Population epidemiological study on the prevalence of dizziness in the city of São Paulo

Evaluation of cervical vestibular miogenic evoked potential and electrococleography in the diagnosis of vestibular migraine

OBJECTIVES

Vestibular migraine is a neurological disorder characterized by the association of vertigo and headache, affecting up to 1% of the population. Among its differential diagnoses is endolymphatic hydrops. The aim of this study was to investigate the role of cervical vestibular-evoked myogenic potential and electrocochleography in the diagnosis of vestibular migraine.

METHOD

Thirteen women with clinical diagnosis of vestibular migraine (mean age 44 years) and 13 healthy volunteers without auditory and/or vestibular complaints matched for sex and age were evaluated by performing hydrops examinations of cervical vestibular-evoked myogenic potential and electrocochleography.

RESULTS

The presence of vertigo and headache was reported by all members of the group with vestibular migraine, associated with symptoms such as nausea, photophobia, and phonophobia. Tinnitus was the most frequent auditory complaint. A significant increase in P1 and N1 latencies was observed in the test group. There was no significant difference in the occurrence of asymmetry and decreased amplitude of the cervical vestibular-evoked myogenic potential. Electrocochleography showed an increase in amplitude of the summation potential. The altered SP/AP ratio was double in the group with vestibular migration, without statistical significance.

CONCLUSIONS

Changes in latency increase of cervical vestibular-evoked myogenic potential suggests a central lesion. Patients with vestibular migraine may present electrocochleography compatible with endolymphatic hydrops.

LEVEL OF EVIDENCE

Level 4.

Factors Related to Dizziness in Workers With Noise-Induced Hearing Loss in Brazil

OBJECTIVE

The purpose of this study was to describe the factors related to dizziness in workers with noise-induced hearing loss in Brazil.

METHOD

A cross-sectional study was carried out with a sample from noise-induced hearing loss reports (2007-2019). The dependent variable in this study was dizziness, and the independent variables were sociodemographic characteristics, comorbidities, symptoms, and noise characteristics in the work environment. Logistic regression analysis was performed.

RESULTS

A total of 3,824 individuals with noise-induced hearing loss in Brazil were analyzed. The prevalence of dizziness was 23.4% in the sample. Factors associated with dizziness were women (odds ratio [OR]: 2.10; 95% confidence interval [CI] [1.64, 2.69]), hypertension (OR: 1.68; 95% CI [1.38, 2.06]), headache (OR: 6.31; 95% CI [5.26, 7.57]), tinnitus (OR: 3.46; 95% CI [2.82, 4.25]), and continuous noise at the work environment (OR: 1.54; 95% CI [1.22, 1.94]).

CONCLUSIONS

The factors associated with the outcome-dizziness-were gender (female), systemic arterial hypertension, headache, tinnitus, and continuous exposure to workplace noise. Such findings demonstrate the importance of promoting a multifactorial approach to understanding dizziness among workers exposed to occupational noise.

Brazilian Version of the Vestibular Activities and Participation Measure: Cross-Cultural Adaptation, Validity, and Reliability

BACKGROUND

Vestibular Activities and Participation Measure (VAP) subscales assess the effect of vestibular disorders on activity and participation. This study aimed to perform the cross-cultural adaptation and assess the validity, internal consistency, reliability, and measurement error of the Brazilian version of VAP subscales.

METHODS

The cross-cultural adaptation followed the translation, synthesis, back-translation, review by a committee of experts, and pretesting phases. Structural validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), while Spearman's correlation between VAP subscales and the Dizziness Handicap Inventory (DHI) was used to assess construct validity. Cronbach's alpha measured internal consistency. Intraclass correlation coefficient (ICC) assessed intra- and inter-rater reliability, and measurement error was calculated by using the standard error of measurement (SEM) and minimal detectable change (MDC).

RESULTS

Additional information was included in the Brazilian version of the Vestibular Activities and Participation measure (VAP-BR) after approval by one of the developers of the instrument to improve the understanding among individuals. One factor was found in the EFA for each subscale with 50% explained variance. Regarding CFA, the subscales 1 (S1) and 2 (S2) presented, respectively, adequate model fit indices (ie, comparative fit index of 0.99 and 0.97, and standardized root mean square residual of 0.04 for both subscales), but a very low factor load in item 6 of S1 (0.08). Chronbach's alpha was 0.80 (S1) and 0.82 (S2). For intra-rater assessment, the S1 and S2 presented an ICC of 0.87 and 0.90, SEM of 0.01 and 1.16, and MDC of 0.39 and 0.46, respectively. When assessed by 2 different raters, SEM values were 1.03 and 1.53, and MDC values were 2.85 and 4.23 for S1 and S2, respectively; both subscales showed an ICC of 0.92. Correlations between DHI and VAP subscales presented coefficients above 0.57.

CONCLUSION

The Brazilian version of VAP subscales presents good measurement properties and may assist health professionals in identifying activity limitations and participation restrictions in individuals with vestibular disorders.

Vertigo and its burden of disease-Results from a population-based cohort study

Objectives

Vertigo describes symptoms of abnormal movement of the environment or the patient's own body. As such, it affects patients' quality of life, prevents them from following their daily activities, and increases healthcare utilization. The Global Burden of Disease Project aims to quantify morbidity and mortality worldwide. In 2013, a separate disability weight for vertigo was introduced. The aim of this study is to estimate the symptom burden of disease caused by vertigo.

Methods

This study analyzes data from the Gutenberg Health Study (GHS). The GHS is a population-based cohort study representative of the city of Mainz and its district. Participants were asked whether they suffered from vertigo and, if so, how bothered they felt by it, rating their distress on a six-level scale from 1 = little stressful to 6 = extremely stressful.

Results

Eight thousand five hundred and nineteen participants could be included in the study. The overall prevalence of vertigo was 21.6% (95%-confidence interval [CI] [20.7%; 22.5%]). Vertigo prevalence peaked in the age group of 55-64 years. Vertigo annoyance averaged 2.42 (± 1.28). When an annoyance of 3-6 was considered bothersome, the prevalence of bothersome vertigo was 8.1 % (95%-CI [7.5%; 8.7%]). Age-standardized to the European Standard Population 2013, vertigo caused a burden of 2102 years lived with disability per 100,000 population.

Conclusion

In this study, it was found that one in five people suffer at least occasionally from vertigo. This result suggests a significant burden of disease. This burden is reported at the symptom level. Future studies are needed to attribute the burden to specific causes.

Level of Evidence

2.

Climatic variations and pollution on benign paroxysmal positional vertigo in Kars, Türkiye

Benign paroxysmal positional vertigo (BPPV) is the most common diagnosis for peripheral vertigo. Although pathophysiological mechanisms remain unclear, BPPV is mostly idiopathic and factors related to BPPV are still being investigated. Knowing these factors can contribute to the prevention and management of BPPV. In this study, we investigated the correlations between climatic variations, pollution, and BPPV retrospectively. 262 patients diagnosed with BPPV between 2019 and 2021 in Kars, Türkiye, were included in our study. Meteorological parameters were obtained from Turkish State Meteorological Service. Horizontal BPPV increased significantly with the humidity (p < 0.05). In addition, carbon monoxide levels significantly increased the potantial of BPPV (p < 0.05). Surprisingly, BPPV increased in the summertime and showed a significant relationship with humidity. We believe this change is related with the city-specific features as it is the coldest place in the country, emigrant province and crowded in the summer times.

What is the current status of primary care in the diagnosis and treatment of patients with vertigo and dizziness in Switzerland? A national survey

Background

Vertigo and dizziness are among the most frequent presenting symptoms in the primary care physicians' (PCPs) office. With patients facing difficulties in describing their complaints and clinical findings often being subtle and transient, the diagnostic workup of the dizzy patient remains challenging. We aimed to gain more insights into the current state of practice in order to identify the limitations and needs of the PCPs and define strategies to continuously improve their knowledge in the care of the dizzy patient.

Materials and methods

Board-certified PCPs working in Switzerland were invited to participate in an online survey. A descriptive statistical analysis was performed, and prospectively defined hypotheses were assessed using regression analyses.

Results

A vast majority of participating PCPs (n = 152) were familiar with the key questions when taking the dizzy patient's history and with performing provocation/repositioning maneuvers when posterior-canal benign paroxysmal positional vertigo (BPPV) was suspected (91%). In contrast, strong agreement that performing the alternating cover test (21%), looking for a spontaneous nystagmus with fixation removed (42%), and performing the head-impulse test (47%) were important was considerably lower, and only 19% of PCPs were familiar with lateral-canal BPPV treatment. No specific diagnosis could be reached in substantial fractions of patients with acute (35% [25; 50%], median [inter-quartile range]) and episodic/chronic (50% [40; 65.8%]) dizziness/vertigo. Referral to specialists was higher in patients with episodic/chronic dizziness than in acutely dizzy patients (50% [20.3; 75] vs. 30% [20; 50]), with younger PCPs (aged 30-40 years) demonstrating significantly increased odds of referral to specialists (odds ratio = 2.20 [1.01-4.81], p = 0.048).

Conclusion

The assessment of dizzy patients takes longer than that of average patients in most primary care practices. Many dizzy patients remain undiagnosed even after a thorough examination, highlighting the challenges faced by PCPs and potentially leading to frequent referrals to specialists. To address this, it is crucial to promote state-of-the-art neuro-otological examination and treatment techniques that are currently neglected by most PCPs, such as "HINTS" and lateral-canal BPPV treatment. This can help reduce referral rates allowing more targeted treatment and referrals.

The Influence of Degrees of Severity of Temporomandibular Dysfunction on Report of Vestibular Symptoms - A Cross-Sectional Study

INTRODUCTION

Due to the anatomical proximity and functional connection, vestibular symptoms (VS) are common in temporomandibular disorders (TMD). However, it is not known whether the degree of severity of TMD affect the report of associated vestibular symptoms.

OBJECTIVE

To evaluate associations of demographic, clinical and functional factors, as well as report of VS, with the severity of TMD.

METHOD

Cross-sectional study carried out at a higher education institution in Salvador, Bahia, Brazil. After approval by the Ethics Committee of Hospital Santo Antônio (CAAE 81517317.2.0000.0047), the collection team applied the Dizziness Handicap Inventory (DHI), the Fonseca Anamnestic Questionnaire (QAF) and the Research Diagnostic Criteria for Temporomandibular Disorders axis II questions (RDC/TMD) in employees, teachers and students. Statistical tests of association with the Chi-square, t test for independent samples and ANOVA (alpha 5% and 80% power) were performed.

RESULTS

The sample of 623 participants identified 333 (63.7%) people with TMD and 418 (79.9%) with VS. Females were associated with both temporomandibular dysfunction and vestibular symptoms. The degree of severity of the TMD showed a strong correlation with VS (p < 0.001).

CONCLUSION

In the studied sample, it was observed that the greater the degree of severity of the TMD, the greater the VS, which confirms the need to evaluate both systems in symptomatic patients for each of the clinical conditions.

Chronic diseases and health conditions in adolescents: Sex inequalities

OBJECTIVE

To estimate the prevalence of chronic diseases and health conditions in adolescents from Campinas (São Paulo), investigating sex differences according to age group.

METHODS

This population-based study analyzed data from the ISACamp 2014/15 health survey, with a total of 1,022 adolescents interviewed. The interviewees consisted of 517 boys and 505 girls; 492 of them in the ten to 14 age group and 530 in the 15 to 19 age group. We verified the associations using the χ2 test with Rao Scott adjustment and estimated prevalence ratios (PR) with multiple Poisson regression adjusted for age. Analyses were also stratified by age group.

RESULTS

Respiratory diseases, such as rhinitis (25.3%), sinusitis (15.7%), and asthma (10.9%), were the most prevalent among adolescents. Health complaints were high, especially headaches (39.5%), emotional conditions (34.5%), allergies (27.5%), and back pain (21.3%). More than 22.0% of adolescents reported having three or more health conditions. Girls declared a higher number of health conditions (three or more) than boys (PR=2.27).

CONCLUSION

The study showed that adolescents presented a significant number of health conditions, particularly regarding complaints, indicating the need for clinical care and public policies aimed at controlling and preventing these diseases in this age group.

Chronic diseases and health conditions in adolescents: Sex inequalities

ABSTRACT Objective: To estimate the prevalence of chronic diseases and health conditions in adolescents from Campinas (São Paulo), investigating sex differences according to age group. Methods: This population-based study analyzed data from the ISACamp 2014/15 health survey, with a total of 1,022 adolescents interviewed. The interviewees consisted of 517 boys and 505 girls; 492 of them in the ten to 14 age group and 530 in the 15 to 19 age group. We verified the associations using the χ2 test with Rao Scott adjustment and estimated prevalence ratios (PR) with multiple Poisson regression adjusted for age. Analyses were also stratified by age group. Results: Respiratory diseases, such as rhinitis (25.3%), sinusitis (15.7%), and asthma (10.9%), were the most prevalent among adolescents. Health complaints were high, especially headaches (39.5%), emotional conditions (34.5%), allergies (27.5%), and back pain (21.3%). More than 22.0% of adolescents reported having three or more health conditions. Girls declared a higher number of health conditions (three or more) than boys (PR=2.27). Conclusion: The study showed that adolescents presented a significant number of health conditions, particularly regarding complaints, indicating the need for clinical care and public policies aimed at controlling and preventing these diseases in this age group.

Dizziness in Saudi Arabia: An epidemiologic study

Introduction

Dizziness is one of the most common and recurring complaints in adults presenting at the clinic. However, its prevalence in the population of the Kingdom of Saudi Arabia remains unclear. We aimed to examine the prevalence and correlates of dizziness in a large sample of the Saudi population.

Methods

In this is cross-sectional study, we used an electronic survey, which was completed by 1.478 respondents, with a response rate of 84% across five regions of Saudi Arabia. The online survey was launched on the Qualtrics website and distributed via social media channels to obtain heterogeneous responses. The study included adults aged ≥18 years who resided in Saudi Arabia during data collection. We used t-test and chi-square test for descriptive analysis and multiple logistic regression model to assess prevalence and predictors of dizziness.

Results

More than half of the participants were aged between 26 years and 45 years (58.66%). Of the participants, 42.97% reported having dizziness at the time of taking the survey. Women were less likely than men to report dizziness (OR = 0.65; CI, 0.49, 0.87; p = 0.003). A description of the type of dizziness by age revealed that vertigo slightly decreased with age. Unclear vision with movement or blurry vision was common in young adults, whereas imbalance was common in older adults. A multiple regression model adjusted for demographic characteristics revealed a statistically significant association between dizziness and age group. Participants in the age group of 46-55 years were 1.83 times more likely to report dizziness compared to those aged >65 years (odds ratio = 1.83; confidence interval, 0.62, 5.41; p = 0.0009).

Discussion

Dizziness is a common complaint in Saudi Arabia. Future studies should elucidate the risk factors for and mechanisms of dizziness to help prevent falls and reduced quality of life.

Sintomas vestibulares encaminhados ao otorrinolaringologista pela atenção primária da cidade do Recife

Introdução: A Atenção Primária é a “porta de entrada” do usuário ao Sistema Único de Saúde. Caso o médico tenha dificuldade em conduzir o caso, ele encaminha-o a um especialista. A otorrinolaringologia é uma das especialidades que mais recebe referências, com longo tempo de espera em nosso meio. Objetivo: Estimar a frequência das queixas de tontura e suspeita de doença vestibular nos encaminhamentos dos pacientes que aguardam consulta com otorrinolaringologista. Há poucos estudos semelhantes na literatura, e esse levantamento é importante para traçar o perfil desses pacientes e planejar ações de saúde pública. Métodos: Estudo observacional, longitudinal, descritivo, baseado na coleta de dados secundários do Sistema de Regulação da Secretaria de Saúde da Prefeitura do Recife. Foram incluídas as solicitações dos médicos da Estratégia Saúde da Família para o serviço de otorrinolaringologia em outubro-novembro de 2019, que estavam na fila de espera desde junho–julho de 2018. Resultados: A frequência dos encaminhamentos por tontura e suspeita de doença vestibular foi 22,5% de todas as solicitações para otorrinolaringologia. O tempo de espera foi um ano e quatro meses. A maioria era de mulheres (74,7%) e idosos acima de 60 anos (48,3%). Os motivos dos encaminhamentos foram: zumbido (43,2%), labirintite (20%), múltiplos sintomas (17,3%), tontura (11,6%), vertigem (3,9%), labirintopatia (3,6%) e vertigem posicional paroxística benigna (0,6%). Os sintomas aumentam com a idade. Conclusão: A taxa de encaminhamento foi compatível com a literatura. O zumbido é um sintoma muito incômodo, comum tanto nas doenças do labirinto quanto em outras patologias, por isso a alta frequência de solicitação. O termo labirintite nem sempre se refere à neuronite vestibular, mas erroneamente pode ser usado para qualquer síndrome vertiginosa, o que pode justificar a alta taxa de encaminhamento em detrimento de outras vestibulopatias. A educação continuada na Atenção Primária é importante tanto para o diagnóstico correto quanto para a solicitação apropriada da interconsulta. É preciso novas estratégias para diminuir o tempo de espera, como o aumento da oferta de serviços de especialistas, a qualificação da demanda e a otimização do sistema de regulação.

Does the video head impulse test replace caloric testing in the assessment of patients with chronic dizziness? A systematic review and meta-analysis

INTRODUCTION

Caloric testing is the most frequently used test to assess peripheral vestibular function since the beginning of the 20th century. However, the video head impulse test, vHIT, has gained prominence in the field of neurotology, as it is a faster examination, easier to perform and less uncomfortable for the patient.

OBJECTIVE

To compare, through systematic review and meta-analysis, the proportion of altered cases between vHIT tests and caloric testing in patients with chronic dizziness, in addition to assessing the sensitivity and specificity of vHIT, with caloric testing as the gold standard.

METHODS

The literature search was carried out in the PubMed, Scopus, BVS-Bireme, Web of Science, Embase, Cochrane and ProQuest indexed databases, with no restrictions regarding the publication period. All articles that contained the results of the two tests were included in the evaluation of patients with dizziness. Two researchers independently conducted data selection and extraction from the studies, strictly following the inclusion and exclusion criteria defined in the research protocol. In case of disagreement during the selection, a discussion was carried out with a third evaluator.

RESULTS

Eleven of the 1293 initial articles met the eligibility criteria and were analyzed. 2670 patients were evaluated, of which 1112 (41.6%) were males and 1558 (58.4%) females, with a mean age of 51.6 years. The proportion of altered results in the vHIT was 21% (95%CI 9% -33%), and 55% in the caloric testing (95%CI 43% -67%).

CONCLUSION

The vHIT does not substitute for caloric testing. The tests are complementary in assessing the patient with dizziness, as they describe the tonotopy of the ampullary crest at different frequency ranges of stimulation. In chronic cases, the vHIT has a low sensitivity and high diagnostic specificity in comparison to caloric testing.

Lian gong as a Therapeutic Treatment Option in Primary Care for Patients with Dizziness: A Randomized Controlled Trial

Introduction  Dizziness is one of the most common reasons for seeking primary health care. Vestibular rehabilitation (VR) is a conventional treatment method for peripheral balance disorders that effectively decreases symptoms. Lian gong [LG] is believed to benefit patients with dizziness and to reduce the impact of the condition on quality of life by stimulating visual fixation, attention, body balance, and neuroplasticity. Objective  The present study aimed to evaluate the effects of LG on the impact of dizziness on quality of life and fear of falling in primary health care patients. Methods  This was a two-arm, parallel randomized clinical trial that included 36 patients with dizziness not caused by central changes. After specific medical evaluations and indications for treatment, the participants were randomly assigned to 3 groups: the LG group ( n  = 11), the VR group ( n  = 11), and the control group ( n  = 14). The interventions were conducted collectively over a period of 12 weeks. Results  Lian gong reduced the influence of dizziness on quality of life in physical (1.8 points, 95% confidence interval [CI]: 0.2-3.4), functional (4.0 points, 95% CI: 2.1-5.9), and emotional domains of quality of life (4.4 points, 95% CI: 1.7-7.2), with no differences compared with VR. There were similar concerns among the groups about the risk of falling. Conclusion  Lian gong was shown to be an effective balance rehabilitation strategy to reduce the impact of dizziness on quality of life, with similar results to those of VR.

Postural balance in type 2 diabetics with vertigo, dizziness and/or unsteadiness

PURPOSE

To evaluate the postural balance of type 2 diabetics with vertigo, dizziness, and/or unsteadiness.

METHODS

limit of stability, pressure center displacement area, and sway velocity of 20 patients with type 2 diabetes were compared with 22 controls using the Balance Rehabilitation Unit (BRUTM, Medicaa) posturography.

RESULTS

Compared to the control group, patients with type 2 diabetes showed a significantly lower limit of stability and a significantly higher-pressure center displacement area on a firm surface with eyes open, eyes closed, and horizontal vestibular-visual interaction; and higher sway velocity on a firm surface with eyes open and with eyes closed.

CONCLUSION

type 2 diabetics with vertigo, dizziness, and/or imbalance compromised postural balance related to visual stimuli and vestibular-visual interaction and moderate impairment in the quality of life.

Evaluation of the vestibulo-ocular reflex in patients with chronic otitis media

Introduction

In recent years, scientific evidence has shown that chronic otitis media may cause balance and vestibular dysfunction.

Objective

To compare the results of the video head impulse test (gain and symmetry of the vestibulo-ocular reflex and presence of covert and overt saccades) in patients with chronic otitis media and controls.

Methods

Cross-sectional study of patients with chronic otitis media (study group), aged between 18 and 60 years. The patients in the study group were further divided according to the chronic otitis media type as (1) non-suppurative, (2) suppurative, and (3) cholesteatomatous. For the comparative analysis, we selected volunteers with no history of ear and vestibular diseases (control group), who met the same inclusion and exclusion criteria as the study group. Patients in both groups underwent a video head impulse test.

Results

The study group consisted of 96 volunteers, and the control group of 61 individuals. The prevalence of vestibular symptoms was 66% in the study group and 3.2% in the control group (p <  0.001). The results show a higher prevalence of changes in the vestibulo-ocular reflex gain (22.9%) and corrective saccades (12.6%) in the chronic otitis media group compared to the control group (p <  0.001). Despite the higher prevalence of changes in gain, the average vestibulo-ocular reflex gains in the chronic otitis media groups were within the pre-defined values ​​of normality; however, the mean vestibulo-ocular reflex gain in the anterior semicircular canal was statistically worse in the cholesteatomatous chronic otitis media group compared to controls (p <  0.001). Regarding the corrective saccades, the prevalence of saccades was statistically higher in the suppurative and cholesteatomatous chronic otitis media subgroups compared to the non-suppurative and control groups (p =  0.004).

Conclusion

The present study demonstrated that chronic otitis media is associated with a higher prevalence of vestibular symptoms and also a higher prevalence of changes in gain and corrective saccades when compared to controls.

Does the C3/4 disc play a role in cervical spondylosis with dizziness? A retrospective study

PURPOSE

To investigate the effect of C3/4 disc degeneration on cervical spondylosis with dizziness (CSD) and to assess the curative effect of anterior cervical decompression and fusion (ACDF) in patients with CSD.

METHOD

Four hundred nineteen patients who underwent ACDF for treatment of myelopathy or radiculopathy were divided into dizziness and non-dizziness group. The visual analog scale (VAS) score and Japanese Orthopaedic Association (JOA) score were used to determine the intensity of dizziness and neurological symptoms, respectively. Cervical disc degeneration was evaluated using Miyazaki's classification system. Some parameters were measured using cervical radiographs. The surgical effects on CSD were compared between surgery with and without C3/4 level. Multivariate logistic regression analysis was used to determine the risk factors for CSD.

RESULTS

The pre-operative incidence of CSD was 33.9%. Women were more likely to develop dizziness than men (p < 0.05), CSD was significantly associated with C3/4 disc degeneration (69.7%, p < 0.001), and smokers were more subject to dizziness (p < 0.05). Regression analysis showed that female (OR = 1.611, p = 0.031), smoking (OR = 1.719, p = 0.032), Miyazaki grade of C3/4 ≥ IV (OR = 2.648, p < 0.001), and instability on C3/4 (OR = 1.672, p = 0.024) were risk factors for CSD. Treatment of CSD by ACDF involving C3/4 was more effective than not involving C3/4 (efficacy rate, 73.2% vs 51.7%, p < 0.05).

CONCLUSION

The CSD is a common clinical manifestation in elderly patients, especially patients with cervical spondylosis at the C3/4 level. Female, smoking, instability on C3/4, and C3/4 Miyazaki grade ≥ IV could be considered significant risk factors for CSD. CSD is more likely to be alleviated by ACDF involving C3/4.

[Sleep disturbance and cognitive dysfunction in patients with persistent postural and perceptual dizziness]

OBJECTIVE

To study sleep quality and cognitive status and their correlation in patients with persistent postural and perceptual dizziness (PPPD).

METHODS

We assessed sleep quality and cognitive function among 70 patients with PPPD and 70 age-matched heathy volunteers using Mini-Mental State Examination (MMSE), Montreal Cognitive Assessment (MoCA), Pittsburgh Sleep Quality Index and polysomnography (PSG).

RESULTS

The patients had a mean MMSE score of 25.10±3.87 and a mean MoCA score of 23.10±6.11, both suggesting mild cognitive impairment of the patients. The mean PSQI score of the patients was 14.60 ± 2.06, suggesting moderate insomnia among the patients. The MMSE scores in 3 dimensions (attention, memory and recall ability) and the dimension scores of MoCA for visual space and executive ability, attention and delayed recall all showed significant positive correlations with PSQI scores for sleep quality, sleep latency, sleep duration, sleep efficiency, sleep disorders and daytime dysfunction.

CONCLUSIONS

Moderate sleep disorder and mild cognitive dysfunction are common in PPPD patients. Sleep quality is correlated with cognitive function among these patients, suggesting that improving sleep quality of the patients helps to improve their cognitive function.

The Association between Sleep Duration and Dizziness in Korean Women: The Korea National Health and Nutrition Examination Survey

BACKGROUND

The aim of this study was to investigate the association between sleep duration and dizziness in a representative Korean population.

METHODS

We analyzed data from the Korea National Health and Nutrition Examination Surveys (2010-2012). A total of 12,499 adults who completed otolaryngologic examinations were evaluated.

RESULTS

Both men and women with severely short sleep duration (≤ 5 hours) and severely long sleep duration (≥ 9 hours) tended to have higher dizziness prevalence. However, the adjusted odds ratio (OR) for sleep duration was only significant in women with dizziness after adjusting for confounders. Compared to that in an optimal sleep group (6-8 hr/day), the OR (95% confidence interval) for dizziness prevalence after adjusting for age and health behaviors (body mass index, smoking habit, alcohol consumption, level of exercise, metabolic syndrome, and tinnitus) was 1.473 (1.194-1.818) for the severely short sleep group (≤ 5 hr/day) and 1.472 (1.078-2.009) for the severely long sleep group (≥ 9 hr/day) only in women.

CONCLUSION

In the Korean population, dizziness was associated with shorter or longer sleep durations only among women. Further epidemiologic and experimental studies are necessary to clarify the impact of dizziness on sleep disorders.

Postural instability and the condition of physical frailty in the elderly

OBJECTIVE

to analyze the relationship between postural instability and the condition and markers of physical frailty of the elderly people in outpatient geriatric and gerontology care.

METHOD

a cross-sectional study with a sample of 381 elderly subjects. Physical frailty was evaluated by the frailty phenotype and postural instability through the Berg Balance Scale. Univariate analyses consisted in Chi-square tests, and multivariate analyses used the Forward Stepwise method, which resulted in a model of physical frailty associated with postural instability.

RESULTS

among the participants, 56 (14.7%) were frail, 217 (57%) pre-frail, and 68 (28.3%) non-frail. Pre-frailty (p < 0.001), frailty (p = 0.000), and the markers hand grip strength (p = 0.0008), unintentional weight loss (p = 0.0094), level of physical activity (p = 0.0001), fatigue/exhaustion (p = 0.0001), and gait speed (p = 0.0001) were associated with postural instability.

CONCLUSION

the presence of postural instability determines a greater chance of the elderly being frail or pre-frail. This result favors the planning of gerontological nursing care and strengthens the treatment plan under a specific approach.

Effects of a vestibular rehabilitation program on workers in the working environment: a pilot study

ABSTRACT Objective: to verify the effect of a vestibular rehabilitation program on workers with dizziness from the Division of Nutrition and Dietetics at a University Hospital. Methods: a total of 13 employees between 42 and 65 years of age participated, of whom, 1 was male, and 12, females. They were evaluated before and after the vestibular rehabilitation program using the Dizziness Handicap Inventory, Work Ability Index and Visual Analog Scale. The program was conducted in groups at the workplace. Statistical analysis was performed using the analysis of variance test for paired factors and the chi-square test. Results: in the pre- and post-vestibular rehabilitation comparison, significant differences were found in the Dizziness Handicap Inventory and Visual Analogue Scale scores. In the qualitative analysis of the Work Ability Index, an increase was observed in the number of workers who considered their ability to work to have improved. Conclusion: vestibular rehabilitation conducted in groups and in the working environment was effective in improving dizziness complaint in workers at the Division of Nutrition and Dietetics. It is believed that the positive experience of this program may be extended to other areas.

Health-related quality of life and economic burden of vestibular loss in older adults

Objectives

Vestibular loss is a debilitating condition, and despite its high prevalence in older adults, the quality of life (QoL) burden of vestibular loss in older individuals has not been well-studied. This report quantifies the impact on overall QoL and identifies domains of health most affected. We hypothesize vestibular loss will be associated with impairment in diverse domains of health-related QoL.

Study Design

Prospective, case-control study.

Methods

A convenience sample of 27 patients age ≥60 years with vestibular physiologic loss was recruited from an academic neurotology clinic. The patients did not have any identifiable cause of their vestibular loss other than aging. The convenience sample was compared to an age-matched cross-sectional sample of the general US population (n = 1266). The main outcome was QoL measured by the Ontario Health Utilities Index Mark III (HUI3).

Results

Compared to the general population, patients with vestibular loss had significantly lower overall unadjusted HUI3 scores (-0.32, p < 0.001). Multivariate regression analysis showed vestibular loss was significantly associated with poorer performance in vision (-0.11 p < 0.0001), speech (-0.15, p < 0.0001), dexterity (-0.13, p < 0.0001), and emotion (-0.07, p = 0.0065). Adjusted aggregate HUI3 was also significantly lower for vestibular loss (-0.15, p = 0.0105). These QoL decrements resulted in an average loss of 1.30 Quality-Adjusted Life Years (QALYs). When using a $50,000/QALY willingness-to-pay threshold, vestibular loss was associated with a $64,929 lifetime economic burden per affected older adult, resulting in a total lifetime societal burden of $227 billion for the US population ≥60 years of age.

Conclusions

Loss of vestibular function with aging significantly decreases quality of life across multiple domains of well-being. These QoL reductions are responsible for heavy societal economic burdens of vestibular loss, which reveal potential benefits of prompt diagnosis and treatment of this condition.

Level of Evidence

3.

Physical functioning in older persons with dizziness: a population-based study

BACKGROUND

Dizziness is one of the most prevalent symptoms in old age and tends to increase with age.

AIMS

To report physical functioning, health-related aspects and gender differences in elderly persons with and without dizziness in a population-based sample of 75-year-olds.

METHODS

A cross-sectional sample of 75-year-olds from Gothenburg, Sweden (n = 675, 398 women and 277 men) was examined by means of questionnaires and functional tests. The questions concerned dizziness/imbalance, physical activity level, walking habits, falls efficacy, number of falls, subjective health or general fatigue and medication. The tests included were self-selected and maximum gait speed, stair climbing capacity, one leg stance and grip strength.

RESULTS

More women than men reported dizziness/imbalance (40 vs 30 %, p < 0.001). Persons with dizziness, compared to those without dizziness, less often regularly exercised at a moderate intensity level (summer: 62 vs 74 %, p < 0.001; winter: 41 vs 51 %, p < 0.001), less often took a daily walk (p < 0.05), had lower scores on the FES(S) (p < 0.001), more often reported general fatigue (p < 0.001), more often had fallen in the previous year (40 vs 23 %, p < 0.001) and had a higher intake of medical drugs (4.6 vs 3.3, p < 0.001). They also performed worse regarding gait speed, stair climbing and one leg stance (p < 0.001), but there was no difference in grip strength.

CONCLUSION

Older persons with dizziness are less physically active, have worse lower extremity function, are more often fallers and report lower self-rated health than persons without dizziness.

Efficacy of Carbon Microcoils in Relieving Cervicogenic Dizziness

Introduction Cervical pain contributes to postural deviations and imbalance. Nanotechnology may be used for the treatment of neck pain by fixing to the skin small rounds silicone patches containing double spiral carbon nanotubes arranged in the form of a coil (Helical), which would then relieve dizziness caused by muscular contraction.

Objective The objective of this study is to Evaluate pain and dizziness scores before and after Helical patches effect on cervicogenic dizziness treatment.

Methods The selected patients should have neck pain arising from muscle contraction with loss of balance or instability lasting more than 90 days and normal electrooculography. Treatment consisted of placing 10 Helical patches distributed as follows: two in the upper cervical area, two in the lower cervical area (near the 5^th and 6^th vertebrae), two in the upper trapezius muscle area (between neck and shoulder), and four in the tender point area (as reported by the patient). Using a Visual Analogue Scale (VAS), we matched pain and dizziness scores from Day 1 to those from Day 15 and Day 30 using Mann-Whitney test.

Results There was a significant difference between pain score reported on Day 1 and Day 15 (Z = 2.43, U = 5, p = 0.01). We also found significant differences between dizziness scores reported on days 1 and 15 (Z = 2.62, U = 3.5, p = 0.01) and days 1 and 30 (Z = 2.36, U = 5.5, p = 0.01).

Conclusion The Helical patches seem to be an effective treatment for cervicogenic dizziness.

Vascular loops in the anterior inferior cerebellar artery, as identified by magnetic resonance imaging, and their relationship with otologic symptoms

OBJECTIVE

To use magnetic resonance imaging to identify vascular loops in the anterior inferior cerebellar artery and to evaluate their relationship with otologic symptoms.

MATERIALS AND METHODS

We selected 33 adults with otologic complaints who underwent magnetic resonance imaging at our institution between June and November 2013. Three experienced independent observers evaluated the trajectory of the anterior inferior cerebellar artery in relation to the internal auditory meatus and graded the anterior inferior cerebellar artery vascular loops according to the Chavda classification. Kappa and chi-square tests were used. Values of p < 0.05 were considered significant.

RESULTS

The interobserver agreement was moderate. Comparing ears that presented vascular loops with those that did not, we found no association with tinnitus, hearing loss, or vertigo. Similarly, we found no association between the Chavda grade and any otological symptom.

CONCLUSION

Vascular loops do not appear to be associated with otoneurological manifestations.

Prevalence of dizziness in the population of Minas Gerais, Brazil, and its association with demographic and socioeconomic characteristics and health status

Introduction

The state of Minas Gerais, Brazil has no data on the prevalence of dizziness in the population and this information can be fundamental as the basis of public health policies, promotion, prevention and rehabilitation campaigns.

Objective

Investigate the prevalence of the symptom of dizziness in the population of Minas Gerais according to Sample Survey of Households, as well as describe the profile of interviewed individuals and the association between dizziness and socioeconomic, demographic features and health status.

Methods

This was a cross-sectional observational study that analyzed individuals with dizziness symptom reported in the previous month. The data entered in the Sample Survey of Households of 2011 were analyzed. An independent statistical association was determined between the selected variables and dizziness through multivariate analysis.

Results

Dizziness was the third major complaint among individuals who mentioned any health problems in the previous month, with an estimated population of 209,025 individuals and reported by 6.7% of symptomatic ones, with higher prevalence values only reported for the symptoms of fever and headache. Among individuals who reported dizziness, 94% were adults or elderly (p ≤ 0.001) and 63% were females (p = 0.003). A statistically significant association (p < 0.001) was observed between the response variable and the variables: self-perceived health, hypertension, heart disease, diabetes, depression, seeking or requiring medical or health care in the previous month and private health care plan or insurance. Among individuals with dizziness, 84.2% sought or required medical or health care and 80.1% did not have a private health plan or insurance in the assessed period.

Conclusion

The dizziness symptom was highly prevalent in the population of Minas Gerais during the assessed month of the investigation. Dizziness was prevalent in adults and the elderly and showed a statistical association with socioeconomic and demographic characteristics, as well as the assessed health status.

The institutionalized elderly: sociodemographic and clinical-functional profiles related to dizziness

Introduction

Dizziness is among the most common complaints in the elderly population.

Objective

To determine the sociodemographic and clinical-functional profiles of institutionalized elderly people related to dizziness.

Methods

Cross-sectional prospective study with institutionalized elderly people aged 60 or more years. A questionnaire on sociodemographic and clinical-functional characteristics was applied, and an anamnesis of occurrence of dizziness was held, as well as the Dizziness Handicap Inventory questionnaire.

Results

48.9% of the elderly subjects had dizziness. The mean numbers of diseases and medications associated with dizziness were, respectively, 4.5 diseases and 7.8 medications. We found a significant association between the occurrence of dizziness and diseases of the musculoskeletal system, sub-connective tissue and genitourinary system, as well as the use of medications for the musculoskeletal system. The scores for handicap degree in functional DHI were significantly higher among elderly subjects who needed walking aids, who had suffered falls, and those manifesting anxiety.

Conclusion

Our sample included subjects of advanced age, primarily women, who were institutionalized less than five years, with multiple diseases and polypharmacy users. They presented long-standing short-duration mixed dizziness, that occurred more than once a month and affected mainly the functional aspect.

The epidemiology of dizziness and vertigo

This chapter gives an overview of the epidemiology of dizziness, vertigo, and imbalance, and of specific vestibular disorders. In the last decade, population-based epidemiologic studies have complemented previous publications from specialized settings and provided evidence for the high burden of dizziness and vertigo in the community. Dizziness (including vertigo) affects about 15% to over 20% of adults yearly in large population-based studies. Vestibular vertigo accounts for about a quarter of dizziness complaints and has a 12-month prevalence of 5% and an annual incidence of 1.4%. Its prevalence rises with age and is about two to three times higher in women than in men. Imbalance has been increasingly studied as a highly prevalent complaint particularly affecting healthy aging. Studies have documented the high prevalence of benign paroxysmal positional vertigo (BPPV) and vestibular migraine (VM), as well as of comorbid anxiety at the population level. BPPV and VM are largely underdiagnosed, while Menière's disease, which is about 10 times less frequent than BPPV, appears to be overdiagnosed. Risk factor research is only at its beginning, but has provided some interesting observations, such as the consistent association of vertigo and migraine, which has greatly contributed to the recognition of VM as a distinct vestibular syndrome.

Influência do tratamento com fármacos antivertiginosos sobre o equilíbrio postural e qualidade de vida de indivíduos com queixas de tontura

Resumo: OBJETIVO: avaliar a influência do tratamento com fármacos antivertiginosos sobre a qualidade de vida e o equilíbrio postural de adultos e idosos com queixas de tontura. MÉTODOS: estudo transversal, com amostra de 51 indivíduos portadores de queixas de tontura, divididos em dois grupos, de acordo com o uso (grupo medicado, n=25) ou não (grupo não medicado, n=26) de fármacos antivertiginosos. Foram coletadas informações sobre: caracterização dos sintomas (ficha elaborada pelos pesquisadores), autopercepção de qualidade de vida (Dizziness Handicap Inventory),intensidade de tontura (escala visual analógica de tontura) e equilíbrio postural (plataforma de força). RESULTADOS: verificou-se intensidade moderada de tontura (Média: 4,6 ± 2,8) e impacto negativo das vestibulopatias sobre a qualidade de vida (Média: 47,3 ± 22,4) na amostra total. Quando comparados os dois grupos, não houve diferença estatisticamente significante na intensidade da tontura (p=0,74) ou qualidade de vida (p=0,79), e também, nos parâmetros da estabilometria, em quatro tarefas (teste t independente, p>0,05). Contudo, após a inclusão do tempo de utilização de fármacos antivertiginosos como uma covariável do estudo, foi verificado pior desempenho nas diferentes tarefas da estabilometria no grupo medicado (ANCOVA, p<0,05). CONCLUSÃO: o uso de fármacos antivertiginosos não melhora a qualidade de vida de indivíduos com queixas de tontura e o equilíbrio postural esteve alterado no grupo medicado.

Effectiveness of a Vestibular Rehabilitation Protocol to Improve the Health-Related Quality of Life and Postural Balance in Patients with Vertigo

Introduction Dizziness can be characterized as a balance disorder that causes discomfort, leading to several functional limitations. Currently, vestibular rehabilitation has been highlighted as a possible treatment. Objective Analyze the effects of completing a vestibular rehabilitation treatment protocol on quality of life and postural balance in patients with vestibular complaints, as well as to compare these effects between the patients taking or not taking antivertigo drugs. Methods A nonrandomized controlled trial was performed with 20 patients previously diagnosed with vestibular diseases. Information regarding vertigo symptoms, quality of life as assessed through the Dizziness Handicap Inventory, visual analog scale of dizziness, and stabilometry using force platform was collected. Patients were treated for 12 weeks by a custom protocol. The sample was divided into two groups according to the use (medicated group, n = 9) or not (control group, n = 11) of antivertigo drugs. Results There was improvement in quality of life (p < 0.001) and intensity of dizziness (p = 0.003) with the intervention. An improvement of postural balance was observed through functional tests. However, no statistically significant difference was noted in stabilometry. When both groups were compared, no statistically significant differences between the variations of the variables analyzed were found in the re-evaluation session. Conclusion Quality of life and postural balance are improved with intervention. However, this improvement is not associated with pharmacologic treatment.

Seasonality of dizziness and vertigo in a tropical region

Vertigo and dizziness are among the most common medical complaints in the emergency room, and are associated with a considerable personal and health care burden. Scarce and conflicting reports indicate those symptoms may present a seasonal distribution. This study aimed at investigating the existence of a seasonal distribution of vertigo/dizziness in a tropical region, and the correlations of these findings with climatic variables. The charts of all patients consecutively admitted between 2009 and 2012 in the emergency room of a Brazilian general hospital were reviewed. A total of 4920 cases containing these terms were sorted from a sample of 276,076 emergency records. Seasonality was assessed using Cosinor Analysis. Pearson's correlations were performed between the incidence of consultations, considering separately dizziness and vertigo and each of the predictor climatic variables of that index month. Significant seasonal patterns were observed for dizziness and vertigo in the emergency room. Vertigo was more frequent in late winter-spring, negatively correlating to humidity (r = -0.374; p = 0.013) and rainfall (r = -0.334; p = 0.020). Dizziness peaked on summer months, and positively correlated to average temperatures (r = 0.520; p < 0.001) and rainfall (r = 0.297; p = 0.040), but negatively to atmospheric pressure (r = -0.424; p = 0.003). The different seasonal patterns evidenced for dizziness and vertigo indicate possible distinct underlying mechanisms of how seasons may influence the occurrence of those symptoms.

Tinnitus prevalence in the city of São Paulo

Introduction

The public and private health care in the city of São Paulo has no data on tinnitus prevalence.

Objective

Determine tinnitus prevalence in São Paulo city.

Study design

Series study.

Methods

Cross-sectional study by field questionnaire with 1960 interviews. Predictor variables included gender, age, tinnitus.

Results

The prevalence of tinnitus was 22%. It affects more women (26%) than men (17%) and increases with advancing age. Approximately one third of cases (32%) assert that they have constant tinnitus (i.e., “ringing”), while most describe intermittent tinnitus (68%). The majority (64%) reported feeling annoyed, while others (36%) denied any annoyance. Among women, the occurrence of an annoying tinnitus was significantly higher (73%) than among men (50%). The percentages were: mildly annoying (11%), moderately annoying (55%), and severely annoying (34%). Tinnitus interferes with daily activities in 18% of those reporting to be annoyed.

Conclusion

The population in the city of São Paulo suffering from tinnitus was more prevalent than previously estimated. Generally, it affects more women and those without occupation, and increases significantly with age. Most respondents described the tinnitus as annoying, and this was more prevalent in females. The degree of discomfort measured by a Visual Analogue Scale showed moderate tinnitus, with responses averaging 6.3.

Clinical characteristics of patients with persistent postural-perceptual dizziness

Introduction

Persistent postural-perceptual dizziness is the dizziness that lasts for over three months with no clinical explanation for its persistence. The patient's motor response pattern presents changes and most patients manifest significant anxiety.

Objective

To evaluate the clinical characteristics of patients with persistent postural and perceptual dizziness.

Methods

statistical analysis of clinical aspects of patients with persistent postural-perceptual dizziness.

Results

81 patients, average age: 50.06 ± 12.16 years; female/male ratio: 5.7/1; main reasons for dizziness: visual stimuli (74%), body movements (52%), and sleep deprivation (38%). The most prevalent comorbidities were hypercholesterolemia (31%), migraine headaches (26%), carbohydrate metabolism disorders (22%) and cervical syndrome (21%). DHI, State-Trait Anxiety Inventory – Trait, Beck Depression Inventory, and Hospital Anxiety and Depression Scale questionnaires were statistically different (p < 0.05) when compared to controls. 68% demonstrated clinical improvement after treatment with serotonin reuptake inhibitors.

Conclusion

Persistent postural-perceptual dizziness affects more women than men, with a high associated prevalence of metabolic disorders and migraine. Questionnaires help to identify the predisposition to persistent postural-perceptual dizziness. The prognosis is good with adequate treatment.