The epidemiology of dizziness and vertigo

Excess weight is associated with neurological and neuropsychiatric symptoms in post-COVID-19 condition: A systematic review and meta-analysis

BACKGROUND/PURPOSE

Excess weight has been identified as a potential risk factor for post-COVID-19 condition (PCC). This systematic review and meta-analysis aimed to investigate whether excess weight is associated with the development or experience of neurological and neuropsychiatric symptoms in PCC.

METHODS

We conducted a comprehensive search of eight databases (PubMed, Embase, Scopus, Web of Science, VHL, Google Scholar, ProQuest, and medRxiv) for studies published up to July 2023. Studies were included if they assessed PCC symptoms in relation to nutritional status, specifically the development of neurological and neuropsychiatric symptoms more than 12 weeks post-infection. The analysis compared exposure and controls groups (excess weight vs. normal weight; obesity vs. non-obesity). Data were synthesized using a random-effects model.

RESULTS

Of the 10,122 abstracts screened, 18 studies (n = 139,091 adults) were included. These studies included 79,050 individuals with excess weight vs 57,926 normal-weight individuals and 30,694 individuals with obesity vs 107,612 non-obese individuals. The presence of excess weight in PCC was significantly associated with persistent depression (RR = 1.21; 95% CI: 1.03-1.42), headache (OR = 1.23; 95% CI: 1.10-1.37), memory issues (RR = 1.43; 95% CI: 1.24-1.65), sleep disturbance (RR = 1.31; 95% CI: 1.16-1.48), and vertigo (RR = 1.21; 95% CI: 1.04-1.41). Obesity was significantly associated with persistent headache (OR = 1.45; 95% CI: 1.37-1.53), numbness (RR = 1.61; 95% CI: 1.46-1.78), smell disorder (OR = 1.16; 95% CI: 1.11-1.22), taste disorder (OR = 1.22; 95% CI: 1.08-1.38), and vertigo (RR = 1.44; 95% CI: 1.35-1.53).

CONCLUSIONS

Excess weight, including overweight and obesity, is associated with experiencing neuro-symptoms related to PCC. Individuals with these conditions urgently need enhanced personalized care management in current post-pandemic context.

Characterization of Optokinetic Nystagmus in Healthy Participants With a Novel Oculography Device

OBJECTIVE

To develop a proof-of-concept smart-phone-based eye-tracking algorithm to assess non-pathologic optokinetic (OKN) nystagmus in healthy participants. Current videonystagmography (VNG) is typically restricted to in-office use, and advances in portable vestibular diagnostics would yield immense public health benefits.

STUDY DESIGN

Prospective cohort study.

SETTING

Tertiary academic medical center.

METHODS

Healthy participants (n = 39) without dizziness or vertigo were recruited. A smart-phone attached to a custom head stabilization device illuminated by a white LED circuit was used to record nystagmus induced with a 30 frames per second OKN stimulus over a 60-second period. A centroid tracking algorithm was created to detect slow-phase velocity (SPV) of horizontal nystagmus in a diverse subject cohort in a variety of lighting conditions. Nystagmus recordings were compared to those obtained with a standard VNG system.

RESULTS

Non-pathologic nystagmus from an OKN stimulus was measured across multiple lighting conditions, with high signal-to-noise ratios (SNR) and mean SPV 22.13 ± 5.26°/s. Nystagmus SPV was not significantly different between the device and standard VNG system (t = -0.5, P = .6). Lighting conditions produced SNRs of 57.30 (ideal), 50.59 (backlit), 51.33 (side-lit), 49.28 (dark), 54.52 (outdoor lighting).

CONCLUSION

We demonstrate the feasibility of a novel portable oculography system in the detection of non-pathologic nystagmus in healthy subjects. Future applications of this system include: (1) to obtain real-time measurements of nystagmus during an acute vertigo attack; (2) to test patients unable or unwilling to present to a specialized vestibular laboratory; (3) to efficiently repeat testing overtime; (4) to improve accessibility of vestibular testing.

Risk factors for residual dizziness after successful repositioning in elderly patients with benign paroxysmal positional vertigo

OBJECTIVE

This study aims to investigate the factors influencing RD in elderly patients with BPPV following successful manual reduction.

METHODS

A total of 112 elderly patients diagnosed with benign paroxysmal positional vertigo (BPPV) were selected. The patients' general information, comorbidities, and scores on the Dizziness Handicap Inventory (DHI) were recorded. Following a successful canalith repositioning procedure (CRP), bone mineral density (BMD) was assessed using dual-energy X-ray absorptiometry and evaluated with the T-score. The mean blood flow velocity (Vm) and pulse index (PI) of the bilateral middle cerebral arteries (MCA) and basilar artery (BA) were measured using transcranial Doppler (TCD). Cerebrovascular reactivity (CVR) was evaluated through the Breath Holding Index (BHI). White matter lesions are assessed using cranial Magnetic Resonance Imaging (MRI) and evaluated with the Leukoaraiosis score (LA-score). The patients were divided into residual dizziness (RD) and non-RD groups based on the presence of RD one week after the reduction. The effects of bone mineral density, cerebral blood flow, and cerebral white matter on short-term RD in elderly BPPV patients were subsequently evaluated.

RESULTS

In the RD group, the DHI and LA-score were significantly higher than those in the non-RD group, while the T-score and BHI were lower, with statistically significant differences between the two groups (P < 0.05). The decreases in BHI and T-score, along with the increases in DHI and LA-score, were identified as risk factors for short-term RD following reduction in elderly patients with BPPV. Multivariate logistic regression analysis indicated that BHI, T-score, and LA-score were independent risk factors for RD. T-score and BHI exhibited a negative correlation with RD, while LA-score demonstrated a positive correlation. The diagnostic performance of each indicator was evaluated using ROC curve analysis. The results showed that the AUC for BHI was 0.715, T-score was 0.730, and LA-score was 0.732. Notably, when the three indicators were combined, the AUC significantly increased to 0.842, demonstrating high diagnostic efficiency, with a sensitivity of 70.73 % and a specificity of 90.14 %.

CONCLUSION

The decreases in the BHI and T-score, along with the increases in the DHI and LA-score, are all identified as risk factors for short-term RD following reduction in elderly patients with BPPV. BHI, T-score, and LA-score serve as independent risk factors for RD and can effectively predict its occurrence, with their combined predictive value being superior. BMD, CVR, and LA were utilized to predict short-term RD after successful manual reduction of BPPV.

Co-Existing Vestibular Hypofunction Impairs Postural Control, but Not Frailty and Well-Being, in Older Adults with Benign Paroxysmal Positional Vertigo

Background: Vestibular hypofunction occurs in 29.5% of older adults with benign paroxysmal positional vertigo (BPPV), but its impact on postural control, well-being and frailty was not studied before. This study compared the well-being, frailty and postural control between older adults with BPPV and vestibular hypofunction (oaBPPV+), and older adults with only BPPV (oaBPPV). Methods: Thirty-one older adults (≥65 years old) diagnosed with BPPV were recruited. Unilateral vestibular hypofunction was defined as a >25% caloric asymmetry, and bilateral vestibular hypofunction as a total response <6°/s per ear, using bithermal caloric irrigations. The oaBPPV+ group was compared to the oaBPPV group using the measures of well-being (Dizziness Handicap Inventory, Falls Efficacy Scale and 15-item Geriatric Depression Scale), frailty (Modified Fried Criteria), and postural control (timed chair stand test, mini-Balance Evaluation Systems test and Clinical Test of Sensory Interaction on Balance (CTSIB)). Falls and the number of repositioning maneuvers were documented. Significance level was set at α = 0.05. Results: Unilateral vestibular hypofunction was present in 32% of participants, mainly in females (p = 0.04). Bilateral vestibular hypofunction was not found. The oaBPPV+ group (n = 10, mean age 72.5 (4.5)) experienced more comorbidities (p = 0.02) than the oaBPPV group (n = 21, mean age 72.6 (4.9)). Groups did not differ regarding dizziness symptoms (p = 0.46), fear of falling (p = 0.44), depression (p = 0.48), falls (p = 0.08) or frailty (p = 0.36). However, the oaBPPV+ group showed significantly worse postural control under vestibular-dependent conditions (p < 0.001). Conclusions: Despite equally impaired well-being and frailty, the oaBPPV+ group showed greater sensory orientation deficits. Clinicians and researchers should be alert for co-existing vestibular hypofunction in older adults with BPPV, since this may exacerbate their already impaired postural control more than only BPPV.

Poly-symptomatology of chronic multi-canalicular benign paroxysmal positional vertigo: a deductive, inductive, and abductive narrative review

This narrative review aims to present an overview of the symptomatology of chronic multi-canalicular benign paroxysmal positional vertigo (mc-BPPV) from deductive (what is believed to be known), inductive (what is likely), and abductive (hypothetical) perspectives. The purpose is to recognize these symptoms as expressions of an eventual mc-BPPV when they occur in patients with vestibular migraine, whiplash associated disorders (WAD) and other chronic pain disorders. These symptoms are often considered to be biopsychosocial conditions due to a lack of objective findings, that is, the absence of the findings one is looking for-not the absence of findings generally. The symptomatology of mc-BPPV follows a basic neurophysiologic principle: a disorder in one part of the vestibular system often affects the functions of other parts of the vestibular system. In patients with chronic mc-BPPV, abnormal signals are transmitted as afferents to the vestibular nuclei complex; from there, consistently abnormal efferent reflexes are transmitted. These symptoms can include dizziness, visual disturbances, headache, neck pain, temporomandibular joint region pain, other musculoskeletal pain, involuntary movements, tinnitus, temperature disturbance, and cognitive dysfunction. Therefore, it is necessary to consider the possibility of mc-BPPV in patients with vestibular migraine, WAD and other chronic pain disorders.

Impact of vestibular rehabilitation therapy on quality of life and cognitive function in individuals with chronic dizziness or vertigo

PURPOSE

Dizziness and vertigo are among the most frequently reported complaints among patients across various medical and healthcare specialties. Studies have revealed that they are associated with cognitive impairments, particularly in older adults. While vestibular rehabilitation therapy (VRT) alleviates physical symptoms, its effects on cognitive function remain underexplored. Hence, this study aims to assess the impact of VRT on the quality of life and cognitive performance of individuals with chronic dizziness or vertigo.

METHODS

This was a randomized control trial in which 60 participants experienced chronic dizziness or vertigo. The participants were assigned to either the medication-only group receiving betahistine or the VRT + medication group receiving VRT combined with betahistine. Quality of life was measured via the Dizziness Handicap Inventory (DHI). Cognitive performance was assessed via a digit span test, task-switching test, and recording of P300 response.

RESULTS

The VRT + Medication group showed significant improvements in cognitive performance, particularly in the digit span and task-switching tests, with reduced P300 response latency and increased amplitude. No significant cognitive changes were observed in the medication-only group. Both groups showed improvement in quality of life, with a greater reduction in DHI scores observed in the VRT + Medication group.

CONCLUSION

VRT combined with medication significantly improves cognitive function and quality of life in individuals with chronic dizziness or vertigo. These findings suggest that VRT not only addresses physical symptoms but also enhances cognitive performance, highlighting its potential as a comprehensive therapeutic approach.

TRIAL REGISTRATION

The study protocol was registered in the Clinical Trial Registry of India (CTRI number: CTRI/2020/03/023934).

Dizziness and imbalance and their association with general and mental health in a community-based cross-sectional study of middle-aged individuals: the Busselton healthy ageing study

BACKGROUND

Dizziness and imbalance are common symptoms among patients visiting healthcare providers. Current knowledge about their prevalence, impact on daily life, and associated factors is primarily based on selected samples from individuals seeking medical help, particularly older individuals. This study aimed to estimate the prevalence, symptoms, and impact of dizziness or imbalance symptoms, and to assess the association between these symptoms and their characteristics with demographic, general health, and mental health factors in middle-aged men and women from a representative, general population sample.

METHODS

Cross-sectional data were collected from participants aged 45 to 70 years in the Busselton Healthy Ageing Study (BHAS), recruited in the City of Busselton, Western Australia. The data included physical tests and health-related questionnaires covering demographics, medical history, general and mental health, including any dizziness and imbalance symptoms and their impact on daily life. Estimates were made of the prevalence, patterns, and impact of dizziness and imbalance symptoms. Logistic regression was employed to calculate the association between demographic, mental and general health (independent variables) and the presence of dizziness or imbalance symptoms (dependent variable). Adjustments were made for sex and age as confounding factors.

RESULTS

Of the 5086 participants, 1216 (23.9%) reported imbalance or dizziness, with light-headedness the most common type (64.3%; 782 of 1216). For nearly half (565; 46.5%) the imbalance or dizziness occasionally effected daily life, while for some, the impact was frequent (n = 50, 4.1%) or constant (n = 15, 1.2%). Being female (adjusted OR 2.05, 95%CI 1.79-2.34) and older in age (in years; adjusted OR 1.02, 95%CI 1.00-1.03), having a history of general health issues, and experiencing mental health problems or mental health symptoms were significantly associated with dizziness or imbalance symptoms.

CONCLUSIONS

Dizziness or imbalance are common symptoms among individuals aged 45 to 70 years and are associated with older age, being female, and poorer general and mental health. Given that approximately half of those affected reported occasional effects on daily life, with a few reporting frequent or constant effects, the outcomes of the study could help to raise awareness among healthcare providers about the prevalence, symptoms, and associated conditions.

The Association of Sarcopenia and Body Composition With Benign Positional Paroxysmal Vertigo in Older Adults

OBJECTIVES

One-third of older adults suffer from dizziness and vertigo. Benign positional paroxysmal vertigo (BPPV), which occurs due to otoconia moving into the semicircular canal, is the most common vestibular disorder. We evaluated the connection between BPPV and geriatric symptoms.

METHODS

A comprehensive geriatric evaluation included daily living activities, Mini-Mental State Examination (MMSE), and Geriatric Depression Scale tests for all patients. Patients' nutritional status was assessed using the Mini-Nutritional Assessment. Body weight and fat free mass were determined from the bioimpedance analyzer. Hand grip strength was measured using an electronic hand dynamometer to determine muscle strength. Sarcopenia was assessed using the European Working Group on Sarcopenia in Older People-2 recommendations. The patients were divided into three groups as BPPV-positive, BPPV-negative, and healthy (control).

RESULTS

Obesity, low muscle mass, dynapenia, gait speed, low gait speed, and history of falling statistically significantly differed between the three groups, but age, gender, smoking, alcohol consumption, body mass index, MMSE, depression, number of falls, and comorbid diseases did not differ. The BPPV-positive group had greater rates of obesity, low muscle mass, dynapenia, and sarcopenia than the control group (p = 0.008, 0.007, 0.01, 0.03). In the unadjusted univariate analysis, low muscle mass, sarcopenia, and obesity were risk factors for "BPPV" (Odds Ratio [OR]: 3.43, Confidence Interval [Cl]: 1.25-9.37, p = 0.016; OR: 3.47, Cl: 1.32-9.13, p = 0.011; OR: 2.71, Cl: 1.09-6.70, p = 0.031).

CONCLUSIONS

Obesity, sarcopenia, and low muscle mass are risk factors for BPPV, and we urge the older population to adopt healthy diet and exercise regimens to reduce BPPV-related falls.

LEVEL OF EVIDENCE

3 Laryngoscope, 135:1486-1492, 2025.

A Comparison of cVEMP and VNG Examination Results Between Adults and Children with a History of Vertigo

Background/Objectives: Dizziness and vertigo are common symptoms. Vertigo, caused by vestibular deficit, is usually diagnosed with videonystagmography (VNG) and cervical vestibular evoked myogenic potential (cVEMP). Normative values of these examinations have been established for adults; however, the impact of age is still uncertain. This study aimed to compare the results of VNG and cVEMP between adults and children. Methods: We analyzed and compared the results of VNG and cVEMP in 119 patients (35 adults and 84 children.) Results: Statistically significant differences were observed between adults and children in the amplitude of the cVEMP examination. In the subgroup analysis by age, we also noticed differences in VNG examination in nystagmus induced by rotation in patients with peripheral vertigo and in IFO (index fixation test) and VOR (vestibulo-ocular reflex) in patients with non-peripheral vertigo. Conclusions: This study confirms that there are differences in vestibular examination results between children and adults. However, the exact impact of age on each part of the vestibular examination requires further investigation.

Dizziness and neck pain: a perspective on cervicogenic dizziness exploring pathophysiology, diagnostic challenges, and therapeutic implications

Dizziness and vertigo affect up to 20% of adults annually. Cervicogenic dizziness (CGD), a debated clinical entity, is characterized by dizziness associated with cervical pain or dysfunction, stemming from altered proprioceptive input from the cervical spine. Despite its recognition in clinical practice, CGD remains controversial due to its reliance on exclusionary diagnosis and the absence of specific diagnostic criteria or gold-standard tests. This perspective explores the pathophysiology of CGD, emphasizing the sensory mismatch theory, where disrupted cervical proprioception interacts maladaptively with vestibular and visual systems, leading to postural instability and dizziness. Central mechanisms, including sensory reweighting and maladaptation, further complicate symptom resolution, particularly in the context of chronic cervical dysfunction. Current diagnostic approaches provide insights but lack specificity. Management strategies, including manual therapy and sensorimotor exercises, show promise in alleviating symptoms by targeting cervical dysfunction and enhancing proprioceptive integration. However, these interventions highlight the need for an integrated approach that addresses both cervical and vestibular contributions to dizziness. This paper underscores the importance of advancing CGD research, particularly understanding central maladaptation mechanisms. By bridging gaps in clinical and research knowledge, a more comprehensive framework for diagnosing and managing CGD can emerge, benefiting patients with persistent dizziness and cervical involvement.

Sex differences in dizziness diagnoses across acute and chronic neurological settings

BACKGROUND & OBJECTIVE

Dizziness is commoner in females and therefore clinical diagnostic frameworks are perhaps biased towards this gender. This study specifically aimed to analyse the distribution of diagnoses in neuro-otology clinics based on sex, and across age.

METHODS

Retrospective cohort study based on a case note review of 474 adult patients (≥ 18 years) using electronic healthcare records from patients who were referred with a primary complaint of dizziness, vertigo, or unsteadiness in outpatient neurological clinics from January 2023 to September 2024 at University College London Hospitals, UK.

RESULTS

Among the 474 patients, the most common diagnosis for dizziness was persistent postural perceptual dizziness (PPPD) (24.3%), followed by vestibular migraine (VM) (22.4%). In women the most common diagnosis was VM (31.9%), while in men it was PPPD (21.7%). In the population under 65 years old the major cause was VM (28.9%), followed by PPPD (28.6%) and "other central causes" (12.19%), while in the population over 65 years old they were benign paroxysmal positional vertigo (BPPV) (18.4%) and "other central causes" (18.4%). PPPD (28.3%) and VM (21.4%) were the commonest causes of chronic vertigo, while in the acute phase the commonest causes were VM (26%), vascular (14%) and BPPV (14%).

DISCUSSION

Overall, PPPD is the most common cause of dizziness in males, and vascular vertigo was the most common cause of acute dizziness in males, regardless of age. The combination of age and sex may be helpful in constructing a priori diagnostic possibilities for Neurologists, Otorhinolaryngologists and other clinicians seeing dizzy patients.

Epley maneuver, performed by family doctors or emergency physicians, for benign paroxysmal positional vertigo in adults

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the effects of the Epley maneuver, performed by family doctors or emergency physicians, for adults with benign paroxysmal positional vertigo.

Chronic Dizziness and Positional Symptoms: An Exploration of Symptom Clusters and Participant-Reported Experiences

PURPOSE

This mixed-methods design (a) quantitatively describes the symptom cluster assignments of patients with chronic dizziness who completed a dizziness triage questionnaire and (b) qualitatively explains patient-reported themes associated with the most frequently assigned symptom cluster.

METHOD

A retrospective hybrid explanatory mixed-methods design was implemented to examine an artificial intelligence dizziness triage questionnaire posted online in a vestibular disorders support group from June 2021 to November 2022. Symptom cluster assignments are described in 791 participants. In the qualitative analysis, emerging codes were identified in the dominant symptom cluster in 50 participants.

RESULTS

Quantitative analysis identified a total of 301 symptom cluster combinations. The analysis from 791 participants revealed that females exhibited more symptom clusters than males, age impacted symptoms inversely, and longer duration of symptom history exhibited more symptom clusters. "Positional" was the most common symptom cluster among 50 participants. Of those 50, six major themes emerged from the data: (a) physical symptoms, (b) cognitive symptoms, (c) triggers, (d) temporal information, (e) management, and (f) emotions.

CONCLUSIONS

The results from this study emphasize the complexity and variability of chronic dizziness. Comprehensive patient assessments that combine questionnaires with clinical expertise and patient dialogue are needed to improve diagnosis and management.

Understanding Factors That Cause Benign Paroxysmal Positional Vertigo, Ménière Disease, and Vestibular Neuritis: A Two-Sample Mendelian Randomization Study

OBJECTIVES

Vertigo is a prevalent clinical symptom, frequently associated with benign paroxysmal positional vertigo (BPPV), Ménière disease (MD), and vestibular neuritis (VN), which are three common peripheral vestibular disorders. However, there is a relative lack of research in epidemiology and etiology, with some existing studies presenting discrepancies in their conclusions. We conducted a two-sample Mendelian randomization (MR) analysis to explore potential risk and protective factors for these three peripheral vestibular disorders.

DESIGN

Based on genome-wide association studies, we executed a univariable MR to investigate the potential associations between 38 phenotypes and MD, BPPV, and VN. We used the inverse variance weighted method as the primary MR result and conducted multiple sensitivity analyses. We used false discovery rate (FDR) correction to control for type I errors. For findings that were significant in the univariable MR, a multivariable MR analysis was implemented to ascertain direct effects. In addition, we replicated analyses of significant results from the univariable MR to enhance the robustness of our analyses.

RESULTS

For BPPV, both alcohol consumption (odds ratio [OR] = 0.57, 95% confidence interval [CI] = 0.43 to 0.76, FDR Q = 0.004) and educational attainment (OR = 0.77, 95% CI = 0.68 to 0.88, FDR Q = 0.003) were found to decrease the risk. The genetic prediction analysis identified major depression (OR = 1.75, 95% CI = 1.28 to 2.39, FDR Q = 0.008) and anxiety (OR = 5.25, 95% CI = 1.79 to 15.42, FDR Q = 0.036) increased the risk of MD. However, the impact of major depression on MD could be influenced by potential horizontal pleiotropy. Systolic blood pressures (OR = 1.03, 95% CI = 1.02 to 1.04, FDR Q = 4.00 × 10 -7 ) and diastolic blood pressures (OR = 1.05, 95% CI = 1.03 to 1.07, FDR Q = 2.83 × 10 -6 ) were associated with an increased risk of VN, whereas high-density lipoprotein (OR = 0.77, 95% CI = 0.67 to 0.89, FDR Q = 0.009) and urate (OR = 0.75, 95% CI = 0.63 to 0.91, FDR Q = 0.041) reduces the risk of VN. Only the relationship between urate and VN was not replicated in the replication analysis. Multivariable MR showed that the protective effect of education on BPPV was independent of Townsend deprivation index. The protective effect of high-density lipoprotein against VN was independent of triglycerides and apolipoprotein A1. The risk impacts of systolic and diastolic blood pressures on VN exhibited collinearity, but both are independent of chronic kidney disease and estimated glomerular filtration rate. The impacts of anxiety and severe depression on MD demonstrated collinearity.

CONCLUSIONS

Our study identified the risk association between systolic and diastolic blood pressure with VN and the protective influence of high-density lipoprotein on VN, which may support the vascular hypothesis underlying VN. Furthermore, we observed an elevated risk of MD associated with anxiety. The potential protective effects of education and alcohol consumption on BPPV need further exploration in subsequent studies to elucidate specific mechanistic pathways. In summary, our MR study offers novel insights into the etiology of three peripheral vestibular diseases from a genetic epidemiological standpoint.

Updated Views on Vestibular Physical Therapy for Patients with Vestibular Disorders

Background/Objectives: Vestibular Physical Therapy (VPT) plays a crucial role in the rehabilitation of patients with vestibular disorders by promoting vestibular compensation through adaptation, habituation, and substitution mechanisms. While traditional VPT approaches have demonstrated effectiveness in restoring balance and gaze stability, some patients with chronic vestibular dysfunction continue to experience persistent deficits. Methods: review of recent advancements in neuroplasticity research suggest the need for updated rehabilitation strategies that integrate sensorimotor substitution, saccadic training, optokinetic stimulation, and cognitive-motor dual-task training to optimize vestibular compensation. Results: This perspective article explores innovative VPT approaches aimed at improving dynamic gaze and postural stability in a more challenging way. We emphasize the importance of personalized rehabilitation strategies that leverage multisensory integration to enhance neuroplastic recovery. Conclusions: By refining VPT interventions, we can maximize functional outcomes and improve the quality of life for individuals with vestibular disorders.

Mining and analysis of dizziness adverse event signals in postoperative analgesia patients based on the FDA adverse event reporting system database

Objective

This study aimed to explore the association between drugs used in postoperative anesthesia patients and postoperative dizziness using the U.S. Food and Drug Administration's Adverse Event Reporting System (FAERS) database, along with other risk factors for dizziness.

Methods

Using the FAERS database, we retrospectively analyzed dizziness cases reported between 2004 and the third quarter of 2023. We analyzed the relationship between drugs during postoperative anesthesia and the risk of postoperative dizziness, and conducted subgroup analysis according to age, sex and other factors. Signal detection was further performed using the reported odds ratio (ROR) method to identify medications significantly associated with an increased risk of postoperative dizziness.

Results

A total of 166,292 dizziness case reports were obtained, with 128 cases specifically related to postoperative analgesia. The number of dizziness reports has been increasing yearly, with a higher concentration of cases among individuals aged 18-85 years, predominantly in female patients. The analysis identified that amitriptyline, clonazepam, and ketamine were significantly associated with an increased risk of dizziness, with RORs of 34.91, 17.39, and 7.37, respectively. Subgroup analyses revealed variations in the relative risk of dizziness based on sex and age groups. Ketamine may be associated with higher risk of dizziness in the adult male subgroup.

Conclusion

The results of this study suggest that specific medications used by patients with postoperative analgesia are associated with an increased risk of postoperative dizziness. Future studies should further validate this finding and explore other potential risk factors.

Atlas Subluxation Complex, National Upper Cervical Chiropractic Association Intervention, and Dizziness Improvement: A Narrative Review of Historical Perspectives, Literature Synthesis, and a Path for Future Care

Dizziness is a non-specific and common condition in which the afflicted individual experiences abnormal sensations such as lightheadedness, imbalance, or a false sense of spinning (vertigo). The experience of "dizziness" can result from a wide spectrum of abnormal physiological states, including exhaustion, hypotension, and hypoglycemia, but could also indicate a serious underlying health issue. Since it has many potential generating causes, accurate identification of the underlying etiology of dizziness can present a challenge to clinicians, often resulting in ineffective treatments. We present a hypothesis that atlas subluxation complex (ASC) may comprise an etiological agent of dizziness that can be successfully addressed with National Upper Cervical Chiropractic Association (NUCCA) chiropractic care. In this review, we discuss the pathophysiology of the ASC, introduce the NUCCA chiropractic procedure, and complete a literature review and synthesis. Conceptual evidence, case reports, and theory provide foundational evidence that the ASC may be a contributory factor of dizziness generation and that NUCCA chiropractic corrective care of the ASC may produce favorable dizziness outcomes. However, high-quality studies are lacking. The foundation evidence provides indication that further research via observational studies and randomized controlled trials (RCTs) is warranted.

Dizziness in Fabry Disease

Background/Objectives: Fabry disease is an X-linked lysosomal storage disease. Earlier studies have mentioned dizziness/balance issues and vestibular involvement as a symptom of Fabry disease. Research on the matter remains scarce. This pilot study aims to show the prevalence of dizziness/balance issues and whether it is due to peripheral, central, or other factors. Methods: A Dizziness Handicap Inventory, with added questions, was sent out to 91 Fabry patients to estimate the prevalence of dizziness/balance issues. Additionally, this study reports analyses from eight Fabry patients with self-reported dizziness/balance issues who were offered referrals for in-depth investigations of their condition. All eight underwent a comprehensive oto-neurological examination, Videonystagmography, a Video Head impulse test, vestibular myogenic evoked potential, and audiometry. Results: A total of 55 of the 91 patients with Fabry disease answered the survey. Of these, 78.2% felt symptoms of dizziness/balance issues. The most common form of dizziness/balance issues was short-lasting attacks. All eight ENT-examined patients had normal outer and middle ear conditions. Five of eight Fabry patients had abnormal results in the optokinetic test and audiometry. Conclusions: The survey showed a high prevalence of dizziness/balance issues in Fabry patients. The abnormal optokinetic test suggested a central cause and was the only objective measurement we found that could lead to an explanation for dizziness/balance issues. Polypharmacy was present in all eight examined patients and could also explain the dizziness/balance issues in Fabry patients. There is no other clear pattern regarding the characteristics of dizziness/balance issues in Fabry patients in this exploratory study.

Evidence-Based Aeromedical Assessments

INTRODUCTION

Assessment of fitness for flight constitutes one of the core tasks of aeromedical professionals. The value of such evaluations depends on the decision to be based on complete medical information, valid risk methodology, and genuine flight safety indicators. To achieve these goals, the aeromedical practitioner should ensure an evidence-based approach.

METHODS

This article describes a pragmatic and evidence-based methodology for aeromedical fitness assessments, grounded on already validated principles within scientific epistemology and evidence-based clinical medicine.

RESULTS

The aeromedical assessment should integrate both individual variables of the particular applicant, deductive reasoning by relevant experts, and the best available scientific evidence. Each of these three pillars includes a set of specific aspects based on knowledge of precision medicine, flight environment, risk methodology, statistics, metacognition, and scientific method.

DISCUSSION

Despite evidence-based approach being the benchmark, the aeromedical practitioner should be aware of limitations and potential pitfalls. The conclusion should be based on both functional performance and future risk of medical incapacitation using a transparent and objective risk matrix. Saehle T. Evidence-based aeromedical assessments. Aerosp Med Hum Perform. 2025; 96(1):71-77.

Vestibular migraine as a mimic of benign paroxysmal positioning vertigo and Meniere's disease

BackgroundVestibular migraine (VM) is a common cause of recurrent spontaneous and positional dizziness of varying durations. Short episodes of VM lasting seconds to minutes, triggered by changes in head position can resemble those of benign paroxysmal positioning vertigo (BPPV), while episodes lasting minutes to hours can mimic those of Meniere's disease (MD).ObjectiveWe aimed to compare symptoms and vestibular test results in patients with VM, BPPV and MD, where VM was categorized by episode duration.MethodsWe compared vestibular, aural and migraine symptoms, as well as cervical and ocular vestibular evoked myogenic potentials and 3D video head impulse tests, in 108 patients: 24 with BPPV, 33 with VM episodes of short duration (<10 min), 29 with VM of medium duration (≥10 min) and 22 with MD.ResultsWe found significant overlap in the symptoms of all patient groups, and no significant differences between patients with short and medium VM. Abnormal test results occurred infrequently in all groups.ConclusionsOur results confirm significant symptom overlap between BPPV or MD and VM, and suggest that VM mimics other conditions when the episode duration matches the differential diagnosis, rather than because patients with different durations of vertigo have different symptoms.

Efficacy of Nortriptyline and Migraine Lifestyle Modifications in Vestibular Migraine Management

OBJECTIVE

To evaluate the effectiveness of nortriptyline regimen and migraine dietary/lifestyle modifications on dizziness and stress levels in patients diagnosed with vestibular migraine (VM).

METHODS

A total of 35 patients diagnosed with definite VM based on the International Classification of Headache Disorders were included in this intervention study. Patients self-selected to receive either nortriptyline regimen alone (10-40 mg daily with biweekly escalation) (group A, n = 17) or migraine dietary/lifestyle modifications alone (group B, n = 18). Main outcome measures were dizziness severity and stress level measured by the visual analog scale (VAS).

RESULTS

At 4-week post-treatment, dizziness decreased from 6.0 ± 2.5 to 4.2 ± 3.4 (p = 0.069) in group A and from 8.7 ± 1.5 to 3.6 ± 3.0 (p < 0.001) in group B. VAS for stress changed from 5.5 ± 1.3 to 5.4 ± 2.9 (p = 0.93) and from 6.9 ± 3.2 to 5.0 ± 2.7 (p = 0.025) in groups A and B, respectively. The δ values of the VAS score for dizziness were 1.8 ± 3.7 and 5.1 ± 3.1 and the δ values of the VAS score for stress were 0.06 ± 2.9 and 1.9 ± 3.3 in groups A and B, respectively. Quality of life (QOL) improved in 88% patients in group A and 94% patients in group B.

CONCLUSIONS

Nortriptyline, at a maximum dose of 40 mg, effectively alleviates patient symptoms, while a migraine diet and lifestyle modifications notably reduce vertiginous symptoms and stress levels in VM patients in 4 weeks. Both interventions are equally effective in ameliorating the QOL of patients. The ideal treatment for patients would likely need to include both medication and diet/lifestyle changes.

Cavernous Hemangioma With Right Vestibulopathy: A Case Report Illustrating Multidisciplinary Clinical Decision-Making in Vestibular Diagnostics

This paper describes a case study of a 56-year-old male patient with a small cavernous hemangioma and concurrent peripheral vestibular symptoms, initially thought to warrant neurosurgical intervention. A structured, multidisciplinary approach involving audiology, ear, nose and throat, and physiotherapy revealed that peripheral vestibular dysfunction, rather than the central lesion, was the primary cause of symptoms. The report illustrates the diagnostic utility of video head impulse testing (vHIT), caloric testing, and vestibular evoked myogenic potentials (VEMPs) in differentiating central and peripheral vestibular dysfunction, leading to a nonsurgical treatment plan. The case underscores the importance of multidisciplinary collaboration in preventing unnecessary interventions and highlights an effective clinical decision-making framework for similar cases.

The effect of climate changes on incidence of benign paroxysmal positional vertigo; a systematic review with meta-analysis of 16144 patients

BACKGROUND

There were controversial findings in terms of the association between the incidence of Benign Paroxysmal Positional Vertigo (BPPV) and climate changes, so the current systematic review plus meta-analysis is designed to discover this possible relationship.

METHODS

Web of science, PubMed, Scopus, Google Scholar, Embase, and Cochrane library were systematically searched up to August 2023. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Problem/Population, Intervention, Comparison, and Outcome (PICO) guidelines were used. Two authors independently reviewed the eligible articles and assessed the quality of them.

RESULTS

In total, 15 studies including 16144 patients met the inclusion criteria. Ten studies reported the relation of BPPV to monthly mean temperature, 7 to monthly average humidity, 4 to monthly average rainfall, 6 to monthly sunlight time, and 2 to average solar radiation. The incidence of BPPV was associated significantly with atmospheric pressure (P: 0.003) and rainfall (P: 0.017). However, there was not any statistically significant correlation between incidence of BPPV and humidity, sunlight time, temperature, and solar radiation level (P > 0.05).

CONCLUSIONS

The incidence of BPPV was higher in cold months of a year in both northern hemisphere and southern hemisphere countries. Although it can be because of negative correlation with temperature, the current meta-analysis did not find any statistically significant negative correlation with temperature. In addition, the incidence of BPPV was associated significantly with atmospheric pressure (positive correlation) and rainfall (negative correlation).

Nationwide Prevalence of Video Head Impulse Test Abnormality and its Risk Factors in South Korea

OBJECTIVE

To identify the prevalence of and relevant information for video head impulse test (vHIT) abnormality in a large population.

STUDY DESIGN

A cross-sectional design.

SETTING

Korean National Health and Nutrition Examination Survey, 2021.

METHODS

The sample was representative of the Korean population, with 2237 participants aged ≥40 years. A vHIT was performed to evaluate vestibular function. The vestibulo-ocular reflex (VOR) gain and the presence of reproducible catch-up saccades was assessed in a vHIT. Participants also completed questionnaires for demographics, socioeconomic status, and basic information regarding systemic diseases and dizziness and underwent hearing tests with automated pure-tone audiometry.

RESULTS

The prevalence of vHIT abnormality was 22.5%, with unilateral (14.3%) being more common than bilateral (8.2%). The prevalence of vHIT abnormality increased significantly with age, with the highest rate observed in individuals aged >70 years (42.5%). Both hearing and VOR gain deteriorated with age, but the patterns of age-related progression were different. While hearing loss (HL) deteriorated gradually and progressively throughout adulthood, VOR gain deterioration was markedly evident after 70 years of age.

CONCLUSION

Considering the high prevalence of vHIT abnormality, appropriate social and medical policies are needed to prevent associated injuries and improve patients' quality of life. The distinct age-related changes in HL and objective findings of vestibular dysfunction indicate the need for different approaches to address these social problems in aging countries.

Causal association between blood metabolites and vertigo: A Mendelian randomization study

Metabolic disorders have been identified as an important factor causing nervous system diseases. However, due to the interference of confounding factors, the causal relationship between them has not been clearly elucidated, so it is necessary to study the causal relationship between them. To explore the causal relationship between blood metabolites and vertigo by Mendelian randomization. To assess causality, the inverse variance weighting method was employed as the primary analytical approach, complemented by additional sensitivity analyses. Metabolic pathway enrichment analysis and genetic correlation analysis were employed to further assess the metabolites. All statistical analyses were conducted using the R software. The study employed metabolite Genome Wide Association Study and vertigo diseases summary data sets to examine the causal relationship between 486 blood metabolites and 3 types of vertigo. A total of 55 potential metabolites associated with the 3 types of vertigo were identified, with 22, 16, and 13 candidate metabolites showing relatively reliable MR Evidence for Vestibular Dysfunction, Peripheral Vertigo, and Central Vertigo, respectively. Enrichment analysis was conducted to investigate the biological significance of these candidate metabolites, resulting in the identification of 7 key metabolic pathways across the 3 diseases, the metabolic pathway known as "Valine, leucine, and isoleucine biosynthesis" was found to be associated with all 3 types of vertigo, suggesting its potential influence on the vestibular system. Genetic correlation analysis revealed a genetic correlation between X-10510 and dodecanedioate with Vestibular Dysfunction. This study offers novel perspectives on the causal impact of blood metabolites on vertigo through the integration of genomics and metabolomics. Identifying metabolites that contribute to vertigo could serve as potential biomarkers and contribute to a better understanding of the underlying biological mechanisms associated with vertigo.

Comparative Study of Clinical Features of Patients with Different Types of Benign Paroxysmal Positional Vertigo

Objectives: Even though BPPV is one of the most common causes of vertigo, it is often underdiagnosed and omitted in the diagnosis of patients reporting vertigo. The aim of the study was to establish a diagnostic pattern useful in patients admitted due to vertigo, based on the most common clinical characteristics of patients suffered from posterior canal BPPV (PC-BPPV), horizontal canal BPPV with geotropic (HCG-BPPV) and apogeotropic nystagmus (HCA-BPPV). Methods: The analysis covered the results obtained in 105 patients with a positive result of the Dix-Hallpike maneuver or the supine roll test. The patients were divided into 3 groups based on the BPPV type: gr.1:PC-BPPV (60%); gr.2: HCG-BPPV (27%); gr.3: HCA-BPPV (13%). Patients before the diagnostic maneuvers filled the questionnaire concerning their symptoms and previous diseases. Results: Almost all patients had vertigo during turning over in bed and the character of the symptoms was paroxysmal. The answers to questions about the type of head movement evoked vertigo and how long vertigo lasted were differentiating. The percentages of correct diagnosis speculated by the combined answers were 69.6% in PC-BPPV, 61.8% in HCG-BPPV, and 80% in HCA-BPPV. Conclusions: Basing on those observations there is presented the diagnostic schedule which could be useful in dizziness examination. The above results indicate that a properly collected interview with the patient allows for a high percentage of accurate diagnosis.

Molecular profile of vestibular compensation in the medial vestibular nucleus after unilateral labyrinthectomy

Long non-coding RNAs (lncRNAs) have emerged as crucial regulators in the central nervous system, yet their role in vestibular compensation remains elusive. To address this knowledge gap, we employed unilateral labyrinthectomy (UL) in rats to establish animal models of peripheral vestibular dysfunction. Utilizing ribonucleic acid sequencing (RNA-seq), we comprehensively analysed the expression profiles of genes dysregulated in the medial vestibular nucleus (MVN) of these rats at distinct time points: 4 h, 4 days, and 14 days post-UL. Through trans-target prediction analysis integrating differentially co-expressed messenger RNAs (mRNAs) and lncRNAs, we constructed lncRNA-mRNA regulatory networks. Validation of selected mRNAs and lncRNAs was performed using RT-qPCR. Our RNA-seq analysis revealed significant aberrant expression of 3054 lncRNAs and 1135 mRNAs compared to control samples. By applying weighted gene co-expression network analysis (WGCNA), we identified 11 co-expressed modules encompassing all genes. Notably, within the MEmagenta module, we observed an initial upregulation of differentially expressed genes (DEGs) at 4 h, followed by downregulation at 4- and 14-days post-UL. Our findings indicated that 3068 lncRNAs positively regulated 1259 DEGs, while 1482 lncRNAs negatively regulated 433 DEGs in the MVN. The RT-qPCR results corroborated the RNA-seq data, validating our findings. This study offers novel insights into the lncRNA-mRNA expression landscape during vestibular compensation, paving the way for further exploration of lncRNA functions in this context.

Altered thalamus functional connectivity in patients with acute unilateral vestibulopathy: a resting-state fMRI study

Objective

Acute unilateral vestibulopathy (AUVP) is the second leading cause of peripheral vestibular vertigo. Full recovery of AUVP is related to sufficient central vestibular compensation. It has been confirmed that the vestibular nucleus and vestibular cortex are involved in the process of vestibular compensatory in AUVP patients. However, few studies have focused on the functional compensation of thalamus in patients with AUVP. This study aimed to explore the alterations of resting-state functional connectivity (FC) focused on thalamus using functional magnetic resonance imaging (fMRI) in AUVP patients.

Methods

Data of 3D-T1 and resting-state fMRI were collected from 40 AUVP patients and 35 healthy controls (HC). Seeds-based (bilateral thalamus) FC was analyzed to investigate the changes in FC between the two groups. Furthermore, we evaluated the associations between altered thalamus FC and clinical features in AUVP patients using Pearson's partial correlation.

Results

Compared with HC, AUVP patients showed decreased FC between bilateral thalamus and left insula. We also observed decreased FC between right thalamus and left supramarginal gyrus. Additionally, we found increased FC between left thalamus and right postcentral gyrus (PCG), as well as increased FC between right thalamus and regions of bilateral PCG, right middle frontal gyrus and right middle occipital gyrus in AUVP patients. Furthermore, the FC between left thalamus and left insula was negatively correlated with values of canal paresis in patients with AUVP (p = 0.010, r = -0.434).

Conclusion

Our results provided first evidence for the decreased thalamo-vestibular cortex pathway, as well as increased thalamo-somatosensory and thalamo-visual cortex pathway in AUVP patients. These findings help us better understand the underlying mechanisms of central dynamic compensatory following an acute unilateral peripheral vestibular damage.

Advances in diagnosis and treatment of vestibular migraine and the vestibular disorders it mimics

Dizziness is one of the most common chief complaints in both the ambulatory care setting and the emergency department. These symptoms may be representative of a broad range of entities. Therefore, any attempt at treatment must first start with determining the etiology. In this current perspective, we focus specifically on the diagnosis of and treatment of vestibular migraine, which is common and overlaps clinically with a variety of other diagnoses. We discuss the traditional treatments for vestibular migraine in addition to the recent explosion of novel migraine therapeutics. Because vestibular migraine can mimic, or co-exist with, a variety of other vestibular diseases, we discuss several of these disorders including persistent postural-perceptual dizziness, benign paroxysmal positional vertigo, post-concussive syndrome, Ménière's disease, and cerebrovascular etiologies. We discuss the diagnosis of each, as well as overlapping and distinguishing clinical features of which the reader should be aware. Finally, we conclude with evidence based as well as expert commentary on management, with a particular emphasis on vestibular migraine.

Association between Benign Paroxysmal Positional Vertigo and Thyroid Diseases: Systematic Review and Meta-Analysis

Introduction  Benign paroxysmal positional vertigo (BPPV) is the peripheral vestibular dysfunction that most affects people worldwide, but its etiopathogenesis is still not fully understood. Considering the etiological diversity, some studies highlight the association between BPPV and thyroid diseases. Objective  To investigate the association between thyroid diseases and BPPV. Data Synthesis  Systematic review and meta-analysis of epidemiological studies searched in the PubMed, Web of Science, Embase, Cochrane Library, and Scopus databases. Studies that were fully available and investigated the association between BPPV and thyroid diseases were selected. The articles that composed the meta-analysis were analyzed using the dichotomous model, the Mantel-Haenszel statistical test, odds ratio (OR), and a 95% confidence interval (CI). Of the 67 articles retrieved from the databases, 7 met the eligibility criteria of the systematic review, and 4 had data necessary to perform the meta-analysis. Qualitative analysis revealed that the studies were conducted in the European and Asian continents. The predominant methodological design was the case-control type, and thyroid dysfunctions, hypothyroidism, and Hashimoto thyroiditis occurred more frequently. The meta-analysis showed no association between hypothyroidism and BPPV; however, there was a statistically significant relationship between Hashimoto thyroiditis and BPPV. Conclusion  The meta-analysis results suggest a possible association between BPPV and Hashimoto thyroiditis. Nevertheless, we emphasize the need for further studies to elucidate the evidence obtained.

Application of clinical indicators in evaluating vestibular compensation efficacy in benign recurrent vestibular vertigo patients with short-term personalized vestibular rehabilitation

BACKGROUND

Short-term personalized vestibular rehabilitation (ST-PVR) can establish stable vestibular compensation. However, there is a lack of a clear definition for clinical indicators that can dynamically reflect the progress of vestibular rehabilitation (VR).

OBJECTIVE

To explore the clinical indicators suitable for evaluating the effectiveness of ST-PVR in treating benign recurrent vertigo (BRV).

METHODS

In total, 50 patients diagnosed with BRV were enrolled. All patients received the ST-PVR treatment program. At 2 and 4 weeks after rehabilitation, subjective scales, including the visual analogue scale (VAS), dizziness handicap inventory scale (DHI), activities-specific balance confidence scale (ABC) and generalized anxiety disorder (GAD-7) were assessed. Objective vestibular function tests were performed. VR grading was determined.

RESULTS

At 2 weeks after rehabilitation, significant enhancements were observed in VAS, DHI, ABC, GAD-7, UW, vHIT results, and VR grading scores (p < 0.05). The sensory organization test (SOT) results demonstrated statistically significant improvements at 2 weeks and 4 weeks after rehabilitation (p < 0.05).

CONCLUSION AND SIGNIFICANCE

Both subjective scales and partial examination results in objective assessment can serve as indicators to dynamically monitor the compensatory process of vestibular function in patients with BRV. The VR efficacy grading score, which incorporates the above indicators, allows for quantification of the changes that occur during the vestibular rehabilitation process.

Combination of UPLC-Q-TOF/MS and network pharmacology to reveal the mechanism of Chaihu-jia-Longgu-Muli decoction for treating vertigo with anxiety disorder

Chaihu-jia-Longgu-Muli decoction (CLMD) has been proven clinically effective in treating vertigo with anxiety disorder. However, the mechanism is not clear. This study aimed to explore the mechanism of CLMD in treating vertigo with anxiety disorder based on ultra-performance liquid chromatography-quadrupole time-of-flight/mass spectrometry (UPLC-Q-TOF/MS) and network pharmacology. UPLC-Q-TOF/MS was performed to identify the compounds in blood and the targets of compounds of CLMD in vertigo and anxiety were searched using databases. A protein-protein interaction network was built to screen the core targets. The core targets were analyzed by Gene Ontology (GO) and Kyoto Encyclopedia of Genes and Genomes (KEGG) pathway analyses. In addition, the vertigo with anxiety rat model was used to verify the results. A total of 22 compounds were absorbed into the blood. Eighty-one potential targets associated with CLMD for vertigo with anxiety disorder were identified through network pharmacological analysis. Subsequently, GO and KEGG analysis showed that CLMD treatment for vertigo with anxiety disorder is associated with neurotransmitter levels and other pertinent physiological processes. The results of the animal experiments showed that CLMD decreased the levels of serotonin, norepinephrine and dopamine, alleviating the symptoms of vertigo and anxiety disorder in model rats. The study revealed CLMD could alleviate vertigo and anxiety symptoms through reducing the levels of neurotransmitters.

Probabilities of Isolated and Co-Occurring Vestibular Disorder Symptom Clusters Identified Using the Dizziness Symptom Profile

OBJECTIVES

Dizziness is among the most common reasons people seek medical care. There are data indicating patients with dizziness, unsteadiness, or vertigo may have multiple underlying vestibular disorders simultaneously contributing to the overall symptoms. Greater awareness of the probability that a patient will present with symptoms of co-occurring vestibular disorders has the potential to improve assessment and management, which could reduce healthcare costs and improve patient quality of life. The purpose of the current investigation was to determine the probabilities that a patient presenting to a clinic for vestibular function testing has symptoms of an isolated vestibular disorder or co-occurring vestibular disorders.

DESIGN

All patients who are seen for vestibular function testing in our center complete the dizziness symptom profile, a validated self-report measure, before evaluation with the clinician. For this retrospective study, patient scores on the dizziness symptom profile, patient age, and patient gender were extracted from the medical record. The dizziness symptom profile includes symptom clusters specific to six disorders that cause vestibular symptoms, specifically: benign paroxysmal positional vertigo, vestibular migraine, vestibular neuritis, superior canal dehiscence, Meniere disease, and persistent postural perceptual dizziness. For the present study, data were collected from 617 participants (mean age = 56 years, 376 women, and 241 men) presenting with complaints of vertigo, dizziness, or imbalance. Patients were evaluated in a tertiary care dizziness specialty clinic from October 2020 to October 2021. Self-report data were analyzed using a Bayesian framework to determine the probabilities of reporting symptom clusters specific to an isolated disorder and co-occurring vestibular disorders.

RESULTS

There was a 42% probability of a participant reporting symptoms that were not consistent with any of the six vestibular disorders represented in the dizziness symptom profile. Participants were nearly as likely to report symptom clusters of co-occurring disorders (28%) as they were to report symptom clusters of an isolated disorder (30%). When in isolation, participants were most likely to report symptom clusters consistent with benign paroxysmal positional vertigo and vestibular migraine, with estimated probabilities of 12% and 10%, respectively. The combination of co-occurring disorders with the highest probability was benign paroxysmal positional vertigo + vestibular migraine (~5%). Probabilities decreased as number of symptom clusters on the dizziness symptom profile increased. The probability of endorsing vestibular migraine increased with the number of symptom clusters reported.

CONCLUSIONS

Many patients reported symptoms of more than one vestibular disorder, suggesting their symptoms were not sufficiently captured by the symptom clusters used to summarize any single vestibular disorder covered by the dizziness symptom profile. Our results indicate that probability of symptom clusters indicated by the dizziness symptom profile is comparable to prior published work on the prevalence of vestibular disorders. These findings support use of this tool by clinicians to assist with identification of symptom clusters consistent with isolated and co-occurring vestibular disorders.

Imaging Outcomes of Emergency MR Imaging in Dizziness and Vertigo: A Retrospective Cohort Study

BACKGROUND AND PURPOSE

Patients exhibiting acute dizziness or vertigo often represent a diagnostic challenge, and many undergo neuroimaging for stroke detection. We aimed to demonstrate the imaging outcomes of first-line emergency MR imaging among patients with acute dizziness or vertigo and to determine the clinical risk factors for stroke and other acute pathology.

MATERIALS AND METHODS

This retrospective study included consecutive patients with acute dizziness or vertigo referred for emergency MR imaging in a tertiary hospital during 5 years. We recorded and analyzed patient characteristics, relevant clinical information, and imaging outcomes. Risk score models were derived to predict which patients were more likely to present with positive MR imaging findings.

RESULTS

A total of 1169 patients were included. Acute stroke was found in 17%; other clinically significant pathology, in 8% of patients. In 75% of the patients, emergency MR imaging showed no significant abnormalities. Risk factors for acute stroke included older age, male sex, and a prevalence of cardiovascular risk factors and neurologic signs. Isolated dizziness had no discriminative power on imaging outcomes, and 14% of these patients showed acute stroke. Risk scores had only moderate performance in predicting acute ischemic stroke (receiver operating characteristic area under curve = 0.75) or any significant pathology (receiver operating characteristic area under curve = 0.70).

CONCLUSIONS

Acute dizziness and vertigo remain challenging even when emergency MR imaging is readily available. One in 4 patients had acute pathology on MR imaging. Predictors for acute pathology (older age, male sex, cardiovascular risk factors, and neurologic signs) may aid in patient selection for MR imaging, optimizing the yield and clinical impact of emergency neuroimaging. Low diagnostic yields of CT and internal acoustic canal MR imaging may offer an opportunity to reduce health care expenditures in the future.

Different clinical course of BPPV according to the medical conditions

Dizziness is one of the most prevalent complaints in medicine, and benign paroxysmal positional vertigo (BPPV) accounts for one-third of all cases. The present study was aimed at identifying differences in the course and prognosis of BPPV depending on the patient's medical condition during hospitalization. Patients in group 1 were hospitalized due to trauma, those in group 2 for scheduled surgery, and those in group 3 for medical treatment. The intervals from admission to symptom onset, surgery to symptom onset, and symptom onset to ENT department referral were compared. The interval from admission to symptom onset was shortest in group 1 (3.1 ± 8.0 days) and differed significantly from that in group 3 (20.0 ± 35.0 days, p < 0.001). The interval from surgery to symptom onset for group 2 was 5.6 ± 5.8 days and was significantly shorter than that from admission to symptom onset for group 3 (p = 0.014). The interval from symptom onset to ENT referral in group 3 (2.0 ± 2.8 days) was significantly shorter than in groups 1 and 2 (4.1 ± 5.1 and 4.0 ± 3.6 days, p = 0.008 and p = 0.002, respectively). The findings imply that the course of BPPV differed according to the patients' medical condition.

Dizziness in Primary Care

Dizziness is a prevalent symptom in the general population and is among the most common reasons patients present for medical evaluations. This article focuses on high yield information to support primary clinicians in the efficient and effective evaluation and management of dizziness. Key points are as follows: do not anchor on the type of dizziness symptom, do use symptom timing and prior medical history to inform diagnostics probabilities, do evaluate for hallmark examination findings of vestibular disorders, and seek out opportunities to deliver evidence-based interventions particularly the canalith repositioning maneuver and gaze stabilization exercises.

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

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.

ChatGPT vs UpToDate: comparative study of usefulness and reliability of Chatbot in common clinical presentations of otorhinolaryngology-head and neck surgery

PURPOSE

The usage of Chatbots as a kind of Artificial Intelligence in medicine is getting to increase in recent years. UpToDate® is another well-known search tool established on evidence-based knowledge and is used daily by doctors worldwide. In this study, we aimed to investigate the usefulness and reliability of ChatGPT compared to UpToDate in Otorhinolaryngology and Head and Neck Surgery (ORL-HNS).

MATERIALS AND METHODS

ChatGPT-3.5 and UpToDate were interrogated for the management of 25 common clinical case scenarios (13 males/12 females) recruited from literature considering the daily observation at the Department of Otorhinolaryngology of Ege University Faculty of Medicine. Scientific references for the management were requested for each clinical case. The accuracy of the references in the ChatGPT answers was assessed on a 0-2 scale and the usefulness of the ChatGPT and UpToDate answers was assessed with 1-3 scores by reviewers. UpToDate and ChatGPT 3.5 responses were compared.

RESULTS

ChatGPT did not give references in some questions in contrast to UpToDate. Information on the ChatGPT was limited to 2021. UpToDate supported the paper with subheadings, tables, figures, and algorithms. The mean accuracy score of references in ChatGPT answers was 0.25-weak/unrelated. The median (Q1-Q3) was 1.00 (1.25-2.00) for ChatGPT and 2.63 (2.75-3.00) for UpToDate, the difference was statistically significant (p < 0.001). UpToDate was observed more useful and reliable than ChatGPT.

CONCLUSIONS

ChatGPT has the potential to support the physicians to find out the information but our results suggest that ChatGPT needs to be improved to increase the usefulness and reliability of medical evidence-based knowledge.

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).

Increased prevalence of peripheral vestibular disorder among patients with Fabry disease

BACKGROUND

Although peripheral vestibular disorder is a non-fatal complication of Fabry disease, fatalities have been reported in some case reports and case series. To date, no studies have examined the relative risk of peripheral vestibular disorder in patients with Fabry disease compared to the general population without the condition. Due to the high prevalence of Fabry disease in East Asia and the potential shared pathogenic pathways between Fabry disease and vasculopathy, we conducted a study using a nationwide population-based dataset to compare the prevalence of peripheral vestibular disorder between patients with Fabry disease and matched comparison patients.

METHODS

Data was sourced from Taiwan's Longitudinal Health Insurance Database 2010. this study consists of 11,668 sampled patients, 2917 study patients with Fabry disease and 8751 propensity-score-matching comparison patients. We conducted multiple logistic regression analysis to study the association between peripheral vestibular disorder and Fabry disease.

RESULTS

The study identified notable differences in the prevalence of various vestibular disorders between the study and comparison groups. Specifically, there was a 7.2% increased prevalence of peripheral vestibular disorder in the study group (28.3%) compared to the comparison group (20.9%), Meniere's disease (5.4% vs. 3.7%), benign paroxysmal positional vertigo (5.1% vs. 3.3%), and other/ unspecified peripheral vestibular dizziness (15.6% vs. 11.8%) (all p < 0.001). The odds ratios for PVD, MD, BPPV, and other PVD were 1.44 (95% CI = 1.29-1.60), 1.50 (95% CI = 1.23-1.83), 1.59 (95% CI = 1.30-1.95), and 1.40 (95% CI = 1.24-1.58), respectively, among the Fabry disease group relative to the comparison group after adjusting for age, monthly income, geographic location, urbanization level, hyperlipidemia, diabetes, coronary heart disease, and hypertension.

CONCLUSION

This study found that patients with Fabry disease had increased prevalence of peripheral vestibular disorder.

Muscle mass and chronic dizziness: a cross-sectional study of a Korean population

BACKGROUND AND OBJECTIVES

Weight gain is associated with imbalance in older people. In contrast, overweightness or mild obesity is less common in patients with chronic dizziness. This paradox may be, at least in part, related to differences in the body composition indices adopted in the previous studies. This study aimed to determine any association between the predicted body composition and chronic dizziness or imbalance of unknown causes.

METHODS

We measured the lean body mass, body fat mass, and appendicular skeletal mass in 9243 people who participated in the Korean National Health and Nutrition Examination Survey 2019-2021. Sarcopenia was defined according to the Asian Working Group for Sarcopenia's guidelines. Obesity was defined as a body fat percentage of ≥ 25% for men and ≥ 35% for women.

RESULTS

The participants with chronic dizziness had a lower body mass index than those without (p = 0.001). Furthermore, sarcopenia was more common in those with chronic dizziness. In contrast, the degree of obesity was comparable in both groups. Multiple logistic regression analysis showed that sarcopenia was associated with a higher risk of chronic dizziness (odds ratio = 1.6, 95% confidence interval: 1.1-2.5; p = 0.026).

DISCUSSION

Given the association of sarcopenia with chronic dizziness or imbalance, muscle mass may play a role in maintaining balance and stability. Physical exercise could be recommended to increase muscle mass in patients with chronic dizziness/imbalance and sarcopenia. Additional research is required to establish a causal relationship between chronic dizziness and sarcopenia.

Effects of Different Durations and Frequencies of Vestibular Rehabilitation in Patients With Residual Symptoms After Benign Paroxysmal Positional Vertigo Repositioning

OBJECTIVES

This study aimed to explore the effects of different duration and daily frequency of vestibular rehabilitation (VR) in patients with residual symptoms after benign paroxysmal positional vertigo (BPPV) successful repositioning.

METHOD

Patients with successful BPPV repositioning (n = 118) were divided into 3 groups according to VR duration and frequency: group A (n = 30; 15 minutes, 3 times/day), group B (n = 30; 30 minutes, 3 times/day), group C (n = 28; 15 minutes, 6 times/day), and control group D (n = 30; no VR). All patients completed the dizziness handicap inventory (DHI) and vestibular rehabilitation benefit questionnaire (VRBQ) at baseline and after 2 and 4 weeks.

RESULTS

The emotional scores and the proportion of severe dizziness disability in the DHI scores were significant differences between VR groups A to C and control group D after 2 and 4 weeks (all P < .05). There were significant differences in total DHI and VRBQ scores among the VR groups A to C after 2 and 4 weeks (all P < .05). Interestingly, emotion scores were not significantly different in group A (P = .385), group B (P = .569), and group C (P = .340) between 2 and 4 weeks. Meanwhile at 2 weeks, the difference in motion-provoked dizziness score between group A and B was statistically significant (P = .02).

CONCLUSIONS

A total VR duration over 4 weeks can reduce dizziness and improve VR benefits in routine therapy in patients with residual dizziness after successful BPPV repositioning. Emotional improvement can be observed after 2 weeks. VR may help to relieve motion-provoked dizziness earlier if patients are willing to consider increasing the duration to more than 15 minutes.

[The six most frequent peripheral vestibular syndromes]

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.

Peripheral vertigo and subsequent risk of depression and anxiety disorders: a prospective cohort study using the UK Biobank

BACKGROUND

Peripheral vertigo is often comorbid with psychiatric disorders. However, no longitudinal study has quantified the association between peripheral vertigo and risk of psychiatric disorders. Furthermore, it remains unknown how the white matter integrity of frontal-limbic network relates to the putative peripheral vertigo-psychiatric disorder link.

METHODS

We conducted a cohort study including 452,053 participants of the UK Biobank with a follow-up from 2006 through 2021. We assessed the risks of depression and anxiety disorders in relation to a hospitalization episode involving peripheral vertigo using Cox proportional hazards models. We also examined the associations of peripheral vertigo, depression, and anxiety with MRI fractional anisotropy (FA) in a subsample with brain MRI data (N = 36,087), using multivariable linear regression.

RESULTS

Individuals with an inpatient diagnosis of peripheral vertigo had elevated risks of incident depression (hazard ratio (HR) 2.18; 95% confidence interval (CI) 1.79-2.67) and anxiety (HR 2.11; 95% CI 1.71-2.61), compared to others, particularly within 2 years after hospitalization (HR for depression 2.91; 95% CI 2.04-4.15; HR for anxiety 4.92; 95% CI 3.62-6.69). Depression was associated with lower FA in most studied white matter regions, whereas anxiety and peripheral vertigo did not show statistically significant associations with FA.

CONCLUSIONS

Individuals with an inpatient diagnosis of peripheral vertigo have increased subsequent risks of depression and anxiety disorders, especially within 2 years after hospitalization. Our findings further indicate a link between depression and lower microstructural connectivity as well as integrity beyond the frontal-limbic network.

Impact and experiences of vestibular disorders and psychological distress: Qualitative findings from patients, family members and healthcare professionals

INTRODUCTION

People with vestibular disorders frequently experience reduced quality of life and challenges with activities of daily living. Anxiety, depression and cognitive problems often co-present with vestibular disorders and can aggravate symptoms and prolong clinical recovery. We aimed to gain in-depth insights into the impact of vestibular disorders and the contribution of psychological factors by exploring multistakeholder perspectives.

METHODS

Semistructured interviews were conducted between October 2021 and March 2022 with 47 participants in the United Kingdom including: 20 patients (age M = 50.45 ± 13.75; 15 females), nine family members (age M = 61.0 ± 14.10; four females), and 18 healthcare professionals. Data were analysed using framework analysis.

RESULTS

Vestibular disorders impact diverse aspects of patients' lives including work, household chores, socialising, and relationships with family and friends. Being unable to engage in valued activities or fulfil social roles contributes to feelings of grief and frustration, affecting identity, confidence, and autonomy. Anxiety and low mood contribute to negative thought processes, avoidance, and social withdrawal, which can impede clinical recovery through reduced activity levels, and end engagement with treatment. Coping strategies were thought to help empower patients to self-manage their symptoms and regain a sense of control, but these require oversight from healthcare providers.

CONCLUSIONS

Daily activity limitations, social participation restrictions, and psychological distress can interact to impact quality of life, sense of self, and clinical recovery amongst people with vestibular disorders. Information and resources could aid societal awareness of the impact of vestibular disorders and help patients and families feel understood. An individualised and comprehensive approach that concurrently addresses mental, physical, social, and occupational needs is likely to be beneficial.

PATIENT OR PUBLIC CONTRIBUTION

Two group meetings were held at the beginning and end of the study with a patient and public involvement network formed of people with vestibular disorders and family members. These individuals commented on the study aims, interview schedule, participant recruitment practices, and interpretation of the themes identified. Two core patient members were involved at all stages of the research. These individuals contributed to the formulation of the interview schedule, development and application of the coding scheme, development and interpretation of themes, and preparation of the final manuscript.

Ten-year incidence, predictors and impact of dizziness and vertigo in community-dwelling adults

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.

Does Catastrophizing Predict Response to Treatment in Patients With Vestibular Disorders? A Prospective Cohort Study

OBJECTIVE

Determine levels of catastrophizing in patients with vestibular disorders and prospectively evaluate their relationship with patient-reported outcome measures.

STUDY DESIGN

Prospective cohort study.

SETTING

Tertiary care neurotology vestibular disorders clinic.

PATIENTS

Adult patients with various vestibular disorders.

INTERVENTIONS

Patients were given the Dizziness Handicap Inventory (DHI) and the Dizziness Catastrophizing Scale (DCS) at a baseline visit and follow-up visit after treatment.

MAIN OUTCOME MEASURES

Correlation studies were used to determine the relationships between DHI and DCS. Multivariable linear regression was performed to determine the relationship between DCS and DHI change with treatment, accounting for demographic variables.

RESULTS

Forty-six subjects completed both the DHI and the DCS before and after treatment. Patients with higher baseline DCS scores had higher baseline DHI scores ( p < 0.001). There was a significant improvement in both DHI score ( p < 0.001) and DCS ( p < 0.001) at follow-up. Patients who had reduction in DCS scores during were more likely to show reduction in DHI scores ( p < 0.001). A subset of patients had a mindfulness-based stress reduction program included in their treatment. These patients had a greater reduction in both DCS and DHI scores at follow-up compared with those who received other treatments.

CONCLUSIONS

Catastrophizing is associated with higher pretreatment DHI scores and worse treatment outcomes. Addressing dizziness catastrophizing may help improve vestibular outcomes.