triggered by physical or emotional stress. Interictal examinations showed uni- or bi-directional horizontal gaze-evoked nystagmus in three of the individuals. They had no causative mutations in genes causing familial hemiplegic migraine or episodic ataxia. Through whole-exome sequencing from three affected individuals, we identified a nonsense mutation c.3526C>T in TRPM7 that encodes a cation channel selective to Ca2+ and Mg2+. Conclusions: Alterations in intracellular Ca2+ and Mg2+ homeostasis by TRPM7 mutation may contribute to the development of the VM phenotype. Our result suggest that TRPM7 is a novel candidate gene for VM.
Collapse
Affiliation(s)
- Eun Hye Oh
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Jin-Hong Shin
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Jae Wook Cho
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| | - Seo-Young Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, South Korea
| | - Kwang-Dong Choi
- Department of Neurology, Pusan National University Hospital, Pusan National University School of Medicine and Biomedical Research Institute, Busan, South Korea
| | - Jae-Hwan Choi
- Department of Neurology, Pusan National University School of Medicine, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, South Korea
| |
Collapse
|
37
|
Association of cervical vestibular-evoked myogenic potential tuning property test results with MRI findings of endolymphatic hydrops in Meniere's disease. Eur Arch Otorhinolaryngol 2020; 278:3267-3273. [PMID: 33037440 DOI: 10.1007/s00405-020-06410-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2020] [Accepted: 09/28/2020] [Indexed: 12/19/2022]
Abstract
PURPOSE To examine the concordance between cervical vestibular-evoked myogenic potential (cVEMP) tuning property test results and MRI findings of endolymphatic hydrops (EH). METHODS Fourteen subjects (age 24-76 years) that had been diagnosed with unilateral definite Meniere's disease (MD) (N = 8) or unilateral probable MD (N = 6) were enrolled. All of the subjects underwent cVEMP tests (using 500 Hz and 1000 Hz tone bursts), pure-tone audiometry, and gadolinium-enhanced 3 T-MRI. To examine tuning properties of cVEMP, the 500-1000 Hz amplitude ratio was calculated as the SLOPE. The results of the cVEMP tuning property test results were compared with EH-related MRI findings. RESULTS EH positivity in both the cochlea and vestibule on MRI was observed in 7 of the 8 affected ears of definite MD and 3 of the 6 affected ears of probable MD, although it was only in one of the 14 unaffected ears. EH(+) or no response (NR) in cVEMP tuning property test was significantly associated with EH positivity on MRI, while EH(-) in the cVEMP tuning property test was significantly associated with EH-negativity on MRI (p = 0.0016 Fisher's exact test test). CONCLUSION EH(+) or NR in the cVEMP tuning property test correspond well to EH positivity in the MRI findings. The cVEMP tuning property test is useful for screening and following up EH.
Collapse
|
38
|
陈 元, 孙 悍, 张 清, 屈 媛, 李 健, 周 玲, 杨 萌, 路 华, 赵 龙, 孙 勍. [Clinical characteristics analysis of patients with Meniere's disease and vestibular migraine]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2020; 34:820-823. [PMID: 33040507 PMCID: PMC10127737 DOI: 10.13201/j.issn.2096-7993.2020.09.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Indexed: 11/12/2022]
Abstract
Objective:To analyze the clinical characteristics of patients with Meniere's disease and vestibular migraine, improve the understanding of such diseases for accurate treatment. Method:Eighteen patients with MD and VM were reviewed and the clinical characteristics of the patients were evaluated. Result:There were 4 males and 14 females whose average age was 55.2 years old. The average onset age was 36.5 years meanwhile the headache occured 7.5 years earlier than the vertigo. The average time of vertigo attacks was 30 min-24 h; The mainly kind of headache was unilateral pulsatile headache with or without vertigo attacks; All patients showed the characteristics of photophobia or phonophobia, 7 of them showed visual aura and 9 of them experienced vertigo attacks with headache but without auditory symptoms; 11 patients experienced motion sickness and 10 patients had a related family history. Electrocochleogram abnormal was 11 ears; c-VEMP abnormal was 11 cases; Caloric test abnormal was 13 cases; Velocity step test abnormal was 4 cases. Conclusion:MD and VM shows recurrent vertigo, There are evidences of hearing loss and abnormal changes of electrocochleogram、c-VEMP and lateral semicircular canal function in MD; VM experienced migraine attacks with the characteristics of photophobia、phonophobia and visual aura; The patients can be diagnosed with overlap syndrome when they fulfill the diagnostic criteria of MD and VM at the same time and the two diseases should be treated at the same time.
Collapse
Affiliation(s)
- 元星 陈
- 解放军总医院第三医学中心 解放军总医院耳鼻咽喉头颈外科医学部 国家耳鼻咽喉疾病临床医学研究中心 聋病教育部重点实验室 聋病防治北京市重点实验室(北京,100039)Department of Otolaryngology Head and Neck Surgery, the Third Medical Center of PLA General Hospital, ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, 100039, China
| | - 悍军 孙
- 解放军总医院第三医学中心 解放军总医院耳鼻咽喉头颈外科医学部 国家耳鼻咽喉疾病临床医学研究中心 聋病教育部重点实验室 聋病防治北京市重点实验室(北京,100039)Department of Otolaryngology Head and Neck Surgery, the Third Medical Center of PLA General Hospital, ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, 100039, China
| | - 清华 张
- 解放军总医院第三医学中心 解放军总医院耳鼻咽喉头颈外科医学部 国家耳鼻咽喉疾病临床医学研究中心 聋病教育部重点实验室 聋病防治北京市重点实验室(北京,100039)Department of Otolaryngology Head and Neck Surgery, the Third Medical Center of PLA General Hospital, ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, 100039, China
| | - 媛怡 屈
- 解放军总医院第三医学中心 解放军总医院耳鼻咽喉头颈外科医学部 国家耳鼻咽喉疾病临床医学研究中心 聋病教育部重点实验室 聋病防治北京市重点实验室(北京,100039)Department of Otolaryngology Head and Neck Surgery, the Third Medical Center of PLA General Hospital, ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, 100039, China
| | - 健 李
- 解放军总医院第三医学中心 解放军总医院耳鼻咽喉头颈外科医学部 国家耳鼻咽喉疾病临床医学研究中心 聋病教育部重点实验室 聋病防治北京市重点实验室(北京,100039)Department of Otolaryngology Head and Neck Surgery, the Third Medical Center of PLA General Hospital, ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, 100039, China
| | - 玲玲 周
- 解放军总医院第三医学中心 解放军总医院耳鼻咽喉头颈外科医学部 国家耳鼻咽喉疾病临床医学研究中心 聋病教育部重点实验室 聋病防治北京市重点实验室(北京,100039)Department of Otolaryngology Head and Neck Surgery, the Third Medical Center of PLA General Hospital, ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, 100039, China
| | - 萌 杨
- 解放军总医院第三医学中心 解放军总医院耳鼻咽喉头颈外科医学部 国家耳鼻咽喉疾病临床医学研究中心 聋病教育部重点实验室 聋病防治北京市重点实验室(北京,100039)Department of Otolaryngology Head and Neck Surgery, the Third Medical Center of PLA General Hospital, ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, 100039, China
| | - 华玉 路
- 解放军总医院第三医学中心 解放军总医院耳鼻咽喉头颈外科医学部 国家耳鼻咽喉疾病临床医学研究中心 聋病教育部重点实验室 聋病防治北京市重点实验室(北京,100039)Department of Otolaryngology Head and Neck Surgery, the Third Medical Center of PLA General Hospital, ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, 100039, China
| | - 龙珠 赵
- 解放军总医院第三医学中心 解放军总医院耳鼻咽喉头颈外科医学部 国家耳鼻咽喉疾病临床医学研究中心 聋病教育部重点实验室 聋病防治北京市重点实验室(北京,100039)Department of Otolaryngology Head and Neck Surgery, the Third Medical Center of PLA General Hospital, ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, 100039, China
| | - 勍 孙
- 解放军总医院第三医学中心 解放军总医院耳鼻咽喉头颈外科医学部 国家耳鼻咽喉疾病临床医学研究中心 聋病教育部重点实验室 聋病防治北京市重点实验室(北京,100039)Department of Otolaryngology Head and Neck Surgery, the Third Medical Center of PLA General Hospital, ColIege of Otolaryngology Head and Neck Surgery, Chinese PLA General Hospital, National Clinical Research Center for Otolaryngologic Diseases, Key Lab of Hearing Science, Ministry of Education, Beijing Key Lab of Hearing Impairment for Prevention and Treatment, Beijing, 100039, China
| |
Collapse
|
39
|
Wang A, Zhou G, Lipson S, Kawai K, Corcoran M, Brodsky JR. Multifactorial Characteristics of Pediatric Dizziness and Imbalance. Laryngoscope 2020; 131:E1308-E1314. [PMID: 32809223 DOI: 10.1002/lary.29024] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Revised: 06/26/2020] [Accepted: 07/21/2020] [Indexed: 12/14/2022]
Abstract
OBJECTIVES To examine the relative prevalence of individual diagnoses in children and adolescents presenting with dizziness and/or imbalance, and to assess the proportion of patients assigned multiple contributing diagnoses. STUDY DESIGN Retrospective cohort study. METHODS We retrospectively reviewed our internal database of all patients seen at our pediatric vestibular program between January 2012 and March 2019 to determine the incidence of common diagnoses and groups of diagnoses for patients ages 21 or younger. RESULTS One thousand twenty-one patients were included with a mean age of 12.5 ± 4.9 years (range: 9 months-21 years). Of this total, 624 patients were female and 397 were male. Common diagnoses included vestibular migraine (VM; 35.0%), benign paroxysmal positional vertigo (BPPV; 21.6%), primary dysautonomia (15.7%), anxiety disorder (13.5%), and persistent postural perceptual dizziness (PPPD; 11.2%). A high proportion of patients (44.4%) received multiple contributing diagnoses. VM was frequently diagnosed with BPPV or PPPD, and 22 patients were diagnosed with all three concurrently. CONCLUSION The causes of dizziness and imbalance in the pediatric population are diverse, and many patients have multiple diagnoses that are often interrelated. It is important that providers recognize that the causes of vestibular symptoms in children and adolescents may be multifactorial and may span across multiple specialties. LEVEL OF EVIDENCE 4 Laryngoscope, 131:E1308-E1314, 2021.
Collapse
Affiliation(s)
- Alicia Wang
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Guangwei Zhou
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Sophie Lipson
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Tufts School of Medicine, Boston, Massachusetts, U.S.A
| | - Kosuke Kawai
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
| | - Meghan Corcoran
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A
| | - Jacob R Brodsky
- Department of Otolaryngology and Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts, U.S.A.,Harvard Medical School, Boston, Massachusetts, U.S.A
| |
Collapse
|
40
|
Gerb J, Ahmadi SA, Kierig E, Ertl-Wagner B, Dieterich M, Kirsch V. VOLT: a novel open-source pipeline for automatic segmentation of endolymphatic space in inner ear MRI. J Neurol 2020; 267:185-196. [PMID: 32666134 PMCID: PMC7718192 DOI: 10.1007/s00415-020-10062-8] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Revised: 06/02/2020] [Accepted: 07/06/2020] [Indexed: 12/16/2022]
Abstract
Background Objective and volumetric quantification is a necessary step in the assessment and comparison of endolymphatic hydrops (ELH) results. Here, we introduce a novel tool for automatic volumetric segmentation of the endolymphatic space (ELS) for ELH detection in delayed intravenous gadolinium-enhanced magnetic resonance imaging of inner ear (iMRI) data. Methods The core component is a novel algorithm based on Volumetric Local Thresholding (VOLT). The study included three different data sets: a real-world data set (D1) to develop the novel ELH detection algorithm and two validating data sets, one artificial (D2) and one entirely unseen prospective real-world data set (D3). D1 included 210 inner ears of 105 patients (50 male; mean age 50.4 ± 17.1 years), and D3 included 20 inner ears of 10 patients (5 male; mean age 46.8 ± 14.4 years) with episodic vertigo attacks of different etiology. D1 and D3 did not differ significantly concerning age, gender, the grade of ELH, or data quality. As an artificial data set, D2 provided a known ground truth and consisted of an 8-bit cuboid volume using the same voxel-size and grid as real-world data with different sized cylindrical and cuboid-shaped cutouts (signal) whose grayscale values matched the real-world data set D1 (mean 68.7 ± 7.8; range 48.9–92.8). The evaluation included segmentation accuracy using the Sørensen-Dice overlap coefficient and segmentation precision by comparing the volume of the ELS. Results VOLT resulted in a high level of performance and accuracy in comparison with the respective gold standard. In the case of the artificial data set, VOLT outperformed the gold standard in higher noise levels. Data processing steps are fully automated and run without further user input in less than 60 s. ELS volume measured by automatic segmentation correlated significantly with the clinical grading of the ELS (p < 0.01). Conclusion VOLT enables an open-source reproducible, reliable, and automatic volumetric quantification of the inner ears’ fluid space using MR volumetric assessment of endolymphatic hydrops. This tool constitutes an important step towards comparable and systematic big data analyses of the ELS in patients with the frequent syndrome of episodic vertigo attacks. A generic version of our three-dimensional thresholding algorithm has been made available to the scientific community via GitHub as an ImageJ-plugin.
Collapse
Affiliation(s)
- J Gerb
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, Munich, Germany.,German Center for Vertigo and Balance Disorders - IFB-LMU, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - S A Ahmadi
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, Munich, Germany.,Graduate School of Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität München, Munich, Germany
| | - E Kierig
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, Munich, Germany.,German Center for Vertigo and Balance Disorders - IFB-LMU, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany
| | - B Ertl-Wagner
- Department of Radiology, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.,Department of Radiology, The Hospital for Sick Children, University of Toronto, Toronto, Canada
| | - M Dieterich
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, Munich, Germany.,German Center for Vertigo and Balance Disorders - IFB-LMU, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany.,Graduate School of Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität München, Munich, Germany.,Munich Cluster for Systems Neurology (SyNergy), Munich, Germany
| | - V Kirsch
- Department of Neurology, University Hospital, Ludwig-Maximilians-Universität München, Marchioninistraße 15, 81377, Munich, Germany. .,German Center for Vertigo and Balance Disorders - IFB-LMU, University Hospital, Ludwig-Maximilians-Universität München, Munich, Germany. .,Graduate School of Systemic Neuroscience (GSN), Ludwig-Maximilians-Universität München, Munich, Germany.
| |
Collapse
|
41
|
Vestibular evoked myogenic potentials in vestibular migraine and Menière's disease: cVEMPs make the difference. J Neurol 2020; 267:169-180. [PMID: 32494851 PMCID: PMC7718204 DOI: 10.1007/s00415-020-09902-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 05/06/2020] [Accepted: 05/07/2020] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Vestibular evoked myogenic potentials (VEMPs) have been suggested as biomarkers in the differential diagnosis of Menière's disease (MD) and vestibular migraine (VM). The aim of this study was to compare the degree of asymmetry for ocular (o) and cervical (c) VEMPs in large cohorts of patients with MD and VM and to follow up the responses. STUDY DESIGN Retrospective study in an interdisciplinary tertiary center for vertigo and balance disorders. METHODS cVEMPs to air-conducted sound and oVEMPs to bone-conducted vibration were recorded in 100 patients with VM and unilateral MD, respectively. Outcome parameters were asymmetry ratios (ARs) of oVEMP n10p15 and cVEMP p13n23 amplitudes, and of the respective latencies (mean ± SD). RESULTS The AR of cVEMP p13n23 amplitudes was significantly higher for MD (0.43 ± 0.34) than for VM (0.26 ± 0.24; adjusted p = 0.0002). MD-but not VM-patients displayed a higher AR for cVEMP than for oVEMP amplitudes (MD 0.43 ± 0.34 versus 0.23 ± 0.22, p < 0.0001; VM 0.26 ± 0.14 versus 0.19 ± 0.15, p = 0.11). Monitoring of VEMPs in single patients indicated stable or fluctuating amplitude ARs in VM, while ARs in MD appeared to increase or remain stable over time. No differences were observed for latency ARs between MD and VM. CONCLUSIONS These results are in line with (1) a more common saccular than utricular dysfunction in MD and (2) a more permanent loss of otolith function in MD versus VM. The different patterns of o- and cVEMP responses, in particular their longitudinal assessment, might add to the differential diagnosis between MD and VM.
Collapse
|
42
|
Xue J, Ma X, Lin Y, Shan H, Yu L. Audiological Findings in Patients with Vestibular Migraine and Migraine: History of Migraine May Be a Cause of Low-Tone Sudden Sensorineural Hearing Loss. Audiol Neurootol 2020; 25:209-214. [PMID: 32200386 DOI: 10.1159/000506147] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2019] [Accepted: 01/24/2020] [Indexed: 11/19/2022] Open
Abstract
INTRODUCTION The aim of this study was to investigate and compare the auditory findings in migraine, vestibular migraine (VM), and healthy controls. METHODS Twenty-eight migraine patients (56 ears), 18 VM (36 ears), and 25 healthy controls (50 ears) were included. Audiometry, speech discrimination scores, distortion product optoacoustic emission (DPOAE), and auditory brainstem response were tested. RESULTS The pure tone in the VM group showed higher thresholds at lower frequencies (250, 500, 1,000, 2,000 Hz) than the control group, with statistical differences observed (P250 Hz = 0.001, P500 Hz = 0.003, P1,000 Hz = 0.016, P2,000 Hz = 0.002). Compared with the healthy controls, the patients with VM had significantly lower amplitudes of DPOAE at 1 kHz (p < 0.001) and 2 kHz (p = 0.020), and the patients with migraine had lower amplitudes at 2 kHz (p = 0.042). Compared with the control group, the patients with migraine reported prolonged latency of wave V (p = 0.016) and IPL I-V (p = 0.003). The patients with VM had significant prolongation of IPL I-V (p = 0.024). CONCLUSION Not only the peripheral, but also the central auditory system was involved in patients with migraine and VM. In particular, lower frequencies of the auditory system were more likely to be involved in VM. The history of migraine may be a cause of low-tone sudden sensorineural hearing loss.
Collapse
Affiliation(s)
- Junfang Xue
- Department of Otolaryngology, Peking University People's Hospital, Beijing, China
| | - Xin Ma
- Department of Otolaryngology, Peking University People's Hospital, Beijing, China
| | - Yunjuan Lin
- Department of Otolaryngology, Peking University International Hospital, Beijing, China
| | - Haijun Shan
- Department of Otolaryngology, Peking University International Hospital, Beijing, China
| | - Lisheng Yu
- Department of Otolaryngology, Peking University People's Hospital, Beijing, China,
| |
Collapse
|
43
|
Pyykkö I, Pyykkö N, Manchaiah V. Vestibular drop attacks in Ménière’s disease and its association with migraine. Eur Arch Otorhinolaryngol 2020; 277:1907-1916. [DOI: 10.1007/s00405-020-05890-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2019] [Accepted: 02/25/2020] [Indexed: 12/12/2022]
|
44
|
Murofushi T, Goto F, Tsubota M. Vestibular Migraine Patients Show Lack of Habituation in Auditory Middle Latency Responses to Repetitive Stimuli: Comparison With Meniere's Disease Patients. Front Neurol 2020; 11:24. [PMID: 32153487 PMCID: PMC7044244 DOI: 10.3389/fneur.2020.00024] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2019] [Accepted: 01/09/2020] [Indexed: 11/13/2022] Open
Abstract
Objectives: To compare habituation in auditory middle latency response (AMLR) to repetitive stimuli of vestibular migraine (VM) patients with Meniere's disease (MD) patients and healthy controls (HC) and to assess usefulness of AMLR for diagnosis of VM. Subjects: Thirteen unilateral definite MD patients (2 men, 11 women, mean age 50.6), 13 definite VM patients (3 men, 10 women, mean age 45.5), and 8 HC subjects (2 men, 6 women, mean age 37.1) were enrolled. Methods: The electrodes were placed on the vertex and the spinal process of the fifth cervical vertebra. Binaural click stimulation (0.1 ms, 70 dBnHL) was presented. A total of 800 responses were averaged. Averaged responses were divided into four sets (S1 to S4) according to the temporal order. No, Po, Na, and Pa were identified, and amplitudes and latencies were measured. Results: Concerning latencies, HC subjects showed a tendency of shorter latencies. However, there was no clear effect of repetitive stimulation. Concerning No-Po amplitudes, no significant differences were observed. Raw amplitudes of Na-Pa showed statistically significant differences in S1 and S2 among the groups (p < 0.01 one-way ANOVA). Differences were shown in MD vs. VM and HC vs. VM in S1 (smaller in VM) (p < 0.01 Bonferroni's test) and in MD vs. VM in S2 (smaller in VM) (p < 0.01 Bonferroni test). Relative amplitudes of Na-Pa to S1 showed statistically significant differences in S4 (p < 0.01 one-way ANOVA). Differences were shown in MD vs. VM and HC vs. VM (larger in VM) (p < 0.01 Bonferroni's test). Differences of Na-Pa amplitudes in S2 to S4 from Na-Pa amplitude in S1 were significant in S4 of VM patients (Dunnett's test). Conclusions: VM patients showed lack of habituation (potentiation) of Na-Pa amplitude in AMLR to repetitive stimuli while MD patients and HC subjects showed habituation. Observation of lack of habituation has high diagnostic accuracy for differential diagnosis of VM from MD.
Collapse
Affiliation(s)
- Toshihisa Murofushi
- Department of Otolaryngology, Teikyo University School of Medicine Mizonokuchi Hospital, Kawasaki, Japan
| | - Fumiyuki Goto
- Department of Otolaryngology, Tokai University School of Medicine, Isehara, Japan
| | - Masahito Tsubota
- Department of Otolaryngology, Teikyo University School of Medicine Mizonokuchi Hospital, Kawasaki, Japan
| |
Collapse
|
45
|
Han DG, Kim DJ. The evolutionary hypothesis of benign paroxysmal positional vertigo. Med Hypotheses 2020; 134:109445. [DOI: 10.1016/j.mehy.2019.109445] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2019] [Accepted: 10/17/2019] [Indexed: 01/04/2023]
|
46
|
Pyykkö I, Manchaiah V, Färkkilä M, Kentala E, Zou J. Association between Ménière’s disease and vestibular migraine. Auris Nasus Larynx 2019; 46:724-733. [DOI: 10.1016/j.anl.2019.02.002] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Revised: 01/16/2019] [Accepted: 02/03/2019] [Indexed: 12/17/2022]
|
47
|
Abstract
The term vestibular migraine designates recurrent vertigo that is caused by migraine. Vestibular migraine presents with episodes of spontaneous or positional vertigo lasting seconds to days that are accompanied by migraine symptoms. Because headache is often absent during acute attacks, other migraine features have to be identified by thorough history taking. In contrast, vestibular testing serves mainly for the exclusion of other diagnoses. Treatment still lacks solid evidence. It is targeted at the underlying migraine and comprises explanation and reassurance, lifestyle modifications, and drugs.
Collapse
Affiliation(s)
- Thomas Lempert
- Department of Neurology, Schlosspark-Klinik, Heubnerweg 2, Berlin 14059, Germany.
| | | |
Collapse
|
48
|
Kutlubaev MA, Pal'chun VT, Savel'eva EE, Guseva AL. [Vascular mechanisms in Meniere's disease]. Vestn Otorinolaringol 2019; 84:70-77. [PMID: 31198220 DOI: 10.17116/otorino20198402170] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Meniere's disease (MD) is chronic multifactorial medical condition caused by endolymphatic hydrops, which etiology is unclear. This review highlights possible vascular mechanisms of MD. Impairment of vascular regulation, further ischemic damage of labyrinth and venous drainage pathology could lead to endolymphatic hydrops. Epidemiologic studies reveal high comorbidity of MD and migraine. Both diseases could be the result of trigeminovascular dysfunction. Betahistine, the medication with vascular effect, is widely used in treatment of MD, the effectiveness of calcium channel blockers is evaluated. Keywords: vertigo, Meniere's disease, endolymphatichydrops, migraine, vascular mechanisms, betahistine.
Collapse
Affiliation(s)
- M A Kutlubaev
- Kuvatov Republican Clinical Hospital, Ufa, Russia, 450005,Bashkir State Medical University of the Ministry of Health of Russia, Ufa, Russia, 450000
| | - V T Pal'chun
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia, 117997,Sverzhevsky Research Institute of Clinical Otorhinolaryngology, Moscow, Russia, 117152
| | - E E Savel'eva
- Bashkir State Medical University of the Ministry of Health of Russia, Ufa, Russia, 450000
| | - A L Guseva
- N.I. Pirogov Russian National Research Medical University of the Ministry of Health of Russia, Moscow, Russia, 117997
| |
Collapse
|
49
|
Murofushi T, Tsubota M, Suzuki D. Idiopathic acute high-tone sensorineural hearing loss accompanied by vertigo: vestibulo-cochlear artery syndrome? Consideration based on VEMP and vHIT. J Neurol 2019; 266:2066-2067. [DOI: 10.1007/s00415-019-09353-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2019] [Revised: 04/29/2019] [Accepted: 05/02/2019] [Indexed: 11/24/2022]
|
50
|
Kaya I, Eraslan S, Tarhan C, Bilgen C, Kirazli T, Gokcay F, Karapolat H, Celebisoy N. Can verapamil be effective in controlling vertigo and headache attacks in vestibular migraine accompanied with Meniere's disease? A preliminary study. J Neurol 2019; 266:62-64. [PMID: 30989371 DOI: 10.1007/s00415-019-09309-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/28/2019] [Accepted: 04/02/2019] [Indexed: 01/03/2023]
Affiliation(s)
- Isa Kaya
- Department of Otolaryngology, Ege University Medical School, Izmir, Turkey
| | - Sevinc Eraslan
- Department of Otolaryngology, Ege University Medical School, Izmir, Turkey
| | - Ceyda Tarhan
- Department of Otolaryngology, Iğdır State Hospital, Iğdır, Turkey
| | - Cem Bilgen
- Department of Otolaryngology, Ege University Medical School, Izmir, Turkey
| | - Tayfun Kirazli
- Department of Otolaryngology, Ege University Medical School, Izmir, Turkey
| | - Figen Gokcay
- Department of Neurology, Ege University Medical School, Bornova, 35100, Izmir, Turkey
| | - Hale Karapolat
- Department of Physical Therapy and Rehabilitation, Ege University Medical School, Izmir, Turkey
| | - Nese Celebisoy
- Department of Neurology, Ege University Medical School, Bornova, 35100, Izmir, Turkey.
| |
Collapse
|