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Yetiser S, Ince D. Bilateral simultaneous presentation of posterior canal benign paroxysmal positional vertigo. J Laryngol Otol 2024; 138:284-288. [PMID: 37350236 DOI: 10.1017/s0022215123001111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/24/2023]
Abstract
OBJECTIVE To outline the clinical picture of bilateral posterior canal benign paroxysmal positional vertigo. METHODS A total of 573 patients with posterior canal benign paroxysmal positional vertigo were classified as having unilateral, or true or pseudo bilateral, posterior canal benign paroxysmal positional vertigo, and were treated with the Epley manoeuvre. Statistical significance was set at p < 0.05. RESULTS Of the patients, 483 had unilateral and 90 (15.7 per cent) had bilateral presentation. Of the latter, 72 patients had pseudo bilateral posterior canal benign paroxysmal positional vertigo. Comparisons of site of involvement, male to female ratio and the incidence of associated problems in unilateral, and true and pseudo bilateral posterior canal benign paroxysmal positional vertigo did not reveal any statistically significant differences (p = 0.828, p = 0.200, p = 0.142). Comparisons of the number of manoeuvres required to provide symptom relief and the rate of recurrence were significant (p < 0.05). CONCLUSION Identification of true and pseudo bilateral posterior canal benign paroxysmal positional vertigo is important given the differences in aetiology and treatment outcome. Treatment of patients with true bilateral posterior canal benign paroxysmal positional vertigo requires several therapeutic manoeuvre attempts, and patients should be warned about recurrence.
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Affiliation(s)
- Sertac Yetiser
- Department of Otorhinolaryngology and Head and Neck Surgery, Anadolu Medical Center, Kocaeli, Turkey
| | - Dilay Ince
- Vestibular Laboratory, Department of Otorhinolaryngology and Head and Neck Surgery, Anadolu Medical Center, Kocaeli, Turkey
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Francavilla B, Velletrani G, Chiaramonte C, Di Girolamo S, Giacomini PG. Assessing Cognitive Effort in Ménière's Disease: Pupillometry as a Novel Tool for Postural Control. J Int Adv Otol 2024; 20:69-75. [PMID: 38454292 PMCID: PMC10895865 DOI: 10.5152/iao.2024.231150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2023] [Accepted: 03/30/2023] [Indexed: 03/09/2024] Open
Abstract
BACKGROUND This study aimed to investigate the utility of pupillometry as a measure of cognitive effort in individuals with Ménière's disease experiencing chronic postural destabilization. By integrating pupillometry with static posturography, we sought to gain deeper insights into the cognitive demands and arousal levels associated with postural control in this specific patient population. METHODS The study included 36 patients who met the diagnostic criteria for Ménière's disease and a control group comprising 36 healthy volunteers. We performed static posturography using a computerized static posturography platform to objectively assess postural imbalance. Additionally, pupillometry was recorded using infrared video-oculoscopy. Pupil dilation was measured before and after participants walked for 7 steps on-site with their vision obscured. RESULTS Baseline tonic pupil size showed no significant difference between healthy controls and Ménière's patients. However, after walking stimulation, Ménière's patients exhibited highly significant abnormal walking-induced pupil dilation. This suggests increased arousal in response to the challenging task of walking with closed eyes, linked to static upright stance imbalance as correlated with posturography parameters. CONCLUSION Pupillometry holds promise as an objective tool to assess cognitive effort and arousal during postural control in Ménière's disease. Implementing pupillometry in clinical practice could enhance the management of postural instability in these patients. Our findings contribute to the understanding of cognitive aspects in balance control and open new avenues for further investigations in vestibular dysfunction.
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Affiliation(s)
| | - Gianluca Velletrani
- Department of Otorhinolaryngology, University of Rome Tor Vergata, Rome, Italy
| | - Carlo Chiaramonte
- Department of Biomedicine and Prevention, University of Rome Tor Vergata, Rome, Italy
| | - Stefano Di Girolamo
- Department of Otorhinolaryngology, University of Rome Tor Vergata, Rome, Italy
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Kirazli G, Erbek HS. A comparison of the video head impulse test and the functional head impulse test in chronic unilateral vestibular loss. J Laryngol Otol 2024; 138:43-51. [PMID: 37667906 PMCID: PMC10772026 DOI: 10.1017/s0022215123001536] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 07/19/2023] [Accepted: 08/01/2023] [Indexed: 09/06/2023]
Abstract
OBJECTIVE To examine the correlation of video head impulse test, functional head impulse test and Dizziness Handicap Inventory results in patients with chronic unilateral vestibular loss, and to compare the results with healthy controls. METHODS Forty-eight patients diagnosed with chronic unilateral vestibular loss and 35 healthy individuals, aged 18-65 years, were included. The video head impulse test, functional head impulse test and Dizziness Handicap Inventory were administered. RESULTS A significant positive correlation was found between functional head impulse test and video head impulse test results for the study group in all semicircular canals (p < 0.05). There was no significant correlation between Dizziness Handicap Inventory, functional head impulse test and video head impulse test results (p > 0.05). The functional head impulse test and video head impulse test results of the control group were significantly higher than those of the study group in all semicircular canals planes (p < 0.05). CONCLUSION In chronic unilateral vestibular loss patients, with high head accelerations, the functional head impulse test indicates deterioration in vestibulo-ocular reflex functionality. It would be beneficial to include the video head impulse test and functional head impulse test in clinical practice as complementary tests in vestibulo-ocular reflex evaluation.
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Affiliation(s)
- Gulce Kirazli
- Department of Audiology, Faculty of Health Sciences, Ege University, Izmir, Turkey
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van Vugt VA, Ngo HT, van der Wouden JC, Twisk JW, van der Horst HE, Maarsingh OR. Online vestibular rehabilitation for chronic vestibular syndrome: 36-month follow-up of a randomised controlled trial in general practice. Br J Gen Pract 2023; 73:e710-e719. [PMID: 37487644 PMCID: PMC10394610 DOI: 10.3399/bjgp.2022.0468] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2022] [Accepted: 03/13/2023] [Indexed: 07/26/2023] Open
Abstract
BACKGROUND Vestibular rehabilitation (VR) is the preferred treatment for chronic vestibular symptoms such as dizziness and vertigo. An internet-based programme was developed to increase uptake of VR. The authors have previously reported that internet-based VR resulted in a clinically relevant decrease of vestibular symptoms for up to 6 months, compared with usual care. AIM To evaluate long-term outcomes of internet-based VR in patients with chronic vestibular syndrome. DESIGN AND SETTING A randomised controlled trial was conducted in Dutch general practice involving 322 participants aged ≥50 years with chronic vestibular syndrome. Participants were randomised to stand-alone VR, blended VR (with physiotherapy support), and usual care. Usual care participants were allowed to cross over to stand-alone VR 6 months after randomisation. METHOD Participants were approached 36 months after randomisation. The primary outcome was the presence of vestibular symptoms as measured by the vertigo symptom scale-short form (VSS-SF). Secondary outcomes were dizziness-related impairment, anxiety, depressive symptoms, and healthcare utilisation. RESULTS At 36-month follow-up, 65% of participants filled in the VSS-SF. In the usual care group, 38% of participants had crossed over to VR at 6 months. There were no significant differences in vestibular symptoms between VR groups and usual care (mean difference = -0.8 points, 95% confidence interval [CI] = -2.8 to 1.2, for stand-alone VR; -0.3, 95% CI = -2.2 to 1.7, for blended VR). In VR groups, clinically relevant improvement compared with baseline was maintained over time. CONCLUSION Internet-based VR provides a maintained improvement of vestibular symptoms for up to 36 months in patients with chronic vestibular syndrome.
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Affiliation(s)
- Vincent A van Vugt
- Department of General Practice, Amsterdam UMC location Vrije Universiteit Amsterdam; Amsterdam Public Health Research Institute, Amsterdam
| | - Hà Tn Ngo
- Department of General Practice, Amsterdam UMC location Vrije Universiteit Amsterdam; Amsterdam Public Health Research Institute, Amsterdam
| | - Johannes C van der Wouden
- Department of General Practice, Amsterdam UMC location Vrije Universiteit Amsterdam; Amsterdam Public Health Research Institute, Amsterdam
| | - Jos Wr Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC location Vrije Universiteit Amsterdam; Amsterdam Public Health Research Institute, Amsterdam
| | - Henriëtte E van der Horst
- Department of General Practice, Amsterdam UMC location Vrije Universiteit Amsterdam; Amsterdam Public Health Research Institute, Amsterdam
| | - Otto R Maarsingh
- Department of General Practice, Amsterdam UMC location Vrije Universiteit Amsterdam; Amsterdam Public Health Research Institute, Amsterdam
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Djian C, Champion K, Lai N, Drouet L, Amador Borrero B, Depond A, Mouly S, Jourdaine C, Herman P, Eliezer M, Hautefort C, Sène D. Infliximab for the Treatment of Inflammatory Labyrinthitis: A Retrospective Cohort Study. J Clin Med 2023; 12:4350. [PMID: 37445384 DOI: 10.3390/jcm12134350] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Revised: 06/21/2023] [Accepted: 06/26/2023] [Indexed: 07/15/2023] Open
Abstract
Inflammatory labyrinthitis is defined as a fluctuant vestibulo-cochlear syndrome associated with an impairment of the blood-labyrinthine barrier (BLB) on delayed FLAIR MRI sequences. Systemic and intratympanic corticosteroids are the gold standard treatment but their effect is frequently insufficient. The objective is here to determine whether infliximab could be of value in the treatment of bilateral inflammatory labyrinthitis. A retrospective monocentric study was conducted between January 2013 and December 2021. All patients included in the study were affected with a bilateral vestibulo-cochlear syndrome associated with bilateral blood-labyrinthine barrier impairment. Patients were administered infliximab at the dose of 5 mg/kg every 6 weeks for 6 months. Audiometry, MRI with delayed FLAIR sequences on the labyrinth, and corticosteroid doses still required were assessed both before and after treatment with infliximab was completed. Pure-tone average (PTA) was the primary outcome. The secondary outcomes were the speech recognition threshold (SRT), the Dizziness Handicap Inventory (DHI) score, and the corticosteroid (CS) dose. A total of nine patients including five men and four women were enrolled in the study. Thirteen ears were analyzed. After a 6-month period of treatment, the mean PTA (54 ± 24 db versus 66 ± 22 db; p = 0.027), SRT (54 ± 37 db versus 66 ± 32 db; p = 0.041) and DHI score (27 ± 15 versus 9 ± 2; p = 0.032) significantly improved. After the 6-month treatment period, the mean CS dose decreased from 38 ± 33 to 6 ± 5 mg/day (p = 0.003). We conclude that infliximab substantially improves the vestibulo-cochlear function in patients with bilateral inflammatory labyrinthitis and could be of value in corticosteroid-dependent cases.
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Affiliation(s)
- Cassandre Djian
- Department of Otolaryngology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France
| | - Karine Champion
- Department of Internal Medicine, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France
| | - Nicolas Lai
- Department of Otolaryngology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France
| | - Ludovic Drouet
- Department of Internal Medicine, Saint Joseph Hospital, 75014 Paris, France
| | - Blanca Amador Borrero
- Department of Internal Medicine, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France
| | - Audrey Depond
- Department of Internal Medicine, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France
| | - Stéphane Mouly
- Department of Internal Medicine, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France
- Faculté de Médecine, Paris Cité University, 75006 Paris, France
| | - Clément Jourdaine
- Department of Otolaryngology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France
| | - Philippe Herman
- Department of Otolaryngology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France
- Faculté de Médecine, Paris Cité University, 75006 Paris, France
| | - Michael Eliezer
- Department of Neuroradiology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France
| | - Charlotte Hautefort
- Department of Otolaryngology, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France
| | - Damien Sène
- Department of Internal Medicine, Hôpital Lariboisière, Assistance Publique-Hôpitaux de Paris, 75010 Paris, France
- Faculté de Médecine, Paris Cité University, 75006 Paris, France
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Bragg PG, Norton BM, Petrak MR, Weiss AD, Kandl LM, Corrigan ML, Bahner CL, Matsuoka AJ. Application of supervised machine learning algorithms for the evaluation of utricular function on patients with Meniere's disease: utilizing subjective visual vertical and ocular-vestibular-evoked myogenic potentials. Acta Otolaryngol 2023; 143:262-273. [PMID: 37067348 DOI: 10.1080/00016489.2023.2190163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Research on the otolith organs remains inconclusive. OBJECTIVES This study seeks to further elucidate utricular function in patients with Meniere's disease (MD) in three ways: (1) We aimed to disambiguate the role of the Subjective Visual Vertical (SVV) and Ocular Vestibular Evoked Myogenic Potential (o-VEMP) tests regarding which utricular subsystem each is measuring. (2) We sought to characterize the acute and chronic state of MD by identifying differences in the relationship of SVV and o-VEMP results across patients with acute and chronic MD. (3) We attempted to find a machine-learning algorithm that could predict acute versus chronic MD using SVV and o-VEMP. METHODS A prospective study with ninety subjects. RESULTS (1) SVV and o-VEMP tests were found to have a moderate linear relationship in patients with acute MD, suggesting each test measures a different utricular subsystem. (2) Regression analyses statistically differed across the two patient populations, suggesting that SVV results were normalized in chronic MD patients. (3) Logistic regression and Naïve Bayes algorithms were found to predict acute and chronic MD accurately. SIGNIFICANCE A better understanding of what diagnostic tests measure will lead to a better classification system for MD and more targeted treatment options in the future.
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Affiliation(s)
- Phillip G Bragg
- Department of Otolaryngology-Head and Neck Surgery, Northwestern Medicine, Chicago, IL, USA
| | - Benjamin M Norton
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | | | - Allyson D Weiss
- Department of Otolaryngology-Head and Neck Surgery, Northwestern Medicine, Chicago, IL, USA
| | - Lindsay M Kandl
- Department of Otolaryngology-Head and Neck Surgery, Northwestern Medicine, Chicago, IL, USA
| | - Megan L Corrigan
- Department of Otolaryngology-Head and Neck Surgery, Northwestern Medicine, Chicago, IL, USA
| | | | - Akihiro J Matsuoka
- Department of Otolaryngology-Head and Neck Surgery, Northwestern Medicine, Chicago, IL, USA
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Hugh Knowles Hearing Centre, Evanston, IL, USA
- Department of Otolaryngology-Head and Neck Surgery, University of California San Diego, San Diego, CA, USA
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7
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Donovan J, De Silva L, Cox H, Palmer G, Semciw AI. Vestibular dysfunction in people who fall: A systematic review and meta-analysis of prevalence and associated factors. Clin Rehabil 2023:2692155231162423. [PMID: 37036433 DOI: 10.1177/02692155231162423] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/11/2023]
Abstract
OBJECTIVES To evaluate the prevalence and factors associated with vestibular dysfunction in people who fall. DATA SOURCES All electronic records from MEDLINE, CINAHL, Embase and psycINFO databases were searched to 9 December 2022. REVIEW METHODS Participants were adults with at least one fall within the previous year who were exposed to at least one vestibular function test. Any published peer reviewed trial designs were accepted. Included studies were assessed for risk of bias using a modified Epidemiological Appraisal Instrument. The quality of each meta-analysis was assessed using modified Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS Ten trials (468 participants) were identified, six of which had high methodological quality. Vestibular dysfunction was found in 61% (48.01-72.32) I2 = 78% of participants. The most prevalent type of dysfunction was from tests of vestibulo-ocular reflex at 61% (49.79 to 70.49) I2 = 68%, followed by benign paroxysmal positional vertigo at 22% (10.30-40.32) I2 = 87% and central dysfunction at 11% (2.24-37.76) I2 = 50%. People who fall with vestibular dysfunction had reduced walking function compared to those without dysfunction -0.51 (-0.85 to -0.16) I2 = 11%. Dizziness was not related to vestibular dysfunction in people who fall 0.25 (-0.10 to 0.60), I2 = 0%. The quality of the body of evidence ranged from very low to high. CONCLUSION More than one in two people who fall have vestibular dysfunction. Clinicians cannot rely on dizziness report to indicate need for vestibular screening in those who fall. A vestibular screen should be incorporated into a comprehensive falls assessment.
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Affiliation(s)
- Jacquelin Donovan
- Physiotherapy Department, 1966Princess Alexandra Hospital, Queensland Health, Brisbane, Australia
| | | | - Hayley Cox
- Physiotherapy Department, 1966Princess Alexandra Hospital, Queensland Health, Brisbane, Australia
| | - Gretta Palmer
- Physiotherapy Department, 1966Princess Alexandra Hospital, Queensland Health, Brisbane, Australia
| | - Adam Ivan Semciw
- Allied Health, Northern Health, Melbourne, Australia
- School of Allied Health, 2080Latrobe University, Melbourne, Australia
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Oka M, Ichijo K, Koda K, Kamogashira T, Kinoshita M, Igarashi K, Kawahara T, Takashima I, Yamasoba T, Fujimoto C. Preceding Balance Disorders Affect Vestibular Function in Persistent Postural-Perceptual Dizziness. J Clin Med 2023; 12:2589. [PMID: 37048672 PMCID: PMC10095344 DOI: 10.3390/jcm12072589] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2023] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 04/14/2023] Open
Abstract
Persistent postural-perceptual dizziness (PPPD) is induced by preceding conditions that cause balance disorders. To investigate the association between vestibular function and preceding balance disorders in PPPD patients, a retrospective chart review was performed. Vestibular function in 55 PPPD patients was measured using the caloric test, cervical vestibular evoked myogenic potential testing to air-conducted sound (ACS cVEMP), ocular vestibular evoked myogenic potential testing to bone-conducted vibration (BCV oVEMP), and video head impulse testing (vHIT). Patients were classified according to the type of preceding balance disorder. The age-stratified Cochran-Mantel-Haenszel (CMH) test and the exact test for the common odds ratio were conducted to evaluate the association between preceding n ≥ 4 balance disorders and present peripheral vestibular dysfunction. PPPD patients with preceding vestibular neuritis presented a significant positive association with abnormal caloric responses (p = 0.013), while those with preceding benign paroxysmal positional vertigo (BPPV) had significantly lower rates of abnormal BCV oVEMP (p = 0.003). Furthermore, patients with preceding vestibular neuritis showed lateral semicircular canal dysfunction, while those with preceding BPPV presented normal utricular functions. These results present the influence of preceding balance disorders on the vestibular function in PPPD.
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Affiliation(s)
- Mineko Oka
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Kentaro Ichijo
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Kento Koda
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Teru Kamogashira
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Makoto Kinoshita
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Kazunori Igarashi
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Takuya Kawahara
- Clinical Research Promotion Center, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Ikumi Takashima
- Clinical Research Promotion Center, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Chisato Fujimoto
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo 113-8655, Japan
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Tanaka R, Fushiki H, Tsunoda R, Kamo T, Kato T, Ogihara H, Azami M, Honaga K, Fujiwara T. Effect of Vestibular Rehabilitation Program Using a Booklet in Patients with Chronic Peripheral Vestibular Hypofunction: A Randomized Controlled Trial. Prog Rehabil Med 2023; 8:20230002. [PMID: 36703800 PMCID: PMC9836908 DOI: 10.2490/prm.20230002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2022] [Accepted: 12/13/2022] [Indexed: 01/15/2023] Open
Abstract
Objectives This study investigated the effects of a supervised home-based vestibular rehabilitation program using a booklet on gait function and dizziness in patients with chronic peripheral vestibular hypofunction. Methods This was a non-blinded, randomized, controlled trial. Patients (n=42) with chronic peripheral vestibular hypofunction were randomly divided into the vestibular rehabilitation group (VR group; n=20) or the control group (n=22). Patients in the VR group received a supervised home-based vestibular rehabilitation program using a booklet in addition to physician care for 4 weeks. The physical therapist checked the home program when the VR group visited the outpatient clinic once a week. Patients in the control group received physician care only during the trial period. The primary outcome was functional gait assessment (FGA). The secondary outcomes were the dynamic gait index (DGI) and the dizziness handicap inventory (DHI). Results Two-way repeated measures analysis of variance showed a significant interaction for FGA, DGI, DHI total, and DHI emotional scores (P<0.05) with the VR group improving more than the control group. No significant interactions were found for DHI physical and DHI functional scores (P≥0.05). Conclusions The home-based vestibular rehabilitation program in this study was effective in improving gait function and dizziness in patients with chronic peripheral vestibular hypofunction. Regular supervision may have improved adherence to home exercise and contributed to the effectiveness of vestibular rehabilitation.
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Affiliation(s)
- Ryozo Tanaka
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan, Mejiro University Ear Institute Clinic, Saitama, Japan, Department of Physical Therapy, Faculty of Health Sciences, Mejiro University, Saitama, Japan
| | | | - Reiko Tsunoda
- Mejiro University Ear Institute Clinic, Saitama, Japan
| | - Tomohiko Kamo
- Mejiro University Ear Institute Clinic, Saitama, Japan, Department of Physical Therapy, Faculty of Rehabilitation, Gunma Paz University, Takasaki, Japan
| | - Takumi Kato
- Mejiro University Ear Institute Clinic, Saitama, Japan
| | - Hirofumi Ogihara
- 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
| | - Masato Azami
- Mejiro University Ear Institute Clinic, Saitama, Japan, Department of Physical Therapy, Faculty of Health Sciences, Japan University of Health Sciences, Satte, Japan
| | - Kaoru Honaga
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
| | - Toshiyuki Fujiwara
- Department of Rehabilitation Medicine, Juntendo University Graduate School of Medicine, Tokyo, Japan
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10
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Pähler vor der Holte A, Welkoborsky´ H. Case report: Langerhans cell histiocytosis of the temporal bone in children: Challenging diagnosis of a rare disease with some pitfalls. Clin Case Rep 2022; 10:e6057. [PMID: 36254150 PMCID: PMC9556999 DOI: 10.1002/ccr3.6057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2021] [Revised: 03/12/2022] [Accepted: 05/28/2022] [Indexed: 11/11/2022] Open
Abstract
A 4‐year‐old girl was admitted to hospital with disturbance of balance. After being questioned, parents remembered an otitis with effusion 3 months earlier. CT‐scans revealed destruction of both temporal bones. Initial biopsy showed granulomatous, necrotic inflammation, which led to comprehensive differential diagnoses. A second tissue sample confirmed Langerhans cell histiocytosis.
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Affiliation(s)
- Anja Pähler vor der Holte
- Department of Otorhinolaryngology, Head and Neck SurgeryNordstadt ClinicAcademic HospitalHanoverGermany
| | - Hans‐Jürgen Welkoborsky´
- Department of Otorhinolaryngology, Head and Neck SurgeryNordstadt ClinicAcademic HospitalHanoverGermany
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11
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Altın B, Aksoy S. Is Inadequate Water Intake a Risk Factor for Vestibular Disorders? J Int Adv Otol 2022; 18:264-268. [PMID: 35608497 PMCID: PMC10682806 DOI: 10.5152/iao.2022.21303] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 06/18/2021] [Indexed: 11/30/2023] Open
Abstract
BACKGROUND Water is a vital nutrient for the human body system and failing to consume enough water could cause health problems. The purpose of this study is to investigate the relationship between water intake and vestibular system disorders. METHODS Data from 93 patients (aged between 20 and 76 years) with vestibular disorders were analyzed in the study. The mean age of the patients was 46.96 ±13.94 years (female: 45.68 ±13.45, male: 49.96 ±14.85), and 69.9% (n=65) were female. Participants were sub-categorized into diagnostic groups as follows: benign paroxysmal positional vertigo, Meniere's disease, vestibular neuritis, vestibular migraine, and persistent postural perceptual dizziness. The water intake information was analyzed for total water, plain water, and caffeinated beverages separately and compared between groups. RESULTS There was a significant difference between vestibular neuritis and benign paroxysmal positional vertigo (P < .001) and also between vestibular neuritis and Meniere's disease (P = .021) in terms of the intake values of plain water and total water. No significant difference was found between groups in caffeinated beverages intake (P = .151), and it was found that there is no statistically significant difference in plain water and total water intake in terms of gender (P > .05). CONCLUSION The most significant result of this study is that inadequate water intake can be a risk factor for some forms of peripheral vestibular disorders. People should be informed about the importance of drinking water and be encouraged to increase their water intake.
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Affiliation(s)
- Büşra Altın
- Department of Audiology, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
| | - Songül Aksoy
- Department of Audiology, Hacettepe University Faculty of Health Sciences, Ankara, Turkey
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Robijn SMM, Smits JJ, Sezer K, Huygen PLM, Beynon AJ, van Wijk E, Kremer H, de Vrieze E, Lanting CP, Pennings RJE. Genotype-Phenotype Correlations of Pathogenic COCH Variants in DFNA9: A HuGE Systematic Review and Audiometric Meta-Analysis. Biomolecules 2022; 12:220. [PMID: 35204720 PMCID: PMC8961530 DOI: 10.3390/biom12020220] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2021] [Revised: 01/21/2022] [Accepted: 01/23/2022] [Indexed: 02/04/2023] Open
Abstract
Pathogenic missense variants in COCH are associated with DFNA9, an autosomal dominantly inherited type of progressive sensorineural hearing loss with or without vestibular dysfunction. This study is a comprehensive overview of genotype-phenotype correlations using the PRISMA and HuGENet guidelines. Study characteristics, risk of bias, genotyping and data on the self-reported age of onset, symptoms of vestibular dysfunction, normative test results for vestibular function, and results of audiovestibular examinations were extracted for each underlying pathogenic COCH variant. The literature search yielded 48 studies describing the audiovestibular phenotypes of 27 DFNA9-associated variants in COCH. Subsequently, meta-analysis of audiometric data was performed by constructing age-related typical audiograms and by performing non-linear regression analyses on the age of onset and progression of hearing loss. Significant differences were found between the calculated ages of onset and progression of the audiovestibular phenotypes of subjects with pathogenic variants affecting either the LCCL domain of cochlin or the vWFA2 and Ivd1 domains. We conclude that the audiovestibular phenotypes associated with DFNA9 are highly variable. Variants affecting the LCCL domain of cochlin generally lead to more progression of hearing loss when compared to variants affecting the other domains. This review serves as a reference for prospective natural history studies in anticipation of mutation-specific therapeutic interventions.
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Affiliation(s)
- Sybren M. M. Robijn
- Department of Otorhinolaryngology, Hearing & Genes, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (S.M.M.R.); (J.J.S.); (K.S.); (P.L.M.H.); (A.J.B.); (E.v.W.); (E.d.V.); (C.P.L.)
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6500 GL Nijmegen, The Netherlands;
| | - Jeroen J. Smits
- Department of Otorhinolaryngology, Hearing & Genes, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (S.M.M.R.); (J.J.S.); (K.S.); (P.L.M.H.); (A.J.B.); (E.v.W.); (E.d.V.); (C.P.L.)
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6500 GL Nijmegen, The Netherlands;
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Kadriye Sezer
- Department of Otorhinolaryngology, Hearing & Genes, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (S.M.M.R.); (J.J.S.); (K.S.); (P.L.M.H.); (A.J.B.); (E.v.W.); (E.d.V.); (C.P.L.)
| | - Patrick L. M. Huygen
- Department of Otorhinolaryngology, Hearing & Genes, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (S.M.M.R.); (J.J.S.); (K.S.); (P.L.M.H.); (A.J.B.); (E.v.W.); (E.d.V.); (C.P.L.)
| | - Andy J. Beynon
- Department of Otorhinolaryngology, Hearing & Genes, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (S.M.M.R.); (J.J.S.); (K.S.); (P.L.M.H.); (A.J.B.); (E.v.W.); (E.d.V.); (C.P.L.)
| | - Erwin van Wijk
- Department of Otorhinolaryngology, Hearing & Genes, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (S.M.M.R.); (J.J.S.); (K.S.); (P.L.M.H.); (A.J.B.); (E.v.W.); (E.d.V.); (C.P.L.)
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6500 GL Nijmegen, The Netherlands;
| | - Hannie Kremer
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6500 GL Nijmegen, The Netherlands;
- Department of Human Genetics, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands
| | - Erik de Vrieze
- Department of Otorhinolaryngology, Hearing & Genes, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (S.M.M.R.); (J.J.S.); (K.S.); (P.L.M.H.); (A.J.B.); (E.v.W.); (E.d.V.); (C.P.L.)
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6500 GL Nijmegen, The Netherlands;
| | - Cornelis P. Lanting
- Department of Otorhinolaryngology, Hearing & Genes, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (S.M.M.R.); (J.J.S.); (K.S.); (P.L.M.H.); (A.J.B.); (E.v.W.); (E.d.V.); (C.P.L.)
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6500 GL Nijmegen, The Netherlands;
| | - Ronald J. E. Pennings
- Department of Otorhinolaryngology, Hearing & Genes, Radboud University Medical Center, 6525 GA Nijmegen, The Netherlands; (S.M.M.R.); (J.J.S.); (K.S.); (P.L.M.H.); (A.J.B.); (E.v.W.); (E.d.V.); (C.P.L.)
- Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, 6500 GL Nijmegen, The Netherlands;
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van de Berg R, Kingma H. History Taking in Non-Acute Vestibular Symptoms: A 4-Step Approach. J Clin Med 2021; 10:5726. [PMID: 34945023 DOI: 10.3390/jcm10245726] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2021] [Revised: 11/26/2021] [Accepted: 12/06/2021] [Indexed: 01/20/2023] Open
Abstract
History taking is crucial in the diagnostic process for vestibular disorders. To facilitate the process, systems such as TiTrATE, SO STONED, and DISCOHAT have been used to describe the different paradigms; together, they address the most important aspects of history taking, viz. time course, triggers, and accompanying symptoms. However, multiple (vestibular) disorders may co-occur in the same patient. This complicates history taking, since the time course, triggers, and accompanying symptoms can vary, depending on the disorder. History taking can, therefore, be improved by addressing the important aspects of each co-occurring vestibular disorder separately. The aim of this document is to describe a 4-step approach for improving history taking in patients with non-acute vestibular symptoms, by guiding the clinician and the patient through the history taking process. It involves a systematic approach that explicitly identifies all co-occurring vestibular disorders in the same patient, and which addresses each of these vestibular disorders separately. The four steps are: (1) describing any attack(s) of vertigo and/or dizziness; (2) describing any chronic vestibular symptoms; (3) screening for functional, psychological, and psychiatric co-morbidity; (4) establishing a comprehensive diagnosis, including all possible co-occurring (vestibular) disorders. In addition, pearls and pitfalls will be discussed separately for each step.
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Smith JL, Trofimova A, Ahluwalia V, Casado Garrido JJ, Hurtado J, Frank R, Hodge A, Gore RK, Allen JW. The "vestibular neuromatrix": A proposed, expanded vestibular network from graph theory in post-concussive vestibular dysfunction. Hum Brain Mapp 2021; 43:1501-1518. [PMID: 34862683 PMCID: PMC8886666 DOI: 10.1002/hbm.25737] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Revised: 11/21/2021] [Accepted: 11/23/2021] [Indexed: 11/07/2022] Open
Abstract
Convergent clinical and neuroimaging evidence suggests that higher vestibular function is subserved by a distributed network including visuospatial, cognitive-affective, proprioceptive, and integrative brain regions. Clinical vestibular syndromes may perturb this network, resulting in deficits across a variety of functional domains. Here, we leverage structural and functional neuroimaging to characterize this extended network in healthy control participants and patients with post-concussive vestibular dysfunction (PCVD). Then, 27 healthy control subjects (15 females) and 18 patients with subacute PCVD (12 female) were selected for participation. Eighty-two regions of interest (network nodes) were identified based on previous publications, group-wise differences in BOLD signal amplitude and connectivity, and multivariate pattern analysis on affective tests. Group-specific "core" networks, as well as a "consensus" network comprised of connections common to all participants, were then generated based on probabilistic tractography and functional connectivity between the 82 nodes and subjected to analyses of node centrality and community structure. Whereas the consensus network was comprised of affective, integrative, and vestibular nodes, PCVD participants exhibited diminished integration and centrality among vestibular and affective nodes and increased centrality of visual, supplementary motor, and frontal and cingulate eye field nodes. Clinical outcomes, derived from dynamic posturography, were associated with approximately 62% of all connections but best predicted by amygdalar, prefrontal, and cingulate connectivity. No group-wise differences in diffusion metrics or tractography were noted. These findings indicate that cognitive, affective, and proprioceptive substrates contribute to vestibular processing and performance and highlight the need to consider these domains during clinical diagnosis and treatment planning.
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Affiliation(s)
- Jeremy L Smith
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anna Trofimova
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Vishwadeep Ahluwalia
- Georgia State University, Atlanta, Georgia, USA.,Center for Advanced Brain Imaging, Georgia Institute of Technology, Atlanta, Georgia, USA
| | - Jose J Casado Garrido
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA
| | | | | | | | - Russell K Gore
- Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA.,Shepherd Center, Atlanta, Georgia, USA
| | - Jason W Allen
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia, USA.,Wallace H. Coulter Department of Biomedical Engineering, Georgia Institute of Technology and Emory University, Atlanta, Georgia, USA.,Department of Neurology, Emory University School of Medicine Emory University Hospital, Atlanta, Georgia, USA
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刘 嘉, 胡 亚, 汪 芹, 丁 艳, 李 娟, 唐 海. [Correlation and difference analysis in parameters between video head impulse test and caloric test in vestibular disease]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2021; 35:802-806. [PMID: 34628832 PMCID: PMC10127836 DOI: 10.13201/j.issn.2096-7993.2021.09.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 05/17/2021] [Indexed: 06/13/2023]
Abstract
Objective:To investigate interrelationships in parameters between caloric test and video head impulse test(vHIT) in the common peripheral vertigo diseases and healthy people, and to conduct correlation and difference analysis between the results in two tests, so as to evaluate the clinical diagnosis value of peripheral vertigo. Methods:The caloric test and vHIT were fulfilled in 68 patients with vertigo and 17 healthy volunteers. The diagnosis was done according to history inquiring, otology and audiology examination and vestibular tests. The vestibulo-ocular reflex(VOR) gain and gain asymmetry(GA) of a vHIT as well as unilateral weakness(UW) and the sum of the slow-phase velocities(SPVs) of warm and cold irrigation of the same side were compared. A cutoff value of VOR gain of a vHIT was also calculated using a receiver-operating characteristic curve. Results:In all ears(n=170), there was significant correlation in ipsilateral SPVs and VOR gain(r=0.568, P<0.0001); In all ears(n=34) of 17 healthy volunteers, there was no correlation in ipsilateral SPVs and VOR gain(r=-0.05, P=0.778); In all affected ears(n=76), there was statistically positive correlation in ipsilateral SPVs and VOR gain(r=0.571, P<0.0001); In all the unaffected ears(n=94), there was positive correlation in ipsilateral SPVs and VOR gain(r=0.286, P=0.005). In 60 patients with unilateral vestibular disease(n=60), there was statistically significant negative correlation between the VOR gain of affected ears and UW(r=-0.513, P<0.0001); there was statistically significant positive correlation between GA of a vHIT and UW(r=0.713, P<0.0001). There was a statistically significant negative correlation between the VOR gain of affected ears and UW in the fluctuating vertigo group(r=-0.516, P=0.002) as well as a positive correlation between GA and UW(r=0.529, P=0.001); In the non-fluctuating vertigo group, there was a statistically significant negative correlation between the VOR gain of affected ears and UW(r=-0.428, P=0.029); there was a positive correlation between GA of a vHIT and UW(r=0.743, P<0.0001). In the vestibular neuropathy group, there was a negative correlation between the VOR gain of affected ears and UW(r=-0.462, P=0.030); there was a statistically significant positive correlation between GA of a vHIT and UW(r=0.757, P<0.0001). There was a negative correlation between the VOR gain of affected ears and UW in the vestibular peripheral disease group(r=-0.516, P=0.002) as well as a statistically significant positive correlation between GA and UW(r=0.529, P=0.001). The mean value of UW(65.5%) was higher in the overt saccade group than that in the normal VOR group, there was statistically significant difference(P=0.006). According to the UW damage degree grading, there was statistically significant difference in abnormal educe rates(χ²=17.76, P<0.05). Based on the gold standard of caloric response, a cutoff value of 0.865 was determined; the parameters of the two tests were dissociated in 28.3%. Conclusion:There was a statistically significant correlation in parameters between vHIT and caloric test. The patients of overt saccade always accompany with the high UW, which could indicate that the vestibular function severely damaged. vHIT and caloric test can be complementary tools for the comprehensive evaluation of patients' vestibule function, on account of dissociation between the results of vHIT and caloric test and general result of consistent check.
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Affiliation(s)
- 嘉 刘
- 中南大学湘雅二医院耳鼻咽喉头颈外科(长沙,410011)Department of Otolaryngology Head and Neck Surgery, the Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - 亚 胡
- 中南大学湘雅二医院耳鼻咽喉头颈外科(长沙,410011)Department of Otolaryngology Head and Neck Surgery, the Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - 芹 汪
- 中南大学湘雅二医院耳鼻咽喉头颈外科(长沙,410011)Department of Otolaryngology Head and Neck Surgery, the Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - 艳 丁
- 中南大学湘雅二医院耳鼻咽喉头颈外科(长沙,410011)Department of Otolaryngology Head and Neck Surgery, the Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - 娟 李
- 中南大学湘雅二医院耳鼻咽喉头颈外科(长沙,410011)Department of Otolaryngology Head and Neck Surgery, the Second Xiangya Hospital, Central South University, Changsha, 410011, China
| | - 海兰 唐
- 中南大学湘雅二医院耳鼻咽喉头颈外科(长沙,410011)Department of Otolaryngology Head and Neck Surgery, the Second Xiangya Hospital, Central South University, Changsha, 410011, China
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Bilgeç MD, Erdoğmuş Küçükcan N, Birdane L, İncesulu A, Yıldırım N. Evaluation of the Vestibulocochlear System in Patients with Pseudoexfoliation Syndrome. Turk J Ophthalmol 2021; 51:156-160. [PMID: 34187149 PMCID: PMC8251668 DOI: 10.4274/tjo.galenos.2020.14892] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022] Open
Abstract
Objectives Patients with pseudoexfoliation syndrome (PES) can also have sensorineural hearing loss as well as balance problems. Our aim was to evaluate vestibulocochlear system involvement in PES patients. Materials and Methods The study included 16 subjects with PES (study group) with a mean age of 66.12±5.64 years and 17 healthy subjects (control group) with a mean age of 61.70±8.46 years. Both groups underwent ophthalmological, neuro-otological, audiological, and vestibular evaluation. Pure-tone audiometry and tympanometry were performed as audiological tests and bithermal caloric test and vestibular-evoked myogenic potential (VEMP) testing were used as vestibular tests. The Romberg, tandem Romberg, and Unterberger tests were also performed. Results In the PES group, bithermal caloric tests revealed right canal paresis in 6 patients, left canal paresis in 3 patients, and bilateral stimulation loss in 2 patients, despite no clinical evidence of balance loss. Paresis was not detected in any of the control subjects. Unilateral VEMP responses could not be obtained in 3 patients in the PES group. The ocular PES patients whose VEMP waves were obtained differed significantly from the control group (p<0.05). In office tests for vestibular evaluation, pathologic findings were found in 7 of 16 patients in the study group and only 4 subjects in the control group. Audiological evaluation with pure-tone thresholds revealed sensorineural decline at 4000 and 8000 Hertz in the PES patients. A statistically significant difference was found between the study group and the control group (p<0.05). Conclusion Patients with PES showed elevation in pure-tone thresholds and a decrease in superior and inferior vestibular nerve function, demonstrating that the vestibular system as well as the auditory system are affected in PES.
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Affiliation(s)
- Mustafa Değer Bilgeç
- Eskişehir Osmangazi University Faculty of Medicine, Department of Ophthalmology, Eskişehir, Turkey
| | | | - Leman Birdane
- Yunus Emre State Hospital, Clinic of Otorhinolaryngology, Eskişehir, Turkey
| | - Armağan İncesulu
- Eskişehir Osmangazi University Faculty of Medicine, Department of Otorhinolaryngology, Eskişehir, Turkey
| | - Nilgün Yıldırım
- Eskişehir Osmangazi University Faculty of Medicine, Department of Ophthalmology, Eskişehir, Turkey
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Abstract
Vestibular migraine (VM) is one of the most common types of episodic vertigo. Over the last 11 years, this disorder has been studied by both neurologists and otolaryngologists. Based on the clinical symptoms and previous migraine history, the Barany Society and the International Classification of Headache Disorders have created the diagnostic criteria for VM. Unilateral and pulsatile headache, phonophobia, photophobia, auras, and a previous history of migraine have been included in these criteria. Although these symptoms are common and widely known, other symptoms not included in the Barany Society criteria are emerging and have been described in some clinical studies. These emerging criteria include audio-vestibular symptoms such as hearing loss, ear fullness, and tinnitus. Ringing ears could be associated with other vestibular disorders such as superior canal dehiscence and Ménière’s disease, but not in VM. The frequency, pathophysiological contributors, and clinical characteristics of this symptom in individuals with VM will be explored in this review.
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Affiliation(s)
- Alejandro García
- Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, USA
| | - Jorge Madrigal
- Otoneurology, Centro de Vértigo y Mareo, Mexico City, MEX
| | - Melissa Castillo
- Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, USA
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18
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da Costa Monsanto R, Knoll RM, de Oliveira Penido N, Song G, Santos F, Paparella MM, Cureoglu S. Otopathologic Abnormalities in CHARGE Syndrome. Otolaryngol Head Neck Surg 2021; 166:363-372. [PMID: 33874787 DOI: 10.1177/01945998211008911] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To perform an otopathologic analysis of temporal bones (TBs) with CHARGE syndrome. STUDY DESIGN Otopathologic study of human TB specimens. SETTING Otopathology laboratories. METHODS From the otopathology laboratories at the University of Minnesota and Massachusetts Eye and Ear Infirmary, we selected TBs from donors with CHARGE syndrome. These TBs were serially sectioned at a thickness of 20 µm, and every 10th section was stained with hematoxylin and eosin. We performed otopathologic analyses of the external ear, middle ear (middle ear cleft, mucosal lining, ossicles, mastoid, and facial nerve), and inner ear (cochlea, vestibule, internal auditory canal, and cochlear and vestibular nerves). The gathered data were statistically analyzed. RESULTS Our study included 12 TBs from 6 donors. We found a high prevalence of abnormalities affecting the ears. The most frequent findings were stapes malformation (100%), aberrant course of the facial nerve (100%) with narrow facial recess (50%), sclerotic and hypodeveloped mastoids (50%), cochlear (100%) and vestibular (83.3%) hypoplasia with aplasia of the semicircular canals, hypoplasia and aplasia of the cochlear (66.6%) and vestibular (91.6%) nerves, and narrowing of the bony canal of the cochlear nerve (66.6%). The number of spiral ganglion and Scarpa's ganglion neurons were decreased in all specimens (versus normative data). CONCLUSIONS In our study, CHARGE syndrome was associated with multiple TB abnormalities that may severely affect audiovestibular function and rehabilitation.
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Affiliation(s)
- Rafael da Costa Monsanto
- Department of Otolaryngology-Head and Neck Surgery, Universidade Federal de São Paulo / Escola Paulista de Medicina, São Paulo, Brazil.,Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Renata Malimpensa Knoll
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary / Harvard Medical School, Boston, Massachusetts, USA
| | - Norma de Oliveira Penido
- Department of Otolaryngology-Head and Neck Surgery, Universidade Federal de São Paulo / Escola Paulista de Medicina, São Paulo, Brazil
| | - Grace Song
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Felipe Santos
- Department of Otolaryngology-Head and Neck Surgery, Massachusetts Eye and Ear Infirmary / Harvard Medical School, Boston, Massachusetts, USA
| | - Michael Mauro Paparella
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
| | - Sebahattin Cureoglu
- Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA
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19
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Newman JL, Phillips JS, Cox SJ. Reconstructing animated eye movements from electrooculography data to aid the diagnosis of vestibular disorders. Int J Audiol 2021; 61:78-83. [PMID: 33825603 DOI: 10.1080/14992027.2021.1883196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To develop a method of visualising electrooculography data to improve the interpretability of nystagmus eye-movements captured using the Continuous Ambulatory Vestibular Assessment (CAVA®) device. DESIGN We are currently undertaking a clinical investigation to evaluate the capabilities of the CAVA® device to detect periods of pathological nystagmus. The work presented here was undertaken using unblinded data obtained from the preliminary phase of this investigation. STUDY SAMPLE One patient with Ménière's disease and one with Benign Paroxysmal Positional Vertigo. RESULTS Using the electrooculography data captured by the CAVA® device, we reconstructed 2D animations of patients' eye movements during attacks of vertigo. We were able to reanimate nystagmus produced as a consequence of two conditions. Concurrent video footage showed that the animations were visually very similar to the patient's actual eye-movements, excepting torsional eye-movements. CONCLUSIONS The reconstructed animations provide an alternative presentation modality, enabling clinicians to largely interpret electrooculography data as if they were present during a vertigo attack. We were able to recreate nystagmus from attacks experienced in the community rather than a clinical setting. This information provides an objective record of a patient's nystagmus and could be used to complement a full neurotologic history when considering diagnosis and treatment options.
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Affiliation(s)
| | - John S Phillips
- Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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20
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Heigle B, Kee M, Ottwell R, Arthur W, Brame L, Wright DN, Hartwell M, Khojasteh J, Vassar M. Spin the Abstracts of Systematic Reviews and Meta-Analyses Regarding the Treatment of Ménière's Disease. Ann Otol Rhinol Laryngol 2021; 130:34894211000493. [PMID: 33730925 DOI: 10.1177/00034894211000493] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
OBJECTIVES To identify, quantify, and characterize the presence of spin-specific strategies leading to misrepresentation of study results-in the abstracts of systematic reviews and meta-analyses of Ménière's disease treatment. METHODS Using a cross-sectional design, we searched MEDLINE and Embase on May 28, 2020, for systematic reviews and meta-analyses focused on Ménière's disease treatment. Returned searches were screened, and data were extracted in a masked, duplicate fashion. RESULTS Our sample included 36 systematic reviews and meta-analyses. Of the 36 included studies, 22 (61.1%) abstracts contained spin while 14 (38.9%) did not. The most common spin types were selective reporting of benefit (10/36, 27.8%) or harm (8/36, 22.2%). Other types of spin occurred when findings were extrapolated to the global improvement of the disease (5/36, 13.9%), beneficial effects were reported with high risk of bias in primary studies (3/36, 8.3%), and when beneficial effects were extrapolated to an entire class of interventions (1/36, 2.8%). No instances of other spin types occurred. Abstracts containing spin were substantively associated with studies of critically low methodological quality compared with studies with low and moderate quality. No studies had a methodological rating of high quality. No associations were observed between spin and intervention types, journal recommendation of adhering to Preferred Reporting Items for Systematic Reviews and Meta-Analyses, or funding. We found a negative correlation (r = -.31) between abstract word limit and presence of spin. CONCLUSIONS Our study highlights that spin in the abstracts of systematic reviews of Ménière's disease is common, and it further enhances the discussion surrounding spin in abstracts of scientific research. Spin in an abstract does not discredit a study's findings; however, its occurrence should be eliminated.
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Affiliation(s)
- Benjamin Heigle
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Micah Kee
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Ryan Ottwell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Wade Arthur
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Lacy Brame
- Department of Otolaryngology-Head and Neck Surgery, Oklahoma State University Medical Center, Tulsa, OK, USA
| | - Drew N Wright
- Samuel J. Wood Library & C. V. Starr Biomedical Information Center, Weill Cornell Medical College, New York, NY, USA
| | - Micah Hartwell
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
- Department of Psychiatry and Behavioral Science, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
| | - Jam Khojasteh
- Research, Evaluation, Measurement and Statistics, Oklahoma State University, Tulsa, OK, USA
| | - Matt Vassar
- Office of Medical Student Research, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
- Department of Psychiatry and Behavioral Science, Oklahoma State University Center for Health Sciences, Tulsa, OK, USA
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Domínguez-Durán E, Doménech-Vadillo E, Bécares-Martínez C, Montilla-Ibáñez MA, Álvarez-Morujo de Sande MG, González-Aguado R, Guerra-Jiménez G. Exploring the frontiers of vestibular migraine: A case series. J Vestib Res 2021; 31:91-99. [PMID: 33361625 DOI: 10.3233/ves-201559] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
INTRODUCTION Patients with episodic vestibular syndrome (EVS) whose symptoms resemble those of vestibular migraine (VM) but who do not meet the criteria for it are common. OBJECTIVE To describe those patients suffering from EVS in whom defined etiologies have been ruled out in order to determine if their symptoms can be linked to VM. MATERIAL AND METHODS Prospective multicenter study. The medical records of patients with VM and patients with EVS suggestive of VM but not meeting the criteria for it were examined. The characteristics of headache, the number and the length of attacks, the association of vestibular symptoms and headache, the intensity of symptoms and the response to treatment were recorded. RESULTS 58 patients met the criteria for VM or probable VM; 30 did not. All of the symptoms improved significantly in the treated patients with VM or probable VM; in the rest of the treated patients, only the vestibular symptoms improved. CONCLUSION A subgroup of patients that cannot be attributed to any known vestibulopathy according to present day VM criteria profited from migraine treatment, suggesting that their vestibular symptoms belong to the migraine spectrum; whereas some do not, yet our analysis could not identify distinctive features that allowed subgroup attribution.
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Affiliation(s)
| | - Esther Doménech-Vadillo
- Hospital Universitari Joan XXIII, Tarragona, Spain.,Institud D'Investigació Sanitària Pere Virgili, Reus, Spain
| | | | | | | | | | - Gloria Guerra-Jiménez
- Complejo Hospitalario Universitario Insular Materno-Infantil, Las Palmas de Gran Canaria, Spain
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Phillips JS, Newman JL, Cox SJ. Clinical Techniques and Technology: Vestibular Telemetry. Otolaryngol Head Neck Surg 2021; 165:751-753. [PMID: 33650899 PMCID: PMC8564261 DOI: 10.1177/0194599821993411] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
When a patient presents to a clinician with dizziness, it can be difficult for the
patient to describe their symptoms in a clear manner, and clinical examination often
yields entirely normal results. Ideally, it would be favorable to measure key
physiological parameters during their episodes of dizziness. From a clinical perspective,
this would allow a more timely and more accurate diagnosis. From a research perspective,
it would allow a greater understanding of how the vestibular system malfunctions as a
consequence of vestibular disease. The authors of this report have been funded by the UK
Medical Research Council to develop and test a novel technology to measure, record, and
analyze key physiological parameters provided by the dizzy individual during an episode of
dizziness while active in the community. We provide the context to evolving work in this
field, the outcome of preliminary studies, and a consideration of future
opportunities.
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Affiliation(s)
- John S Phillips
- Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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余 力, 马 鑫. [Advanced understanding of migraine and central sensitization syndrome]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2021; 35:97-100. [PMID: 33540986 PMCID: PMC10127884 DOI: 10.13201/j.issn.2096-7993.2021.02.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/21/2020] [Indexed: 06/12/2023]
Affiliation(s)
- 力生 余
- 北京大学人民医院耳鼻咽喉头颈外科(北京,100044)
| | - 鑫 马
- 北京大学人民医院耳鼻咽喉头颈外科(北京,100044)
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24
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Domínguez-Durán E, Moreno-de-Jesús C, Prieto-Sánchez-de-Puerta L, Mármol-Szombathy I, Sánchez-Gómez S. Identifying Training, Diagnostic and Therapeutic Needs From a Comparison in the Distribution of Vestibular Disorders in Primary Care and in a Neurotology Unit. Front Neurol 2020; 11:605613. [PMID: 33329367 PMCID: PMC7714908 DOI: 10.3389/fneur.2020.605613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2020] [Accepted: 10/28/2020] [Indexed: 11/13/2022] Open
Abstract
Introduction: Several epidemiological studies in Neurotology have been previously carried out in the general population. This approach is useful for learning about the most common disorders in clinical population, but it may fail when one is trying to help professionals to guide their training, to optimize their resources and to decide on the highest-priority research objectives. Objective: To identify which of the neurotological diseases are most common in two different populations, those who attended a consultation in the Neurotology Unit of a tertiary level hospital and those who did so in Primary Care in order to infer which of them requires more attention in each context and their specific needs. Methods: All the diagnoses made in Hospital Care between October 15, 2017 and October 14, 2018 were reviewed. These diagnoses were coded and classified into syndromes and diseases. Later, the proportions of each category were compared with the proportions of the neurotological diagnoses made in five Primary Care centers over the same period of time. Results: BPPV is the most common cause of vestibular symptoms in both contexts. Vestibular migraine, ischemic vestibular symptoms, orthostatic hypotension and side effects of drugs are common in Primary Care, whereas Ménière's disease and undifferentiated episodic vestibular syndrome are common in specialized centers. Conclusion: The proportion of diagnoses in neurotologic patients is different in the general population and in the specialized center population, and therefore they have different needs. Primary Care professionals would benefit from training on maneuvers for repositioning otoliths, the treatment of headache, the identification of cardiovascular risk factors, the orthostatic hypotension and the side effects of the most commonly used drugs. The professionals who work in specialized centers need strategies for dealing with cases of BPPV associated to other vestibular diseases and refractory cases and their research should focus on the development of new diagnostic tools for the diagnosis of undifferentiated episodic vestibular syndrome and new therapeutic options for Ménière's disease.
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Affiliation(s)
- Emilio Domínguez-Durán
- Unidad de Gestión Clínica de Otorrinolaringología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Carolina Moreno-de-Jesús
- Unidad de Gestión Clínica de Otorrinolaringología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | | | - Irene Mármol-Szombathy
- Unidad de Gestión Clínica de Otorrinolaringología, Hospital Universitario Virgen Macarena, Sevilla, Spain
| | - Serafín Sánchez-Gómez
- Unidad de Gestión Clínica de Otorrinolaringología, Hospital Universitario Virgen Macarena, Sevilla, Spain
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25
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Liu B, Leng Y, Zhou R, Liu J, Wang H. [Clinical analysis of idiopathic bilateral vestibulopathy]. Lin Chung Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2020; 34:906-910. [PMID: 33254296 PMCID: PMC10128508 DOI: 10.13201/j.issn.2096-7993.2020.10.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Received: 02/17/2020] [Indexed: 11/12/2022]
Abstract
Objective:To improve the level of clinical diagnosis and treatment of idiopathic bilateral vestibulopathy(IBV) by investigating the clinical characteristics of this disease. Method:Retrospective analysis was performed on patients with IBV diagnosed, excluding patients with clear primary factors, and including IBV patients with unknown causes, to analyze their clinical symptoms and vestibular function examination results. Result:In this group of cases, three cases were in line with the diagnosis of IBV. The clinical manifestations included imbalance, oscillopsia, and normal hearing level, which cannot be explained by other diseases. The vestibular function testing of the patients with IBV showed bilateral reduced response in caloric tests, positive response in video head impulse test, and decreased score in sensory organization test. Vestibular rehabilitation therapy were carried for these patients, and could improve the patients' symptoms. Conclusion:IBV has typical clinical manifestations. Vestibular function testing indicates bilateral vestibular dysfunction. Other diseases with bilateral vestibulopathy should be excluded for diagnoses, and vestibular rehabilitation therapy is one of the appropriate treatments.
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Affiliation(s)
- Bo Liu
- Department of Otorhinolaryngology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430022,China
| | - Yangming Leng
- Department of Otorhinolaryngology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430022,China
| | - Renhong Zhou
- Department of Otorhinolaryngology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430022,China
| | - Jingjing Liu
- Department of Otorhinolaryngology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430022,China
| | - Hongchang Wang
- Department of Otorhinolaryngology,Union Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan,430022,China
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26
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Bayat A, Hoseinabadi R, Saki N, Sanayi R. Disability and Anxiety in Vestibular Diseases: A Cross-Sectional Study. Cureus 2020; 12:e11813. [PMID: 33409058 PMCID: PMC7781499 DOI: 10.7759/cureus.11813] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Patients with dizziness and vertigo usually experience psychological, physical, and social functioning limitations that may affect their daily living activities. In order to better understand disability and anxiety in patients with vertigo, in the present study we aimed to investigate the correlation between disability and anxiety in four different types of diseases causing vertigo. Moreover, the difference between the observed disabilities in these etiologies of vertigo was studied. Materials and methods In this analytic cross-sectional design, 130 patients (52 male, 78 female; age range: 18-75 years) with dizziness/vertigo who were referred to our balance clinic participated. All patients underwent a detailed diagnostic procedure including neurological, clinical, and otological evaluations. Dizziness Handicap Inventory (DHI) and the Beck Anxiety Inventory (BAI) were used to assess handicap and anxiety, respectively. Results There were no significant differences in "total DHI" and DHI subcomponent scores among different study populations (p>0.05). In terms of the BAI score, the one-way analysis of variance (ANOVA) test indicated no significant differences among the four groups (p=0.158). Our results exhibited a significant positive correlation between the BAI and "total DHI" and "DHI subcomponents" values. Conclusion The degree of disability and anxiety is not different between patients with Benign paroxysmal positional vertigo (BPPV), Meniere's disease (MD), unilateral weakness (UW), and central causes. The significant positive correlation between the BAI and "total DHI" and "DHI subcomponents" values shows that the possibility of anxiety in patients with vertigo should not be ignored.
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Affiliation(s)
- Arash Bayat
- Hearing Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IRN
| | - Reza Hoseinabadi
- Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, IRN
| | - Nader Saki
- Hearing Research Center, Ahvaz Jundishapur University of Medical Sciences, Ahvaz, IRN
| | - Roya Sanayi
- Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, IRN
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27
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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] [What about the content of this article? (0)] [Affiliation(s)] [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.
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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
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Abstract
OBJECTIVE We are currently undertaking a clinical investigation to evaluate the diagnostic capability of a system for detecting periods of pathological dizziness. This article presents an analysis of the data captured during an acute attack of Ménière's disease. DESIGN The Continuous Ambulatory Vestibular Assessment (CAVA) device is worn by patients in the community, and continuously records eye and head movement data (vestibular telemetry). STUDY SAMPLE A 53-year-old lady with a fifteen-year history of left-sided unilateral Ménière's disease. RESULTS The patient wore the device nearly continuously for thirty days. The data revealed a three-hour long attack of vertigo consisting of four separate phases of nystagmus. The duration, beat-direction and slow phase velocity of the nystagmus evolved through time. The first phase contained isolated nystagmus beats which preceded the patient's record of the vertigo attack onset but coincided with anticipation of an impending vertigo attack. CONCLUSIONS CAVA provides a unique insight into the physiological parameters present during episodes of dizziness. Here, it has provided the first full example of an acute Ménière's attack, including a period of prodrome. These findings have implications for the prediction of vertigo attack onset, for the diagnosis of Ménière's disease and other diseases resulting in dizziness.
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Affiliation(s)
- John S Phillips
- Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | | | - John FitzGerald
- Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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Kim SY, Cho YS, Kim JS, Koo JW. Association between Bone Metabolism and Vestibular Problems in the Modified Romberg Test: Data from the 2009-2010 Korean National Health and Nutrition Examination Survey. J Clin Med 2020; 9:E2415. [PMID: 32731479 DOI: 10.3390/jcm9082415] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2020] [Revised: 07/24/2020] [Accepted: 07/27/2020] [Indexed: 11/16/2022] Open
Abstract
Osteoporosis contributes to the occurrence of falling and vestibular problems, particularly in elderly patients. This study aimed to investigate the association between bone metabolism with vestibular problems and falling. A total of 4054 participants of the Korean National Health and Nutrition Examination Survey (KNHANES) from 2009 to 2010 aged ≥50 years old were surveyed on their history of falling, vestibular problems evaluated by the modified Romberg test, variables involving bone metabolism, and serum levels of vitamin D and alkaline phosphatase. They also underwent dual energy X-ray absorptiometry. The crude (simple) and adjusted odd ratios (ORs) of variables involving bone metabolism for vestibular problems in the modified Romberg test and falling were analyzed using a logistic regression model. A subgroup analysis was performed according to sex and the presence of menopause in females. Vestibular problems in the modified Romberg test group but not the falling group were associated with decreased serum vitamin D levels (p < 0.001; odds ratio (OR) = 0.951; 95% confidence interval (CI), 0.926-0.976). In subgroup analysis according to sex, the post-menopause group showed a higher rate of vestibular problems in the modified Romberg test compared to the pre-menopause group (4.5% vs. 0.7%, p = 0.019). In the post-menopause group, osteoporosis was positively associated with vestibular problems in the modified Romberg test (p = 0.001, OR = 10.971, 95% CI = 2.650-45.414). On the other hand, a history of hormone replacement therapy was negatively related with vestibular problems in this subgroup (p = 0.035; OR = 0.473; 95% CI = 0.239-0.948). A decrease in serum vitamin D levels may impact the vestibular system through neural signaling or by osteoporotic changes of the otic capsule, as well as otolith particles. Decreased estrogen levels in postmenopausal women may make them more prone to osteoporotic changes, which were associated with vestibular problems in the modified Romberg test. Because this is a cross-sectional study, the causal relationship of bone metabolism with vestibular function needs to be investigated.
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葛 畅, 席 淑, 吴 沛. [Reliability and validity of chinese version of vestibular rehabilitation benefit questionnaire]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2020; 34:511-515. [PMID: 32842181 PMCID: PMC10128335 DOI: 10.13201/j.issn.2096-7993.2020.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Indexed: 06/11/2023]
Abstract
Objective:To translate the English version of vestibular rehabilitation benefit questionnaire (VRBQ) into Chinese, and to test its reliability and validity. Method:The VRBQ was forward and backward-translated according to the Brislin model. Cultural adaption was done by expert discussion and pilot study. The scale was applied to 158 patients to test its reliability and validity. Result:The Cronbach's α coefficient was 0.90, and the test-retest reliability was 0.98, the total scale responsiveness is 2.066. Chinese version of VRBQ consisted of 22 items. Four factors were extracted by factor analysis, which could explain 73.341% of the total variance. Conclusion:The Chinese version of VRBQ is reliable and valid, therefore can be used to evaluate the quality of life and rehabilitation efficacy of patients with vestibular dysfunction in Chinese cultural background.
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Affiliation(s)
- 畅 葛
- 复旦大学护理学院(上海,200032)School of Nursing, Fudan University, Shanghai, 200032, China
| | - 淑新 席
- 复旦大学附属眼耳鼻喉科医院Eye and ENT Hospital Hospital of Fudan University
| | - 沛霞 吴
- 复旦大学附属眼耳鼻喉科医院Eye and ENT Hospital Hospital of Fudan University
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31
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Mueller AL, Liebmann LB, Petrak MR, Bahner CM, Weberling LM, Weiss AD, Matsuoka AJ. Evaluation of the utricular function with the virtual-subject visual vertical system: comparison with ocular vestibular-evoked myogenic potentials. Acta Otolaryngol 2020; 140:366-372. [PMID: 32022613 DOI: 10.1080/00016489.2020.1718202] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
Abstract
Introduction: The subjective visual vertical (SVV) is the most frequently assessed modality of verticality perception and has been measured in a variety of clinical situations, including peripheral vestibular lesions.Aim: The main objectives are (1) to collect normative data of Virtual SVV™ from healthy subjects, and (2) to study the correlation between Virtual SVV™ and ocular vestibular-evoked myogenic potentials (o-VEMP) on healthy subjects.Materials and methods: Forty-three healthy subjects were recruited. Air conduction (AC)-elicited oVEMPs and bone conduction (BC)-elicited oVEMPs were measured. BC stimuli were produced with a RadioEar B-81 High Output Bone Transducer. Virtual SVV™ were also measured.Results: Virtual SVV™ data from our healthy subjects were consistent with previously published normative SVV data. Normal Virtual SVV™ data did not correlate with normal AC-elicited and BC-elicited oVEMPs.Conclusions: Virtual SVV™ data from our healthy subjects were consistent with previously published normative SVV data. Virtual SVV™ data from our 43 health subjects only had weak correlation with c-VEMP, AC-elicited and BC-elicited oVEMPs. These data serve as a baseline for a future study of patients with unilateral utricular dysfunction.Significance: The Virtual SVV™ can be an attractive substitute for traditional SVV in clinical settings.
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Affiliation(s)
- Amanda L. Mueller
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL, USA
| | - Lara B. Liebmann
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL, USA
| | | | | | | | | | - Akihiro J. Matsuoka
- Roxelyn and Richard Pepper Department of Communication Sciences and Disorders, School of Communication, Northwestern University, Evanston, IL, USA
- Northwestern Medicine, Chicago, IL, USA
- Department of Otolaryngology-Head and Neck Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
- Hugh Knowles Hearing Centre, Evanston, IL, USA
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Peinado-Rubia A, Osuna-Pérez MC, Rodríguez-Almagro D, Zagalaz-Anula N, López-Ruiz MC, Lomas-Vega R. Impaired Balance in Patients with Fibromyalgia Syndrome: Predictors of the Impact of This Disorder and Balance Confidence. Int J Environ Res Public Health 2020; 17:E3160. [PMID: 32370043 DOI: 10.3390/ijerph17093160] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/01/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 12/05/2022]
Abstract
Patients with fibromyalgia syndrome (FMS) have a nonspecific postural balance disorder and a greater prevalence of falls. Objective: to clarify which aspects of maintaining balance are associated with the impact of the disorder and with balance confidence. Methods: A total of 182 persons with FMS agreed to participate in this study. After re-evaluation, 57 fully met inclusion criteria: age 40–70 years and moderate-severe impact of the illness according to the Fibromyalgia Impact Questionnaire (FIQ). All participants underwent a posture control analysis with a stabilometric platform, an evaluation of the perception of verticality and an exploration of the vestibular system via functional tests. Additionally, they self-completed questionnaires about balance confidence, central sensitization, pain catastrophizing, kinesiophobia, dizziness and days with episodes of instability. Results: The FIQ was associated with central sensitization and dizziness, which explained 56% of its variance (AdjR2 = 0.566), while days with instability, kinesiophobia and dizziness also explained more than half of the variance of the balance confidence scale (AdjR2 = 0.527). A high percentage of positive responses was found for functional tests (>50%) and a high dispersion in the stabilometric parameters. Conclusion: the detection of factors susceptible to intervention, such as disability due to dizziness, takes on special relevance in patients with FMS.
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王 涛, 唐 凤, 袁 弘. [Current status and new progress of vestibular assistant systems]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2020; 34:285-288. [PMID: 32791603 PMCID: PMC10127860 DOI: 10.13201/j.issn.2096-7993.2020.03.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Indexed: 04/30/2023]
Abstract
Vestibular dysfunction can seriously affect patients' daily life and work. There is an urgent need for new methods to treat vestibular dysfunction. As awareness of these diseases increases, efforts are being made to improve vestibular function through a number of vestibular assistant systems. As far as current development is concerned, vestibular assistant system mainly focuses on two fields: external prosthesis and vestibular implant. This review shows the current status and future development trend of the vestibular assistant system.
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Affiliation(s)
- 涛 王
- 广西壮族自治区人民医院耳鼻咽喉头颈外科(南宁,530021)
| | - 凤珠 唐
- 广西壮族自治区人民医院耳鼻咽喉头颈外科(南宁,530021)
- 唐凤珠,
| | - 弘 袁
- 广西壮族自治区人民医院耳鼻咽喉头颈外科(南宁,530021)
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García-Muñoz C, Cortés-Vega MD, Heredia-Rizo AM, Martín-Valero R, García-Bernal MI, Casuso-Holgado MJ. Effectiveness of Vestibular Training for Balance and Dizziness Rehabilitation in People with Multiple Sclerosis: A Systematic Review and Meta-Analysis. J Clin Med 2020; 9:E590. [PMID: 32098162 DOI: 10.3390/jcm9020590] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Revised: 02/08/2020] [Accepted: 02/08/2020] [Indexed: 12/30/2022] Open
Abstract
Postural instability and dizziness are commonly observed in people with multiple sclerosis (PwMS). The aim of this systematic review was to evaluate the evidence for the use of vestibular rehabilitation, in comparison with other exercise interventions or no intervention, to treat balance impairments and dizziness in PwMS. An electronic search was conducted by two independent reviewers in the following databases: MEDLINE (Pubmed), Scopus, the Physiotherapy Evidence Database (PEDro), Web of Science (WOS), Lilacs, CINHAL and the Cochrane Database of Systematic Reviews (CDSR). A quality assessment was performed using the PEDro scale and the Cochrane Risk of Bias Tool. When possible, the data were pooled in a meta-analysis (95%CI). This systematic review followed the PRISMA guideline statement and was registered in the PROSPERO database (CRD42019134230). Seven studies were included, with a total of 321 participants analysed. Compared with no intervention, vestibular rehabilitation was more effective for balance development (SMD = 2.12; 95% CI = 0.49, 3.75; p = 0.01; I2 = 89%) and dizziness symptoms improvement (SMD = −17.43; 95% CI = −29.99, −4.87; p= 0.007; I2= 66%). Compared with other exercise interventions, improvements in favour of the experimental group were observed, but statistical significance for the differences between groups was not reached.
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Lee JY, Kwon E, Kim HJ, Choi JY, Oh HJ, Koo JW, Kim JS. Dissociated Results between Caloric and Video Head Impulse Tests in Dizziness: Prevalence, Pattern, Lesion Location, and Etiology. J Clin Neurol 2020; 16:277-284. [PMID: 32319245 PMCID: PMC7174114 DOI: 10.3988/jcn.2020.16.2.277] [Citation(s) in RCA: 27] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Revised: 12/03/2019] [Accepted: 12/05/2019] [Indexed: 01/23/2023] Open
Abstract
Background and Purpose This study was designed to determine the prevalence, pattern, lesion location, and etiology of dissociation in the results of the bithermal caloric test and the horizontal video head impulse test (vHIT) in dizzy patients with various etiologies and disease durations. Methods We analyzed the results of bithermal caloric tests and vHITs performed over 26 months in 893 consecutive patients who underwent both tests within a 10-day period. Results Dissociation in the results of the two tests was found in 162 (18.1%) patients. Among them, 123 (75.9%) had abnormal caloric tests (unilateral paresis in 118 and bilateral paresis in 5) but normal vHITs. Peripheral lesions were identified in 105 (85.4%) of these patients, with the main underlying diseases being Meniere's disease (62/105, 59%) and vestibular neuritis/labyrinthitis (29/105, 27.6%). In contrast, central pathologies of diverse etiologies were found only in 18 (14.6%) patients. Abnormal vHIT (bilaterally positive in 18, unilaterally positive in 19, and hyperactive in 2) and normal caloric responses were found in 39 patients, with an equal prevalence of central (n=19) and peripheral (n=20) lesions. The peripheral lesions included vestibular neuritis/labyrinthitis in seven patients and Meniere's disease in another seven. The central lesions had diverse etiologies. Conclusions Dissociation in the results between caloric tests and horizontal vHITs is not uncommon. The present patients with abnormal caloric tests and normal vHITs mostly had peripheral lesions, while central lesions were likely to underlie those with abnormal vHITs and normal caloric tests.
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Affiliation(s)
- Ju Young Lee
- Department of Neurology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - Eunjin Kwon
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Hyo Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Jeong Yoon Choi
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea.
| | - Hui Jong Oh
- The MTV (Migraine, Tinnitus, and Vertigo) Clinic, Oh Neurology Center, Daegu, Korea
| | - Ja Won Koo
- Dizziness Center and Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Bundang Hospital, Seongnam, Korea
| | - Ji Soo Kim
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, Seongnam, Korea
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Coelho AR, Perobelli JLL, Sonobe LS, Moraes R, Barros CGDC, Abreu DCCD. Severe Dizziness Related to Postural Instability, Changes in Gait and Cognitive Skills in Patients with Chronic Peripheral Vestibulopathy. Int Arch Otorhinolaryngol 2020; 24:e99-e106. [PMID: 31892965 PMCID: PMC6828563 DOI: 10.1055/s-0039-1695025] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2018] [Accepted: 06/18/2019] [Indexed: 01/09/2023] Open
Abstract
Introduction Peripheral vestibular disorders can lead to cognitive deficits and are more common in elderly patients. Objective To evaluate and correlate cognitive, balance and gait aspects in elderly women with chronic peripheral vestibular dizziness, and to compare them with elderly women without vestibular disorders. Methods Twenty-two women presenting peripheral vestibular dizziness episodes for at least six months participated in the study. The individuals were categorized by dizziness severity level: moderate ( n = 11) or severe ( n = 11). The control group ( n = 11) included women showing no vestibulopathy, light-headedness or dizziness. Cognitive assessments and semi-static and dynamic balance assessments were performed with the Balance Master (Neurocom International, Inc., Clackamas, OR), while the Dizziness Handicap Inventory provided a score for the severity of the symptoms. The groups were submitted to statistics of inference and correlation between cognitive, balance and stability variables. Results The group with severe dizziness showed higher sway speed of the center of pressure in the anteroposterior direction, smaller step length, and slower gait than the control group. Regarding the cognitive variables, the group with severe dizziness symptoms presented significant correlations with stability and gait variables. Conclusion The relationship between cognitive aspects, balance and gait was stronger in women with severe dizziness than in those with no vestibulopathy.
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Affiliation(s)
- Almir Resende Coelho
- Department of Health Sciences, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
- Department of Physiotherapy, Universidade de Franca, Franca, SP, Brazil
| | | | - Lilian Shizuka Sonobe
- Department of Health Sciences, Faculdade de Medicina de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
| | - Renato Moraes
- Escola de Educação Física e Esporte de Ribeirão Preto, Universidade de São Paulo, Ribeirão Preto, SP, Brazil
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Boffino CC, Pereira ACAC, Coelho DB, Xavier RF, Berto CC, Da Silva M, Tanaka C, Ramos RT, Yamaguti WP, Carvalho CRF. Age and Disease have a Distinct Influence on Postural Balance of Patients with COPD. COPD 2019; 16:246-253. [PMID: 31328579 DOI: 10.1080/15412555.2019.1634683] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
The postural imbalance is an extra-pulmonary condition, associated with chronic obstructive pulmonary disease (COPD). COPD affects older individuals and it is unclear whether balance abnormalities can be described as pathophysiological mechanism or aging. The present study aimed to evaluate the influence of age or disease on postural balance of patients with COPD. Patients with COPD over 50 years old were compared with age- and sex-matched healthy adults, and with sex-matched younger healthy adults (n = 30 in each group). The Modified Sensory Organization Test (mSOT) was performed in four different conditions fixed or sway-referenced surface both either with full or no vision. It was analyzed the center of pressure (CoP) variables: amplitude, velocity, root-mean-square and load asymmetry. Three-way ANOVA and post hoc analysis were performed been represented of age (older or COPD compared with younger healthy adults) or disease influences (COPD compared with older healthy groups). Main results were as follows: The CoP excursion was faster, with higher amplitude and variability progressively from COPD vs. older healthy vs. younger healthy adults (p < 0.05) showing age and disease influences (p < 0.05). Age and disease influences were also observed in the sway-referenced surface in both vision conditions. Impairment in postural balance was found related to aging and disease in patients with COPD older than 50 years.
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Affiliation(s)
- Catarina Costa Boffino
- LIM 23 do Instituto de Psiquiatria do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo , São Paulo , Brazil.,LIM 44 do Departamento de Radiologia do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo , São Paulo , Brazil.,Divisão de Fisioterapia do Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de São Paulo , São Paulo , Brazil
| | | | - Daniel Boari Coelho
- Human Motor Systems Laboratory, School of Physical Education and Sport, University of São Paulo , Brazil
| | | | | | - Marques Da Silva
- Physical Therapy Department, School of Medicine, University of São Paulo , São Paulo , Brazil
| | - Clarice Tanaka
- Physical Therapy Department, School of Medicine, University of São Paulo , São Paulo , Brazil
| | - Renato Teodoro Ramos
- Frederick W. Thompson Anxiety Disorders Centre, Sunnybrook Health Sciences Centre, Department of Psychiatry, University of Toronto , Canada
| | | | - Celso R F Carvalho
- Physical Therapy Department, School of Medicine, University of São Paulo , São Paulo , Brazil
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Fujimoto C, Kawahara T, Kinoshita M, Kikkawa YS, Sugasawa K, Yagi M, Yamasoba T, Iwasaki S, Murofushi T. Aging Is a Risk Factor for Utricular Dysfunction in Idiopathic Benign Paroxysmal Positional Vertigo. Front Neurol 2018; 9:1049. [PMID: 30559714 PMCID: PMC6287371 DOI: 10.3389/fneur.2018.01049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/19/2018] [Indexed: 11/13/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is the most common cause of balance disorders in the elderly. Dislodgement of the otoconia in BPPV might have an association with damage to the otolith organs. The aim of this study was to investigate whether aging is a risk factor for otolith organ dysfunction in idiopathic BPPV. We retrospectively reviewed the medical records of 112 consecutive idiopathic BPPV patients who underwent cervical VEMP testing to air-conducted sound (ACS cVEMP), ocular VEMP testing to bone-conducted vibration (BCV oVEMP), and caloric testing. We performed binomial logistic regression analyses to see whether age, the side affected by BPPV or the canal affected by BPPV have an association with the presence of peripheral vestibular dysfunction in idiopathic BPPV patients. The elderly group (aged ≥65 years) had a significantly positive association with abnormalities in BCV oVEMPs (p = 0.0109), while the side affected by BPPV (p = 0.598) and the canal affected by BPPV (p = 0.576) did not. The odds ratio of the abnormal BCV oVEMPs for the elderly group compared with the non-elderly group (aged < 65 years) was 2.676 (95% confidence interval, 1.254–5.079). The elderly group had no significant association with the abnormalities in ACS cVEMPs (p = 0.0955) or caloric testing (p = 0.488). Dysfunction of the utricle, where the dislodgement of the otoconia mainly occurs, is affected by aging in idiopathic BPPV.
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Affiliation(s)
- Chisato Fujimoto
- Department of Otolaryngology, Tokyo Teishin Hospital, Tokyo, Japan.,Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Takuya Kawahara
- Biostatistics Division, Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Makoto Kinoshita
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yayoi S Kikkawa
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Keiko Sugasawa
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masato Yagi
- Department of Otolaryngology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Shinichi Iwasaki
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Toshihisa Murofushi
- Department of Otolaryngology, Tokyo Teishin Hospital, Tokyo, Japan.,Department of Otolaryngology, School of Medicine, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
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Fujimoto C, Egami N, Kawahara T, Uemura Y, Yamamoto Y, Yamasoba T, Iwasaki S. Noisy Galvanic Vestibular Stimulation Sustainably Improves Posture in Bilateral Vestibulopathy. Front Neurol 2018; 9:900. [PMID: 30405522 PMCID: PMC6204397 DOI: 10.3389/fneur.2018.00900] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2018] [Accepted: 10/03/2018] [Indexed: 11/26/2022] Open
Abstract
Patients with bilateral vestibulopathy (BV) suffer from persistent postural imbalance, leading to a marked decrease in quality of life and a higher risk of falls. However, so far, the effective treatments for BV are very limited. We examined whether long-term noisy galvanic vestibular stimulation (nGVS) keeps improving body balance after the cessation of the stimulus in BV patients. Thirteen BV patients received nGVS for 30 min with a lower intensity than the intensity at which they feel any cutaneous sensations, and their postural movement was monitored for 6 h after the stimuli. The same session was repeated at 14-day intervals. Stance tasks on two legs were performed with eyes closed. The velocity of the center of pressure (COP) movement, the area enclosed by the COP movement, and the root mean square of the displacement of the COP were measured. The power spectrum of the COP movement was assessed. Subjective improvement of body balance was graded as worsened (−2), slightly worsened (−1), unchanged (0), slightly improved (+1) and improved (+2) in comparison with that without nGVS. In each session, the velocity of the COP movement was significantly improved for 6 h after the stimulus had ceased (P < 0.01). Concomitantly, the mean frequency of the COP power spectrum was significantly reduced in the anterior-posterior axis (P < 0.05). Subjective symptoms of imbalance were improved during the post-stimulation effect (P < 0.05). nGVS leads to an improvement in body balance that lasts for several hours after the end of the stimulus in BV patients with a reduction in the high-frequency components of their postural movement. This trial was registered with the University Hospital Medical Information Network (UMIN) Clinical Trials Registry (UMINCTR: UMIN000028054).
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Affiliation(s)
- Chisato Fujimoto
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Naoya Egami
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Takuya Kawahara
- Biostatistics Division, Clinical Research Support Center, University of Tokyo Hospital, Tokyo, Japan
| | - Yukari Uemura
- Biostatistics Division, Clinical Research Support Center, University of Tokyo Hospital, Tokyo, Japan
| | - Yoshiharu Yamamoto
- Educational Physiology Laboratory, Graduate School of Education, University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Shinichi Iwasaki
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
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Abstract
BACKGROUND The association between otitis media and vestibular symptoms has been hypothesized in the past. Thus, in this study, we aimed to critically analyze (based in a systematic review of the literature) whether patients who have otitis media are at greater risk of developing vestibular impairment or not. METHODS We performed a systematic review of the literature and identified potentially relevant articles reporting vestibular symptoms and results of vestibular function tests in patients with otitis media through searches of the PubMED, Web of Science, Scopus, and Google Scholar databases. The quality of the final set of records was assessed using the "Newcaste-Ottawa Scale". RESULTS Of the 2334 records searched, 43 met our inclusion and exclusion criteria, and those included 2250 patients. The records comprised 20 longitudinal studies, 21 cross-sectional studies, and 2 case reports. Regarding the type of otitis media studied, 25 examined vestibular impairment in otitis media with effusion, 6 acute otitis media, and 12 chronic otitis media. Results of anamnesis, clinical exams, and several vestibular function tests are reported and critically discussed. CONCLUSION Most studies evaluating the association between otitis media and vestibular symptoms have potential methodological flaws. Clinical evidence suggests that patients with otitis media have increased chances for having vestibular symptoms, delayed acquisition of developmental milestones, and abnormalities in several vestibular function tests as compared with controls. Future studies with rigorous methodology aiming to assess the clinical significance (and prognostic factors) of the association between otitis media and vestibular impairment are warranted. Key message Several studies demonstrated long-term sequelae secondary to otitis media. However, the evidence supporting those assumptions are based in low-quality evidence. Thus, better structured studies are warranted to better understand the clinical relevance of such association.
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Affiliation(s)
- Rafael da Costa Monsanto
- a Department of Otorhinolaryngology, Head and Neck Surgery , Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM) , São Paulo , Brazil
| | - Ana Luiza Papi Kasemodel
- a Department of Otorhinolaryngology, Head and Neck Surgery , Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM) , São Paulo , Brazil
| | - Andreza Tomaz
- a Department of Otorhinolaryngology, Head and Neck Surgery , Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM) , São Paulo , Brazil
| | - Michael M Paparella
- b Department of Otolaryngology , University of Minnesota , Minneapolis , MN , USA.,c Paparella Ear, Head & Neck Institute , Minneapolis , MN , USA
| | - Norma de Oliveira Penido
- a Department of Otorhinolaryngology, Head and Neck Surgery , Universidade Federal de São Paulo/Escola Paulista de Medicina (UNIFESP/EPM) , São Paulo , Brazil
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Mucci V, Cha YH, Wuyts FL, Van Ombergen A. Perspective: Stepping Stones to Unraveling the Pathophysiology of Mal de Debarquement Syndrome with Neuroimaging. Front Neurol 2018; 9:42. [PMID: 29483889 PMCID: PMC5816028 DOI: 10.3389/fneur.2018.00042] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2017] [Accepted: 01/17/2018] [Indexed: 01/07/2023] Open
Abstract
Mal de debarquement syndrome (MdDS) is a neurological condition typically characterized by a sensation of motion, which in most cases manifests after disembarking from a vehicle (e.g., boat, plane, and car). However, the same symptoms can also occur spontaneously. Two main theories of the pathophysiology of MdDS are briefly summarized here. In this perspective, we aimed to report the most recent findings on neuroimaging studies related to MdDS, as well as to suggest further potential research questions that could be addressed with the use of neuroimaging techniques. A detailed analysis of previous work on MdDS has led to five main research questions that could be addressed in new neuroimaging studies. Furthermore, in this perspective, we propose new stepping-stones to addressing critical research questions related to MdDS and its pathophysiology. We propose considerations for new studies, as well as a detailed analysis of the current limitations and challenges present when studying MdDS patients. We hope that our examination of the nuances of MdDS as a neurological disorder will contribute to more directed research on this topic.
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Affiliation(s)
- Viviana Mucci
- Antwerp University Research Centre for Equilibrium and Aerospace, Department of Biomedical Physics, Faculty of Sciences, University of Antwerp, Antwerp, Belgium
| | - Yoon-Hee Cha
- Laureate Institute for Brain Research, Tulsa, OK, United States
| | - Floris L Wuyts
- Antwerp University Research Centre for Equilibrium and Aerospace, Department of Biomedical Physics, Faculty of Sciences, University of Antwerp, Antwerp, Belgium
| | - Angelique Van Ombergen
- E.N.T., Translational Neurosciences, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
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Mijovic T, Remillard A, Zaia EH, Reid YM, Harrington JK, Westerberg BD, Lea J. A closer look at subjective caloric sensations: Is there more to vertigo than spinning? J Vestib Res 2017; 27:271-277. [PMID: 29154301 DOI: 10.3233/ves-170624] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND There is a prevailing opinion that spinning sensations signify a peripheral vestibular pathology while non-spinning sensations are not of vestibular origin. OBJECTIVES 1) Characterize the subjective sensations reported by patients during caloric testing. 2) Assess if the sensation was correlated with the peak slow phase velocity (SPV). METHODS Retrospective chart review at a Canadian adult tertiary-quaternary care balance centre for patients undergoing diagnostic caloric testing between December 2014 and September 2015. RESULTS Of 163 patients included, 122 had normal calorics and 41 demonstrated unilateral weakness. Spinning/rotatory movements were the most commonly reported sensations (55-70%). No sensation was reported among 10-20% of patients. Other non-rotatory sensations were reported 20-25% of the time. Both lack of sensation and other sensations were more likely to be correlated with SPVs that were significantly lower than those associated with spinning/rotating sensations. However, 18% of patients with normal calorics and robust SPVs with warm irrigation still reported non-spinning sensations. CONCLUSIONS During caloric irrigation, subjective sensations other than spinning and rotating are reported 20-25% of the time and these tend to be associated with lower peak SPV. Non-spinning vertigo is not uncommon as a subjective description of vestibular sensation even in normal patients with strong SPVs.
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Affiliation(s)
- Tamara Mijovic
- Department of Otolaryngology, Head and Neck Surgery, McGill University, Royal Victoria Hospital, Montreal, QC, Canada
| | - Andrew Remillard
- Division of Otolaryngology Head and Neck Surgery, Royal Inland Hospital, Kamloops, BC, Canada
| | | | | | | | - Brian David Westerberg
- Division of Otolaryngology - Head and Neck Surgery, B.C. Rotary Hearing and Balance Centre, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
| | - Jane Lea
- Division of Otolaryngology - Head and Neck Surgery, B.C. Rotary Hearing and Balance Centre, St. Paul's Hospital, University of British Columbia, Vancouver, BC, Canada
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43
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Agrawal Y. Editorial: Age-Related Vestibular Loss: Current Understanding and Future Research Directions. Front Neurol 2017; 8:443. [PMID: 28912748 PMCID: PMC5582205 DOI: 10.3389/fneur.2017.00443] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Accepted: 08/11/2017] [Indexed: 11/23/2022] Open
Affiliation(s)
- Yuri Agrawal
- Johns Hopkins University, Baltimore, MD, United States
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Abstract
Superior semicircular canal dehiscence syndrome was first reported by Lloyd Minor and colleagues in 1998. Patients with a dehiscence in the bone overlying the superior semicircular canal experience symptoms of pressure or sound-induced vertigo, bone conduction hyperacusis, and pulsatile tinnitus. The initial series of patients were diagnosed based on common symptoms, a physical examination finding of eye movements in the plane of the superior semicircular canal when ear canal pressure or loud tones were applied to the ear, and high-resolution computed tomography imaging demonstrating a dehiscence in the bone over the superior semicircular canal. Research productivity directed at understanding better methods for diagnosing and treating this condition has substantially increased over the last two decades. We now have a sound understanding of the pathophysiology of third mobile window syndromes, higher resolution imaging protocols, and several sensitive and specific diagnostic tests. Furthermore, we have a treatment (surgical occlusion of the superior semicircular canal) that has demonstrated efficacy. This review will highlight some of the fundamental insights gained in SCDS, propose diagnostic criteria, and discuss future research directions.
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Affiliation(s)
- Bryan K Ward
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - John P Carey
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA
| | - Lloyd B Minor
- Department of Otolaryngology-Head and Neck Surgery, Stanford University School of Medicine, Stanford, CA, USA
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45
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Faryniuk JH, Zeigelboim BS, Teive HAG, Fo VR, Liberalesso PBN, Marques JM. The Importance of Labyrinthine Examination in the Prognosis and Therapy for Balance in Spinocerebellar Ataxia. Int Tinnitus J 2017; 20:93-101. [PMID: 28422031 DOI: 10.5935/0946-5448.20160018] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
Abstract
INTRODUCTION Spinocerebellar ataxias (SCAs) are a heterogeneous group of neurodegenerative diseases that are characterized by the presence of progressive cerebellar ataxia. OBJECTIVE Identify vestibular disorders and demonstrate the importance of labyrinthine examination in the prognosis and therapy for balance in patients with SCAs. MATERIALS AND METHODS The study had a retrospective cross-sectional design and evaluated 57 patients, mean age of 41.6 years and standard deviation of 13 years. Patients underwent the following procedures: anamnesis, ENT examination and vestibular exam using electronystagmography (ENG). RESULTS The most frequent complaints were gait imbalance (71.9%), dysarthria (49.1%), dizziness (43.8%) and dysphagia (36.8%). 84.2% of the tests showed alterations. The most common tests with alterations were the caloric test (78.9%), slow saccades (61.4%) and the rotating chair test (49.1%). CONCLUSION The clinical history of the patient and oculomotor alterations in the labyrinthine examination provide sufficient information for the proper use of virtual rehabilitation protocols in the treatment of imbalance, making it the most effective therapy method. It was evident that changes in ENG are related to the severity of the SCA or the clinical stage of the disease. The labyrinthine examination proved to be an important concomitant tool to clinical and genetic study.
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Affiliation(s)
| | | | - Hélio Afonso Ghizoni Teive
- Department of Clinical Medical - Hospital das Clinicas, Universidade Federal do Parana - Curitiba - PR - Brazil
| | - Vinicius Ribas Fo
- Department of Otoneurology - Universidade Tuiuti do Parana - Curitiba - PR - Brazil
| | | | - Jair Mendes Marques
- Department of Otoneurology - Universidade Tuiuti do Parana - Curitiba - PR - Brazil
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Ward BK, Otero-Millan J, Jareonsettasin P, Schubert MC, Roberts DC, Zee DS. Magnetic Vestibular Stimulation (MVS) As a Technique for Understanding the Normal and Diseased Labyrinth. Front Neurol 2017; 8:122. [PMID: 28424657 PMCID: PMC5380677 DOI: 10.3389/fneur.2017.00122] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2017] [Accepted: 03/15/2017] [Indexed: 12/03/2022] Open
Abstract
Humans often experience dizziness and vertigo around strong static magnetic fields such as those present in an MRI scanner. Recent evidence supports the idea that this effect is the result of inner ear vestibular stimulation and that the mechanism is a magnetohydrodynamic force (Lorentz force) that is generated by the interactions between normal ionic currents in the inner ear endolymph and the strong static magnetic field of MRI machines. While in the MRI, the Lorentz force displaces the cupula of the lateral and anterior semicircular canals, as if the head was rotating with a constant acceleration. If a human subject’s eye movements are recorded when they are in darkness in an MRI machine (i.e., without fixation), there is a persistent nystagmus that diminishes but does not completely disappear over time. When the person exits the magnetic field, there is a transient aftereffect (nystagmus beating in the opposite direction) that reflects adaptation that occurred in the MRI. This magnetic vestibular stimulation (MVS) is a useful technique for exploring set-point adaptation, the process by which the brain adapts to a change in its environment, which in this case is vestibular imbalance. Here, we review the mechanism of MVS, how MVS produces a unique stimulus to the labyrinth that allows us to explore set-point adaptation, and how this technique might apply to the understanding and treatment of vestibular and other neurological disorders.
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Affiliation(s)
- Bryan K Ward
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Jorge Otero-Millan
- Department of Neurology, The Johns Hopkins University, Baltimore, MD, USA
| | - Prem Jareonsettasin
- Department of Neuroscience, Exeter College, University of Oxford, Oxford, UK
| | - Michael C Schubert
- Department of Neuroscience, Exeter College, University of Oxford, Oxford, UK.,Department of Physical Medicine and Rehabilitation, The Johns Hopkins University, Baltimore, MD, USA
| | - Dale C Roberts
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, MD, USA.,Department of Neurology, The Johns Hopkins University, Baltimore, MD, USA
| | - David S Zee
- Department of Otolaryngology-Head and Neck Surgery, The Johns Hopkins University, Baltimore, MD, USA.,Department of Neurology, The Johns Hopkins University, Baltimore, MD, USA.,Department of Neuroscience, The Johns Hopkins University, Baltimore, MD, USA.,Department of Ophthalmology, The Johns Hopkins University, Baltimore, MD, USA
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Sugaya N, Arai M, Goto F. Is the Headache in Patients with Vestibular Migraine Attenuated by Vestibular Rehabilitation? Front Neurol 2017; 8:124. [PMID: 28421034 PMCID: PMC5377541 DOI: 10.3389/fneur.2017.00124] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 03/15/2017] [Indexed: 01/03/2023] Open
Abstract
Background Vestibular rehabilitation is the most effective treatment for dizziness due to vestibular dysfunction. Given the biological relationship between vestibular symptoms and headache, headache in patients with vestibular migraine (VM) could be improved by vestibular rehabilitation that leads to the improvement of dizziness. This study aimed to compare the effects of vestibular rehabilitation on headache and other outcomes relating to dizziness, and the psychological factors in patients with VM patients, patients with dizziness and tension-type headache, and patients without headache. Methods Our participants included 251 patients with dizziness comprising 28 patients with VM, 79 patients with tension-type headache, and 144 patients without headache. Participants were hospitalized for 5 days and taught to conduct a vestibular rehabilitation program. They were assessed using the Dizziness Handicap Inventory (DHI), Headache Impact Test (HIT-6), Hospital Anxiety and Depression Scale (HADS), and Somatosensory Catastrophizing Scale (SSCS) and underwent center of gravity fluctuation measurement as an objective dizziness severity index before, 1 month after, and 4 months after their hospitalization. Results The VM and tension-type headache groups demonstrated a significant improvement in the HIT-6 score with improvement of the DHI, HADS, SSCS, and a part of the objective dizziness index that also shown in patients without headache following vestibular rehabilitation. The change in HIT-6 during rehabilitation in the VM group was positively correlated with changes in the DHI and anxiety in the HADS. Changes in the HIT-6 in tension-type headache group positively correlated with changes in anxiety and SSCS. Conclusion Vestibular rehabilitation contributed to improvement of headache both in patients with VM and patients with dizziness and tension-type headache, in addition to improvement of dizziness and psychological factors. Improvement in dizziness following vestibular rehabilitation could be associated with the improvement of headache more prominently in VM compared with comorbid tension-type headache.
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Affiliation(s)
- Nagisa Sugaya
- Unit of Public Health and Preventive Medicine, School of Medicine, Yokohama City University, Yokohama, Japan
| | - Miki Arai
- Department of Otolaryngology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
| | - Fumiyuki Goto
- Department of Otolaryngology, National Hospital Organization Tokyo Medical Center, Tokyo, Japan
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Abstract
OBJECTIVE To investigate the use of canalith repositioning manoeuvres and vestibular rehabilitation (VR) by GPs and to assess reasons for not using these techniques in patients with vertigo. DESIGN Online survey. SETTING GPs in the western and central part of the Netherlands. SUBJECTS AND METHOD Of GPs, 1169 were approached to participate in the survey. A sample of 426 GPs filled out the questionnaire (36.4% response rate). The 22-item questionnaire contained both multiple choice and free-text questions on the Epley manoeuvre, the Brandt-Daroff exercises and VR. Results of the survey were descriptively analyzed. MAIN OUTCOME MEASURES The use of the Epley manoeuvre, the Brandt-Daroff exercises and VR by GPs; reasons that deter GPs from using these techniques. RESULTS The repositioning manoeuvres (Epley manoeuvre and Brandt-Daroff exercises) were used by approximately half of all GPs (57.3 and 50.2%), while only a small group of GPs applied VR (6.8%). The most important reason for GPs not to use the Epley manoeuvre, Brandt-Daroff exercises and VR was that they did not know how to perform the technique (49.5, 89.6 and 92.4%). CONCLUSIONS Despite the proven effectiveness, repositioning manoeuvres and VR are remarkably underused by Dutch GPs. Not knowing how to perform the technique is the most important reason for GPs not to use these techniques. Efforts should be made to increase the knowledge and skills of GPs regarding canalith repositioning manoeuvres and VR. Key points Dizziness is a common symptom with limited therapeutic options. • Canalith repositioning manoeuvres and vestibular rehabilitation represent the best treatment options currently available for vertigo. • Canalith repositioning manoeuvres and vestibular rehabilitation are still widely underused by GPs. • The most important reason for GPs not to use these techniques is that they do not know how to perform them. • Efforts should be made to increase the knowledge and skills of GPs regarding canalith repositioning manoeuvres and vestibular rehabilitation.
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Affiliation(s)
- Vincent A. van Vugt
- CONTACT Vincent A. van Vugt VU University Medical Center, Department of General Practice & Elderly Care Medicine/Amsterdam Public Health Research Institute, Van der Boechorststraat 7, Room D-550, 1081 BT Amsterdam, the Netherlands
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Grigol TADAES, Silva AM, Ferreira MM, Manso A, Ganança MM, Caovilla HH. Dizziness Handicap Inventory and Visual Vertigo Analog Scale in Vestibular Dysfunction. Int Arch Otorhinolaryngol 2016; 20:241-3. [PMID: 27413406 PMCID: PMC4942285 DOI: 10.1055/s-0035-1567808] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2015] [Accepted: 08/18/2015] [Indexed: 12/02/2022] Open
Abstract
Introduction
Dizziness is one of the most common symptoms among the population, producing numerous consequences for individual's quality of life. There are some questionnaires that can trace the patient's profile and quality of life impairment from dizziness, including the Dizziness Handicap Inventory (DHI) and the Visual Vertigo Analogue Scale (VVAS). Objective
This study aims to correlate the results of the DHI and VVAS in patients with vestibular dysfunction. Methods
This is a retrospective study of medical records of patients treated in a medical school between 2006 and 2012. Results of the DHI and EVA were collected and subjected to statistical analysis using Pearson's correlation test with p < 0.001. The significance level adopted for the statistical tests was p ≤ 0.05. Results
A total of 91 records were included in this study, 72 (79.1%) from female and 19 (20.9%) from male patients, aged 23 to 86 years, with a mean age of 52.5 years. The mean score on the DHI total was 43.9 and 5.2 points for the EVA. The result of Pearson's correlation test was 0.54. Conclusion
Self-perceived dizziness measured with the Dizziness Handicap Inventory has a regular and positive correlation with the Visual Vertigo Analog Scale in patients with vestibular dysfunction. The clinical trial is registered under number UTN U1111–1170–5065.
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Affiliation(s)
| | | | | | - Andrea Manso
- Department of Otorhinolaryngology, UNIFESP, São Paulo, São Paulo, Brazil
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Liu B, Sun JJ. [The standardization of diagnosis and treatment of peripheral vertigo]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2016; 30:593-595. [PMID: 29871083 DOI: 10.13201/j.issn.1001-1781.2016.08.001] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 03/02/2016] [Indexed: 06/08/2023]
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