1
|
Lee JM, Lee HJ. Different clinical course of BPPV according to the medical conditions. Sci Rep 2024; 14:12941. [PMID: 38839867 PMCID: PMC11153214 DOI: 10.1038/s41598-024-63882-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2024] [Accepted: 06/03/2024] [Indexed: 06/07/2024] Open
Abstract
Dizziness is one of the most prevalent complaints in medicine, and benign paroxysmal positional vertigo (BPPV) accounts for one-third of all cases. The present study was aimed at identifying differences in the course and prognosis of BPPV depending on the patient's medical condition during hospitalization. Patients in group 1 were hospitalized due to trauma, those in group 2 for scheduled surgery, and those in group 3 for medical treatment. The intervals from admission to symptom onset, surgery to symptom onset, and symptom onset to ENT department referral were compared. The interval from admission to symptom onset was shortest in group 1 (3.1 ± 8.0 days) and differed significantly from that in group 3 (20.0 ± 35.0 days, p < 0.001). The interval from surgery to symptom onset for group 2 was 5.6 ± 5.8 days and was significantly shorter than that from admission to symptom onset for group 3 (p = 0.014). The interval from symptom onset to ENT referral in group 3 (2.0 ± 2.8 days) was significantly shorter than in groups 1 and 2 (4.1 ± 5.1 and 4.0 ± 3.6 days, p = 0.008 and p = 0.002, respectively). The findings imply that the course of BPPV differed according to the patients' medical condition.
Collapse
Affiliation(s)
- Jeon Mi Lee
- Department of Otorhinolaryngology, Ilsan Paik Hospital, Inje University College of Medicine, Goyang, Korea
| | - Hyun Jin Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Incheon St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea.
| |
Collapse
|
2
|
Castillo-Bustamante M, Çelebisoy N, Echavarria LG, Franco I, Valencia S, Gonzalez S, García A. Balance in Transition: Unraveling the Link Between Menopause and Vertigo. Cureus 2024; 16:e59277. [PMID: 38813338 PMCID: PMC11135238 DOI: 10.7759/cureus.59277] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/29/2024] [Indexed: 05/31/2024] Open
Abstract
The onset of menopause, marked by hormonal fluctuations and a decline in estrogen levels, is suggested to be linked to increased susceptibility to vestibular disturbances. Estrogen, beyond its established association with reproductive physiology, plays modulatory roles in various physiological systems, including neurosensory function. The vestibular system, crucial for balance and spatial orientation, is influenced by hormonal changes during menopause, potentially contributing to the emergence of vertigo symptoms. This interplay between hormones and the vestibular system is a burgeoning area of research with clinical implications, offering insights into novel diagnostic and therapeutic approaches for managing postmenopausal women with vestibular disorders. The article reviews current scientific literature, delves into the hormonal intricacies of menopause, and investigates potential mechanisms underlying the connection between hormonal fluctuations and vertigo symptoms.
Collapse
Affiliation(s)
- Melissa Castillo-Bustamante
- Otoneurology, Centro de Vértigo y Mareo, Mexico City, MEX
- Medicine, Universidad Pontificia Bolivariana, Medellín, COL
| | | | - Luis G Echavarria
- Obstetrics and Gynecology, Clinica Universitaria Bolivariana, Medellín, COL
| | - Isabela Franco
- Otolaryngology, Universidad Pontificia Bolivariana, Medellín, COL
| | | | - Sara Gonzalez
- Otolaryngology, Universidad Pontificia Bolivariana, Medellin, COL
| | | |
Collapse
|
3
|
Abedi MS, Flink TS, Roca CP. A Rare Presentation of Multicanal Benign Paroxysmal Positional Vertigo in a Premenopausal Woman With Osteopenia: A Case Report. Cureus 2024; 16:e55421. [PMID: 38567227 PMCID: PMC10985560 DOI: 10.7759/cureus.55421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2023] [Accepted: 03/03/2024] [Indexed: 04/04/2024] Open
Abstract
We report a case of non-traumatic, multicanal benign paroxysmal positional vertigo (BPPV) in a premenopausal, osteopenic 35-year-old female with corresponding low bone mineral density. Dix-Hallpike and supine roll tests confirmed unilateral posterior canal (PC) BPPV from 2012-2014, and later, a rare presentation of multicanal BPPV with specifically ipsilateral horizontal canals (HC) and anterior canals (AC) affected in 2015. Heel scans displayed T-scores within the osteopenia range in 2012 until levels normalized one year later. Despite treatment with indicated canalith repositioning treatments (CRTs), symptoms continued to persist. Complete resolution of symptoms occurred in 2016, which is most likely due to self-treatment with daily 5000 IU vitamin D in 2015. This case emphasizes the rare presentation of unilateral single-canal BPPV to multi-canal BPPV, along with the importance of vitamin D treatment in preventing the recurrence of symptoms.
Collapse
Affiliation(s)
- Maleeha S Abedi
- Medicine, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | - Tania S Flink
- Physiology, Lake Erie College of Osteopathic Medicine, Bradenton, USA
| | | |
Collapse
|
4
|
Ren YY, Wang YJ, Li JL, Liu M, Xia F. Low vitamin D and uric acid status in patients with benign paroxysmal positional vertigo. Sci Prog 2023; 106:368504231205397. [PMID: 37807761 PMCID: PMC10563478 DOI: 10.1177/00368504231205397] [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: 10/10/2023]
Abstract
PURPOSE Growing evidence reported that vitamin D and uric acid metabolism played roles in the occurrence of benign paroxysmal positional vertigo, an otoconia-related vestibular disorder. We aimed to investigate the serum 25-hydroxy vitamin D (25(OH)D) and uric acid in patients with benign paroxysmal positional vertigo and to determine the risk factor for benign paroxysmal positional vertigo. METHODS This case-control study comprised 182 patients with benign paroxysmal positional vertigo and 182 age- and gender-matched controls. All subjects' age, body mass index, systolic blood pressure, diastolic blood pressure, 25-hydroxyvitamin D (25(OH)D), uric acid and serum calcium measurements were analyzed. RESULTS We found a female preponderance of benign paroxysmal positional vertigo patients, with a median of 60 (52-66) years old. The results showed low vitamin D status both in benign paroxysmal positional vertigo and controls, with no significant difference of 25(OH)D levels between benign paroxysmal positional vertigo patients and controls (P > 0.05). Compared with the control group, patients with benign paroxysmal positional vertigo had a higher prevalence of vitamin D deficiency and a lower prevalence of vitamin D sufficiency (P < 0.05). Uric acid was significantly lower in the benign paroxysmal positional vertigo groups (P < 0.05). Logistic regression analysis revealed that age and uric acid were considered higher risk predictors for benign paroxysmal positional vertigo. CONCLUSION Our study observed low vitamin D status in patients with benign paroxysmal positional vertigo, with no significant differences of the 25(OH)D level in patients with benign paroxysmal positional vertigo and controls. Elderly, vitamin D deficiency and low uric acid levels may be risk factors for benign paroxysmal positional vertigo occurrence.
Collapse
Affiliation(s)
- Yuan-Yuan Ren
- Department of Otorhinolaryngology Head & Neck Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Yan-Jun Wang
- Department of Otorhinolaryngology Head & Neck Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Jin-Lan Li
- Department of Otorhinolaryngology Head & Neck Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Mo Liu
- Department of Otorhinolaryngology Head & Neck Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| | - Fei Xia
- Department of Otorhinolaryngology Head & Neck Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|
5
|
El Khiati R, Tighilet B, Besnard S, Chabbert C. Vestibular Disorders and Hormonal Dysregulations: State of the Art and Clinical Perspectives. Cells 2023; 12:cells12040656. [PMID: 36831323 PMCID: PMC9954452 DOI: 10.3390/cells12040656] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2023] [Revised: 02/13/2023] [Accepted: 02/16/2023] [Indexed: 02/22/2023] Open
Abstract
The interaction between endocrine and vestibular systems remains poorly documented so far, despite numerous observations in humans and animals revealing direct links between the two systems. For example, dizziness or vestibular instabilities often accompany the menstrual cycle and are highly associated with the pre-menopause period, while sex hormones, together with their specific receptors, are expressed at key places of the vestibular sensory network. Similarly, other hormones may be associated with vestibular disorders either as causal/inductive factors or as correlates of the pathology. This review was carried out according to the PRISMA method, covering the last two decades and using the MEDLINE and COCHRANE databases in order to identify studies associating the terms vestibular system and/or vestibular pathologies and hormones. Our literature search identified 646 articles, 67 of which referred directly to vestibular dysfunction associated with hormonal variations. While we noted specific hormonal profiles depending on the pathology considered, very few clinical studies attempted to establish a direct link between the expression of the vestibular syndrome and the level of circulating hormones. This review also proposes different approaches to shed new light on the link between hormones and vestibular disorders, and to improve both the diagnosis and the therapeutic management of dizzy patients.
Collapse
Affiliation(s)
- Rhizlane El Khiati
- Aix Marseille University—Centre National de la Recherche Scientifique (CNRS), Laboratory of Cognitive Neurosciences, UMR7291, Team Pathophysiology and Therapy of Vestibular Disorders, 13331 Marseille, France
- Research Group on Vestibular Pathophysiology, Centre National de la Recherche Scientifique (CNRS), Unit GDR2074, 13331 Marseille, France
| | - Brahim Tighilet
- Aix Marseille University—Centre National de la Recherche Scientifique (CNRS), Laboratory of Cognitive Neurosciences, UMR7291, Team Pathophysiology and Therapy of Vestibular Disorders, 13331 Marseille, France
- Research Group on Vestibular Pathophysiology, Centre National de la Recherche Scientifique (CNRS), Unit GDR2074, 13331 Marseille, France
| | - Stéphane Besnard
- Aix Marseille University—Centre National de la Recherche Scientifique (CNRS), Laboratory of Cognitive Neurosciences, UMR7291, Team Pathophysiology and Therapy of Vestibular Disorders, 13331 Marseille, France
- Research Group on Vestibular Pathophysiology, Centre National de la Recherche Scientifique (CNRS), Unit GDR2074, 13331 Marseille, France
| | - Christian Chabbert
- Aix Marseille University—Centre National de la Recherche Scientifique (CNRS), Laboratory of Cognitive Neurosciences, UMR7291, Team Pathophysiology and Therapy of Vestibular Disorders, 13331 Marseille, France
- Research Group on Vestibular Pathophysiology, Centre National de la Recherche Scientifique (CNRS), Unit GDR2074, 13331 Marseille, France
- Correspondence:
| |
Collapse
|
6
|
Acra-Tolari R, Mejía D, Mirambeaux M, Germán Dihmes A. Audiovestibular Symptoms in Osteoporotic Postmenopausal Dominican Women. Cureus 2022; 14:e25300. [PMID: 35755503 PMCID: PMC9224694 DOI: 10.7759/cureus.25300] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/24/2022] [Indexed: 11/05/2022] Open
|
7
|
Hormones and Vestibular Disorders: The Quest for Biomarkers. Brain Sci 2022; 12:brainsci12050592. [PMID: 35624978 PMCID: PMC9139641 DOI: 10.3390/brainsci12050592] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2022] [Revised: 04/27/2022] [Accepted: 04/29/2022] [Indexed: 12/04/2022] Open
Abstract
The vestibular system exerts control over various functions through neural pathways that are not yet fully mapped. Functional dysregulations or tissue lesions at different levels of the peripheral and the central vestibular networks can alter these different functions, causing a wide variety of symptoms, ranging from posturo-locomotor alterations to psychiatric syndromes such as PPPD, including the deregulation of the main biological functions. These different symptoms differ by their expression kinetics (they each appear and regress with their own kinetics) by the targets affected (muscles, organs, and brain areas) and by the sensitivity specific to each individual. Vestibular pathologies thus cover a mosaic of distinct effects, and they involve various effectors—which constitute the many markers of their different types and stages. It is therefore crucial, to predict the onset of a vertigo syndrome, to follow its temporal course, or to monitor the impact of therapeutic approaches, and to have specific and reliable biomarkers. Hormonal variations are among the possible sources of biomarkers for neurotology. We know that specific hormonal profiles can promote the appearance of vestibular disorders. We also know that the expression of vertigo syndrome is accompanied by measurable hormonal variations. The link between endocrine deregulation and vestibular alterations therefore no longer needs to be proven. However, there are still few data on their precise correlations with the vertigo syndrome. This study was undertaken with the aim to deliver an extensive review of the hormonal alterations linked to vestibular disorders. A review of the literature covering the last two decades was carried out using the MEDLINE and COCHRANE databases in order to identify studies associating the terms vestibular system or vestibular pathologies and hormones. Bibliographic data provides several outcomes in terms of therapeutic innovation in the diagnosis and therapeutic follow-up of vestibular pathologies.
Collapse
|
8
|
Abstract
PURPOSE OF REVIEW Vestibular disorders are gender distributed with a higher prevalence in women. Although research has increased in this field, the mechanisms underlying this unbalance is unclear. This review summarises recent advances in this research sphere, and briefly discusses sex hormone effects on various vestibular conditions and highlights some recent theories. RECENT FINDINGS Recent work has identified a direct link between aberrant gonadal hormone levels and vestibular dysfunction. Benign paroxysmal positional vertigo research suggests that the disorder may be linked to the rapid decrease in oestrogen, observed in menopausal women, which disrupts otoconial metabolism within the inner ear. A successful hormonal therapeutic intervention study has advanced our knowledge of hormonal influences in the inner ear in Ménière's disease. Also, several studies have focused on potential mechanisms involved in the interaction between Vestibular Migraine, Mal de Debarquement Syndrome, and gonadal hormones. SUMMARY In females, gonadal hormones and sex-specific synaptic plasticity may play a significant role in the underlying pathophysiology of peripheral and central vestibular disorders. Overall, this review concludes that clinical assessment of female vestibular patients requires a multifaceted approach which includes auditory and vestibular medicine physicians, gynaecologists and/or endocrinologists, in conjunction with hormonal profile evaluations.
Collapse
Affiliation(s)
- Viviana Mucci
- School of Science, Campbelltown Campus, Western Sydney University, NSW, Australia
| | | | - Yves Jacquemyn
- Antwerp University Hospital UZA, Drie Eikenstraat 655, 2650 Edegem Belgium and Antwerp University UA, ASTARC and GHI, Wilrijk, Belgium
| | - Cherylea J Browne
- School of Science, Campbelltown Campus, Western Sydney University, NSW, Australia
- Translational Neuroscience Facility, School of Medical Sciences, UNSW Sydney, NSW, Australia
| |
Collapse
|
9
|
Nutraceuticals for Peripheral Vestibular Pathology: Properties, Usefulness, Future Perspectives and Medico-Legal Aspects. Nutrients 2021; 13:nu13103646. [PMID: 34684646 PMCID: PMC8538675 DOI: 10.3390/nu13103646] [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: 08/19/2021] [Revised: 10/09/2021] [Accepted: 10/13/2021] [Indexed: 02/07/2023] Open
Abstract
Vestibular disorders may generate complex signs and symptoms, which may alter patients' balance and the quality of life. Dizziness and vertigo can strongly affect daily activities and relations. Despite the presence of conventional drugs, maneuvers, and surgery, another interesting therapeutic opportunity is offered by nutraceuticals. These molecules are often used in the treatment of dizziness and vertigo, but the rationale of their application is not always solidly demonstrated by the scientific evidence. Several substances have shown a variable level of efficacy/usefulness in this field, but there is lack of important evidence for most of them. From a medico-legal point of view, specific information must be provided to the patient regarding the efficacy and possibilities that the use of these preparations can allow. Administering the right nutraceutical to the proper patient is a fundamental clinical skill. Integrating conventional drug treatment with nutraceutical administration seems to be easy, but it may be difficult considering the (in part unexplored) pharmacodynamics and pharmacokinetics of nutraceuticals. The aim of the scientific community should be to elevate nutraceuticals to the same law and technical dignity of conventional drugs.
Collapse
|
10
|
Li C, Guo D, Ma X, Liu S, Liu M, Zhou L. The Impact of Coronavirus Disease 2019 Epidemic on Dizziness/Vertigo Outpatients in a Neurological Clinic in China. Front Neurol 2021; 12:663173. [PMID: 33995259 PMCID: PMC8116702 DOI: 10.3389/fneur.2021.663173] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2021] [Accepted: 03/19/2021] [Indexed: 11/17/2022] Open
Abstract
Objective: This study aims to investigate the impact of the coronavirus disease 2019 (COVID-19) epidemic on dizziness/vertigo outpatients in a neurological clinic in China. Methods: Against the background of the COVID-19 epidemic, the data of patients who visited the neurological clinic of Beijing Chaoyang Hospital West Branch during the pandemic (February 1-May 30, 2020) and the corresponding period in 2019 (February 1-May 30, 2019) were analyzed, and patients with dizziness/vertigo from these two periods were compared to discover their demographic features and etiologic distribution according to their age and sex. Result: The absolute number of neurological outpatients decreased from 14,670 in 2019 to 8,763 in 2020 (-40.3%), with a corresponding decline in dizziness/vertigo patients (2019: n = 856; 2020: n = 1,436, -40.4%). Dizziness/vertigo was more common in women than men in these two periods (2019: women = 63.6%; 2020: women = 63.1%, p = 0.82). The overall etiology distribution was different among all disorders between the two periods (p < 0.001). There was an increase in benign paroxysmal positional vertigo (BPPV) (2019 vs. 2020: 30.7 vs. 35%, p < 0.05) and psychogenic/persistent postural perceptual dizziness (PPPD) (2019 vs. 2020: 28.5 vs. 34.6%, p < 0.05) while a decrease in vascular vertigo during the epidemic (2019 vs. 2020: 13 vs. 9.6%, p < 0.05). During the epidemic, the top three causes of dizziness/vertigo were BPPV (35%), psychogenic/PPPD (34.6%), and vascular vertigo (9.6%). A female predominance was observed in BPPV (women = 67.7%, p < 0.05) and psychogenic/PPPD (women = 67.6%, p < 0.05). In addition, the etiology ratio of different age groups was significantly different (p < 0.001). The most common cause for young and young-old patients was BPPV, and the most common cause for middle-aged and old-old patients was psychogenic/PPPD. Conclusion: The absolute number of outpatients with dizziness/vertigo during the COVID-19 pandemic was reduced during the early period of the COVID-19 outbreak. BPPV and psychogenic/PPPD were more abundant, and vascular vertigo was less frequent. Based on those data, health-care management policy for dizziness/vertigo and mental disorder should be developed during the outbreak of COVID-19 and other infective diseases.
Collapse
Affiliation(s)
- Changqing Li
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Dongsheng Guo
- Department of Emergency, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Xiangke Ma
- Department of Neurosurgery, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Siwei Liu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Mingyong Liu
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| | - Lichun Zhou
- Department of Neurology, Beijing Chaoyang Hospital, Capital Medical University, Beijing, China
| |
Collapse
|