[Management of vertigo and dizziness]

Validation and reliability analysis of the Questionnaire on the Emotional Impact of Vertigo-CIEV version translated to the Brazilian Portuguese language

PURPOSE

To determine the internal consistency and reliability of the "Questionário de Impacto Emocional da Vertigem (CIEV)" and to validate the instrument with respect to the Dizziness Handicap Inventory (DHI) in a sample of individuals with balance disorders.

METHODS

38 subjects participated in the study, males and females, aged from 23 to 85 years, who presented dizziness, vertigo, and/or falls complaints and attended to the Vestibular Disorders clinic at the University Hospital. Individuals with hearing complaints and/or tinnitus unrelated to dizziness, previous psychiatric comorbidities, and/or cognitive impairments were excluded. We performed an anamnesis and collected complementary data from the medical records. After that, the self-perception questionnaires, DHI, and CIEV, were applied. Statistical analysis was performed in which the Cronbach's alpha verified the internal consistency of the CIEV. Reliability and validity of the CIEV related to the DHI were calculated using Intraclass Correlation Index (ICC) and Pearson's correlation test, respectively.

RESULTS

There was a statistically significant correlation between the scores obtained, for both reliability and validation analysis (p<0.001). The mean ICC showed a moderate correlation between the total scores (0.695) and a strong correlation with the physical, emotional, and functional DHI domains (0.706 to 0.869), being the emotional aspect the highest degree (0.869). Pearson's correlation showed strong correlation between the total scores (r=0.820) and varied from moderate to strong, with strongest correlations to the DHI emotional domain (r=0.788).

CONCLUSION

The outcomes illustrate important contribution to validation parameters to consider clinical use of the CIEV in the Brazilian population, aiming to identify emotional aspects in patients with balance disorders.

[Effect of body mass index on efficacy of the repositioning procedure for horizontal canal benign paroxysmal positional vertigo]

Objective:To evaluate the effect of body mass index （BMI） on efficacy of the repositioning procedure for horizontal canal benign paroxysmal positional vertigo （HC-BPPV）. Methods:A total of 172 patients diagnosed with HC-BPPV in the First Affiliated Hospital of Xi'an Jiaotong University School of Medicine from Jan 2021 to Oct 2021 were enrolled. The patients were divided into low BMI group（BMI<24 kg/m² ） and high BMI group（BMI≥24 kg/m²）. The two groups underwent manual repositioning procedure and vertigo treatment system procedure by Barbecue method according to their orders of visits. After two circles of repositioning, the influencing factors of repositioning were analyzed according to efficiency. Results:The effective rate of manual repositioning in HC-BPPV patients was 33.64%, and the effective rate of vertigo treatment system was 63.08%,the effective rate of vertigo treatment system repositioning was higher than that of manual repositioning （P<0.05）. The effective rate of manual repositioning in the low BMI group （58.70%） was higher than that in the high BMI group （14.75%）, P<0.05. The effective rate of vertigo treatment system repositioning was higher in the low BMI group （75.00%） than that in the high BMI group （54.05%）, but there was no statistically significant difference between the two BMI groups （P>0.05）. Logistic regression analysis suggested that BMI was the influencing factor of HC-BPPV repositioning efficacy （P<0.05）. Conclusion:BMI can affect the efficacy of HC-BPPV manual repositioning. Vertigo treatment system for HC-BPPV reduction is better than manual reduction, and the efficacy is not affected by BMI.

Estimating the causal effect of frailty index on vestibular disorders: A two-sample Mendelian randomization

Background

Frailty index and vestibular disorders appear to be associated in observational studies, but causality of the association remains unclear.

Methods

A two-sample Mendelian randomization (MR) study was implemented to explore the causal relationship between the frailty index and vestibular disorders in individuals of European descent. A genome-wide association study (GWAS) of frailty index was used as the exposure (n = 175, 226), whereas the GWAS of vestibular disorders was the outcome (n = 462,933). MR Steiger filtering method was conducted to investigate the causal effect of the frailty index on vestibular disorders. An inverse variance weighted (IVW) approach was used as the essential approach to examine the causality. Additionally, the MR-Egger methods, the simple mode analysis, the weighted median analysis, and the weighted mode analysis were used as supplementary methods. The MR-PRESSO analysis, the MR-Egger intercept analysis, and Cochran's Q statistical analysis also were used to detect the possible heterogeneity as well as directional pleiotropy. To evaluate this association, the odds ratio (OR) with 95% confidence intervals (CIs) was used. All statistical analyses were performed in R. The STROBE-MR checklist for the reporting of MR studies was used in this study.

Results

In total, 14 single nucleotide polymorphisms (SNPs) were identified as effective instrumental variables (IVs) in the two sample MR analyses. The significant causal effect of the frailty index on vestibular disorders was demonstrated by IVW method [OR 1.008 (95% CI 1.003, 1.013), p = 0.001]. Results from the various sensitivity analysis were consistent. The “leave-one-out” analysis indicated that our results were robust even without a single SNP. According to the MR-Egger intercept test [intercept = −0.000151, SE = 0.011, p = 0.544], genetic pleiotropy did not affect the results. No heterogeneity was detected by Cochran's Q test. Results of MR Steiger directionality test indicated the accuracy of our estimate of the potential causal direction (Steiger p < 0.001).

Conclusion

The MR study suggested that genetically predicted frailty index may be associated with an increased risk of vestibular disorders. Notably, considering the limitations of this study, the causal effects between frailty index and vestibular disorders need further investigation. These results support the importance of effectively managing frailty which may minimize vestibular disorders and improve the quality of life for those with vestibular disorders.