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Male AJ, Holmes SL, Koohi N, Dudziec M, Hanna MG, Ramdharry GM, Pizzamiglio C, Pitceathly RDS, Kaski D. A diagnostic framework to identify vestibular involvement in multi-sensory neurological disease. Eur J Neurol 2024; 31:e16216. [PMID: 38247216 DOI: 10.1111/ene.16216] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Revised: 12/13/2023] [Accepted: 01/04/2024] [Indexed: 01/23/2024]
Abstract
BACKGROUND AND PURPOSE Identifying vestibular causes of dizziness and unsteadiness in multi-sensory neurological disease can be challenging, with problems typically attributed to central or peripheral nerve involvement. Acknowledging vestibular dysfunction as part of the presentation provides an opportunity to access targeted vestibular rehabilitation, for which extensive evidence exists. A diagnostic framework was developed and validated to detect vestibular dysfunction, benign paroxysmal positional vertigo or vestibular migraine. The specificity and sensitivity of the diagnostic framework was tested in patients with primary mitochondrial disease. METHODS Adults with a confirmed diagnosis of primary mitochondrial disease were consented, between September 2020 and February 2022. Participants with and without dizziness or unsteadiness underwent remote physiotherapy assessment and had in-person detailed neuro-otological assessment. The six framework question responses were compared against objective neuro-otological assessment or medical notes. The output was binary, with sensitivity and specificity calculated. RESULTS Seventy-four adults completed the study: age range 20-81 years (mean 48 years, ±SD 15.05 years); ratio 2:1 female to male. The framework identified a vestibular diagnosis in 35 participants, with seven having two diagnoses. The framework was able to identify vestibular diagnoses in adults with primary mitochondrial disease, with a moderate (40-59) to very high (90-100) sensitivity and positive predictive value, and moderate to high (60-74) to very high (90-100) specificity and negative predictive value. CONCLUSIONS Overall, the clinical framework identified common vestibular diagnoses with a moderate to very high specificity and sensitivity. This presents an opportunity for patients to access effective treatment in a timely manner, to reduce falls and improve quality of life.
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Affiliation(s)
- Amanda J Male
- SENSE Research Unit, Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, UK
| | - Sarah L Holmes
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Queen Square Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Nehzat Koohi
- SENSE Research Unit, Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, UK
| | - Magdalena Dudziec
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
- Queen Square Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Michael G Hanna
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Queen Square Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, London, UK
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Gita M Ramdharry
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
- Queen Square Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, London, UK
| | - Chiara Pizzamiglio
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Queen Square Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, London, UK
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Robert D S Pitceathly
- NHS Highly Specialised Service for Rare Mitochondrial Disorders, Queen Square Centre for Neuromuscular Diseases, The National Hospital for Neurology and Neurosurgery, London, UK
- Department of Neuromuscular Diseases, UCL Queen Square Institute of Neurology, London, UK
| | - Diego Kaski
- SENSE Research Unit, Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, London, UK
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Murphy BL, Fischer JL, Tolisano AM, Navarro AI, Trinh L, Abuzeid WM, Humphreys IM, Akbar NA, Shah S, Schneider JS, Riley CA, McCoul ED. How Do Patients and Otolaryngologists Define Dizziness? Ann Otol Rhinol Laryngol 2024; 133:512-518. [PMID: 38375799 DOI: 10.1177/00034894241233949] [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: 02/21/2024]
Abstract
OBJECTIVE To assess for differences in how patients and otolaryngologists define the term dizziness. METHODS Between June 2020 and December 2022, otolaryngology clinicians and consecutive patients at 5 academic otolaryngology institutions across the United States were asked to define the term "dizziness" by completing a semantics-based questionnaire containing 20 common descriptors of the term within 5 symptom domains (imbalance-related, lightheadedness-related, motion-related, vision-related, and pain-related). The primary outcome was differences between patient and clinician perceptions of dizzy-related symptoms. Secondary outcomes included differences among patient populations by geographic location. RESULTS Responses were obtained from 271 patients and 31 otolaryngologists. Patients and otolaryngologists selected 7.7 ± 3.5 and 7.1 ± 4.3 symptoms, respectively. Most patients (266, 98.2%) selected from more than 1 domain and 17 (6.3%) patients identified symptoms from all 5 domains. Patients and clinicians were equally likely to define dizziness using terms from the imbalance (difference, -2.3%; 95% CI, -13.2%, 8.6%), lightheadedness (-14.1%; -29.2%, 1.0%), and motion-related (9.4; -0.3, 19.1) domains. Patients were more likely to include terms from the vision-related (23.6%; 10.5, 36.8) and pain-related (18.2%; 10.3%, 26.1%) domains. There were minor variations in how patients defined dizziness based on geographic location. CONCLUSIONS Patients and otolaryngologists commonly described dizziness using symptoms related to imbalance, lightheadedness, and motion. Patients were more likely to use vision or pain-related terms. Understanding of these semantic differences may enable more effective patient-clinician communication.
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Affiliation(s)
- Brianna L Murphy
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
| | - Jakob L Fischer
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Anthony M Tolisano
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Alvaro I Navarro
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, LA, USA
| | - Lily Trinh
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, LA, USA
| | - Waleed M Abuzeid
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA
| | - Ian M Humphreys
- Division of Rhinology and Endoscopic Skull Base Surgery, Department of Otolaryngology-Head and Neck Surgery, University of Washington, Seattle, WA, USA
| | - Nadeem A Akbar
- Division of Rhinology and Skull Base Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Sharan Shah
- Division of Rhinology and Skull Base Surgery, Department of Otorhinolaryngology-Head and Neck Surgery, Albert Einstein College of Medicine, Bronx, NY, USA
| | - John S Schneider
- Department of Otolaryngology-Head and Neck Surgery, Washington University School of Medicine, St. Louis, MO, USA
| | - Charles A Riley
- Department of Otolaryngology-Head and Neck Surgery, Walter Reed National Military Medical Center, Bethesda, MD, USA
- Department of Surgery, Uniformed Services University of the Health Sciences, Bethesda, MD, USA
| | - Edward D McCoul
- Department of Otolaryngology-Head and Neck Surgery, Tulane University, New Orleans, LA, USA
- Department of Otorhinolaryngology and Communication Sciences, Ochsner Clinic Foundation, New Orleans, LA, USA
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Xing Y, Si L, Zhang W, Wang Y, Li K, Yang X. Etiologic distribution of dizziness/vertigo in a neurological outpatient clinic according to the criteria of the international classification of vestibular disorders: a single-center study. J Neurol 2024; 271:2446-2457. [PMID: 38231268 DOI: 10.1007/s00415-023-12166-3] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Revised: 12/19/2023] [Accepted: 12/20/2023] [Indexed: 01/18/2024]
Abstract
OBJECTIVE The study aimed to determine the etiological characteristics of patients with dizziness/vertigo attending a neurological clinic according to the criteria of the International Classification of Vestibular Disorders (ICVD), hoping to provide a valuable reference for clinicians to diagnose and treat dizziness/vertigo. METHOD A total of 638 consecutive patients with a chief complaint of dizziness/vertigo who attended the vertigo clinic of our neurology department from January 2019 to January 2020 were included. Clinical data of patients, including baseline data, medical history, neurological, neuro-otological, and auxiliary examination results were collected. The etiologic distribution of dizziness/vertigo was determined by analyzing the diagnoses of patients. RESULTS Of the 638 patients with dizziness/vertigo, 38.8% were males, 61.2% were females, with a male: female ratio of 1:1.58 and a mean age of 52.9 ± 16.9 years. Benign paroxysmal positional vertigo (BPPV) was the most common cause of dizziness/vertigo in both female (38.9%) and male patients (25.5%). Subgroup analysis based on sex showed that vestibular migraine (VM) and probable autoimmune inner ear disease (p-AIED) were more prevalent in female patients (10.7% and 3.8%, respectively), while vascular vertigo/dizziness was more common in male patients (10.1%). Subgroup analysis based on age showed that the most common diseases were VM in patients aged 0-30 years (27.4%), BPPV in patients aged 31-60 years (27.1%) and 61-100 years (46.0%). Episodic vestibular syndrome (EVS) was the most commonly observed, accounting for up to 60.6% (389/638) of all patients, and the most common diagnoses were BPPV (55.3%, 215/389), VM (15.2%, 59/389), primary unilateral peripheral vestibular dysfunction (p-UPVD) of unknown etiology (11.8%, 46/389), p-AIED (4.4%, 17/389), and vascular vertigo/dizziness (2.8%, 11/389) in these patients. Chronic vestibular syndrome (CVS) was found in 14.0% (90/638) of the patients, and the most common diagnoses were persistent postural-perceptual dizziness (PPPD, 35.6%, 32/90), psychogenic dizziness (18.9%, 17/90), p-UPVD of unknown etiology (15.6%, 14/90), vascular vertigo/dizziness (15.6%, 14/90), and bilateral vestibulopathy (7.8%, 7/90). Acute vestibular syndrome (AVS) was observed in 8.4% (54/638) of the patients, and the most common diagnoses were p-UPVD of unknown etiology (31.5%, 17/54), vestibular neuritis (24.1%, 13/54), probable labyrinthine apoplexy (16.7%, 9/54), stroke (13.0%, 7/54), and psychogenic dizziness (11.1%, 6/54). 16.4% (105/638) of the patients were found to have other disorders, including 15.2% (16/105) of patients with internal diseases, and 84.8% (89/105) of patients with unknown causes. In terms of localization diagnosis, 56.1%, 17.0%, 10.0%, and 16.4% of the patients were diagnosed with peripheral vestibular disorder, central vestibular disorder, psychiatric and functional vestibular disorders, and other disorders, respectively. CONCLUSION (1) Dizziness/vertigo was more common in females, which was frequently caused by damage to the vestibular system. Non-vestibular or unknown etiologies were also seen in some patients; (2) VM was more prevalent in women than in men, vascular vertigo/dizziness was more commonly observed in men; (3) EVS was more common in patients with dizziness/vertigo. The most common causes of dizziness/vertigo were peripheral vestibular disorders in patients with AVS and EVS, PPPD and psychogenic dizziness in patients with CVS. The most common causes were BPPV and p-UPVD of unknown etiology in patients with a peripheral vestibular disorder, VM and vascular vertigo/dizziness in patients with central vestibular disorder, PPPD and psychogenic dizziness in patients with psychiatric and functional vestibular disorders.
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Affiliation(s)
- Yue Xing
- Department of Neurology, School of Clinical Medicine (Aerospace Center Hospital), Peking University Aerospace, No. 15, Yuquan Road, Haidian District, Beijing, 100049, China
| | - Lihong Si
- Department of Neurology, School of Clinical Medicine (Aerospace Center Hospital), Peking University Aerospace, No. 15, Yuquan Road, Haidian District, Beijing, 100049, China
| | - Wanting Zhang
- Department of Neurology, School of Clinical Medicine (Aerospace Center Hospital), Peking University Aerospace, No. 15, Yuquan Road, Haidian District, Beijing, 100049, China
| | - Yuru Wang
- Department of Neurology, School of Clinical Medicine (Aerospace Center Hospital), Peking University Aerospace, No. 15, Yuquan Road, Haidian District, Beijing, 100049, China
| | - Kangzhi Li
- Department of Neurology, School of Clinical Medicine (Aerospace Center Hospital), Peking University Aerospace, No. 15, Yuquan Road, Haidian District, Beijing, 100049, China
| | - Xu Yang
- Department of Neurology, School of Clinical Medicine (Aerospace Center Hospital), Peking University Aerospace, No. 15, Yuquan Road, Haidian District, Beijing, 100049, China.
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Song Z, Ding Y, Sim N, Yun HJ, Feng J, Gu P, Geng X. Vestibular function is associated with immune inflammatory response. Rev Neurosci 2024; 35:293-301. [PMID: 38158886 DOI: 10.1515/revneuro-2023-0114] [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: 09/19/2023] [Accepted: 11/10/2023] [Indexed: 01/03/2024]
Abstract
Association between vestibular function and immune inflammatory response has garnered increasing interest. Immune responses can lead to anatomical or functional alterations of the vestibular system, and inflammatory reactions may impair hearing and balance. Vestibular disorders comprise a variety of conditions, such as vestibular neuritis, benign paroxysmal positional vertigo, Meniere's disease, vestibular migraine, posterior circulation ischemia, and bilateral vestibular disease. Moreover, some patients with autoimmune diseases develop vestibulocochlear symptom. This paper offers an overview of prevalent vestibular diseases and discusses associations between vestibular dysfunction and immune diseases.
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Affiliation(s)
- Zhaohui Song
- Department of Neurology and the Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, No. 82 Xinhua South Road, 101149, Tongzhou District, Beijing, China
| | - Yuchuan Ding
- Department of Neurosurgery, Wayne State University School of Medicine, 550 E Canfield, 48201, Detroit, MI, USA
| | - Nathan Sim
- Department of Neurosurgery, Wayne State University School of Medicine, 550 E Canfield, 48201, Detroit, MI, USA
| | - Ho Jun Yun
- Department of Neurosurgery, Wayne State University School of Medicine, 550 E Canfield, 48201, Detroit, MI, USA
| | - Jing Feng
- Department of Neurology and the Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, No. 82 Xinhua South Road, 101149, Tongzhou District, Beijing, China
| | - Pan Gu
- Department of Neurology and the Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, No. 82 Xinhua South Road, 101149, Tongzhou District, Beijing, China
| | - Xiaokun Geng
- Department of Neurology and the Stroke Intervention and Translational Center (SITC), Beijing Luhe Hospital, Capital Medical University, No. 82 Xinhua South Road, 101149, Tongzhou District, Beijing, China
- Department of Neurosurgery, Wayne State University School of Medicine, 550 E Canfield, 48201, Detroit, MI, USA
- China-America Institute of Neuroscience, Beijing Luhe Hospital, Capital Medical University, No. 82 Xinhua South Road, 101149, Tongzhou District, Beijing, China
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Wang Y, Zhao H, Tian L, Huang YB, Wu JJ, Wang J. [Comparison of efficacy between short-term personalized vestibular rehabilitation supervised by special personnel and fixed vestibular rehabilitation on recurrent peripheral vertigo]. Zhonghua Yi Xue Za Zhi 2024; 104:1132-1137. [PMID: 38583042 DOI: 10.3760/cma.j.cn112137-20231213-01376] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Abstract
Objective: To explore the efficacy of short-term personalized vestibular rehabilitation supervised by special personnel (ST-PVR) versus fixed vestibular rehabilitation (FVR) on decompensated recurrent peripheral vertigo. Methods: A randomized controlled trial was carried out. Patients diagnosed with decompensated recurrent vertigo in the clinic of Eye & ENT Hospital, Fudan University from January to December 2018 were randomly allocated into FVR and ST-PVR groups via computer-generated randomization. The FVR group received fixed scheme involving gaze stabilization exercises, habituation exercises, balance and gait training, while the ST-PVR group received individualized training programs based on symptoms and vestibular function examination results, with adjustments made according to the progress of recovery. Patient symptoms and vestibular function improvement were assessed using the dizziness handicap inventory (DHI), activities-specific balance confidence (ABC), self-rating anxiety scale (SAS), caloric test, and sensory organization test (SOT) at 2, 4, and 8 weeks of treatment. Results: A total of 44 patients were included, including 16 males and 28 females, with an average age of (50.6±13.5) years. There were 21 cases in the FVR group and 23 cases in the ST-PVR group. In the ST-PVR group, DHI score (49.5±26.8 vs 61.3±21.4, P=0.046) and SAS score (39.1±7.8 vs 44.3±6.6, P=0.021) significantly improved after 2 weeks of treatment, while significant improvement occurred only after 8 weeks of treatment in the FVR group (DHI score: 28.1±15.9 vs 53.1±18.5, P=0.001; SAS score: 35.3±6.7 vs 43.1±8.4, P=0.010). There was no significant change of ABC score in the FVR group after 8 weeks of treatment (86.5±12.9 vs 83.4±18.1, P=0.373), while a significant improvement was observed in the ST-PVR group after 4 weeks of treatment (83.6±15.2 vs 78.4±15.1, P=0.015). The caloric test results showed that after 8 weeks of treatment, the proportion of patients with unilateral weakness<25% increased in both groups [FVR group: 57.1% (12/21) vs 9.5% (2/21), P=0.001; ST-PVR group: 52.2% (12/23) vs 17.4% (4/23), P=0.014]. In the ST-PVR group, the proportion of patients with dominant preference≤25% significantly increased [91.3% (21/23) vs 60.9% (14/23), P=0.016], while there was no significant change in the FVR group [61.9 (13/21) vs 57.1% (12/21), P=0.500]. The proportion of patients with SOT score≥70 in the ST-PVR group increased significantly after 2 weeks of treatment [69.6% (16/23) vs 30.4% (7/23), P=0.009], while the FVR group showed a significant increase only after 8 weeks of treatment [81.0% (17/21) vs 42.9% (9/21), P=0.012]. Conclusion: Both FVR and ST-PVR effectively promote vestibular compensation by improving objective vestibular functions and relieving subjective symptoms and anxiety of the patients with decompensation recurrent vertigo, while ST-PVR might shorten the recovery time and increase balance confidence.
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Affiliation(s)
- Y Wang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University/NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai 200031, China
| | - H Zhao
- Department of Nuclear Medicine, the Affiliated Taian City Central Hospital of Qingdao University, Taian 100160, China
| | - L Tian
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University/NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai 200031, China
| | - Y B Huang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University/NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai 200031, China
| | - J J Wu
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University/NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai 200031, China
| | - J Wang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University/NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai 200031, China
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Gao N, Jin F, Meng Y, Yang C, Wang J. [Preliminary observation of wearable balance diagnosis and treatment system in evaluating dynamic and static balance function in patients with vestibular vertigo]. Zhonghua Yi Xue Za Zhi 2024; 104:1180-1183. [PMID: 38583050 DOI: 10.3760/cma.j.cn112137-20240111-00085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Abstract
A newly developed wearable balance diagnosis and treatment system was studied to evaluate the indexes of the abnormal balance function in patients with vestibular vertigo. A cross-sectional study was carried out. A total of 30 patients diagnosed with non-acute vestibular vertigo in the outpatient department of Eye, Ear, Nose and Throat Hospital Affiliated to Fudan University from July 2022 to May 2023 were selected as the vertigo group, including 13 males and 17 females, and aged (45.7±13.9) years. Meanwhile, 20 healthy controls (8 males and 12 females) were included as the control group, with a mean age of (43.6±8.0) years. The static balance and limits of stability (LOS) function of all subjects were assessed with wearable balance diagnosis and treatment system developed under the leadership of Eye & ENT Hospital of Fudan University. In the static balance test, the ratio of eyes open with cushions to eyes open without cushions in the vertigo group was less than that of the control group[1.20% (0.92%, 1.53%) vs 1.49% (1.22%, 1.81%), P=0.008], indicating that patients with non-acute vestibular vertigo may compensate static balance ability earlier. In vertigo group, the directional control in 8 directions, the maximum excursion in anterior, posterior, right anterior and right posterior directions, the endpoint excursion in the posterior, right posterior, and left posterior directions were all smaller than those of the control group (all P<0.05). The reaction time in the left posterior direction of vertigo group was longer than that of the control group (all P<0.05). Those results indicated that the directional control, maximum excursion and endpoint excursion of LOS could be considered as important reference indexes for dynamic balance function.
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Affiliation(s)
- N Gao
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University/NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai 200031, China
| | - F Jin
- Department of Otolaryngology, Xuhui Hospital, Zhongshan Hospital Affiliated to Fudan University, Shanghai 200031, China
| | - Y Meng
- Department of Otolaryngology, Head and Neck Surgery, Maternity and Child Health Care of Zaozhuang, Shandong Province, Zaozhuang 261031, China
| | - C Yang
- Department of Otolaryngology, Nanyang Central Hospital, Nanyang 473005, China
| | - J Wang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University/NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai 200031, China
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Wang J, Chi FL. [The causes and coping strategies for refractory vertigo]. Zhonghua Yi Xue Za Zhi 2024; 104:1087-1091. [PMID: 38583037 DOI: 10.3760/cma.j.cn112137-20240112-00092] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 04/08/2024]
Abstract
Refractory vertigo is a disease entity characterized by uncontrollable recurrent vertigo and/or persistent dizziness instability, which can be caused by various diseases. The main pathogenesis may be related to recurrent episodes of the primary disease and compensatory dysfunction of the vestibular system. Understanding the common causes and pathological mechanisms of refractory vertigo, and comprehensively analyzing the relevant factors that cause symptoms, can facilitate accurate diagnosis and effective differentiation, and then provide comprehensive treatment targeting various factors such as etiology, symptoms, functional status, and psychological problems, ultimately achieving the goal of controlling the occurrence and development of refractory vertigo. Based on the characteristics of symptoms, this article focuses on analyzing possible mechanisms, relative factors, diagnosis and differential diagnosis of common diseases that lead to refractory vertigo, effective coping strategies, key issues that need attention, and future prospects, in order to improve clinical diagnostic accuracy and treatment effectiveness.
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Affiliation(s)
- J Wang
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University/NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai 200031, China
| | - F L Chi
- ENT Institute and Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University/NHC Key Laboratory of Hearing Medicine (Fudan University), Shanghai 200031, China
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Kirbac A, Kaya E, Incesulu SA, Carman KB, Yarar C, Ozen H, Pinarbasli MO, Gurbuz MK. Differentiation of peripheral and non-peripheral etiologies in children with vertigo/dizziness: The video-head impulse test and suppression head impulse paradigm. Int J Pediatr Otorhinolaryngol 2024; 179:111935. [PMID: 38574650 DOI: 10.1016/j.ijporl.2024.111935] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/02/2024] [Revised: 03/14/2024] [Accepted: 03/26/2024] [Indexed: 04/06/2024]
Abstract
OBJECTIVES To identify the etiology of vertigo/dizziness and determine the effectiveness of the video-head impulse test (vHIT) and the suppression head impulse paradigm (SHIMP) tests in distinguishing between peripheral and non-peripheral etiologies in children who presented to the otolaryngology department with complaints of vertigo/dizziness. METHODS The vHIT and SHIMP tests were applied to the children. The vestibulo-ocular reflex (VOR) gain and saccade parameters were compared. RESULTS In 27 children presenting with vertigo/dizziness, the most common etiological factor was inner ear malformation (IEM) (n = 6/27, 22.2%), followed by cochlear implant surgery (11.1%) and migraine (11.1%). Vestibular hypofunction was indicated by the vHIT results at a rate of 60% (9/15 children) and SHIMP results at 73.3% (11/15 children) among the children with a peripheral etiology, while these rates were 8.3% (1/12 children) and 25% (3/12 children), respectively, in the non-peripheral etiology group. SHIMP-VOR and vHIT-VOR gain values had a moderate positive correlation (p = 0.01, r = 0.349). While there were overt/covert saccades in the vHIT, anti-compensatory saccade (ACSs) were not observed in the SHIMP test (p = 0.041). The rates of abnormal vHIT-VOR gain (p = 0.001), over/covert saccades (p = 0.019), abnormal vHIT response (p = 0.014), ACSs (p = 0.001), and abnormal SHIMP response (p = 0.035) were significantly higher in the peripheral etiology group. CONCLUSIONS IEM was the most common etiological cause, and the rate of vestibular hypofunction was higher in these children with peripheral vertigo. vHIT and SHIMP are effective and useful vestibular tests for distinguishing peripheral etiology from non-peripheral etiology in the pediatric population with vertigo/dizziness. These tests can be used together or alone, but the first choice should be the SHIMP test, considering its short application time (approximately 4-5 min) and simplicity.
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Affiliation(s)
- Arzu Kirbac
- Eskişehir Osmangazi University, Faculty of Health Sciences, Department of Audiology, 26480, Eskisehir, Turkiye.
| | - Ercan Kaya
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Otolaryngology, 26480, Eskisehir, Turkiye
| | - Saziye Armagan Incesulu
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Otolaryngology, 26480, Eskisehir, Turkiye
| | - Kursat Bora Carman
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Pediatric Neurology, 26480, Eskisehir, Turkiye
| | - Coskun Yarar
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Pediatric Neurology, 26480, Eskisehir, Turkiye
| | - Hulya Ozen
- University of Health Sciences, Gulhane Faculty of Medicine, Department of Medical Informatics, 06018 Ankara, Turkiye
| | - Mehmet Ozgur Pinarbasli
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Otolaryngology, 26480, Eskisehir, Turkiye
| | - Melek Kezban Gurbuz
- Eskişehir Osmangazi University, Faculty of Medicine, Department of Otolaryngology, 26480, Eskisehir, Turkiye
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9
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Klokman VW, Koningstein FN, Dors JWW, Sanders MS, Koning SW, de Kleijn DPV, Jie KE. Blood biomarkers for the differentiation between central and peripheral vertigo in the emergency department: a systematic review and meta-analysis. Acad Emerg Med 2024; 31:371-385. [PMID: 38403938 DOI: 10.1111/acem.14864] [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: 07/18/2023] [Revised: 12/17/2023] [Accepted: 12/18/2023] [Indexed: 02/27/2024]
Abstract
BACKGROUND/INTRODUCTION In patients with acute vestibular syndrome (AVS), differentiating between stroke and nonstroke causes is challenging in the emergency department (ED). Correct diagnosis of vertigo etiology is essential for early optimum treatment and disposition. OBJECTIVES The aim of this systematic review and meta-analysis was to summarize the published evidence on the potential of blood biomarkers in the diagnosis and differentiation of peripheral from central causes of AVS. METHODS A literature search was conducted for studies published until January 1, 2023, in PubMed, Ovid Medline, and EMBASE databases analyzing biomarkers for the differentiation between central and peripheral AVS. The Quality Assessment of Diagnostic Accuracy Studies questionnaire 2 was used for quality assessment. Pooled standardized mean difference and 95% confidence intervals were calculated if a biomarker was reported in two or more studies. Heterogeneity among included studies was investigated using the I2 metric. RESULTS A total of 17 studies with 859 central and 4844 peripheral causes of acute dizziness or vertigo, and analysis of 61 biomarkers were included. The general laboratory markers creatinine, blood urea nitrogen, albumin, C-reactive protein, glucose, HbA1c, leukocyte counts, and neutrophil counts and the brain-derived biomarkers copeptin, S100 calcium-binding protein β (S100β), and neuron-specific enolase (NSE) significantly differentiated central from peripheral causes of AVS. CONCLUSIONS This systematic review and meta-analysis highlights the potential of generalized inflammatory markers and brain-specific blood protein markers of NSE and S100β as diagnostic biomarkers for central from peripheral differentiation in AVS. These results, as a complement to clinical characteristics, provide guidance for future large-scale diagnostic research, in this challenging ED patient population.
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Affiliation(s)
- Vincent W Klokman
- Department of Emergency Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Fiona N Koningstein
- Department of Emergency Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | - Job W W Dors
- Faculty of Medicine, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Marieke S Sanders
- Department of Emergency Medicine, St. Antonius Hospital, Nieuwegein, The Netherlands
| | - Sam W Koning
- Department of Emergency Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
| | | | - Kim E Jie
- Department of Emergency Medicine, Jeroen Bosch Hospital, 's-Hertogenbosch, The Netherlands
- Department of Vascular Surgery, University Medical Center Utrecht, Utrecht, The Netherlands
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Yu AHK, Leung LY, Leung TWH, Abrigo JM, Cheung KH, Cheng CH, Graham CA. The TriAGe + score for vertigo or dizziness: A validation study in a university hospital emergency department in Hong Kong. Am J Emerg Med 2024; 77:39-45. [PMID: 38096638 DOI: 10.1016/j.ajem.2023.10.055] [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: 02/15/2023] [Revised: 10/13/2023] [Accepted: 10/28/2023] [Indexed: 02/16/2024] Open
Abstract
OBJECTIVE Patients with dizziness commonly present to Emergency Departments (ED) and 6% of these patients will be diagnosed with acute stroke. The TriAGe+ score comprises of eight clinical parameters and stratifies patients into four risk groups. The Japanese authors reported that the tool performed well, so our aim was to validate this diagnostic tool in our ED in Hong Kong. MATERIALS AND METHODS A single-center retrospective observational study was conducted in the ED of our university hospital in Hong Kong. The primary outcome was the diagnosis of an acute cerebrovascular event. Receiver operator characteristic (ROC) analysis was performed to determine the best cut-off score. Secondary outcomes included univariable and multivariable analyses of stroke predictors. RESULTS 455 patients aged 18 years or above with dizziness or vertigo at ED triage were recruited between 19 July and 30 September 2021. The overall prevalence of stroke was 11.9%. The median TriAGe+ score was 7 (IQR = 4-9). The AUC was 0.9. At a cut-off >5, sensitivity was 96.4% (95%CI: 87.3-99.5) and the negative likelihood ratio was 0.09 (95%CI: 0.02-0.3). At a cut-off >10, specificity was 99.8% (95%CI: 98.6-100.0), and the positive likelihood ratio was 237.6 (95%CI: 33.1-1704). On multivariable analyses, atrial fibrillation, blood pressure, gender, dizziness (not vertigo) and no history of dizziness, vertigo or labyrinth/vestibular disease were found to be positively associated with stroke outcomes significantly. CONCLUSION The TriAGe+ score is an efficient stroke prediction score for patients presenting to the ED with dizziness.
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Affiliation(s)
- Adrian Ho-Kun Yu
- Department of Accident and Emergency Medicine, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR.
| | - Ling Yan Leung
- Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR
| | - Thomas W H Leung
- Division of Neurology, Department of Medicine & Therapeutics, Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR.
| | - Jill M Abrigo
- Department of Imaging and Interventional Radiology, Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR.
| | - Koon Ho Cheung
- Department of Accident and Emergency Medicine, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR; Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR.
| | - Chi Hung Cheng
- Department of Accident and Emergency Medicine, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR; Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR.
| | - Colin A Graham
- Department of Accident and Emergency Medicine, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR; Accident and Emergency Medicine Academic Unit, Chinese University of Hong Kong, Prince of Wales Hospital, Ngan Shing Street, Shatin, New Territories, Hong Kong SAR.
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11
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Teggi R, Colombo B, Cugnata F, Albera R, Libonati GA, Balzanelli C, Casani AP, Cangiano I, Familiari M, Lucisano S, Mandalà M, Neri G, Pecci R, Bussi M, Filippi M. Phenotypes and clinical subgroups in vestibular migraine: a cross-sectional study with cluster analysis. Neurol Sci 2024; 45:1209-1216. [PMID: 37845481 DOI: 10.1007/s10072-023-07116-w] [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: 08/04/2023] [Accepted: 10/03/2023] [Indexed: 10/18/2023]
Abstract
OBJECTIVE The aim of this multicentric cross-sectional study was to collect phenotypes and clinical variability on a large sample of 244 patients enrolled in different university centers in Italy, trying to differentiate subtypes of VM. BACKGROUND VM is one of the most frequent episodic vertigo characterized by a great clinical variability for duration of attacks and accompanying symptoms. Diagnosis is based only on clinical history of episodic vertigo in 50% of cases associated with migrainous headache or photo/phonophobia. METHODS We enrolled in different university centers 244 patients affected by definite VM according to the criteria of the Barany Society between January 2022 and December 2022. An audiometric examination and a CNS MRI were performed before inclusion. Patients with low-frequency sensorineural hearing loss were not included, as well as patients with an MRI positive otherwise that for microischemic lesions. Patients were asked to characterize vestibular symptoms choosing among (multiple answers were allowed): internal vertigo, dizziness, visuo-vestibular symptoms/external vertigo; onset of vertigo and duration, neurovegetative, and cochlear accompanying symptoms (hearing loss, tinnitus, and fullness during attacks) were collected as well as migrainous headache and/or photo/phonophobia during vertigo; autoimmune disorders were also analyzed. A bedside examination was performed including study of spontaneous-positional nystagmus with infrared video goggles, post head shaking ny, skull vibration test, and video head impulse test. RESULTS We included 244 subjects, 181 were females (74.2%). The age of onset of the first vertigo was 36.6 ± 14.5 while of the first headache was 23.2 ± 10.1. A positive correlation has been found between the first headache and the first vertigo. The mean duration of vertigo attacks was 11 ± 16 h. We carried on a cluster analysis to identify subgroups of patients with common clinical features. Four variables allowed to aggregate clusters: age of onset of vertigo, duration of vertigo attacks, presence of migrainous headache during vertigo, and presence of cochlear symptoms during vertigo. We identified 5 clusters: cluster 1/group 1 (23 subjects, 9.4%) characterized by longer duration of vertigo attacks; cluster 2/group 2 (52 subjects, 21.3%) characterized by absence of migrainous headache and cochlear symptoms during vertigo; cluster 3/group 3 (44 subjects, 18%) characterized by presence of cochlear symptoms during vertigo but not headache; cluster 4/group 4 (57 subjects, 23.4%) by the presence of both cochlear symptoms and migrainous headache during vertigo; cluster 5/group 5 (68 subjects, 27.9%) characterized by migrainous headache but no cochlear symptoms during vertigo. CONCLUSION VM is with any evidence a heterogeneous disorder and clinical presentations exhibit a great variability. In VM, both symptoms orienting toward a peripheral mechanism (cochlear symptoms) and central ones (long lasting positional non-paroxysmal vertigo) may coexist. Our study is the first published trying to characterize subgroups of VM subjects, thus orienting toward different pathophysiological mechanisms.
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Affiliation(s)
- Roberto Teggi
- ENT Div., San Raffaele Scientific Institute, Vita e Salute University, Milan, Italy.
| | - Bruno Colombo
- Div. of Neurology, San Raffaele Scientific Institute, Vita e Salute University, Milan, Italy
| | - Federica Cugnata
- University Centre for Statistics in the Biomedical Sciences (CUSSB), Vita-Salute San Raffaele University, Milan, Italy
| | - Roberto Albera
- Dipartimento di Scienze, Chirurgiche Università di Torino, Turin, Italy
| | | | - Cristiano Balzanelli
- Department of Otolaryngology, University of Brescia, Spedali Civili, Brescia, Italy
| | - Augusto Pietro Casani
- Department of Otorhinolaryngology, Pisa University Medical School Otorhinolaryngology, Pisa University Medical School, Pisa, Italy
| | - Iacopo Cangiano
- ENT Div., San Raffaele Scientific Institute, Vita e Salute University, Milan, Italy
| | - Marco Familiari
- ENT Div., San Raffaele Scientific Institute, Vita e Salute University, Milan, Italy
| | - Sergio Lucisano
- Dipartimento di Scienze, Chirurgiche Università di Torino, Turin, Italy
| | - Marco Mandalà
- Otology and Skull Base Unit, Azienda Ospedaliera Universitaria Senese, Siena, Italy
| | - Giampiero Neri
- Department of Neurosciences, Imaging and Clinical Sciences, University of Chieti-Pescara, Chieti, Italy
| | - Rudi Pecci
- Unit of Audiology, Department of Surgical Sciences and Translational Medicine, Careggi Hospital, University of Florence, Florence, Italy
| | - Mario Bussi
- ENT Div., San Raffaele Scientific Institute, Vita e Salute University, Milan, Italy
| | - Massimo Filippi
- Div. of Neurology, San Raffaele Scientific Institute, Vita e Salute University, Milan, Italy
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Tozzi A, Castellucci A, Ferrulli G, Brandolini C, Piras G, Martellucci S, Malara P, Ferri GG, Ghidini A, Marchioni D, Presutti L. Audiovestibular Findings in Patients with Concurrent Superior Canal Dehiscence and Vestibular Schwannoma. Otol Neurotol 2024; 45:299-310. [PMID: 38291792 DOI: 10.1097/mao.0000000000004117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/01/2024]
Abstract
OBJECTIVE To describe the clinical-instrumental findings in case of concurrent superior canal dehiscence (SCD) and ipsilateral vestibular schwannoma (VS), aiming to highlight the importance of an extensive instrumental assessment to achieve a correct diagnosis. STUDY DESIGN Retrospective case review. SETTING Tertiary referral center. PATIENTS Five patients with concurrent SCD and VS. INTERVENTION Clinical-instrumental assessment and imaging. MAIN OUTCOME MEASURE Clinical presentation, audiovestibular findings, and imaging. RESULTS The chief complaints were hearing loss (HL) and unsteadiness (80%). Other main symptoms included tinnitus (60%) and pressure-induced vertigo (40%). Mixed-HL was identified in three patients and pure sensorineural-HL in 1, including a roll-over curve in speech-audiometry in two cases. Vibration-induced nystagmus was elicited in all cases, whereas vestibular-evoked myogenic potentials showed reduced thresholds and enhanced amplitudes on the affected side in three patients. Ipsilesional weakness on caloric testing was detected in three patients and a bilateral hyporeflexia in one. A global canal impairment was detected by the video-head impulse test in one case, whereas the rest of the cohort exhibited a reduced function for the affected superior canal, together with ipsilateral posterior canal impairment in two cases. All patients performed both temporal bones HRCT scan and brain-MRI showing unilateral SCD and ipsilateral VS, respectively. All patients were submitted to a wait-and-scan approach, requiring VS removal only in one case. CONCLUSION Simultaneous SCD and VS might result in subtle clinical presentation with puzzling lesion patterns. When unclear symptoms and signs occur, a complete audiovestibular assessment plays a key role to address imaging and diagnosis.
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Affiliation(s)
- Andrea Tozzi
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppe Ferrulli
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Cristina Brandolini
- Otorhinolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Gianluca Piras
- Department of Otology and Skull Base Surgery, Casa Di Cura Privata "Piacenza" S.P.A., Gruppo Otologico, Piacenza-Rome, Italy
| | | | - Pasquale Malara
- Audiology & Vestibology Service, Centromedico, Bellinzona, Switzerland
| | - Gian Gaetano Ferri
- Otorhinolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
| | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Daniele Marchioni
- Otorhinolaryngology-Head and Neck Surgery Department, University Hospital of Modena, Modena, Italy
| | - Livio Presutti
- Otorhinolaryngology and Audiology Unit, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Policlinico S. Orsola-Malpighi, Bologna, Italy
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Martín-Enguix D, Pérez-Fernández N, Gomez-Gabaldón N, Medina-Gámez JA, Morales-Escobar FJ. [Comprehensive approach to vertigo: Diagnostic algorithm, causes, treatments, and referral criteria from the perspective of primary care. SEMERGEN consensus document]. Semergen 2024; 50:102114. [PMID: 37832471 DOI: 10.1016/j.semerg.2023.102114] [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: 07/31/2023] [Revised: 09/06/2023] [Accepted: 09/11/2023] [Indexed: 10/15/2023]
Abstract
Vertigo is a common symptom that can have various causes and may require a comprehensive approach for its diagnosis and treatment from primary care. A diagnostic algorithm based on the classification proposed by the Otoneurology Commission of the SEORL-PCF is suggested, which facilitates the classification of the different types of vertigo and provides referral criteria for patients from primary care to other specialties. A review of the available treatments based on the underlying cause is conducted for appropriate therapeutic management. This document is expected to become a valuable tool for professionals treating patients with vertigo. The document is based on scientific evidence and on the experience of experts in the field from various medical specialties; and seeks to improve the understanding and clinical approach to acute vertigo from primary care.
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Affiliation(s)
- D Martín-Enguix
- Medicina Familiar y Comunitaria, Centro de Salud Albuñol, Distrito Sanitario Granada Sur, Albuñol, Granada, España.
| | - N Pérez-Fernández
- Otorrinolaringología, Clínica Universidad de Navarra, Madrid, España
| | - N Gomez-Gabaldón
- Medicina Familiar y Comunitaria, Otorrinolaringología, Hospital de Hellín, Hellín, Albacete, España
| | - J A Medina-Gámez
- Neurología, Medicina Familiar y Comunitaria, Centro de Salud de Armilla, Distrito Sanitario Granada Metropolitano, Armilla, Granada, España
| | - F J Morales-Escobar
- Medicina Familiar y Comunitaria, Centro de Salud Arucas, Arucas, Las Palmas, España
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Ayiotis AI, Schoo DP, Fernandez Brillet C, Lane KE, Carey JP, Della Santina CC. Patient-Reported Outcomes After Vestibular Implantation for Bilateral Vestibular Hypofunction. JAMA Otolaryngol Head Neck Surg 2024; 150:240-248. [PMID: 38300591 PMCID: PMC10835607 DOI: 10.1001/jamaoto.2023.4475] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2023] [Accepted: 12/02/2023] [Indexed: 02/02/2024]
Abstract
Importance Standard-of-care treatment proves inadequate for many patients with bilateral vestibular hypofunction (BVH). Vestibular implantation is an emerging alternative. Objective To examine patient-reported outcomes from prosthetic vestibular stimulation. Design, Setting, and Participants The Multichannel Vestibular Implant (MVI) Early Feasibility Study is an ongoing prospective, nonrandomized, single-group, single-center cohort study conducted at Johns Hopkins Hospital that has been active since 2016 in which participants serve as their own controls. The study includes adults with severe or profound adult-onset BVH for at least 1 year and inadequate compensation despite standard-of-care treatment. As of March 2023, 12 candidates completed the eligibility screening process. Intervention The MVI system electrically stimulates semicircular canal branches of the vestibular nerve to convey head rotation. Main Outcomes and Measures Patient-reported outcome instruments assessing dizziness (Dizziness Handicap Inventory [DHI]) and vestibular-related disability (Vestibular Disorders-Activities of Daily Living [VADL]). Health-related quality of life (HRQOL) assessed using the Short Form-36 Utility (SF36U) and Health Utilities Index Mark 3 (HUI3), from which quality-adjusted life-years were computed. Results Ten individuals (5 female [50%]; mean [SD] age, 58.5 [5.0] years; range, 51-66 years) underwent unilateral implantation. A control group of 10 trial applicants (5 female [50%]; mean [SD] age, 55.1 [8.5] years; range, 42-73 years) completed 6-month follow-up surveys after the initial application. After 0.5 years of continuous MVI use, a pooled mean (95% CI) of within-participant changes showed improvements in dizziness (DHI, -36; 95% CI, -55 to -18), vestibular disability (VADL, -1.7; 95% CI, -2.6 to -0.7), and HRQOL by SF36U (0.12; 95% CI, 0.07-0.17) but not HUI3 (0.02; 95% CI, -0.22 to 0.27). Improvements exceeded minimally important differences in the direction of benefit (exceeding 18, 0.65, and 0.03, respectively, for DHI, VADL, and SF36U). The control group reported no mean change in dizziness (DHI, -4; 95% CI, -10 to 2), vestibular disability (VADL, 0.1; 95% CI, -0.9 to 1.1) or HRQOL per SF36U (0; 95% CI, -0.06 to 0.05) but an increase in HRQOL per HUI3 (0.10; 95% CI, 0.04-0.16). Lifetime HRQOL gain for MVI users was estimated to be 1.7 quality-adjusted life-years (95% CI, 0.6-2.8) using SF36U and 1.4 (95% CI, -1.2 to 4.0) using HUI3. Conclusions and Relevance This cohort study found that vestibular implant recipients report vestibular symptom improvements not reported by a control group. These patient-reported benefits support the use of vestibular implantation as a treatment for bilateral vestibular hypofunction.
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Affiliation(s)
- Andrianna I. Ayiotis
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Desi P. Schoo
- Department of Otolaryngology–Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Otolaryngology, The Ohio State University Wexner Medical Center, Columbus
| | | | - Kelly E. Lane
- Department of Otolaryngology–Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - John P. Carey
- Department of Otolaryngology–Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Charles C. Della Santina
- Department of Biomedical Engineering, Johns Hopkins School of Medicine, Baltimore, Maryland
- Department of Otolaryngology–Head & Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
- Labyrinth Devices, LLC
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15
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Zenner BP, Schmitz D, Zenner HP, Wirth M. [Structured ABEV Exercises for the Treatment of vestibular dysfunction]. Laryngorhinootologie 2024; 103:207-212. [PMID: 37678393 DOI: 10.1055/a-2135-5762] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/09/2023]
Abstract
INTRODUCTION In addition to medication, the standard clinical treatment for vestibular vertigo primarily includes physical therapy in the form of regular exercises. Vertidisan is a future digital health application (DiGA) for structured dizziness therapy. Its content is multimodal and consists of Adaptive Balance and Eye Movements and Visual Stimulation (ABEV) exercises, which are expected to have an anti-vertigo effect through neural learning. METHODS A cohort study with 104 patients with intra-individual control was conducted to examine the clinical efficacy of solely 16 ABEV exercises for the treatment of peripheral vestibulopathies which are also used digitally in the future DiGA Vertidisan. Using the short version vertigo symptom scale short form1 vertigo and related symptoms (VSS-sf1-VER) of the vertigo-specific and validated VSS rating scale (Vertigo Symptom Scale) as the primary outcome variable, the vertigo scores before therapy (time T0) were compared with the corresponding data at the end of a period of 12-16 weeks (time T1). RESULTS Complete datasets on T0 and T1 were available for N=104 patients. The mean VSS-sf1-V score decreased from 3.80 (median 4, SD 0.47) to 0.92 (median 1, SD 1.19) from T0 to T1 (weeks 12-16). The result is statistically significant (p=0.001) and shows a high clinical effect size. CONCLUSION In summary, the analysis of the dizziness score shows a statistically and clinically significant reduction in dizziness through the use of the 16 ABEV exercises.
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Affiliation(s)
- Benedikt P Zenner
- Institut für Health Care und Public Management, Universität Hohenheim, Stuttgart, Germany
| | | | - Hans-Peter Zenner
- Universitätsklinik für Hals-Nasen-Ohren-Heilkunde, Eberhard-Karls-Universität Tübingen, Medizinische Fakultät, Tübingen, Germany
| | - Markus Wirth
- Klinik und Poliklinik für Hals-, Nasen-, Ohrenheilkunde, Klinikum rechts der Isar der Technischen Universität München, München, Germany
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16
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Strupp ML, Zwergal A, Goldschagg N. [The six most frequent peripheral vestibular syndromes]. Laryngorhinootologie 2024; 103:196-206. [PMID: 38134907 DOI: 10.1055/a-2144-3801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2023]
Abstract
Three forms of peripheral vestibular disorders, each with its typical symptoms and clinical signs, can be differentiated functionally, anatomically and pathophysiologically: 1. inadequate unilateral paroxysmal stimulation or rarely inhibition of the peripheral vestibular system, e. g., BPPV, Menière's disease, vestibular paroxysmia or syndrome of the third mobile windows; 2. acute unilateral vestibulopathy leading to an acute vestibular tone imbalance manifesting as an acute peripheral vestibular syndrome; and 3. loss or impairment of function of the vestibular nerve and/or labyrinth: bilateral vestibulopathy. For all of these diseases, current diagnostic criteria by the Bárány-Society are available with a high clinical and scientific impact, also for clinical trials. The treatment depends on the underlying disease. It basically consists of 5 principles: 1. Explaining the symptoms and signs, pathophysiology, aetiology and treatment options to the patient; this is important for compliance, adherence and persistence. 2. Physical therapy: A) For BPPV specific liberatory maneuvers, depending on canal involved. Posterior canal: The new SémontPLUS maneuver is superior to the regular Sémont and Epley maneuvers; horizontal canal: the modified roll-maneuver; anterior canal the modified Yacovino-maneuver; 3. Symptomatic or causative drug therapy. There is still a deficit of placebo-controlled clinical trials so that the level of evidence for pharmacotherapy is most often low. 4. Surgery, mainly for the syndrome of the third mobile windows. 5. Psychotherapeutic measures for secondary functional dizziness.
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Affiliation(s)
- Michael Leo Strupp
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, München, Germany
- Deutsches Schwindel- und Gleichgewichtszentrum, DSGZ, Ludwig-Maximilians-Universität München, München, Germany
| | - Andreas Zwergal
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, München, Germany
- Deutsches Schwindel- und Gleichgewichtszentrum, DSGZ, Ludwig-Maximilians-Universität München, München, Germany
| | - Nicolina Goldschagg
- Neurologische Klinik und Poliklinik, Ludwig-Maximilians-Universität München, München, Germany
- Deutsches Schwindel- und Gleichgewichtszentrum, DSGZ, Ludwig-Maximilians-Universität München, München, Germany
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17
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Yueh HZ, Chu HL, Lu SC, Lee YJ, Lin CH. The role of vestibular function tests in nontuberculous mycobacterial otomastoiditis: A case report. Medicine (Baltimore) 2024; 103:e37007. [PMID: 38306553 PMCID: PMC10843242 DOI: 10.1097/md.0000000000037007] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/21/2023] [Accepted: 12/29/2023] [Indexed: 02/04/2024] Open
Abstract
BACKGROUND Nontuberculous mycobacteria (NTM), an extremely rare pathogen causing cervicofacial infections, may result in permanent hearing impairment or intracranial complications. Due to the lack of specific manifestations during the initial onset of NTM otomastoiditis, physicians may misdiagnose it as cholesteatoma or other common bacterial infections. PATIENT CONCERNS A 44-year-old male who complained of left-sided aural fullness, otalgia, and dizziness for 2 months. DIAGNOSIS The initial diagnosis was hypothesized to be cholesteatoma based on a whitish mass with mucoid discharge filling the entire outer ear canal on otoscopy and left-sided mixed hearing loss. However, NTM was identified by microbial culture at the 2-month follow-up after surgery. INTERVENTIONS The patient underwent a left-sided exploratory tympanotomy. Because NTM otomastoiditis was diagnosed, 3 weeks of starting therapies were administered with azithromycin (500 mg/day, oral administration), cefoxitin (3 g/day, intravenous drip), and amikacin (750 mg/day, intravenous drip). The maintenance therapies were azithromycin (500 mg/day, oral administration) and doxycycline (200 mg/day, oral administration) for 7 months. OUTCOMES The patient's clinical condition improved initially after surgery, but the otomastoiditis gradually worsened, combined with subtle meningitis, 2 months after surgery. The external auditory canal became swollen and obstructed, making it difficult to monitor the treatment efficacy through otoscopy. Thus, we used regular vestibular function tests, including static posturography, cervical vestibular evoked myogenic potentials, and video Head Impulse Test, to assess recovery outcomes. After antibiotic treatment, the infectious symptoms subsided significantly, and there was no evidence of infection recurrence 7 months after treatment. Improvements in static posturography and cervical vestibular evoked myogenic potentials were compatible with the clinical manifestations, but video Head Impulse Test showed an unremarkable correlation. LESSONS The clinical condition of NTM otomastoiditis may be evaluated using vestibular tests if patients have symptoms of dizziness.
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Affiliation(s)
- Hann-Ziong Yueh
- Department of Otolaryngology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Hung-Lun Chu
- Department of Otolaryngology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of General Medicine, Taipei Medical University Hospital, Taipei, Taiwan
| | - Shih-Chun Lu
- Department of Otolaryngology, Taipei Medical University Hospital, Taipei, Taiwan
| | - Yuarn-Jang Lee
- Division of Infectious Diseases, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan
- Division of Infectious Diseases, Department of Internal Medicine, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Che-Hsuan Lin
- Department of Otolaryngology, Taipei Medical University Hospital, Taipei, Taiwan
- Department of Otolaryngology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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Hannigan IP, Rosengren SM, Bharathy GK, Prasad M, Welgampola MS, Watson SRD. Subjective and objective responses to caloric stimulation help separate vestibular migraine from other vestibular disorders. J Neurol 2024; 271:887-898. [PMID: 37847290 PMCID: PMC10828018 DOI: 10.1007/s00415-023-12027-z] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2023] [Revised: 09/23/2023] [Accepted: 09/25/2023] [Indexed: 10/18/2023]
Abstract
BACKGROUND Nystagmus generated during bithermal caloric test assesses the horizontal vestibulo-ocular-reflex. Any induced symptoms are considered unwanted side effects rather than diagnostic information. AIM We hypothesized that nystagmus slow-phase-velocity (SPV) and subjective symptoms during caloric testing would be higher in vestibular migraine (VM) patients compared with peripheral disorders such as Meniere's disease (MD) and non-vestibular dizziness (NVD). METHODS Consecutive patients (n = 1373, 60% female) referred for caloric testing were recruited. During caloric irrigations, patients scored their subjective sensations. We assessed objective-measures, subjective vertigo (SVS), subjective nausea (SNS), and test completion status. RESULTS Nystagmus SPV for VM, MD (unaffected side), and NVD were 29 ± 12.8, 30 ± 15.4, and 28 ± 14.2 for warm irrigation and 24 ± 8.9, 22 ± 10.0, and 25 ± 12.8 for cold-irrigation. The mean SVS were 2.5 ± 1.1, 1.5 ± 1.33, and 1.5 ± 1.42 for warm irrigation and 2.2 ± 1.1, 1.1 ± 1.19, and 1.1 ± 1.16 for cold-irrigation. Age was significantly correlated with SVS and SNS, (p < 0.001) for both. The SVS and SNS were significantly higher in VM compared with non-VM groups (p < 0.001), and there was no difference in nystagmus SPV. VM patients SVS was significantly different to the SVS of migraineurs in the other diagnostic groups (p < 0.001). Testing was incomplete for 34.4% of VM and 3.2% of MD patients. To separate VM from MD, we computed a composite value representing the caloric data, with 83% sensitivity and 71% specificity. Application of machine learning to these metrics plus patient demographics yielded better separation (96% sensitivity and 85% specificity). CONCLUSION Perceptual differences between VM and non-VM patients during caloric stimulation indicate that subjective ratings during caloric testing are meaningful measures. Combining objective and subjective measures could provide optimal separation of VM from MD.
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Affiliation(s)
- I P Hannigan
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, 2006, Australia
- Blacktown Neurology Clinic, Blacktown, NSW, 2148, Australia
| | - S M Rosengren
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, 2006, Australia
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, 2006, Australia
| | - G K Bharathy
- School of Computer Science, Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, 2007, Australia
| | - M Prasad
- School of Computer Science, Faculty of Engineering and Information Technology, University of Technology Sydney, Sydney, 2007, Australia
| | - M S Welgampola
- Central Clinical School, Faculty of Medicine and Health, University of Sydney, Sydney, 2006, Australia
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Camperdown, 2006, Australia
| | - S R D Watson
- Prince of Wales Clinical School, University of New South Wales, Randwick, 2013, Australia.
- Blacktown Neurology Clinic, Blacktown, NSW, 2148, Australia.
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Gopinath B, Tang D, Burlutsky G, Mitchell P. Ten-year incidence, predictors and impact of dizziness and vertigo in community-dwelling adults. Maturitas 2024; 180:107890. [PMID: 38006814 DOI: 10.1016/j.maturitas.2023.107890] [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: 08/15/2023] [Revised: 11/09/2023] [Accepted: 11/16/2023] [Indexed: 11/27/2023]
Abstract
OBJECTIVES We used a cohort of community-dwelling adults to establish the 10-year incidence and predictors of dizziness/vertigo, and its impacts on health-related quality of life. STUDY DESIGN Of the 1152 participants aged 55 + years who did not have dizziness/vertigo at baseline, 799 and 377 participants were followed up after 5 and 10 years, respectively, and had complete data and so were included in the incidence analysis. Hearing loss was determined as the pure-tone average of audiometric hearing thresholds at 500, 1000, 2000 and 4000 Hz, and any hearing loss was defined as >25 dB hearing level. Tinnitus and migraine were assessed by a positive response to a single question. MAIN OUTCOME MEASURES Audiologists screened participants for reported dizziness using a single question. Quality of life was measured using the Short Form 36-item Health Survey (SF-36). RESULTS The cumulative 10-year incidence of dizziness/vertigo, vestibular vertigo and non-vestibular vertigo were 39.8 %, 27.1 %, and 11.9 %, respectively. Age and presence of migraine were significant predictors of incident dizziness/vertigo: multivariable-adjusted hazard ratio (HR) 1.03 (95 % confidence interval, CI, 1.01-1.06) and HR 1.63 (95 % CI 1.13-2.35), respectively. A significant decrease in scores for the following SF-36 domains was observed over the 10 years among participants reporting baseline dizziness/vertigo: physical functioning (P-trend ≤ 0.0001), role limitation due to physical problems (P-trend ≤ 0.0001), general health (P-trend = 0.01), and vitality (P-trend = 0.01). CONCLUSIONS Dizziness/vertigo was a frequent and detrimental symptom in this population of community-dwelling adults. Our study highlights the burden imposed by dizziness, as evidenced by a significant prospective association with poorer quality of life.
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Affiliation(s)
- Bamini Gopinath
- Macquarie University Hearing, Department of Health Sciences, Macquarie University, NSW, Australia.
| | - Diana Tang
- Macquarie University Hearing, Department of Health Sciences, Macquarie University, NSW, Australia.
| | - George Burlutsky
- Macquarie University Hearing, Department of Health Sciences, Macquarie University, NSW, Australia.
| | - Paul Mitchell
- Centre for Vision Research, Department of Ophthalmology and Westmead Institute for Medical Research, University of Sydney, NSW, Australia.
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Zhao D, Jiang Z, Li C. [Dynamic visual acuity screening test results analysis of 25 patients with peripheral vertigo]. Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2024; 38:146-149. [PMID: 38297869 DOI: 10.13201/j.issn.2096-7993.2024.02.012] [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: 04/26/2023] [Indexed: 02/02/2024]
Abstract
Objective:To observe the results of dynamic visual acuity screening tests in patients with peripheral vertigo and explore its clinical significance. Methods:The number of 48 healthy volunteers were enrolled as control group and 25 peripheral vertigo patients as experimental group. In the experimental group, there are 12 patients with vestibular neuritis, 1 patient with Hunt syndrome, 5 patients with sudden deafness with vertigo and 7 patients with bilateral vestibular dysfunction. Horizontal and vertical dynamic visual acuity screening tests were performed on them. The number of lost rows of horizontal and vertical dynamic visual acuity was compared between the control group and the experimental group to figure out if there is a statistical difference. The number of lost rows of horizontal and vertical dynamic visual acuity was compared within the experimental group to figure out if there is a statistical difference. The two groups of 18 cases of unilateral vestibular function decline and 7 cases of bilateral vestibular function decline in the experimental group were compared with the control group, and figure out if there is a statistical difference. Results:The median number of lost rows of horizontal dynamic visual acuity in 48 healthy volunteers was 1.5 and median number of lost rows of vertical dynamic visual acuity was 1.0 in the control group. The median number of lost rows of horizontal dynamic visual acuity of 26 healthy volunteers was 6 and median number of lost rows of vertical dynamic visual acuity was 5 in the experimental group. Compared to the experimental group, the number of lost rows both have statistical significance in horizontal and vertical dynamic visual acuity(P<0.01). The comparison of horizontal and vertical lost rows within the test group also have statistical significance(P<0.01). Twenty five patients with exceptional vestibular disease in the experimental group were divided into unilateral vestibular function reduction group(n=18) and bilateral vestibular function reduction group(n=7). Compared with the control group, there was significant differences in the number of horizontal and vertical lost rows(P<0.01) within the three groups. After pairwise comparison, the number of lost rows of horizontal and vertical in the control group was significantly lower than that in the unilateral vestibular function reduction group and the bilateral vestibular function reduction group(P<0.01). There was a highly significant correlation between the number of horizontally lost rows of DVA and the mean vHIT values of bilateral horizontal semicircular canals in 25 patients(P<0.01); and a highly significant correlation between the number of vertically lost rows of DVA and the mean vHIT values of vertical semicircular canals in 4 groups bilaterally(P<0.01). Conclusion:The Dynamic Visual Acuity Screening Test is a useful addition to existing tests of peripheral vestibular function, particularly the vHIT test, and provides a rapid assessment of the extent of 2 Hz VOR impairment in patients with reduced vestibular function.
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Affiliation(s)
- Dong Zhao
- Department of Otology,First Hospital of Qinhuangdao,Qinhuangdao,066000,China
| | - Zigang Jiang
- Department of Otology,First Hospital of Qinhuangdao,Qinhuangdao,066000,China
| | - Chunjiao Li
- Department of Otology,First Hospital of Qinhuangdao,Qinhuangdao,066000,China
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Bronstein AM, Kattah J. Vascular neuro-otology: vestibular transient ischemic attacks and chronic dizziness in the elderly. Curr Opin Neurol 2024; 37:59-65. [PMID: 38032270 PMCID: PMC10779463 DOI: 10.1097/wco.0000000000001229] [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: 12/01/2023]
Abstract
PURPOSE OF REVIEW To explore the differential diagnosis of posterior fossa transient ischemic attacks (TIA) associated with vertigo and/or imbalance.To review the contribution of cerebral small vessel (SVD) disease to balance dysfunction and dizziness in the elderly. MAIN FINDINGS TIAs involving vestibular structures that mediate the vestibulo-ocular and vestibulospinal reflexes remain a diagnostic challenge because they overlap with causes of benign episodic vertigo. Here, we summarize the results of multidisciplinary specialty efforts to improve timely recognition and intervention of peripheral and central vestibular ischemia. More papers confirm that SVD is a major cause of gait disability, falls and cognitive disorder in the elderly. Recent work shows that early stages of SVD may also be responsible for dizziness in the elderly. The predominant location of the white matter changes, in the frontal deep white matter and genu of the corpus callosum, explains the association between cognitive and balance dysfunction in SVD related symptoms. SUMMARY The evaluation of patients with intermittent vascular vertigo represent a major diagnostic challenge, recent reviews explore the ideal design approach for a multidisciplinary study to increase early recognition and intervention. Hemispheric white matter microvascular ischemia has been the subject of research progress - advanced stages are known to cause gait disorder and dementia but early stages are associated with "idiopathic" dizziness in the elderly.
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Affiliation(s)
- Adolfo M. Bronstein
- Centre for Vestibular Neuroscience, Department of Brain Sciences, Imperial College London, Charing Cross Hospital, London, UK
| | - Jorge Kattah
- University of Illinois at Chicago | UIC Department of Neurology (Peoria), Chicago, Illinois, USA
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22
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Dlugaiczyk J. [The "difficult" patient-pearls and pitfalls of vestibular diagnostic tests: Part 2 : Difficult aspects of vestibular laboratory testing]. HNO 2024; 72:129-140. [PMID: 38260984 PMCID: PMC10827978 DOI: 10.1007/s00106-023-01401-y] [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] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/01/2023] [Indexed: 01/24/2024]
Abstract
Patients with the cardinal symptoms "vertigo" or "dizziness" may be a real challenge for the treating otorhinolaryngologist. While the first part of this educational series was focused on history taking and bedside neurotological examination, the present paper is devoted to difficult aspects of vestibular laboratory testing, including getting the indication right, what to do if my patient is not able to fully cooperate during the tests, how to choose the adequate diagnostic procedure depending on the patient's comorbidities, how to interpret discordant results of various tests. Finally the paper addresses which conclusions can be drawn (and cannot be drawn) from normal findings in vestibular testing and how to communicate this result to the dizzy patient.
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Affiliation(s)
- Julia Dlugaiczyk
- Klinik für Ohren‑, Nasen‑, Hals- und Gesichtschirurgie & Interdisziplinäres Zentrum für Schwindel und neurologische Sehstörungen, Universitätsspital Zürich (USZ), Universität Zürich (UZH), Rämistrasse 100, 8091, Zürich, Schweiz.
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23
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Wang X, Wang L, Kang W, Gu X. Delayed diagnosis of vascular vertigo: A case report. Asian J Surg 2024; 47:1033-1034. [PMID: 38036342 DOI: 10.1016/j.asjsur.2023.10.093] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2023] [Accepted: 10/20/2023] [Indexed: 12/02/2023] Open
Affiliation(s)
- Xiwen Wang
- Department of Neurology Ward Ⅰ, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, 061000, China.
| | - Lihong Wang
- Department of Neurology Ward Ⅰ, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, 061000, China
| | - Weige Kang
- Department of Neurology Ward Ⅰ, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, 061000, China
| | - Xiaojuan Gu
- Department of Neurology Ward Ⅰ, Cangzhou Clinical College of Integrated Traditional Chinese and Western Medicine of Hebei Medical University, Cangzhou, 061000, China
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Ceriani CEJ. Vestibular Migraine Pathophysiology and Treatment: a Narrative Review. Curr Pain Headache Rep 2024; 28:47-54. [PMID: 37889468 DOI: 10.1007/s11916-023-01182-7] [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] [Accepted: 10/14/2023] [Indexed: 10/28/2023]
Abstract
PURPOSE OF REVIEW To review the diagnosis of vestibular migraine (VM) and update the clinician on the most recent developments in our understanding of its pathophysiology and treatment. RECENT FINDINGS Functional imaging studies have identified multiple regions of the brain with abnormal activity and connectivity in VM. There is evidence of abnormal sensory processing and integration in VM patients. Calcitonin gene-related peptide (CGRP) has also been found to play a role in trigeminal and vestibular nucleus pathways. Research into treatment modalities has identified several neuromodulation devices that may be effective in VM. There are a growing number of evidence-based preventive options for VM, including medications that target CGRP. VM is best understood as a sensory processing disorder. CGRP appears to play a role, and further research is needed to fully understand its effects. Treatment options are expanding, but there is still a need for more randomly controlled trials in this area.
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Affiliation(s)
- Claire E J Ceriani
- Jefferson Headache Center, Department of Neurology, Thomas Jefferson University, 900 Walnut St., Ste 200, Philadelphia, PA, 19107, USA.
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Qiao Q, Chen GG, Yang J, Wu JX, Zhou LY, Li Y. [Design and evaluation of the dizziness/vertigo disease screening questionnaire]. Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi 2024; 59:57-63. [PMID: 38246762 DOI: 10.3760/cma.j.cn115330-20230904-00075] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Affiliation(s)
- Q Qiao
- Department of Otorhinolaryngology Head and Neck Surgery, First Affiliated Hospital of Air Force Military Medical University, Xi'an 710032, China
| | - G G Chen
- Department of Otorhinolaryngology Head and Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - J Yang
- Department of Otorhinolaryngology Head and Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - J X Wu
- Department of Otorhinolaryngology Head and Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - L Y Zhou
- Department of Otorhinolaryngology Head and Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan 030001, China
| | - Y Li
- Department of Otorhinolaryngology Head and Neck Surgery, First Hospital of Shanxi Medical University, Taiyuan 030001, China
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Eggers SDZ, Staab JP. Vestibular migraine and persistent postural perceptual dizziness. Handb Clin Neurol 2024; 199:389-411. [PMID: 38307659 DOI: 10.1016/b978-0-12-823357-3.00028-8] [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] [Indexed: 02/04/2024]
Abstract
Dizziness is a common symptom among patients in primary care, general neurology, and headache clinic practices. Vestibular migraine is conceptualized as a condition of recurrent attacks of vestibular symptoms attributed to migraine. It is now considered the most common cause of spontaneous episodic vertigo. Persistent postural-perceptual dizziness (PPPD) has more recently been defined based on four previous clinical entities as a syndrome of chronic daily dizziness, unsteadiness, or nonspinning vertigo that fluctuates and is exacerbated by postural, motion, or visual factors. Although PPPD is more often precipitated by other conditions causing vertigo, unsteadiness, or dizziness, it is discussed at length in this chapter because vestibular migraine is among the most common triggers for development of PPPD. Pathophysiology of each is incompletely understood, and with lack of biomarkers, the diagnosis of each rests on consensus-derived, symptom-based criteria. Areas of uncertainty exist regarding some overlapping symptoms that may create potential diagnostic confusion between the conditions. This chapter provides a comprehensive review of the current state of vestibular migraine and PPPD, including diagnostic and management guidance for when they occur separately, together, or along with other common comorbidities.
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Affiliation(s)
- Scott D Z Eggers
- Department of Neurology, Mayo Clinic, Rochester, MN, United States.
| | - Jeffrey P Staab
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN, United States; Department of Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, MN, United States
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Ludbrook I, Mair M, Phung D, Corlette T, Huang J, Kong Worimi K, Eisenberg R. Predictive Factors for Subjective Vertigo Following Cochlear Implantation: A Regional Multicenter Cohort Study of 395 Patients. Otol Neurotol 2024; 45:e18-e23. [PMID: 37853779 DOI: 10.1097/mao.0000000000004036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
INTRODUCTION Cochlear implantation (CI) is generally accepted as having a low rate of postoperative complications, but between 9.3% and 13% of cases experience vertigo postoperatively. This study aimed to examine patient, surgical, and device factors contributing toward the risk of postoperative vertigo. METHODOLOGY A retrospective review was conducted of adult patients who underwent cochlear implant in a regional area of New South Wales from 2007 to 2018. A total of 395 cochlear implant cases were included in the final study. RESULTS The overall incidence of vertigo at 3 months of follow-up was 7.1% (n = 28/395). No difference was identified in this study between rates of postoperative vertigo between device factors, including implant make (Cochlear vs. Med-El), electrode shape (perimodiolar vs. straight), and electrode model. No significant difference was found also for surgical factors such as the number of electrode rings inserted, side of implantation, or surgical approach of tympanic ramp (round window insertion vs. cochleostomy).A higher percentage of patients with preoperative vertigo experienced vertigo postoperatively (18.4%, n = 7/38), compared with the population without preoperative vertigo (6.0%, n = 21/352) ( p = 0.005). Patients with previous mastoid surgery also reported a higher rate of postoperative vertigo (20%, n = 9/45) compared with those who had not had mastoid surgery (5.43%, n = 19/350) ( p = 0.006). The mean age of patients experiencing postoperative vertigo was higher than the population without postoperative symptoms (67 vs. 63). CONCLUSION This study of a large multicenter population outlines that patient factors are more critical than surgical or device factors when considering risk factors for vertigo post-cochlear implant.
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Affiliation(s)
- Isabella Ludbrook
- Department of Ear Nose and Throat Surgery, Tamworth Rural Referral Hospital, North Tamworth, New South Wales, Australia
| | - Manish Mair
- Department of Otolaryngology-Head and Neck Surgery, University of Leicester Hospital, United Kingdom
| | - Daniel Phung
- Department of Ear Nose and Throat Surgery, Orange Medical Service, Orange, New South Wales, Australia
| | - Toby Corlette
- Department of Otolaryngology-Head and Neck Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Johnson Huang
- Department of Otolaryngology-Head and Neck Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Kelvin Kong Worimi
- Department of Otolaryngology-Head and Neck Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
| | - Robert Eisenberg
- Department of Otolaryngology-Head and Neck Surgery, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
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Kwok BYC, Young AS, Kong JHK, Birman CS, Flanagan S, Greenberg SL, Gibson WP, Argaet EC, Fratturo L, Pogson JM, Taylor RL, Rosengren SM, Halmagyi GM, Welgampola MS. Post Cochlear Implantation Vertigo: Ictal Nystagmus and Audiovestibular Test Characteristics. Otol Neurotol 2024; 45:65-74. [PMID: 37853785 DOI: 10.1097/mao.0000000000004037] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2023]
Abstract
OBJECTIVE To investigate ictal nystagmus and audiovestibular characteristics in episodic spontaneous vertigo after cochlear implantation (CI). STUDY DESIGN Retrospective and prospective case series. PATIENTS Twenty-one CI patients with episodic spontaneous vertigo after implantation were recruited. INTERVENTIONS Patient-initiated home video-oculography recordings were performed during one or more attacks of vertigo, using miniature portable home video-glasses. To assess canal and otolith function, video head-impulse tests (vHITs) and vestibular-evoked myogenic potential tests were conducted. MAIN OUTCOME MEASURES Nystagmus slow-phase velocities (SPVs), the presence of horizontal direction-changing nystagmus, and post-CI audiovestibular tests. RESULTS Main final diagnoses were post-CI secondary endolymphatic hydrops (48%) and exacerbation of existing Ménière's disease (29%). Symptomatic patients demonstrated high-velocity horizontal ictal-nystagmus (SPV, 44.2°/s and 68.2°/s in post-CI secondary endolymphatic hydrop and Ménière's disease). Direction-changing nystagmus was observed in 80 and 75%. Two were diagnosed with presumed autoimmune inner ear disease (SPV, 6.6°/s and 172.9°/s). One patient was diagnosed with probable vestibular migraine (15.1°/s).VHIT gains were 0.80 ± 0.20 (lateral), 0.70 ± 0.17 (anterior), and 0.62 ± 0.27 (posterior) in the implanted ear, with abnormal values in 33, 35, and 35% of each canal. Bone-conducted cervical and ocular vestibular-evoked myogenic potentials were asymmetric in 52 and 29% of patients (all lateralized to the implanted ear) with mean asymmetry ratios of 51.2 and 35.7%. Reversible reduction in vHIT gain was recorded in three acutely symptomatic patients. CONCLUSION High-velocity, direction-changing nystagmus time-locked with vertigo attacks may be observed in post-CI implant vertigo and may indicate endolymphatic hydrops. Fluctuating vHIT gain may be an additional marker of a recurrent peripheral vestibulopathy.
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Affiliation(s)
| | | | | | | | - Sean Flanagan
- Department of Otolaryngology, Head and Neck, and Skull Base Surgery, St Vincent's Public Hospital, Sydney
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Michailidou E, Korda A, Wyss T, Bardins S, Schneider E, Morrison M, Wagner F, Caversaccio MD, Mantokoudis G. The value of saccade metrics and VOR gain in detecting a vestibular stroke. J Vestib Res 2024; 34:49-61. [PMID: 38160379 DOI: 10.3233/ves-230083] [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: 01/03/2024]
Abstract
OBJECTIVE A normal video Head Impulse Test is the gold standard in the emergency department to rule-in patients with an acute vestibular syndrome and a stroke. We aimed to compare the diagnostic accuracy of vHIT metrics regarding the vestibulo-ocular reflex gain and the corrective saccades in detecting vestibular strokes. METHODS Prospective cross-sectional study (convenience sample) of patients presenting with acute vestibular syndrome in the emergency department of a tertiary referral centre between February 2015 and May 2020. We screened 1677 patients and enrolled 76 patients fulfilling the inclusion criteria of acute vestibular syndrome. All patients underwent video head impulse test with automated and manual data analysis. A delayed MRI served as a gold standard for vestibular stroke confirmation. RESULTS Out of 76 patients, 52 were diagnosed with acute unilateral vestibulopathy and 24 with vestibular strokes. The overall accuracy of detecting stroke with an automated vestibulo-ocular reflex gain was 86.8%, compared to 77.6% for cumulative saccade amplitude and automatic saccade mean peak velocity measured by an expert and 71% for cumulative saccade amplitude and saccade mean peak velocity measured automatically. Gain misclassified 13.1% of the patients as false positive or false negative, manual cumulative saccade amplitude and saccade mean peak velocity 22.3%, and automated cumulative saccade amplitude and saccade mean peak velocity 28.9% respectively. CONCLUSIONS We found a better accuracy of video head impulse test for the diagnosis of vestibular strokes when using the vestibulo-ocular reflex gain than using saccade metrics. Nevertheless, saccades provide an additional and important information for video head impulse test evaluation. The automated saccade detection algorithm is not yet perfect compared to expert analysis, but it may become a valuable tool for future non-expert video head impulse test evaluations.
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Affiliation(s)
- Efterpi Michailidou
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Thomas Wyss
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Stanislav Bardins
- Institute of Medical Technology, Brandenburg University of Technology Cottbus - Senftenberg, Cottbus, Germany
| | - Erich Schneider
- Institute of Medical Technology, Brandenburg University of Technology Cottbus - Senftenberg, Cottbus, Germany
| | - Miranda Morrison
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Franca Wagner
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Marco D Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and University of Bern, Bern, Switzerland
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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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Cohen HS, Sangi-Haghpeykar H, Sullivan JC, Silver N, Ferreira LD, Dong JL, Sweeney AD, Peng AS. Relationship between clinical measures of hearing and clinical measures of vestibular function. Am J Otolaryngol 2024; 45:104052. [PMID: 37801744 PMCID: PMC10841531 DOI: 10.1016/j.amjoto.2023.104052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2023] [Accepted: 09/12/2023] [Indexed: 10/08/2023]
Abstract
PURPOSE Patients often have basic audiometry (BA) but not objective diagnostic tests of the vestibular system (VNG) when complaining of symptoms of a vestibular disorder. The relationship of BA results to VNG results is unknown. This study sought to determine if BA scores are related to impaired VNG scores. MATERIALS AND METHODS We reviewed electronic medical records at a tertiary care center, for patients seen between 2015 and 2021 who had had both a BA and a VNG (n = 651). BA subtests were pure tone averages, word recognition, and tympanogram. VNG subtests were cervical vestibular evoked myogenic potentials, Dix-Hallpike maneuvers, and bi-thermal caloric tests. All tests were summarized as normal/abnormal. RESULTS More subjects had abnormal BA than abnormal VNG scores. Age but not sex was significantly related to abnormal scores. High BP was a significant comorbidity in 15 % of the sample, more in patients with abnormal than normal VNG scores. Although the abnormal BA and abnormal VNG were significantly related, pure tone averages and tympanogram scores were not related to VNG subtests. Abnormal word recognition with both ears combined was significantly related to normal and abnormal bi-thermal caloric tests. CONCLUSIONS If the clinician needs to know of any VNG impairment, in general, then performing a BA without a VNG might suffice. If the clinician needs information about the details of possible vestibular impairment, then a VNG should be performed.
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Affiliation(s)
- Helen S Cohen
- Bobby R Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA.
| | | | - J Connor Sullivan
- Bobby R Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Nathan Silver
- Bobby R Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Liam D Ferreira
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Jen Li Dong
- School of Medicine, Baylor College of Medicine, Houston, TX, USA
| | - Alex D Sweeney
- Bobby R Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
| | - Angela S Peng
- Bobby R Alford Department of Otolaryngology - Head and Neck Surgery, Baylor College of Medicine, Houston, TX, USA
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Dunlap PM, Alradady FA, Costa CM, Delitto A, Terhorst L, Sparto PJ, Furman JM, Marchetti GF, Staab JP, Chueh J, Whitney SL. The Psychometric Properties of the 9-Item Vestibular Activities Avoidance Instrument. Phys Ther 2023; 103:pzad094. [PMID: 37459243 DOI: 10.1093/ptj/pzad094] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Revised: 04/24/2023] [Accepted: 07/02/2023] [Indexed: 12/29/2023]
Abstract
OBJECTIVE The purpose of this study was to establish the psychometric properties of the 9-Item Vestibular Activities Avoidance Instrument (VAAI-9), a patient-reported outcome measure developed to identify fear avoidance beliefs in persons with vestibular disorders. METHODS This prospective cohort study included 100 participants 18 years and older seeking care at a balance disorders clinic for dizziness. Participants completed the VAAI-9, the Dizziness Handicap Inventory (DHI), and other patient-reported outcomes at the initial visit and the 3-month follow-up. To measure test-retest reliability, the VAAI-9 was completed again 5 days after the initial visit and was analyzed using a 2-way mixed ICC for absolute agreement. Internal consistency was determined using the Cronbach alpha. The Spearman correlation coefficient was used to assess convergent validity of the VAAI-9 with other outcomes. Receiver operating characteristic curves were used to identify baseline VAAI-9 cutoff scores for those who reported mild (DHI ≤ 30) or moderate or severe (DHI > 30) perceived disability at the 3-month follow-up. RESULTS The mean age of the study cohort was 49 (SD = 16) years; 73 (73%) were women. Seventy-one participants completed the 5-day follow-up, and 68 completed the 3-month follow-up. The VAAI-9 demonstrated excellent internal consistency (α = 0.91) and test-retest reliability (ICC = 0.90). Baseline VAAI-9 scores had moderate to strong associations with other outcome measures at baseline and 3 months. A baseline VAAI-9 score of 26 or higher had a sensitivity of 80.6% and a specificity of 78.4% for identifying a DHI score of >30 at 3 months (area under the curve = 0.86). CONCLUSIONS The results provide evidence of excellent reliability and validity for the 9-item VAAI in persons with vestibular disorders. A baseline VAAI-9 score of ≥26 identified individuals at risk of persistent moderate to severe disability due to dizziness. IMPACT Initial levels of fear avoidance beliefs measured using the VAAI-9 provided important prognostic information about outcomes for persons with vestibular symptoms.
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Affiliation(s)
- Pamela M Dunlap
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Fai A Alradady
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | | | - Anthony Delitto
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Lauren Terhorst
- School of Health and Rehabilitation Sciences Data Center and Department of Occupational Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Patrick J Sparto
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Joseph M Furman
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
| | - Gregory F Marchetti
- Department of Physical Therapy, Duquesne University, Pittsburgh, Pennsylvania, USA
| | - Jeffrey P Staab
- Departments of Psychiatry and Psychology and Otorhinolaryngology - Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Jasmine Chueh
- School of Health Professions, Stony Brook University, Stony Brook, New York, USA
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, Pennsylvania, USA
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Riato MLDC, Rocha VBC, Mezzalira R, Stoler G, do Amaral MIR. Validation and reliability analysis of the Questionnaire on the Emotional Impact of Vertigo-CIEV version translated to the Brazilian Portuguese language. Codas 2023; 35:e20220176. [PMID: 38055412 PMCID: PMC10750823 DOI: 10.1590/2317-1782/20232022176pt] [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: 06/30/2022] [Accepted: 11/03/2022] [Indexed: 12/08/2023] Open
Abstract
PURPOSE To determine the internal consistency and reliability of the "Questionário de Impacto Emocional da Vertigem (CIEV)" and to validate the instrument with respect to the Dizziness Handicap Inventory (DHI) in a sample of individuals with balance disorders. METHODS 38 subjects participated in the study, males and females, aged from 23 to 85 years, who presented dizziness, vertigo, and/or falls complaints and attended to the Vestibular Disorders clinic at the University Hospital. Individuals with hearing complaints and/or tinnitus unrelated to dizziness, previous psychiatric comorbidities, and/or cognitive impairments were excluded. We performed an anamnesis and collected complementary data from the medical records. After that, the self-perception questionnaires, DHI, and CIEV, were applied. Statistical analysis was performed in which the Cronbach's alpha verified the internal consistency of the CIEV. Reliability and validity of the CIEV related to the DHI were calculated using Intraclass Correlation Index (ICC) and Pearson's correlation test, respectively. RESULTS There was a statistically significant correlation between the scores obtained, for both reliability and validation analysis (p<0.001). The mean ICC showed a moderate correlation between the total scores (0.695) and a strong correlation with the physical, emotional, and functional DHI domains (0.706 to 0.869), being the emotional aspect the highest degree (0.869). Pearson's correlation showed strong correlation between the total scores (r=0.820) and varied from moderate to strong, with strongest correlations to the DHI emotional domain (r=0.788). CONCLUSION The outcomes illustrate important contribution to validation parameters to consider clinical use of the CIEV in the Brazilian population, aiming to identify emotional aspects in patients with balance disorders.
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Affiliation(s)
- Maria Luiza di Carlo Riato
- Programa de Graduação em Fonoaudiologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP - Campinas (SP), Brasil.
- Departamento de Desenvolvimento Humano e Reabilitação, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP - Campinas (SP), Brasil.
| | - Vanessa Brito Campoy Rocha
- Departamento de Otorrinolaringologia, Cabeça e Pescoço, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP - Campinas (SP), Brasil.
| | - Raquel Mezzalira
- Departamento de Otorrinolaringologia, Cabeça e Pescoço, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP - Campinas (SP), Brasil.
| | - Guita Stoler
- Departamento de Otorrinolaringologia, Cabeça e Pescoço, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP - Campinas (SP), Brasil.
| | - Maria Isabel Ramos do Amaral
- Departamento de Desenvolvimento Humano e Reabilitação, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP - Campinas (SP), Brasil.
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Battat N, Ungar OJ, Handzel O, Eta RA, Oron Y. Video head impulse test for the assessment of vestibular function in patients with idiopathic sudden sensorineural hearing loss without vertigo. J Laryngol Otol 2023; 137:1374-1377. [PMID: 36794537 PMCID: PMC10694636 DOI: 10.1017/s0022215123000245] [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] [Accepted: 02/08/2023] [Indexed: 02/17/2023]
Abstract
OBJECTIVE Idiopathic sudden sensorineural hearing loss may be accompanied by dizziness without true vertigo. This study used the video head impulse test to evaluate vestibular function in idiopathic sudden sensorineural hearing loss patients who described experiencing dizziness and not true vertigo. METHODS A prospective study was conducted of 30 consecutive patients diagnosed with idiopathic sudden sensorineural hearing loss with dizziness without true vertigo. A comparison of the video head impulse test results of the patients who complained of dizziness (symptomatic group) with a group of patients with idiopathic sudden sensorineural hearing loss and no dizziness (asymptomatic) was performed. RESULTS Nine patients (30 per cent) were symptomatic. Two of those patients had abnormal video head impulse test findings. Seven patients in the asymptomatic group (7 out of 21, 33 per cent) presented with abnormal video head impulse test results. No significant difference in vestibular function between the two groups was detected by the video head impulse test. CONCLUSION The site of insult in patients with idiopathic sudden sensorineural hearing loss without true vertigo is usually limited to the cochlea or the cochlear nerve.
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Affiliation(s)
- N Battat
- Department of Otolaryngology – Head and Neck Surgery, Samson Assuta Ashdod University Hospital, Ben Gurion University Faculty of Health Sciences, Ashdod, Israel
| | - O J Ungar
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - O Handzel
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Abu Eta
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Oron
- Department of Otolaryngology Head and Neck Surgery and Maxillofacial Surgery, Tel Aviv Sourasky Medical Center, Tel Aviv, Israel
- Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Karakılıç E, Çelikel E, Uysal PI, Topçuoğlu C, Turhan T, Özakın E. Diagnostic Value of Ischemia-Modified Albumin as a Biomarker in Patients with Peripheral Vertigo at Emergency Department of State Hospital in Ankara: A Cross-Sectional Study. Niger J Clin Pract 2023; 26:1779-1783. [PMID: 38158342 DOI: 10.4103/njcp.njcp_1862_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Accepted: 11/09/2023] [Indexed: 01/03/2024]
Abstract
BACKGROUND In previous studies, it was shown that ischemia-modified albumin (IMA) is an early marker of ischemia and different pathologies. However, IMA level change is unknown in patients with peripheral vertigo. It is also known that serum albumin levels can change in some patients with peripheral vertigo and that changes in serum albumin levels affect IMA levels. AIM In this study, we aimed to assess IMA, albumin-adjusted IMA, and albumin levels in patients with peripheral vertigo by comparing a control group. MATERIALS AND METHODS This prospective, case-control study included 46 patients aged 18-70 years who presented to emergency department with vertigo. Forty-nine healthy volunteers without known disease were included as controls. Serum albumin and IMA levels were measured, and albumin-adjusted IMA levels were calculated. Data were analyzed by statistical methods. RESULTS Mean age was 54.0 ± 15.7 in the patient group, whereas 43.8 ± 9.9 years in the control group. Albumin level was found to be significantly lower in patients with peripheral vertigo when compared to controls (P < 0.001). IMA level was found to be higher in the patient group compared to the controls, but it was not statistically significant (P = 0.06). However, albumin-adjusted IMA, which shows the real IMA level, was found to be higher than the control group (P = 0.02). CONCLUSION It was observed that IMA level was slightly higher in patients with peripheral vertigo, although not significantly, compared to the control group. However, the albumin-adjusted IMA level, which indicates the real IMA level, was observed to be higher in this group than in the control group. It was determined that the sensitivity of this test was 34%, and the specificity was 87%. Patients with peripheral vertigo had lower albumin levels compared to controls.
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Affiliation(s)
- E Karakılıç
- Department of Emergency Medicine, Eskisehir Osmangazi University School of Medicine, Eskişehir, Turkey
| | - E Çelikel
- Department of Emergency Medicine, University of Health Sciences Etlik City Hospital, Ankara, Turkey
| | - P I Uysal
- Department of Emergency Medicine, University of Health Sciences Gülhane Training and Research Hospital, Ankara, Turkey
| | - C Topçuoğlu
- Department of Clinical Biochemistry, University of Health Sciences Ankara City Hospital, Ankara, Turkey
| | - T Turhan
- Department of Clinical Biochemistry, University of Health Sciences Ankara City Hospital, Ankara, Turkey
| | - E Özakın
- Department of Emergency Medicine, Eskisehir Osmangazi University School of Medicine, Eskişehir, Turkey
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Kim EK, Hum M, Sharon JD. Correlating Vestibular Migraine Patient Assessment Tool and Handicap Inventory to Daily Dizziness Symptoms. Otol Neurotol 2023; 44:1052-1056. [PMID: 37733970 DOI: 10.1097/mao.0000000000004014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/23/2023]
Abstract
OBJECTIVE Investigate the relationship between Vestibular Migraine Patient Assessment Tool and Handicap Inventory (VM-PATHI) scores and daily dizziness symptoms. STUDY DESIGN Prospective cohort analysis of 52 patients with vestibular migraine (VM). SETTING Tertiary referral center. PATIENTS Fifty-two patients diagnosed with VM or probable VM according to Barany Society criteria. INTERVENTIONS Subjects reported their dizzy symptoms (on a scale of 0 [no symptoms], 1 [mild], 2 [moderate], and 3 [severe]) every day for 1 month via automated text messaging linked to a cloud-based research database. Subjects completed VM-PATHI and Dizziness Handicap Inventory (DHI) scores at the end of the month. We examined the correlation between a composite of daily dizziness scores with VM-PATHI and DHI scores through linear regression and correlation analysis. MAIN OUTCOME MEASURES Pearson correlation coefficient, R2 value. RESULTS VM-PATHI showed a moderate correlation with daily dizziness symptoms (correlation coefficient, 0.51). DHI showed a lower correlation with daily dizziness (correlation coefficient, 0.38). VM-PATHI score was a strong predictor of daily dizziness with univariate linear regression ( R2 = 0.26, p = 0.001). In a multiple linear regression model with age, history of anxiety and/or depression, and VM-PATHI, the VM-PATHI score was the only statistically significant predictor of daily dizziness ( p < 0.001). CONCLUSIONS Daily dizziness symptoms are better correlated with VM-PATHI score than the DHI, providing further validation of VM-PATHI as a disease-specific outcome measure for patients with VM.
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Affiliation(s)
- Eric K Kim
- Department of Otolaryngology-Head and Neck Surgery, University of California San Francisco, San Francisco, California
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Wibble T, Pansell T. Translation and validation of a Swedish version of the Visual Vertigo Analogue Scale. Ann Med 2023; 55:572-577. [PMID: 36896483 PMCID: PMC10795583 DOI: 10.1080/07853890.2023.2177724] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2022] [Accepted: 02/01/2023] [Indexed: 03/11/2023] Open
Abstract
PURPOSE The present study aimed to construct and validate a Swedish translation (VVAS-S) of the Visual Vertigo Analogue Scale (VVAS). MATERIALS AND METHODS The original English VVAS was translated into Swedish by the two authors and back-translated by an independent professional translator. Pilot-tests were performed on two healthy participants and five patients suffering from Visually Induced Dizziness (VID). The translation was deemed understandable by all subjects. Twenty-one patients with VID were recruited to complete the VVAS-S, once in-lab and once at home after 2-3 weeks. Cronbach's alpha, inter-item consistency and internal consistency were calculated. RESULTS Test-retest values were reliably strong across all items. Cronbach's alpha was 0.843, which is considered to represent very-high reliability. The corrected-item total-correlation was above 0.3 for all items, meaning they were appropriately associated with one-another. Fourteen out of 36 inter-item correlation interactions were within the 0.2-0.4 range. CONCLUSIONS The VVAS-S was found to be comparable to the original VVAS in terms of internal reliability. The translation was perceived as easy to implement by all participants and can be considered ready for clinical use in a Swedish-speaking setting. Item-specific correlations may be valuable for developing future vertigo questionnaires.Key messagesThe Swedish version of the Visual Vertigo Analogue Scale is a questionnaire suitable for evaluating visually induced dizziness in a Swedish population. This study found that the Swedish questionnaire was comparable to the original in terms of internal consistency. The Swedish Visual vertigo Analogue Scale can be found as an appendix to this article.
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Affiliation(s)
- Tobias Wibble
- Department of Clinical Neuroscience, Division of Ophthalmology and Vision, Marianne Bernadotte Centre, Karolinska Institutet, Stockholm, Sweden
| | - Tony Pansell
- Department of Clinical Neuroscience, Division of Ophthalmology and Vision, Marianne Bernadotte Centre, Karolinska Institutet, Stockholm, Sweden
- St. Erik Eye Hospital, Stockholm, Sweden
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Berlot AA, Moskowitz HS, Lin J, Liu J, Sehanobish E, Jerschow E, Ow TJ, Sussman ES. Acute and Longer-Term Effects of COVID-19 on Auditory and Vestibular Symptoms. Otol Neurotol 2023; 44:1100-1105. [PMID: 37758317 DOI: 10.1097/mao.0000000000004027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/03/2023]
Abstract
OBJECTIVE To evaluate long-term effects of COVID-19 on auditory and vestibular symptoms in a diverse cohort impacted by the initial 2020 COVID-19 infection in the pandemic's epicenter, before vaccine availability. STUDY DESIGN Cohort study of individuals with confirmed COVID-19 infection, diagnosed in the March-May 2020 infection wave. A randomized, retrospective chart review of 1,352 individuals was performed to identify those with documented new or worsening auditory (aural fullness, tinnitus, hyperacusis, hearing loss) or vestibular (dizziness, vertigo) symptoms. Those with documented symptoms (613 of the 1,352 initial cohort) were contacted for a follow-up telephone survey in 2021-2022 to obtain self-report of aforementioned symptoms. SETTING Academic tertiary hospital system in Bronx, NY. PATIENTS Adults 18 to 99 years old with confirmed COVID-19 infection, alive at time of review. One hundred forty-eight charts were excluded for restricted access, incomplete data, no COVID-19 swab, or deceased at time of review. INTERVENTION Confirmed COVID-19 infection, March to May 2020. MAIN OUTCOMES MEASURES Auditory and vestibular symptoms documented in 2020 medical records and by self-report on 2021 to 2022 survey. RESULTS Among the 74 individuals with documented symptoms during the first 2020 COVID-19 wave who participated in the 2021 to 2022 follow-up survey, 58% had documented vestibular symptoms initially in 2020, whereas 43% reported vestibular symptoms on the 2021 to 2022 survey ( p = 0.10). In contrast, 9% had documented auditory symptoms initially in 2020 and 55% reported auditory symptoms on the 2021 to 2022 survey ( p < 0.01). CONCLUSIONS COVID-19 may impact vestibular symptoms early and persistently, whereas auditory effects may have more pronounced long-term impact, suggesting the importance of continually assessing COVID-19 patients.
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Affiliation(s)
| | | | - Juan Lin
- Albert Einstein College of Medicine, the Bronx, New York
| | - Jianyou Liu
- Albert Einstein College of Medicine, the Bronx, New York
| | | | - Elina Jerschow
- Allergy Division Chair, Mayo Clinic, Rochester, Minnesota
| | - Thomas J Ow
- Albert Einstein College of Medicine, the Bronx, New York
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Steensnaes MH, Knapstad MK, Goplen FK, Berge JE. Persistent Postural-Perceptual Dizziness (PPPD) and quality of life: a cross-sectional study. Eur Arch Otorhinolaryngol 2023; 280:5285-5292. [PMID: 37256345 PMCID: PMC10620245 DOI: 10.1007/s00405-023-08040-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2023] [Accepted: 05/22/2023] [Indexed: 06/01/2023]
Abstract
PURPOSE To determine if Persistent Postural-Perceptual Dizziness (PPPD) is associated with increased burden of dizziness and quality of life. Secondly, if this association is present, to determine if it can be explained by differences in anxiety and/or depression between patients with PPPD and dizzy patients without PPPD. METHODS Cross-sectional study performed in an outpatient otolaryngology clinic, including patients 18-67 years referred from primary care for suspected vestibular disease with chronic dizziness. Patients underwent clinical examination and completed the following questionnaires: Dizziness Handicap Inventory (DHI), RAND-12 Health Status Inventory and Hospital Anxiety and Depression Scale (HADS). Scores in DHI and RAND-12 were compared between patients diagnosed with PPPD and patients without PPPD. RESULTS 202 patients were included. 150 (74%) were women and 37 (18%) were diagnosed with PPPD. Patients in the PPPD group had increased burden of dizziness and reduced quality of life (QoL) as shown by a higher mean DHI score (49.2 vs. 30.8; p < 0.001) and reduced mean RAND-12 physical score (39.0 vs. 44.6; p = 0.004). After adjusting for age, gender and HADS, PPPD was associated with a 15.3 (p < 0.001) points increase in DHI score, and a 4.0 (p = 0.020) points decrease in RAND-12 physical score. CONCLUSION Patients with PPPD have a higher burden of dizziness and a lower physical health-related quality of life (HRQoL) compared to other dizzy patients. The difference was evident also after adjusting for anxiety and depression, illustrating how PPPD is a different entity than these common psychiatric conditions.
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Affiliation(s)
| | - Mari Kalland Knapstad
- Department of Otorhinolaryngology, Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Health and Functioning, Western Norway University of Applied Sciences, Bergen, Norway
| | - Frederik Kragerud Goplen
- Department of Otorhinolaryngology, Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway
- Department of Clinical Medicine, University of Bergen, Bergen, Norway
| | - Jan Erik Berge
- Department of Otorhinolaryngology, Head and Neck Surgery, Haukeland University Hospital, Bergen, Norway.
- Department of Clinical Medicine, University of Bergen, Bergen, Norway.
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Rocha MF, Sacks B, Al-Lamki A, Koohi N, Kaski D. Acute vestibular migraine: a ghost diagnosis in patients with acute vertigo. J Neurol 2023; 270:6155-6158. [PMID: 37597072 DOI: 10.1007/s00415-023-11930-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 08/05/2023] [Accepted: 08/08/2023] [Indexed: 08/21/2023]
Affiliation(s)
- Maria Francisca Rocha
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Benjamin Sacks
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
| | - Amira Al-Lamki
- The Ear Institute, University College London, London, UK
| | - Nehzat Koohi
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK
- The Ear Institute, University College London, London, UK
- SENSE Research Unit, Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, 33 Queen Square, London, WC1N 3BG, UK
| | - Diego Kaski
- Comprehensive Stroke Service, National Hospital for Neurology and Neurosurgery, Queen Square, London, UK.
- The Ear Institute, University College London, London, UK.
- SENSE Research Unit, Department of Clinical and Movement Neurosciences, Institute of Neurology, University College London, 33 Queen Square, London, WC1N 3BG, UK.
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Rahşan I, Samiye U, Ahmet Y. Vestibular evoked myogenic and auditory brainstem evoked potentials in a female migraine population. Ideggyogy Sz 2023; 76:399-407. [PMID: 38051688 DOI: 10.18071/isz.76.0399] [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] [Subscribe] [Scholar Register] [Indexed: 12/07/2023]
Abstract
Background and purpose The purpose of the present study was to evaluate ocular vestibular evoked myogenic potential (oVEMP), cervical vestibular evoked myogenic potential (cVEMP), and brainstem auditory evoked potential (BAEP) response characteristics and to understand the pathophysiology of vestibular dysfunction in female migraineurs with vertigo symptoms. We also aimed to assess the electrophysiological diagnostic significance of the VEMP responses in vestibular migraine (VM). . Methods 23 patients with migraine without aura (MoA), 23 patients with VM, and 20 sex-and age-matched healthy controls, a total of 66 female participants were enrolled in this study. The outcome parameters were asymmetry ratios (ARs), amplitudes of oVEMP, cVEMP, N1P1, P13N23, and the respective latencies (mean ± SD). From the BAEP graphs, absolute and interpeak interval latencies of waves were analyzed. . Results 30.4% of the MoA group and 21.7% of the VM group had uni- or bilaterally absent cVEMP responses which were statistically significant only in the MoA group (p=0.035) in comparison to control group. Both groups displayed statistically insignificant absent or asymmetrical responses for oVEMP (13.1%). Cervical VEMP P13 and N23 latency, peak-to-peak amplitude, interaural latencies, and amplitude ARs did not show any significant difference between MoA and VM patients and healthy controls. No significant difference was detected among the three groups in the oVEMP and BAEP parameters. . Conclusion Although absent cVEMP responses were more common in MoA and VM patients than in healthy individuals, the VEMP and BAEP test results should not be used in the differential diagnosis of VM and MoA. .
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Affiliation(s)
- Inan Rahşan
- University of Health Sciences, Kartal Dr. Lütfi Kirdar City Hospital, Neurology Department, Istanbul, Turkey
| | - Ulutaş Samiye
- University of Health Sciences, Kartal Dr. Lütfi Kirdar City Hospital, Neurology Department, Istanbul, Turkey
| | - Yildirim Ahmet
- Istanbul Medeniyet University, Göztepe City Hospital, Neurology Department, Istanbul, Turkey
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Herdman D, Ahmad H, Antoniades G, Bailur G, Pajaniappane A, Moss P. Developing an implementation intervention for managing acute vertigo in the emergency department. Emerg Med J 2023; 40:840-846. [PMID: 37875319 DOI: 10.1136/emermed-2023-213344] [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: 05/10/2023] [Accepted: 10/07/2023] [Indexed: 10/26/2023]
Abstract
BACKGROUND There are evidence-based bedside tests for diagnosing acute vertigo, but no evidence-based strategies to support clinicians in implementing them. The purpose of this study was to design an implementation strategy for treating acute vertigo by examining current facilitators and barriers to using these tests in the ED using the principles of implementation science. METHODS A survey was developed using the Theoretical Domains Framework and Consolidated Framework for Implementation Research to examine barriers and facilitators for using HINTS+ (head impulse, nystagmus, test of skew, plus hearing) and Dix-Hallpike tests. The survey was sent to emergency clinicians (ECs) in a teaching hospital in London, UK, between May and September 2022. Semistructured interviews were conducted simultaneously, and data examined using direct content analysis. Implementation strategies were then selected based on the Expert Recommendations for Implementing Change framework. RESULTS Fifty-one ECs responded to the survey and six ECs volunteered for interview. Less than half reported using the bedside tests to make a diagnosis. The most common barriers were beliefs about complexity, a lack of supporting materials, memory, lack of skills and negative experiences. The interview data revealed negative beliefs about the necessity, validity, safety and practicality. There were also barriers in the ED environment (eg, lack of space). There was a strong perception that the current approach to managing acute vertigo needed to change and ECs view this as part of their professional role and responsibility. Based on clinician input, the authors selected strategies to improve diagnostic efforts, which included guidelines for training, developing vertigo champions, protocols, memory aids, audit and feedback. CONCLUSION This study found several barriers to managing acute vertigo such as memory constraints, and inadequate supporting materials and training, although a robust desire for change. The implementation strategy's initial phase is described, which must now be tested.
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Affiliation(s)
- David Herdman
- Audiovestibular Medicine, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Hena Ahmad
- Neurology Department, St George's University Hospitals NHS Foundation Trust, London, UK
| | - George Antoniades
- Emergency Department Clinical Research Group, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Gokul Bailur
- Emergency Department Clinical Research Group, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Arun Pajaniappane
- Audiovestibular Medicine, St George's University Hospitals NHS Foundation Trust, London, UK
| | - Phil Moss
- Emergency Department Clinical Research Group, St George's University Hospitals NHS Foundation Trust, London, UK
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Gottlieb M, Peksa GD, Carlson JN. Head impulse, nystagmus, and test of skew examination for diagnosing central causes of acute vestibular syndrome. Cochrane Database Syst Rev 2023; 11:CD015089. [PMID: 37916744 PMCID: PMC10620998 DOI: 10.1002/14651858.cd015089.pub2] [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] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2023]
Abstract
BACKGROUND Dizziness is a common reason for people to seek medical care. Acute vestibular syndrome (AVS) is a specific type of dizziness, which can include severe vertigo, nausea and vomiting, nystagmus, or unsteadiness. Acute vestibular syndrome can be due to peripheral or central causes. It is important to determine the cause, as the intervention and outcomes differ if it is from a peripheral or central cause. Clinicians can assess for the cause using risk factors, patient history, examination findings, or advanced imaging, such as a magnetic resonance imaging (MRI). The head impulse, nystagmus, test of skew (HINTS) examination is a three-part examination performed by clinicians to determine if AVS is due to a peripheral or central cause. This includes assessing how the eyes move in response to rapidly turning a person's head (head impulse), assessing the direction of involuntary eye movements (nystagmus), and assessing whether the eyes are aligned or misaligned (test of skew). The HINTS Plus examination includes an additional assessment of auditory function. OBJECTIVES To assess the diagnostic accuracy of the HINTS and HINTS Plus examinations, with or without video assistance, for identifying a central etiology for AVS. SEARCH METHODS We searched CENTRAL, MEDLINE, Embase, Google Scholar, the International HTA database, and two trials registers to September 2022. SELECTION CRITERIA We included all retrospective and prospective diagnostic test accuracy studies that evaluated the HINTS or HINTS Plus test used in a primary care clinic, an urgent care clinic, the emergency department, or during inpatient hospitalization against a final diagnosis of a central etiology of AVS, as defined by the reference standard of advanced imaging or final diagnosis by a neurologist. DATA COLLECTION AND ANALYSIS Two review authors independently determined eligibility of each study according to eligibility criteria, extracted data, assessed the risk of bias, and determined the certainty of evidence. Disagreements were adjudicated by consensus or a third review author if needed. The primary outcome was the diagnostic accuracy of the HINTS and HINTS Plus examinations for identifying a central etiology for AVS, conducted clinically (clinician visual assessment) or with video assistance (e.g. video recording with goggles); we independently assessed the clinical and video-assisted examinations. Subgroup analyses were performed by provider type (e.g. physicians, non-physicians), time from symptom onset to presentation (e.g. less than 24 hours, longer than 24 hours), reference standard (e.g. advanced imaging, discharge diagnosis), underlying etiology (e.g. ischemic stroke, alternative etiologies [hemorrhagic stroke, intracranial mass]), study setting (e.g. outpatient [outpatient clinic, urgent care clinic, emergency department], inpatient), physician level of training (e.g. resident, fellow/attending), physician specialty (e.g. otolaryngology, emergency medicine, neurology, and neurologic subspecialist [e.g. neuro-ophthalmology, neuro-otology]), and individual diagnostic accuracy of each component of the examination (e.g. head impulse, direction-changing nystagmus, test of skew). We created 2 x 2 tables of the true positives, true negatives, false positives, and false negatives and used these data to calculate the sensitivity, specificity, positive likelihood ratio, and negative likelihood ratio with 95% confidence intervals (95% CI) for each outcome. MAIN RESULTS We included 16 studies with a total of 2024 participants (981 women and 1043 men) with a mean age of 60 years. Twelve studies assessed the HINTS examination; five assessed the HINTS Plus examination. Thirteen studies were performed in the emergency department; half were performed by neurologists. The clinical HINTS examination (12 studies, 1890 participants) was 94.0% (95% confidence interval [CI] 82.0% to 98.2%) sensitive, and 86.9% (95% CI 75.3% to 93.6%) specific (low-certainty evidence). The video-assisted HINTS examination (3 studies, 199 participants) was 85.0% to 100% sensitive (low-certainty evidence), and 38.9% to 100% specific (very low-certainty evidence). The clinical HINTS Plus examination (5 studies, 451 participants) was 95.3% (95% CI 78.4% to 99.1%) sensitive, and 72.9% (95% CI 44.4% to 90.1%) specific (low-certainty evidence). The video-assisted HINTS Plus examination (2 studies, 163 participants) was 85.0% to 93.8% sensitive, and 28.6% to 38.9% specific (moderate-certainty evidence). Subgroup analyses were limited, as most studies were conducted in the emergency department, by physicians, and with MRI as a reference standard. Time from symptom onset to presentation varied across studies. Three studies were at high risk of bias and three studies were at unclear risk of bias for participant selection. Three studies were at unclear risk of bias for the index test. Four studies were at unclear risk of bias for the reference standard. Two studies were at unclear risk of bias for flow and timing. One study had unclear applicability concerns for participant selection. Two studies had high applicability concerns for the index test and two studies had unclear applicability concerns for the index test. No studies had applicability concerns for the reference standard. AUTHORS' CONCLUSIONS The HINTS and HINTS Plus examinations had good sensitivity and reasonable specificity for diagnosing a central cause for AVS in the emergency department when performed by trained clinicians. Overall, the evidence was of low certainty. There were limited data for the role of video-assistance or specific subgroups. Future research should include more high-quality studies of the HINTS and HINTS Plus examination; assessment of inter-rater reliability across users; accuracy across different providers, specialties, and experience; and direct comparison with no HINTS or MRI to assess the effect on clinical care.
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Affiliation(s)
- Michael Gottlieb
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Gary D Peksa
- Department of Emergency Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Jestin N Carlson
- Emergency Department, Allegheny Health Network, Erie, Pennsylvania, USA
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Shah M, Staab J, Anderson A, Eggers SD, Lohse C, McCaslin DL. Outcomes and Patient Experience in Individuals With Longstanding Dizziness. Am J Audiol 2023; 32:721-729. [PMID: 37079889 DOI: 10.1044/2023_aja-22-00152] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/22/2023] Open
Abstract
PURPOSE This study aimed to describe the relationship between changes in pre and post self-perceived dizziness handicap, scores on the patient health questionnaire, and perceptions of patient's value of being evaluated and managed by a multidisciplinary team. METHOD Seventy-eight patients completed the Dizziness Handicap Inventory (DHI) and Patient Health Questionnaire-Fourth Edition (PHQ-4) questionnaires post multidisciplinary clinical consultations and testing for the chief complaints of dizziness, unsteadiness, vertigo, or balance problems. The diagnoses of each patient were recorded from the clinical reports of each specialty consultation and were classified as structural, functional, or psychiatric. They were contacted by phone at least 6 months after their visit to obtain feedback regarding their symptoms and overall patient experience. RESULTS The change in DHI total score did not differ significantly by diagnosis (p = .56), indicating that patients experienced an improvement in DHI total score regardless of diagnosis. PHQ-4 anxiety scores worsened by a mean of 0.7 points for those with structural diagnoses (p = .04), improved by a mean of 0.7 points for psychiatric diagnoses (p = .16), and improved by a mean of 0.3 points for functional diagnoses (p = .39). Only seven patients would not recommend the team to a family or friend; these patients tended to report worsening DHI total scores (p = .27) compared to the significant improvement in DHI total scores for patients who would make such a recommendation (p < .001). Similarly, only 13 patients did not feel the information they received had a positive impact; these patients tended to report worsening DHI total scores (p = .18) compared to the significant improvement in DHI total scores for patients who did feel the information had a positive impact (p < .001). DISCUSSION The assessment and management of patients with chronic dizziness is challenging due to symptoms arising from multiple etiologies. Our finding of a vast difference between high satisfaction and relatively unchanged dizziness handicap suggests that there is value in seeing a multidisciplinary team where consultations are unhurried, care is coordinated, and expectations regarding treatment can be managed.
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Affiliation(s)
- Manami Shah
- Department of Hearing and Speech Sciences, Vanderbilt University Medical Center, Nashville, TN
| | - Jeffrey Staab
- Department of Psychiatry and Psychology, Mayo Clinic, Rochester, MN
| | - Ann Anderson
- Department of Otorhinolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, MN
| | | | - Christine Lohse
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN
| | - Devin L McCaslin
- Department of Otolaryngology-Head and Neck Surgery, University of Michigan, Ann Arbor
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Plath M, Sand M, Appel M, Euteneuer S, Praetorius M, Baumann I, Zaoui K. [Validity of the German Menière's Disease Patient-Oriented Symptom Severity Index]. Laryngorhinootologie 2023; 102:856-866. [PMID: 37072009 DOI: 10.1055/a-2047-3806] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/20/2023]
Abstract
BACKGROUND The MD POSI is a disease-specific questionnaire to determine the health-related quality of life (HRQoL) of patients with Menière's disease (MD). OBJECTIVES Validity and reliability of the German translation of the MD POSI. MATERIAL AND METHODS Prospective data analysis of a patient group with vertigo (n = 162), which was treated in the otorhinolaryngology of a University Hospital from 2005-2019. A clinical selection was made according to the new Bárány classification in a "definite" and "probable" Menière's disease. HRQoL was assessed using the German translation of the MD POSI, the Vertigo Symptom Score (VSS) and the Short Form (SF-36). Reliability was measured by Cronbach's α and test-retesting after 12 months and again 2 weeks later. Content and agreement validity were examined. RESULTS Cronbach α values greater than 0.9 indicated good internal consistency. There was no statistically significant difference from baseline to 12 months, except for the subscore "during the attack". There were significant positive correlations between the VSS overall/VER/AA and the overall index of the MD POSI and negative significant correlations with the SF-36 domains physical functioning, physical role functioning, social functioning, emotional role functioning, mental well-being. There were low SRM (standardized response mean) values below 0.5. CONCLUSIONS The German translation of the MD POSI is a valid and reliable instrument to evaluate the impact of MD on patients' disease-specific quality of life.
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Affiliation(s)
- Michaela Plath
- Hals-, Nasen- und Ohrenklinik, Heidelberg University Hospital Head Clinic Center, Heidelberg, Germany
| | - Matthias Sand
- GESIS, GESIS - Leibnitz-Institut für Sozialwissenschaften in Mannheim, Mannheim, Germany
| | - Maximilian Appel
- Mund-, Kiefer- und Gesichtschirurgie, Heidelberg University Hospital Head Clinic Center, Heidelberg, Germany
| | - Sara Euteneuer
- Hals-, Nasen- und Ohrenklinik, Heidelberg University Hospital Head Clinic Center, Heidelberg, Germany
| | | | - Ingo Baumann
- Hals-, Nasen- und Ohrenklinik, Heidelberg University Hospital Head Clinic Center, Heidelberg, Germany
| | - Karim Zaoui
- Hals-, Nasen- und Ohrenklinik, Heidelberg University Hospital Head Clinic Center, Heidelberg, Germany
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Kerkar A, Mitra S, Dey P. CSF cytology in a patient with vertigo and earache. Cytopathology 2023; 34:634-635. [PMID: 37455420 DOI: 10.1111/cyt.13274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/18/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023]
Abstract
Large atypical cells in cerebrospinal fluid in a patient with earache and vertigo. In this Enigma Portal case, we described uncommon cerebrospinal fluid findings in a case of vertigo and earache in a 40-year-old man.
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Affiliation(s)
- Aadya Kerkar
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Suvradeep Mitra
- Department of Histopathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Pranab Dey
- Department of Cytology and Gynecological Pathology, Postgraduate Institute of Medical Education and Research, Chandigarh, India
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Jung T, Kim H, Jang M, Kim T, Lee DH, Shin JE, Kim CH. Cerebellopontine angle tumor presenting as acute audiovestibular syndrome. Acta Otolaryngol 2023; 143:951-957. [PMID: 38108643 DOI: 10.1080/00016489.2023.2290202] [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: 10/27/2023] [Accepted: 11/23/2023] [Indexed: 12/19/2023]
Abstract
BACKGROUND Acute audiovestibular deficits may be a harbinger of vestibular schwannoma (VS). OBJECTIVE To investigate clinical and laboratory features of 25 consecutive patients with VS presenting with acute audiovestibular deficits. METHODS A symptomatic combination of acute audiovestibular deficits was investigated. Audiometric and vestibular function tests, and internal auditory canal magnetic resonance imaging (IAC MRI) results were evaluated. RESULTS Varying combinations of symptoms may develop in VS patients with acute audiovestibular deficits, of whom sudden hearing loss (HL) without acute vertigo or acute facial nerve palsy (FNP) was most common. The most common audiometric configuration was high-tone hearing loss, and no patient showed low-tone hearing loss. IAC MRI demonstrated that the tumor had an intracanalicular portion and attachment to the bony IAC wall in all patients and widened the IAC wall in some patients. CONCLUSION Different symptomatic combinations of acute audiovestibular deficits may develop in patients with VS. Awareness about the possibility of VS as a cause of sudden HL, acute vertigo, and acute FNP, as well as subsequent IAC MRI scanning is vital to earlier diagnosis of VS in these patients.
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Affiliation(s)
- Taesik Jung
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute of Medical Science, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Hansol Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute of Medical Science, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Minho Jang
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute of Medical Science, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Taehee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute of Medical Science, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Dong-Han Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute of Medical Science, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Jung Eun Shin
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute of Medical Science, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Chang-Hee Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Research Institute of Medical Science, Konkuk University School of Medicine, Konkuk University Medical Center, Seoul, Republic of Korea
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Akin FW, Swan AA, Kalvesmaki A, Hall CD, Riska KM, Stressman KD, Nguyen H, Amuan M, Pugh MJ. Factors That Impact the Long-Term Outcome of Postconcussive Dizziness Among Post-9/11 Veterans. Am J Audiol 2023; 32:706-720. [PMID: 37040302 DOI: 10.1044/2023_aja-22-00150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/12/2023] Open
Abstract
PURPOSE The primary aim of this study was to examine the factors associated with long-term outcomes of postconcussive disruptive dizziness in Veterans of the post-9/11 wars. METHOD For this observational cohort study, the Neurobehavioral Symptom Inventory-Vestibular subscale (NSI-V) score was used as an outcome measure for dizziness in 987 post-9/11 Veterans who indicated disruptive dizziness at an initial Veterans Health Administration Comprehensive Traumatic Brain Injury Evaluation (CTBIE). An NSI-V change score was calculated as the difference in the scores obtained at the initial CTBIE and on a subsequent survey. Differences in the NSI-V change scores were examined for demographics, injury characteristics, comorbidities, and vestibular and balance function variables, and multiple linear regression analyses were used to explore associations among the variables and the NSI-V change score. RESULTS The majority of Veterans (61%) demonstrated a decrease in the NSI-V score, suggesting less dizziness on the survey compared with the CTBIE; 16% showed no change; and 22% had a higher score. Significant differences in the NSI-V change score were observed for traumatic brain injury (TBI) status, diagnoses of post-traumatic stress disorder (PTSD), headache and insomnia, and vestibular function. Multivariate regressions revealed significant associations between the NSI-V change score and the initial CTBIE NSI-V score, education level, race/ethnicity, TBI status, diagnoses of PTSD or hearing loss, and vestibular function. CONCLUSIONS Postconcussive dizziness can continue for years following an injury. Factors associated with poor prognosis include TBI, diagnoses of PTSD or hearing loss, abnormal vestibular function, increased age, identification as a Black Veteran, and high school education level.
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Affiliation(s)
- Faith W Akin
- Vestibular and Balance Laboratory, James H. Quillen VA Medical Center, Mountain Home, TN
- Department of Audiology & Speech-Language Pathology, East Tennessee State University, Johnson City
| | - Alicia A Swan
- Department of Psychology, The University of Texas at San Antonio
- Polytrauma Rehabilitation Center, South Texas Veterans Health Care System, San Antonio
| | - Andrea Kalvesmaki
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, UT
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Courtney D Hall
- Vestibular and Balance Laboratory, James H. Quillen VA Medical Center, Mountain Home, TN
- Physical Therapy Program, East Tennessee State University, Johnson City
| | - Kristal M Riska
- Department of Head and Neck Surgery & Communication Sciences, Duke University, Durham, NC
| | - Kara D Stressman
- Vestibular and Balance Laboratory, James H. Quillen VA Medical Center, Mountain Home, TN
| | - Huong Nguyen
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, UT
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Megan Amuan
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, UT
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
| | - Mary Jo Pugh
- Informatics, Decision-Enhancement, and Analytic Sciences (IDEAS) Center of Innovation, VA Salt Lake City Health Care System, UT
- Division of Epidemiology, Department of Internal Medicine, University of Utah School of Medicine, Salt Lake City
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Rivero-de-Aguilar A, Soto-Varela A, Puente-Hernandez M, Porta-Etessam J. Neurotological emergencies: a narrative review. Eur Arch Otorhinolaryngol 2023; 280:4759-4774. [PMID: 37548703 DOI: 10.1007/s00405-023-08125-3] [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: 06/08/2023] [Accepted: 07/12/2023] [Indexed: 08/08/2023]
Abstract
INTRODUCTION Vestibular symptoms, including vertigo, dizziness, and gait unsteadiness, are a frequent reason of urgent medical assistance. Their causes are numerous and diverse, including neurological, otorhinolaryngological, and systemic diseases. Therefore, following a systematic approach is essential to differentiate striking but benign conditions from others that can compromise the patient's life. This study is intended to review vestibular disorders from a practical perspective and provide guidance to physicians involved in the emergency care of patients with vestibular symptoms. MATERIALS AND METHODS A narrative review was performed, revisiting the main causes of vestibular disorders. RESULTS Based on the speed of onset, duration, and history of similar episodes in the past, vestibular disorders can be categorized into three syndromic entities (acute, recurrent, and chronic vestibular syndromes). The most representative conditions pertaining to each group were reviewed (including their diagnosis and treatment) and a practical algorithm was proposed for their correct management in the acute care setting. CONCLUSIONS Carrying out a correct categorization of the vestibular disorders is essential to avoid diagnostic pitfalls. This review provides useful tools for clinicians to approach their patients with vestibular symptoms at the emergency room.
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Affiliation(s)
- Alejandro Rivero-de-Aguilar
- Department of Neurology, University Hospital Complex of Pontevedra, Mourente, S/N, 36071, Pontevedra, Spain.
- Department of Preventive Medicine and Public Health, University of Santiago de Compostela, Santiago de Compostela, Spain.
| | - Andrés Soto-Varela
- Department of Otorhinolaryngology, University Hospital Complex of Santiago de Compostela, Santiago de Compostela, Spain
- Department of Surgery and Medical-Surgical Specialities, University of Santiago de Compostela, Santiago de Compostela, Spain
| | | | - Jesús Porta-Etessam
- Department of Neurology, San Carlos Clinical Hospital, Madrid, Spain
- Department of Medicine, Complutense University of Madrid, Madrid, Spain
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Pelletier J, Koyfman A, Long B. Pearls for the Emergency Clinician: Posterior Circulation Stroke. J Emerg Med 2023; 65:e414-e426. [PMID: 37806810 DOI: 10.1016/j.jemermed.2023.07.007] [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] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2022] [Revised: 06/29/2023] [Accepted: 07/15/2023] [Indexed: 10/10/2023]
Abstract
BACKGROUND Posterior circulation (PC) stroke in adults is a rare, frequently misdiagnosed, serious condition that carries a high rate of morbidity. OBJECTIVE OF THE REVIEW This review evaluates the presentation, diagnosis, and management of PC stroke in the emergency department (ED) based on current evidence. DISCUSSION PC stroke presents most commonly with dizziness or vertigo and must be distinguished from more benign diagnoses. Emergency clinicians should consider this condition in patients with dizziness, even in younger patients and those who do not have traditional stroke risk factors. Neurologic examination for focal neurologic deficit, dysmetria, dysarthria, ataxia, and truncal ataxia is essential, as is the differentiation of acute vestibular syndrome vs. spontaneous episodic vestibular syndrome vs. triggered episodic vestibular syndrome. The HINTS (head impulse, nystagmus, and test of skew) examination can be useful for identifying dizziness presentations concerning for stroke when performed by those with appropriate training. However, it should only be used in patients with continuous dizziness who have ongoing nystagmus. Contrast tomography (CT), CT angiography, and CT perfusion have limited sensitivity for identifying PC strokes, and although magnetic resonance imaging is the gold standard, it may miss some PC strokes early in their course. Thrombolysis is recommended in patients presenting within the appropriate time window for thrombolytic therapy, and although some data suggest endovascular therapy for basilar artery and posterior cerebral artery infarcts is beneficial, its applicability for all PC strokes remains to be determined. CONCLUSIONS An understanding of PC stroke can assist emergency clinicians in diagnosing and managing this disease.
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Affiliation(s)
- Jessica Pelletier
- Department of Emergency Medicine, Washington University School of Medicine, St Louis, Missouri
| | - Alex Koyfman
- Department of Emergency Medicine, UT Southwestern, Dallas, Texas
| | - Brit Long
- San Antonio Uniformed Services Health Education Consortium, Department of Emergency Medicine, Brooke Army Medical Center, Fort Sam Houston, Texas.
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