Estimated incidence and characteristics of vestibular neuritis in Japan: A nationwide survey

OBJECTIVE

To assess the annual incidence of vestibular neuritis (VN) in the Japanese population.

METHODS

We conducted a mail-based survey targeting otolaryngologic clinics and hospitals across Japan to estimate the annual number of patients who were newly-diagnosed with VN during the one-year period of 2021. Using a stratified sampling method, we selected 1,107 departments and asked them to report the number of new patients with VN and their demographics. The total number of VN patients was estimated by multiplying the reported numbers by the reciprocal of the sampling rate and response rate.

RESULTS

The overall survey response rate was 40.5 % (448 departments). The estimated number of newly-diagnosed VN patients in 2021 was 8,861 (95 % confidential interval [CI], 2,290-15,432) The annual incidence of VN was 7.05 per 100,000 population in Japan. The male-to-female ratio of VN patients was 0.96, and the mean age was 60.3 ± 16.1 years (range 11-94 years).

CONCLUSIONS

The annual incidence of VN in Japan in 2021 had almost doubled and the mean age had become older compared to the previous study in 1993 (annual incidence; 3.5 per 100,000 per year; mean age: 45 years).

Patients admitted to hospital for vestibular neuritis in 2011-2021

BACKGROUND

The incidence of vestibular neuritis in Norway is unknown. The disorder causes acute dizziness, which is a common reason for hospital admission. The objective of this study was to analyse the number of patients admitted to Norwegian hospitals for vestibular neuritis over an eleven-year period.

MATERIAL AND METHOD

The number of patients admitted to hospital for vestibular neuritis and reported to the Norwegian Patient Registry in the period 2011-2021 was recorded. The figures were compared with the number of patients admitted for other vertiginous disorders.

RESULTS

The number of patients admitted to hospital for vestibular neuritis was 11.2 per 100,000 inhabitants per year (range 8.2-15.3). The number of patients admitted to hospital in the study period increased by an average of 7.9 % per year and was highest in the final year. Out of 63,884 patients admitted for vertiginous disorders in the study period, 6,450 (10.1 %) had vestibular neuritis.

INTERPRETATION

The number of patients admitted to hospital for vestibular neuritis each year increased considerably in the study period. This is likely to be a reflection of the increased hospitalisation rate and improvements in diagnostic workup more than an actual increase in the incidence of the disorder. A minority of patients admitted for vertiginous disorders had vestibular neuritis.

[Demographic and epidemiological risk factors in patients with acute vestibular neuritis]

OBJECTIVE

Vestibular neuritis (VN) is one of the most common peripheral vestibular balance disorder. Demographic and other risk factors associated with VN are insufficiently published. Therefore, the aim of this study is to identify associated risk factors in patients with acute VN.

METHODS

This study evaluated all hospitalized VN cases between 2017-2019. Inclusion criteria was an otoneurologically confirmed diagnosis of acute VN. Patient data was compared with data of the German normal population (Robert Koch Institute, "Gesundheit in Deutschland aktuell").

RESULTS

168 patients (Ø 59.8 years) were included. Compared with the normal German population, the study population was significantly more likely to have preexisting cardiovascular diseases, and the male patients were significantly more likely to have arterial hypertension. No significant differences were measurable between the study population and the normal population for other secondary diseases. Leukocytosis was present in 23% on admission, and 9% of patients reported a history of VZV or HSV-1 disease.

DISCUSSION

Etiology and pathogenesis of VN are poorly understood. Inflammatory and vascular causes are discussed. In this study, patients had increased prevalence of cardiovascular disease compared with the normal population, but the study population had a higher average age. Currently, it is unclear what significance nonspecific elevated leukocyte values could have as a possible sign of VN triggered by an infection. Since the number of inpatient cases with VN is rising, prospective studies should be performed to get a better understanding of the pathogenesis of the disease.

Vestibular syndromes, diagnosis and diagnostic errors in patients with dizziness presenting to the emergency department: a cross-sectional study

OBJECTIVES

We aimed to determine the frequency of vestibular syndromes, diagnoses, diagnostic errors and resources used in patients with dizziness in the emergency department (ED).

DESIGN

Retrospective cross-sectional study.

SETTING

Tertiary referral hospital.

PARTICIPANTS

Adult patients presenting with dizziness.

PRIMARY AND SECONDARY OUTCOME MEASURES

We collected clinical data from the initial ED report from July 2015 to August 2020 and compared them with the follow-up report if available. We calculated the prevalence of vestibular syndromes and stroke prevalence in patients with dizziness. Vestibular syndromes are differentiated in acute (AVS) (eg, stroke, vestibular neuritis), episodic (EVS) (eg, benign paroxysmal positional vertigo, transient ischaemic attack) and chronic (CVS) (eg, persistent postural-perceptual dizziness) vestibular syndrome. We reported the rate of diagnostic errors using the follow-up diagnosis as the reference standard.

RESULTS

We included 1535 patients with dizziness. 19.7% (303) of the patients presented with AVS, 34.7% (533) with EVS, 4.6% (71) with CVS and 40.9% (628) with no or unclassifiable vestibular syndrome. The three most frequent diagnoses were stroke/minor stroke (10.1%, 155), benign paroxysmal positional vertigo (9.8%, 150) and vestibular neuritis (9.6%, 148). Among patients with AVS, 25.4% (77) had stroke. The cause of the dizziness remained unknown in 45.0% (692) and 18.0% received a false diagnosis. There was a follow-up in 662 cases (43.1%) and 58.2% with an initially unknown diagnoses received a final diagnosis. Overall, 69.9% of all 1535 patients with dizziness received neuroimaging (MRI 58.2%, CT 11.6%) in the ED.

CONCLUSIONS

One-fourth of patients with dizziness in the ED presented with AVS with a high prevalence (10%) of vestibular strokes. EVS was more frequent; however, the rate of undiagnosed patients with dizziness and the number of patients receiving neuroimaging were high. Almost half of them still remained without diagnosis and among those diagnosed were often misclassified. Many unclear cases of vertigo could be diagnostically clarified after a follow-up visit.

Incidence of peripheral vestibular disorders based on population data of South Korea

BACKGROUND

There have been no comprehensive studies on the incidence of peripheral vestibular disorders based on population-based data for a long-term period.

OBJECTIVE

We investigated the incidence of peripheral vestibular disorders using population-based data representing the whole population of South Korea.

METHODS

This study used the National Health Insurance Service data in Korea from 2008 to 2020. Peripheral vestibular disorders such as benign paroxysmal positional vertigo (BPPV), vestibular neuritis (VN), and Meniere's disease (MD) were defined with diagnostic, treatment, or audiovestibular test codes. The annual incidence in total and according to sex, age, and residence was analyzed.

RESULTS

The annual incidence of BPPV, VN, and MD per 100,000 was 51.4, 22.7, and 12.4 in 2008 and 181.1, 62.9, and 50.5 in 2020, respectively. The incidence of each was significantly different by sex (p < 0.001), age (p < 0.001), and residence (p < 0.001), with the highest value in female, people aged 60 years or older, and people who resided in metropolitan cities.

CONCLUSIONS

The annual incidence of BPPV, VN, and MD had increasing trends from 2008 through 2020 in South Korea, and all were significantly higher in female, people aged 60 years or older, and people who resided in metropolitan cities.

Monthly and seasonal variations in vestibular neuritis

Seasonal variations in vestibular neuritis (VN) could support the etiology of viral infection. However, several recent studies revealed no significant seasonal variations in VN. Further studies are necessary to determine the etiology of VN. We analyzed patients with VN to evaluate monthly and seasonal variations. Patients with VN who visited our otorhinolaryngology department or were referred to our department from the emergency department between March 2014 and February 2019 were included retrospectively in this study. Differences among the months and seasons of VN visits were analyzed. Patients were divided into 2 groups according to sex and age (65 years or older and younger than 65 years). Differences among the months and seasons of VN visits were analyzed between groups. There were no significant differences in monthly and seasonal distributions in 248 patients with VN. There were also no significant differences in monthly and seasonal distributions in male and female patients or in older and younger patients. There were no significant differences in monthly or seasonal distributions of patients with VN. Factors other than viruses, such as vascular ischemia, should also be considered in the incidence of VN, especially in older patients.

Stroke mimics: Clinical characteristics and outcome

Objectives:

To study the prevalence and nature of stroke mimics (SM) among Saudi patients who came to the emergency department with a sudden neurological deficit and suspected stroke.

Methods:

The electronic health records from February 2016 to July 2018 of patients who were admitted to the Stroke Unit at King Abdulaziz Medical City, Ministry of National Guard Health Affairs, Riyadh, Kingdom of Saudi Arabia (KAMC-RD) with a suspected stroke were all reviewed. A comparison between SM and stroke was established. Our study identified the predictors of SM by using logistic regression analysis. This study was approved by the local institutional review board.

Results:

Out of 1, 063 patients, 131 (12.3%) had SM. The most common causes were a peripheral vestibular disorder (27.4%) followed by psychogenic causes (24.4%). Stroke mimics were more common among younger individuals and women. Arterial hypertension, diabetes, and smoking were less likely to be found in SMs. At discharge, individuals with SM were more likely to be independent, had milder deficits, and shorter hospital stays. Predictors of SM were young age, female gender, mild deficit at presentation, and good functional status before the stroke.

Conclusion:

The incidence of stroke mimics is common among suspected stroke patients. Practicing physicians should consider potential diagnostic errors, particularly in the hyperacute phase of the stroke.

Association between ambient particulate matter and disorders of vestibular function

BACKGROUND

Exposure to environmental chemicals has been suggested to alter the physiologic state of the inner and middle ear. However, it is unknown if particulate matter exposure is associated with acute vestibular dysfunction.

OBJECTIVES

To estimate the effects of particulate matter exposure on the number of hospital visits related to three major diseases of vestibular dysfunction, Meniere's disease (MD), benign paroxysmal positional vertigo (BPPV), and vestibular neuronitis (VN).

METHODS

Our study subject is from Korean National Health Insurance Service-National Sample Cohort, which is dynamic cohort consist of 1 million participants representing the Korean population. Among total cohort participants, we used the hospital visit data of 210,000 individuals who resided in Seoul from 2007 to 2010. Time series analysis using the Poisson generalized additive model and case-crossover analysis using conditional logistic regression were used to investigate the association between daily particulate matter levels (PM_2.5, particulate matter <2.5μg/m³; PM₁₀, particulate matter <10μg/m³; PM_10-2.5, PM₁₀- PM_2.5) and number of MD, BPPV, and VN hospital visits.

RESULTS

Time series analysis showed that an interquartile range (IQR) increase in PM₁₀ and PM_10-2.5 on lag day 1 was associated with an increased risk of MD hospital visits [relative risk (RR), 95% confidence interval (CI), PM₁₀: 1.09 (1.02-1.15); PM_10-2.5: 1.06 (1.02-1.10)]. In addition, elderly individuals (≥60 years old) showed an increased risk of MD hospital visits after particulate matter exposure when compared to younger individuals. An IQR increase in particulate matter on lag day 1 was associated with a marginally significant increase in VN hospital visits [RR (95%CI), PM_2.5: 1.11 (0.98-1.25); PM₁₀: 1.07 (0.99-1.15); PM_10-2.5: 1.04 (0.99-1.09)]. However, no association between particulate matter exposure and BPPV hospital visits was noted. Case-crossover analyses showed similar results to the time-series analysis across all three diseases.

CONCLUSION

MD hospital visits were associated with ambient particulate matter exposure. Elderly individuals, in particular, were more susceptible to particulate matter exposure than younger individuals.

Anxiety and depression among patients with different types of vestibular peripheral vertigo

Numerous studies have been published on comorbid anxiety and depression in patients with vertigo. However, very few studies have separately described and analyzed anxiety or depression in patients with different types of vestibular peripheral vertigo. The present study investigated anxiety and depression among patients with 4 different types of peripheral vertigo. A total of 129 patients with 4 types of peripheral vertigo, namely, benign paroxysmal positional vertigo (BPPV, n = 49), migrainous vertigo (MV, n = 37), Menière disease (MD, n = 28), and vestibular neuritis (VN, n = 15), were included in the present study. Otological and neurootological examinations were carefully performed, and self-rating anxiety scale and self-rating depression scale were used to evaluate anxiety and depression. Patients were divided into 2 groups, according to the vestibular function: normal and abnormal vestibular function. There was no significant difference in the risk of anxiety/depression between these 2 groups. However, for patients with the 4 different vertigo types, the prevalence of anxiety (MV = 45.9%, MD = 50%) and depression (MV = 27%, MD = 28.6%) was significantly higher in the patients with MV or MD than those with BPPV or VN (P < 0.05). Vestibular function is not significantly associated with the risk of anxiety/depression. Anxiety/depression is more common in patients with MV or MD than those with BPPV or VN. This may be due to the different mechanisms involved in these 4 types of vertigo, as well as differences in the prevention and self-control of the patients against the vertigo.

[Vestibular neuritis: treatment and prognosis]

Vestibular neuritis is a sudden unilateral peripheral vestibular deficit of unknown origin without associated hearing loss. It is the second cause of peripheral vertigo after Benign Paroxysmal Positional Vertigo (BPPV). The etiology remains unclear and some treatments are still controversial. The prognosis is good. The differential diagnosis of the disease mainly includes an acute vertigo of central origin. This article summarizes the management and prognosis of vestibular neuritis.

Recurrence of vertigo in patients with vestibular neuritis

CONCLUSION. The recurrence rate of vertigo due to any cause in patients with vestibular neuritis (VN) was about 26.0% in our study. No clinical characteristics were significantly associated with recurrences.

OBJECTIVE

We aimed to: 1) determine the prevalence of recurrent VN; 2) compare the clinical characteristics and epidemiologic factors of patients with non-recurrent and recurrent VN; and 3) determine the prevalence of benign paroxysmal positional vertigo (BPPV) in patients with VN.

METHODS

In 131 patients diagnosed as having VN (68 males, aged 49.8 ± 14.9 years and 63 females, aged 57.5 ± 12.5 years), a retrospective chart review and telephone survey about the recurrent vertigo were performed. Vestibular function testing, inner ear magnetic resonance imaging (MRI), and pure tone audiograms were performed on every patient. Vestibular function testing was repeated in patients with recurrences.

RESULTS

Fourteen of 131 patients (10.7%) had recurrent VN. The subjective intensity of recurrent VN was less than the first attack. There were no significant differences in clinical characteristics such as accompanying headache or preceding respiratory infection and in epidemiologic risk factors between patients with recurrent and non-recurrent VN. Twenty of 131 patients (15.3%) experienced BPPV during the follow-up period.

Clinical and epidemiological study on inpatients with vertigo at the ENT Department of Kyoto University Hospital

CONCLUSION

The number of studies on inpatients with vertigo is limited. This study provides useful information for clarifying the underlying causes of vertigo.

OBJECTIVE

To investigate the epidemiological features of patients with vertigo.

METHODS

This retrospective study investigated 78 patients who had been emergently hospitalized in the Otolaryngology Department of Kyoto University Hospital with vertigo.

RESULTS

The number of female patients was significantly higher than the number of male patients. Meniere's disease was the most common underlying pathology among hospitalized patients. Mean patient age was 56.1 years, with no significant difference between male and female patients.

Vestibular neuritis: recurrence and incidence of secondary benign paroxysmal positional vertigo

CONCLUSIONS

Recurrence of vestibular neuritis (VN) is a rare event in long-term follow-up. The incidence of benign paroxysmal positional vertigo (BPPV) in VN patients represents a quite common outcome. To our knowledge, this study represents the only long-term longitudinal study on recurrence of VN and incidence of secondary BPPV in VN.

OBJECTIVES

To study a large number of VN patients longitudinally to identify the recurrence rate of VN and incidence of BPPV, other peripheral vestibular disorders, sudden hearing loss or Bell's palsy.

METHODS

This prospective cohort study assessed a VN patient-based clinic population. All patients received a complete bedside clinical examination and caloric irrigation.

RESULTS

Long-term (range 4-6 years, mean 4.9 years) longitudinal follow-up examination of 51 VN patients demonstrated a low recurrence rate (1/51 patients, 2.0%). With recurrence, VN affected the same ear after 6 months and caused less severe symptoms. BPPV appears to be more frequent (5/51 patients, 9.8%) in VN patients than in the general population, consistently affecting the posterior canal of the same ear. BPPV occurrence after VN predominantly affects VN patients who did not fully recover from the disease. Moreover, BPPV after VN appears to be more difficult to treat than idiopathic BPPV.

Prevalence of vestibulopathy in benign paroxysmal positional vertigo patients with and without prior otologic history Prevalencia de vestibulopatía en pacientes con vértigo postural paroxístico benigno (BPPV), con y sin historia previa de patología otológica

The purpose of this study was to determine the prevalence of reduced or absent labyrinthine reactivity (vestibulopathy) in two groups of participants with posterior canal BPPV. One group had prior diagnosis of otologic disease (positive history group). No one in the second group had ever been diagnosed with otologic disease (negative history group). Caloric responses were retrospectively analyzed for the two groups. Patients with a positive history exhibited a greater prevalence of vestibulopathy than patients with a negative history. The positive history group, on average, also exhibited a larger unilateral weakness than those patients in the negative history group. We conclude that patients with BPPV and a history of otologic disease are more likely to present with vestibulopathy, than patients with BPPV and no history of otologic disease. This finding supports the benefit of complete vestibular evaluation in patients with BPPV to ensure comprehensive and successful treatment outcome.

Follow-up of vestibular function in bilateral vestibulopathy

OBJECTIVE

Bilateral vestibulopathy (BV) leads to a bilateral deficit of the vestibulo-ocular reflex and has various aetiologies. The main goal of this study was to determine the frequency and degree of recovery or worsening of vestibular function over time.

METHODS

82 patients (59 males, 23 females; mean age at the time of diagnosis 56.3 (SD 17.6) years) were re-examined 51 (36) months after the first examination. All patients underwent a standardised neuro-ophthalmological and neuro-otological examination. Electronystagmography with bithermal caloric irrigation was analysed by measurement of the mean peak slow phase velocity (SPV) of the induced nystagmus. Patients evaluated the course of their disease in terms of balance, gait unsteadiness and health related quality of life.

RESULTS

Statistical analysis of the mean peak SPV of caloric induced nystagmus revealed a non-significant worsening over time (initial mean peak SPV 3.0 (3.5) degrees/s vs 2.1 (2.8) degrees/s). With respect to subgroups of aetiology, only patients with BV due to meningitis exhibited an increasing, but non-significant SPV (1.0 (1.4) degrees/s vs 1.9 (1.6) degrees/s). Vestibular outcome was independent of age, gender, time course of manifestation and severity of BV. Single analysis of all patients showed that a substantial improvement > or = 5 degrees/s occurred in two patients on both sides (idiopathic n = 1, Sjögren's syndrome n = 1) and in eight patients on one side (idiopathic n = 6, meningitis n = 1, Menière's disease n = 1). In 84% of patients there was impairment of their health related quality of life (42% slight, 24% moderate, 18% severe). Forty-three per cent of patients rated the course of their disease as stable, 28% as worsened and 29% as improved.

CONCLUSIONS

Our data support the view that more than 80% of patients with BV do not improve. Thus the prognosis of BV is less favourable than assumed.

Epidemiological aspects of vertigo in the general population of the Autonomic Region of Valencia, Spain

CONCLUSION

Vertigo, defined as an illusion of unequivocal rotatory motion, is a common symptom in the general population that frequently requires individuals to seek medical attention in a primary care centre.

OBJECTIVES

To evaluate the annual incidence of patients who suffer vertigo, and to examine some of the variables associated, in a sample of the general population of the Autonomic Region of Valencia, Spain.

SUBJECTS AND METHODS

The study was designed as an observational, incidence study. The study area included six primary care centres with a total population of 10760 inhabitants. The parameters studied were age, sex, working status, de novo presentation or recurrent vertigo crisis.

RESULTS

A total of 191 patients (17.8 patients per 1000 inhabitants) sought medical attention because of vertigo over the year of the study. Of these, 82 patients (7.6 per 1000 inhabitants) experienced vertigo for the first time, a de novo crisis. Women were more often affected and the crises occurred more frequently in individuals between 50 and 60 years of age. The work status had influence on the results obtained.

Vestibular findings in relapsing, remitting multiple sclerosis: a study of thirty patients

Our objective was to describe vestibular abnormalities in patients with relapsing and remitting multiple sclerosis. Thirty patients (6 men and 24 women) between 27 and 64 years of age underwent neurological and otolaryngological examinations, complete anamnesis, and electronystagmography. Patients with psychological or oculomotor paresis (or both), internuclear ophthalmoparesis, severe visual disturbances, or locomotion restrictions were excluded. The difference-of-proportion test was used to compare affected patients with controls, with a significance level of 5%. Vestibular alterations were found in 26 (86%) of the evaluated patients, from which 25 presented peripheral etiology and only 1 presented a problem of central origin. There was a prevalence of bilateral peripheral irritative vestibulopathy (20%), followed by bilateral peripheral deficit vestibulopathy (20%) and left peripheral deficit vestibulopathy (17%). The high incidence of vestibular disorders observed in this study indicates that this population might benefit from specific rehabilitation programs. Studies with larger samples are still required and may contribute to the understanding of this pathology.

[Skull vibration induced nystagmus test]

OBJECTIVES

To establish during a consensus meeting the fundamental basis, the validity criteria, the main indications and results of the skull vibration induced nystagmus test (SVINT) which explores the vestibule high frequencies.

MATERIAL AND METHODS

The SVINT is applied on the mastoid process (right and left sides) at 100 Hz during 10 seconds on a sitting upright subject. Total unilateral peripheral lesions (tUVL: operated vestibular shwannomas, vestibular neurectomies) and partial unilateral peripheral lesions (pUVL: preoperative neuromas, Meniere's disease, vestibular neuritis, chemical labyrinthectomies) were studied. Thirty-six patients had brainstem lesions and 173 normal subjects were used as controls.

RESULTS

The SVINT is considered positive when the application of the vibrator produces a reproducible sustained nystagmus always beating in the same direction following several trials in various stimulation topographies (on the right and left mastoid). The skull vibratory nystagmus (SVN) begins and ends with the stimulation; the direction of the nystagmus has no secondary reversal. The slow phase velocity (SPV) is>2 degrees /second. In tUVL the SVINT always reveals a lesional nystagmus beating toward the safe side at all frequencies. The mean SVN SPV is 10.8 degrees /s+/-7.5 SD (N=45). The mastoid site was more efficient than the cervical or vertex sites. Mastoïd stimulation efficiency is not correlated with the side of stimulation. The SVN SPV is correlated with the total caloric efficiency on the healthy ear. In pUVL the SVINT is positive in 71 to 76% of cases; the mean SVN. SPV (6.7 degrees /s+/-4.7 SD)(N=30) is significantly lower than in tUVL (P=0.0004). SVINT is positive in 6 to 10% of the normal population, 31% of brain stem lesions and negative in total bilateral vestibular peripheral lesions.

CONCLUSIONS

SVINT is an effective, rapid and non invasive test used to detect vestibular asymmetry between 20 to 150 Hz stimulation. This test used in important cohorts of patients during the ten last years has demonstrated no observable adverse effect. SVINT complements other tests which evaluate lower frequencies (caloric test: 0,003 Hz) and the medium frequencies (Head-Shaking-Test (HST): 2 Hz; the head impulse test (HIT): 6 Hz). SVINT is useful in the diagnosis of labyrinthine hydrops or detection of acoustic neuromas. It is useful when the caloric test can not be practised because of middle ear problems. SVINT has its limits: in pUVL, the nystagmus direction is not always specific of the pathologic side and can change with the stimulus frequency. This test does not precisely point out the level of the lesion on the vestibular pathway.

Recovery of Vestibular Imbalances After Vestibular Neuritis

OBJECTIVES

To determine chronological characteristics of vestibular recovery after vestibular neuritis (VN) by using various clinical parameters.

STUDY DESIGN

Prospective clinical study.

METHODS

Twenty of 22 consecutive patients with acute VN underwent serial follow-ups of static (spontaneous nystagmus, subjective visual vertical, and ocular torsion) and dynamic (head-shaking nystagmus [HSN], vibration-induced nystagmus [VIN], head thrust test, and caloric test) vestibular imbalances for 1 year after symptom onset.

RESULTS

Static vestibular imbalances improved more rapidly than dynamic imbalances. Among the dynamic imbalances, a trend of higher recovery rate was found in head thrust sign, HSN, and VIN than in caloric asymmetry. HSN tended to be more sensitive in detecting vestibular asymmetry than VIN and head thrust sign. Some patients showed direction reversal of HSN (n = 5, 25.0%) or VIN (n = 5, 25.0%) during follow-up. Direction of VIN changed according to the stimulation sites in four (20.0%) patients.

CONCLUSIONS

In view of more rapid resolution of static vestibular imbalance after VN, evaluation of the dynamic vestibular imbalances may provide more useful information for underlying vestibulopathy, especially in the compensated phase. The different temporal profiles ofdynamic vestibular recovery may reflect different chronological characteristics of vestibular compensation according to stimulus frequency. Direction reversal of HSN and VIN during follow-up suggests that lateralization of VNbased on the direction of these nystagmus should be considered in the context of disease phase.

Conscientiousness in Patients With Ménière's Disease

OBJECTIVE

To assess whether a conscientious personality profile is more prevalent in patients with Ménière's disease (MD) in comparison with other vertigo patients. Second, to investigate a sex effect and compare the obtained conscientiousness scores with published normative values.

PATIENTS

A total of 108 patients were included and subdivided into one of five pathology groups: MD, benign paroxysmal positional vertigo, vestibular neuritis, vestibular schwannoma, and posttraumatic nonbenign paroxysmal positional vertigo.

INTERVENTION

The conscientiousness domain of the self-reporting NEO Five-Factor Inventory questionnaire.

MAIN OUTCOME MEASURE

Conscientiousness score.

RESULTS

There was no significant difference between the diagnostic groups or a sex effect. MD patients had a higher score than published normal values.

CONCLUSION

As assessed with the NEO Five-Factor Inventory questionnaire, MD patients do not demonstrate a higher conscientious personality profile in comparison with other vertigo patients. Therefore, this limits the clinical use of the personality profile to discriminate between patient groups.

Epidemiology of vertigo

PURPOSE OF REVIEW

Epidemiological findings on the distribution, determinants and outcome of vertigo can be used for clinical decision making and can help understand the underlying causes of vestibular diseases. This article gives an overview of the epidemiology of the vestibular symptom vertigo and of four specific vestibular disorders: benign paroxysmal positional vertigo, migrainous vertigo, Menière's disease and vestibular neuritis.

RECENT FINDINGS

Based on a neurotologic survey of the general population, 1-year prevalence estimates for vertigo were 4.9%, for migrainous vertigo 0.89% and for benign paroxysmal positional vertigo 1.6%. Diagnostic positional manoeuvres and treatments for benign paroxysmal positional vertigo, however, are still not being done by most doctors. The female preponderance among patients with benign paroxysmal positional vertigo and migrainous vertigo may be linked to migraine but is not fully understood. A recently reported prevalence of Menière's disease of 0.51% is much higher than previous estimates. Follow-up studies have shown benign paroxysmal positional vertigo recurrence rates of 50% at 5 years and a persistence of dizziness related to anxiety in almost a third of patients 1 year after vestibular neuritis.

SUMMARY

The epidemiology of vertigo and vestibular disorders is still an underdeveloped field. Recent studies have underscored the impact of vertigo at the population level, but its determinants and outcome are not well known yet.

Low recurrence rate of vestibular neuritis: a long-term follow-up

We examined 103 patients with vestibular neuritis (VN) in a follow-up study (5.7 to 20.5 years, mean 9.8 years). Two patients (1.9%) had developed a second occurrence of VN 29 to 39 months after the first. VN affected the contralateral ear in both and caused less severe distressing vertigo and postural imbalance. Unlike Bell's palsy and sudden hearing loss, a relapse in the same ear did not occur.

Cerebellar infarction presenting isolated vertigo: Frequency and vascular topographical patterns

OBJECTIVE

To determine the frequency of cerebellar infarction mimicking vestibular neuritis (VN), the pattern of clinical presentation, and the territory of the cerebellar infarction when it simulates VN.

METHODS

We studied 240 consecutive cases of isolated cerebellar infarction in the territories of the cerebellar arteries diagnosed by brain MRI from the acute stroke registry at the Keimyung University Dongsan Medical Center.

RESULTS

We identified 25 patients (10.4%) with isolated cerebellar infarction who had clinical features suggesting VN. Two types of cerebellar infarction simulating VN were found: isolated spontaneous prolonged vertigo with imbalance as a sole manifestation of cerebellar infarction (n = 24) and isolated spontaneous prolonged vertigo with imbalance as an initial manifestation of cerebellar infarction (n = 1) followed by delayed neurologic deficits 2 days after the onset. The cerebellar infarction territory most commonly involved was the medial branch of the posterior inferior cerebellar artery territory (24/25: 96%), followed by the anterior inferior cerebellar artery territory (1/25: 4%). None of patients with infarcts in the territory of the superior cerebellar artery or multiple cerebellar arteries showed isolated spontaneous prolonged vertigo.

CONCLUSIONS

Cerebellar infarction simulating vestibular neuritis is more common than previously thought. Early recognition of the pseudo-vestibular neuritis of vascular cause may allow specific management.

The impact of cognitions on the development of panic and somatoform disorders: a prospective study in patients with vestibular neuritis

BACKGROUND

There is a high incidence of panic and somatoform disorders after vestibular neuritis. However, the occurrence of psychiatric disorders has been shown to be unrelated to persistent functional vestibular impairment. The aim of the present study was to examine the role played by cognitions in the development of panic and somatoform disorders.

METHOD

In a 2-year prospective study, cognitions were recorded at various stages using the Agoraphobic Cognitions Questionnaire and Body Sensations Questionnaire. Our analysis focused on whether body-related anxiety or panic-related thoughts can predict the development of a panic or somatoform disorder.

RESULTS

Fear arising on the first day of an acute vestibular episode did not predict the development of panic or somatoform disorders. One week after the dysfunction, however, the fear of vertigo was a significant predictor, explaining 20% of the variance in the development of either disorder. After 6 weeks, persistent fear of vertigo or vomiting predicted approximately 30% of the variance, and after 6 months panic-related thoughts predicted 40% of the variance and, with the inclusion of body-related fears, as much as 60% of the variance in the development of panic or somatoform disorders.

CONCLUSION

Our data confirm prospectively a number of fundamental assumptions of cognitive theory concerning the development of anxiety disorders. Subjects who experience vertigo as particularly alarming focus more intensely than other patients on the negative symptoms they perceive as being related to the disorder. Patients with panic-related cognitions were prone to develop panic or somatoform disorders.

The outcome of the canalith repositioning procedure for benign paroxysmal positional vertigo: are there any characteristic features of treatment failure cases?

To demonstrate the success rate of the canalith repositioning procedure (CRP) in our clinic and to establish any characteristic features of cases of treatment failure, we reviewed clinical records of 62 patients who were diagnosed with posterior semicircular canal-benign paroxysmal positional vertigo (BPPV) and treated with the CRP. The basic strategy of the CRP was to rotate the involved canal slowly in the plane of gravity so that free-floating materials could migrate into the utricle only once. After the procedure we instructed patients to keep their heads upright for 10 h and not to sleep on the affected ear for 2 weeks. After the initial treatment, successful results were obtained in 51 of the 62 patients (82.2%). After the second treatment, 56 patients (90.3%) experienced success. Six patients (9.7%) did not obtain resolution even after the second treatment. While 46 patients were diagnosed with idiopathic BPPV, in 16 patients a different diagnosis was determined (head injury in 7 patients, Ménière's disease in 2, vestibular neuritis in 2 and unilateral sensorineural hearing loss in 5). We categorized these 16 patients as having secondary BPPV. Patients with idiopathic BPPV showed a significantly higher success rate with CRP than those with secondary BPPV. Patients with secondary BPPV may have quantitatively or qualitatively different lesions than those with idiopathic BPPV.