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Del Risco A, Cherches A, Smith SL, Riska KM. Guideline Adherence to Benign Paroxysmal Positional Vertigo Treatment and Management in Primary Care. Otolaryngol Head Neck Surg 2023; 169:865-874. [PMID: 36884006 PMCID: PMC10782547 DOI: 10.1002/ohn.315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Revised: 02/01/2023] [Accepted: 02/15/2023] [Indexed: 03/09/2023]
Abstract
OBJECTIVE To determine adherence to the 2017 American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) guidelines for the management and treatment of benign paroxysmal positional vertigo (BPPV) in primary care (PC) and compare whether key recommendations differed by sex, race, or insurance status. STUDY DESIGN Retrospective chart review. SETTING Twenty-six clinic locations within a single healthcare system. METHODS Charts of 458 patients diagnosed with BPPV in PC between 2018 and 2022 were reviewed. Encounters where the diagnosis of BPPV was made were identified. From the clinical encounter note, demographics, symptomatology, management, and treatment were extracted. Nonparametric analyses were used to identify whether AAO-HNS guidelines differed regarding sex, race, or insurance status. RESULTS Of 458 patients, 249 (54.4%) did not receive a diagnostic exam, and only 4 (0.9%) patients received imaging. Regarding treatment, only 51 (11.1%) received the Epley maneuver, with 263 (57.4%) receiving vestibular suppressant medication and 12.4% receiving a referral to a specialist. In regard to sex, race, or insurance status, there was no significant difference in receiving a Dix-Hallpike diagnostic maneuver, Epley maneuver, vestibular suppressant medication, imaging, or referral to a specialist. CONCLUSION Our data suggest that there continue to be gaps in the adherence to AAO-HNS guidelines; however, these gaps did not differ by sex, race, or insurance status. Care should be taken to increase the use of diagnostic and treatment maneuvers but decrease the use of vestibular-suppressant medications for the treatment of BPPV in PC.
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Affiliation(s)
| | - Alex Cherches
- Duke University School of Medicine, Durham, North Carolina, USA
| | - Sherri L Smith
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina, USA
- Department of Population Health Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Kristal M Riska
- Department of Head and Neck Surgery and Communication Sciences, Duke University School of Medicine, Durham, North Carolina, USA
- Center for the Study of Aging and Human Development, Duke University School of Medicine, Durham, North Carolina, USA
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Noda M, Kuroda T, Nomura A, Ito M, Yoshizaki T, Fushiki H. Smartphone-Assisted Medical Care for Vestibular Dysfunction as a Telehealth Strategy for Digital Therapy Beyond COVID-19: Scoping Review. JMIR Mhealth Uhealth 2023; 11:e48638. [PMID: 37695671 PMCID: PMC10496931 DOI: 10.2196/48638] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 06/13/2023] [Accepted: 08/08/2023] [Indexed: 09/12/2023] Open
Abstract
BACKGROUND Dizziness and vertigo can be caused by various factors, such as peripheral vestibular and central disorders. Although consultations with specialists are advisable when necessary, patients with severe vertigo symptoms may have limited mobility, which may interfere with hospital visits. The spread of COVID-19 has further limited the number of hospital visits for patients with dizziness; therefore, a method of medical care that enables more accurate treatment under time and geographical constraints is needed. Telemedicine has become widespread, owing to the popularity of smartphone and tablet devices in recent years, and the use of devices and systems has made it possible to provide efficient medical care. However, no previous scoping review has mapped existing studies on telemedicine for vertigo and dizziness, and no recommendations have been made regarding which devices and systems should be used for specific diseases. OBJECTIVE The aim of this review was to map and assess previous studies on the use of information communications technology, smartphones, and apps for treating patients with vertigo and discuss the added value of introducing telemedicine to improve the quality of medical care and create an environment that builds security and trust among patients. METHODS A scoping review was conducted with the methodological framework of Arksey and O'Malley and in accordance with the of the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analysis extension for Scoping Reviews) guidelines. The PubMed, MEDLINE, and Cochrane Library databases were searched to retrieve previous reports on smartphone-assisted telemedicine treatment for vertigo published between January 2000 and May 2023. Two authors independently assessed eligibility and extracted data. RESULTS This review included 20 papers that reported devices or systems for telemedicine for vestibular dysfunction. Among studies that reported the use of a device or app, 2 were related to anamnesis and subjective symptoms, 12 were related to objective examination, 7 were related to remote diagnosis, and 7 were related to treatment and rehabilitation. CONCLUSIONS With the advancement of technology, the use of telemedicine in patients with dizziness may be feasible. In the future, it will be necessary to consider how telemedicine can be used in dizziness treatment and develop an effective treatment system combining in-person medical care and the effective use of devices for the management of severe vertigo and related diseases. The smooth introduction of telemedicine in vertigo treatment is expected to improve the quality of treatment, increase opportunities for patients to receive medical care, and reduce time and travel costs, leading to a sense of security and trust among patients.
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Affiliation(s)
- Masao Noda
- Department of Otolaryngology, Jichi Medical University, Shimotsuke, Japan
- Mejiro University Ear Institute Clinic, Saitama, Japan
| | - Tatsuaki Kuroda
- Mejiro University Ear Institute Clinic, Saitama, Japan
- Kuroda Ear, Nose and Throat Clinic, Kumamoto, Japan
| | - Akihiro Nomura
- College of Transdisciplinary Sciences for Innovation, Kanazawa University, Kanazawa, Japan
| | - Makoto Ito
- Department of Otolaryngology, Jichi Medical University, Shimotsuke, Japan
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Feasibility of an inertial measurement unit sensor-based guiding system for benign paroxysmal positional vertigo treatment: A pilot study. Sci Rep 2023; 13:3169. [PMID: 36823440 PMCID: PMC9950366 DOI: 10.1038/s41598-023-29685-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 02/08/2023] [Indexed: 02/25/2023] Open
Abstract
Performing an accurate canalith repositioning procedure (CRP) is important for treating benign paroxysmal positional vertigo, because inadequate rotational head angles can result in ineffective otolith mobilization and consequent treatment failure. Specialists-guided Epley maneuver reportedly had mean errors of 13.7°-24.4° while they were significantly larger (40.0°-51.5°) when self-administered. Similar results were obtained for the Barbeque maneuver: mean errors were 9.2°-13.0° by the specialists while they were significantly larger (22.9°-28.6°) when self-administered. Our study aimed to validate the feasibility of an inertial measurement unit sensor-based CRP (IMU-CRP) by analyzing the differences in accuracy in the rotational angles, comparing them with education-based conventional CRP (EDU-CRP). A pilot validation was also performed by analyzing the treatment success rate of IMU-CRP in patients with BPPV. This single-institution prospective, comparative effectiveness study examined 19 participants without active vertigo or prior knowledge of benign paroxysmal positional vertigo and CRP. Participants conducted the Epley and Barbeque roll maneuvers without and with auditory guidance (EDU-CRP vs. IMU-CRP, respectively) twice, and head rotation accuracies were compared. Differences in target angles based on the American Academy of Otolaryngology-Head and Neck Surgery guidelines were considered errors. For BPPV participants, treatment success was assessed based on the presence or absence of nystagmus, vertigo, and dizziness. For all the Epley and Barbeque roll maneuvers steps, the absolute errors were smaller for IMU- than for EDU-CRPs, with significant differences in steps 2-4 and 3-6 of the Epley and Barbeque roll maneuvers, respectively. A learning effect was found in steps 4 and 5 of the Barbeque roll maneuver but not in the Epley maneuver. The treatment success rates after 1 h were 71.4% and 100% for the Epley and Barbeque roll maneuvers, respectively. Real-time feedback on head rotation angles induced more appropriate movements in the Epley and Barbeque roll maneuvers. A guiding device based on head monitoring providing real-time auditory feedback may increase the self-administered CRP success rates in treating benign paroxysmal positional vertigo.
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AKBAŞ RN. Vestibüler Rehabilitasyonda Sanal Gerçeklik Teknolojisi. İSTANBUL GELIŞIM ÜNIVERSITESI SAĞLIK BILIMLERI DERGISI 2021. [DOI: 10.38079/igusabder.999714] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
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Heffernan A, Abdelmalek M, Nunez DA. Virtual and augmented reality in the vestibular rehabilitation of peripheral vestibular disorders: systematic review and meta-analysis. Sci Rep 2021; 11:17843. [PMID: 34497323 PMCID: PMC8426502 DOI: 10.1038/s41598-021-97370-9] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2021] [Accepted: 08/23/2021] [Indexed: 02/07/2023] Open
Abstract
Vestibular rehabilitation therapy is an established treatment for patients with vestibular dysfunction. Virtual reality (VR) and augmented reality (AR) can be utilised in vestibular rehabilitation. Evidence of the efficacy of VR and AR delivered rehabilitation in patients with peripheral vestibular disorders is reviewed. MEDLINE, EMBASE, CENTRAL, CINAHL, PsychInfo, PsychBITE, OTSeeker, Ei Compendex, IEE, Clinical trials.gov and WebofScience databases were searched. Reduction in vestibular dysfunction symptoms 0-3 months post-intervention was the primary outcome. Secondary outcomes included long-term symptom improvement and side effects. Risk of bias assessment and meta analyses were planned. Five studies meeting eligibility criteria were included. Dizziness Handicap Inventory (DHI) scores 0-3 months post-intervention were reported by four studies. Meta-analysis identified a 1.13 (95% CI, - 1.74, - 0.52) standardized mean difference reduction in DHI in VR and AR treated patients compared to controls. Side effects reported by two studies were reduced by week four of VR intervention. Bias assessment identified DHI scores and side effects to be at high risk or of some concern. Adjunct VR interventions reduced patient DHI significantly more than vestibular rehabilitation alone 0-3 months post-intervention in adult patients diagnosed with unilateral vestibular disease. High quality studies are needed.
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Affiliation(s)
- Austin Heffernan
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of British Columbia, 2775 Laurel Street, 4th floor, Vancouver, BC, V5Z 1M9, Canada
| | - Mohammed Abdelmalek
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of British Columbia, 2775 Laurel Street, 4th floor, Vancouver, BC, V5Z 1M9, Canada
| | - Desmond A Nunez
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, University of British Columbia, 2775 Laurel Street, 4th floor, Vancouver, BC, V5Z 1M9, Canada.
- Division of Otolaryngology - Head and Neck Surgery, Department of Surgery, Vancouver General Hospital, Vancouver, BC, Canada.
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Moroz M, Choy M, Lee CW, Hadfield H, Lasenby J, Stone T, Bance M. Evaluating the Epley Canalolith Repositioning Procedure With and Without a Visual Assistive Device. Otol Neurotol 2021; 42:765-773. [PMID: 33492058 DOI: 10.1097/mao.0000000000003017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
HYPOTHESIS The primary goal of this study was to examine how accuracy is affected when we employ a guidance device to assist with the execution of the Epley canalolith repositioning procedure. BACKGROUND Benign paroxysmal positional vertigo is a common cause of vestibular vertigo. Treatment is noninvasive and generally effective when performed correctly. Deficiencies in clinical application result in unnecessary failures in response for those affected. METHODS Ten participants were each taken through six iterations of the Epley canalolith repositioning procedure. Iterations were divided evenly between those conducted with and without the use of a guidance device. One clinician performed all 60 procedures. Head movements were recorded using motion capture cameras and strategically placed motion tracking markers. RESULTS Results showed that the guidance device significantly improved the latter phase maneuver accuracy. Rotation error was significantly reduced for hold3 with-device (M = 20.23°, SD = 12.08°) versus without-device (M = 40.13°, SD = 14.62°, p = 0.001). Maximal rotation error during rotation4 of the maneuver demonstrated a similar reduction of error with-device (M = 24.44°, SD = 10.43°) versus without-device (M = 41.36°, SD = 12.89°, p = 0.002). CONCLUSION A simple visual guidance device can increase the execution accuracy of canalith repositioning procedures. Further research is required to show how such improvements influence treatment efficacy.
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Affiliation(s)
| | - Matthew Choy
- School of Clinical Medicine, University of Cambridge
| | - Chang Woo Lee
- Department of ENT, Royal Surrey County Hospital, Guildford
| | | | - Joan Lasenby
- Department of Engineering, University of Cambridge
| | - Thomas Stone
- Department of Clinical Engineering, Addenbrooke's Hospital, Cambridge, UK
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Kwon C, Ku Y, Seo S, Jang E, Kong HJ, Suh MW, Kim HC. Quantitative assessment of self-treated canalith repositioning procedures using inertial measurement unit sensors. J Vestib Res 2021; 31:423-431. [PMID: 33646186 DOI: 10.3233/ves-190747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND Low success and high recurrence of benign paroxysmal positional vertigo (BPPV) after home-based self-treated Epley and Barbeque (BBQ) roll maneuvers is an important issue. OBJECTIVE To quantify the cause of low success rate of self-treated Epley and BBQ roll maneuvers and provide a clinically acceptable criterion to guide self-treatment head rotations. METHODS Twenty-five participants without active BPPV wore a custom head-mount rotation monitoring device for objective measurements. Self-treatment and specialist-assisted maneuvers were compared for head rotation accuracy. Absolute differences between the head rotation evaluation criteria (American Academy of Otolaryngology guidelines) and measured rotation angles were considered as errors. Self-treatment and specialist-treated errors in maneuvers were compared. Between-trial variations and age effects were evaluated. RESULTS A significantly large error and between-trial variation occurred in step 4 of the self-treated Epley maneuver, with a considerable error in the second trial. The cumulative error of all steps of self-treated BBQ roll maneuver was significantly large. Age effect occurred only in the self-treated BBQ roll maneuver. Errors in specialist-treated maneuvers ranged from 10 to 20 degrees. CONCLUSIONS Real-time feedback of head movements during simultaneous head-body rotations could increase success rates of self-treatments. Specialist-treated maneuvers can be used as permissible rotation margin criteria.
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Affiliation(s)
- Chiheon Kwon
- Institute of Medical & Biological Engineering, Medical Research Center, Seoul National University, Seoul, Korea
| | - Yunseo Ku
- Department of Biomedical Engineering, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Shinhye Seo
- Department of Biomedical Engineering, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Eunsook Jang
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hyoun-Joong Kong
- Department of Biomedical Engineering, College of Medicine, Chungnam National University, Daejeon, Korea
| | - Myung-Whan Suh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Hee Chan Kim
- Institute of Medical & Biological Engineering, Medical Research Center, Seoul National University, Seoul, Korea.,Interdisciplinary Program in Bioengineering, Graduate School, Seoul National University, Seoul, Korea.,Department of Biomedical Engineering, College of Medicine, Seoul National University, Seoul, Korea
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Chong JC, Tan CHN, Chen DZ. Teleophthalmology and its evolving role in a COVID-19 pandemic: A scoping
review. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2021. [DOI: 10.47102/annals-acadmedsg.2020459] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
ABSTRACT
Introduction: Teleophthalmology may assist the healthcare sector in adapting to limitations imposed on
clinical practice by a viral pandemic. A scoping review is performed in this study to assess the current
applications of teleophthalmology for its suitability to diagnose, monitor or manage ophthalmological
conditions with accuracy.
Methods: A search of PubMed was conducted for teleophthalmology-related articles published from
1 January 2018 to 4 May 2020. Only articles that focused on the use of teleophthalmology in terms of
diagnosis and management, as well as its benefits and detriments, were included. The Mixed Methods
Appraisal Tool (MMAT) was used to assess the quality of the included articles.
Results: A total of 38 articles were assessed at the full-text level. There were 2 qualitative studies and
1 quantitative randomised controlled trial, while the majority were either quantitative descriptive studies
(19, 50.0%) or quantitative non-randomised studies (16, 42.1%). Overall, 8 studies described reducing
manpower requirements, 4 described reducing direct patient–doctor contact, 17 described storage of
medical imaging and clinical data, and 9 described real-time teleconferencing. The MMAT analysis
revealed limitations in appropriate sampling strategy in both quantitative non-randomised studies (9 of
16, 56.3%) and quantitative descriptive studies (9 of 19, 47.4%). Cost-effectiveness of teleophthalmology
was not performed in any included study.
Conclusion: This current review of the various aspects of teleophthalmology describes how it may
potentially assist the healthcare sector to cope with the limitations imposed by a viral pandemic through
technology. Further research is required to evaluate the cost-effectiveness of the various strategies.
Keywords: Artificial intelligence, health informatics, ophthalmology, teleconsultation, telemedicine
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Shim DB. Treatment of Benign Paroxysmal Positional Vertigo: An Approach Considering Patients' Convenience. Clin Exp Otorhinolaryngol 2020; 13:320-321. [PMID: 33176399 PMCID: PMC7669313 DOI: 10.21053/ceo.2020.02082] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/07/2020] [Accepted: 10/21/2020] [Indexed: 11/22/2022] Open
Affiliation(s)
- Dae Bo Shim
- Department of Otorhinolaryngology, Myongji Hospital, Hanyang University College of Medicine, Goyang, Korea
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Smartphone-enabled wireless otoscope-assisted online telemedicine during the COVID-19 outbreak. Am J Otolaryngol 2020; 41:102476. [PMID: 32305252 PMCID: PMC7128762 DOI: 10.1016/j.amjoto.2020.102476] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2020] [Accepted: 04/01/2020] [Indexed: 11/20/2022]
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Snoswell AJ, Snoswell CL. Immersive Virtual Reality in Health Care: Systematic Review of Technology and Disease States. JMIR BIOMEDICAL ENGINEERING 2019. [DOI: 10.2196/15025] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/03/2023] Open
Abstract
Background
Immersive virtual reality (IVR) presents new possibilities for application in health care. Health care professionals can now immerse their patients in environments to achieve exposure to a specific scene or experience, evoke targeted emotional responses, inspire, or distract from an experience occurring in reality.
Objective
This review aimed to identify patient-focused applications for head-mounted IVR for acute treatment of health conditions and determine the technical specifications of the systems used.
Methods
A systematic review was conducted by searching medical and engineering peer-reviewed literature databases in 2018. The databases included PubMed, EMBASE, Cumulative Index to Nursing and Allied Health Literature, Association for Computing Machinery, Institute of Electrical and Electronics Engineers, Scopus, and Web of Science. Search terms relating to health and IVR were used. To be included, studies had to investigate the effectiveness of IVR for acute treatment of a specific health condition. IVR was defined as a head-mounted platform that provides virtual and auditory immersion for the participant and includes a minimum of 3 degrees of orientation tracking. Once identified, data were extracted from articles and aggregated in a narrative review format.
Results
A total of 58 studies were conducted in 19 countries. The studies reported IVR use for 5 main clinical areas: neurological and development (n=10), pain reduction through distraction (n=20), exposure therapy for phobias (n=9), psychological applications (n=14), and others (n=5). Studies were primarily feasibility studies exploring systems and general user acceptance (n=29) and efficacy studies testing clinical effect (n=28).
Conclusions
IVR has a promising future in health care, both in research and commercial realms. As many of the studies examined are still exploring the feasibility of IVR for acute treatment of health conditions, evidence for the effectiveness of IVR is still developing.
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