1
|
Lasrich M, Helling K, Strieth S, Bahr-Hamm K, Vogt TJ, Fröhlich L, Send T, Hill K, Nitsch L, Rader T, Bärhold F, Becker S, Ernst BP. [Increased report completeness and satisfaction with structured neurotological reporting in the interdisciplinary assessment of vertigo]. HNO 2024:10.1007/s00106-024-01464-5. [PMID: 38592481 DOI: 10.1007/s00106-024-01464-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/04/2024] [Indexed: 04/10/2024]
Abstract
BACKGROUND Results of neurotological function diagnostics in the context of interdisciplinary vertigo assessment are usually formulated as free-text reports (FTR). These are often subject to high variability, which may lead to loss of information. The aim of the present study was to evaluate the completeness of structured reports (SR) and referrer satisfaction in the neurotological assessment of vertigo. MATERIALS AND METHODS Neurotological function diagnostics performed as referrals (n = 88) were evaluated retrospectively. On the basis of the available raw data, SRs corresponding to FTRs from clinical routine were created by means of a specific SR template for neurotological function diagnostics. FTRs and SRs were evaluated for completeness and referring physician satisfaction (n = 8) using a visual analog scale (VAS) questionnaire. RESULTS Compared to FTRs, SRs showed significantly increased overall completeness (73.7% vs. 51.7%, p < 0.001), especially in terms of patient history (92.5% vs. 66.7%, p < 0.001), description of previous findings (87.5% vs. 38%, p < 0.001), and neurotological (33.5% vs. 26.7%, p < 0.001) and audiometric function diagnostics (58% vs. 32.3%, p < 0.001). In addition, SR showed significantly increased referring physician satisfaction (VAS 8.8 vs. 4.9, p < 0.001). CONCLUSION Neurotological SRs enable a significantly increased report completeness with higher referrer satisfaction in the context of interdisciplinary assessment of vertigo. Furthermore, SRs are particularly suitable for scientific data analysis, especially in the context of big data analyses.
Collapse
Affiliation(s)
- M Lasrich
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Bonn, Deutschland
| | - K Helling
- Hals‑, Nasen‑, Ohrenklinik und Poliklinik - Plastische Operationen, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - S Strieth
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Bonn, Deutschland
| | - K Bahr-Hamm
- Hals‑, Nasen‑, Ohrenklinik und Poliklinik - Plastische Operationen, Universitätsmedizin der Johannes Gutenberg-Universität Mainz, Mainz, Deutschland
| | - T J Vogt
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Bonn, Deutschland
| | - L Fröhlich
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Bonn, Deutschland
| | - T Send
- Klinik und Poliklinik für Hals-Nasen-Ohren-Heilkunde, Universitätsklinikum Bonn, Bonn, Deutschland
| | - K Hill
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - L Nitsch
- Klinik und Poliklinik für Neurologie, Universitätsklinikum Bonn, Bonn, Deutschland
| | - T Rader
- Klinik und Poliklinik für Hals-Nasen-Ohrenheilkunde, Abteilung Audiologie, LMU Klinikum der Ludwig-Maximilians-Universität München, München, Deutschland
| | - F Bärhold
- Nasen- und Ohrenheilkunde, Universitätsklinikum Tübingen, Universitätsklinik für Hals-, Tübingen, Deutschland
| | - S Becker
- Nasen- und Ohrenheilkunde, Universitätsklinikum Tübingen, Universitätsklinik für Hals-, Tübingen, Deutschland
| | - B P Ernst
- Klinik für Hals‑, Nasen‑, Ohrenheilkunde, Universitätsklinikum Frankfurt, Theodor-Stern-Kai 7, 60590, Frankfurt, Deutschland.
| |
Collapse
|
2
|
Riato MLDC, Rocha VBC, Mezzalira R, Stoler G, do Amaral MIR. Validation and reliability analysis of the Questionnaire on the Emotional Impact of Vertigo-CIEV version translated to the Brazilian Portuguese language. Codas 2023; 35:e20220176. [PMID: 38055412 PMCID: PMC10750823 DOI: 10.1590/2317-1782/20232022176pt] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Accepted: 11/03/2022] [Indexed: 12/08/2023] Open
Abstract
PURPOSE To determine the internal consistency and reliability of the "Questionário de Impacto Emocional da Vertigem (CIEV)" and to validate the instrument with respect to the Dizziness Handicap Inventory (DHI) in a sample of individuals with balance disorders. METHODS 38 subjects participated in the study, males and females, aged from 23 to 85 years, who presented dizziness, vertigo, and/or falls complaints and attended to the Vestibular Disorders clinic at the University Hospital. Individuals with hearing complaints and/or tinnitus unrelated to dizziness, previous psychiatric comorbidities, and/or cognitive impairments were excluded. We performed an anamnesis and collected complementary data from the medical records. After that, the self-perception questionnaires, DHI, and CIEV, were applied. Statistical analysis was performed in which the Cronbach's alpha verified the internal consistency of the CIEV. Reliability and validity of the CIEV related to the DHI were calculated using Intraclass Correlation Index (ICC) and Pearson's correlation test, respectively. RESULTS There was a statistically significant correlation between the scores obtained, for both reliability and validation analysis (p<0.001). The mean ICC showed a moderate correlation between the total scores (0.695) and a strong correlation with the physical, emotional, and functional DHI domains (0.706 to 0.869), being the emotional aspect the highest degree (0.869). Pearson's correlation showed strong correlation between the total scores (r=0.820) and varied from moderate to strong, with strongest correlations to the DHI emotional domain (r=0.788). CONCLUSION The outcomes illustrate important contribution to validation parameters to consider clinical use of the CIEV in the Brazilian population, aiming to identify emotional aspects in patients with balance disorders.
Collapse
Affiliation(s)
- Maria Luiza di Carlo Riato
- Programa de Graduação em Fonoaudiologia, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP - Campinas (SP), Brasil.
- Departamento de Desenvolvimento Humano e Reabilitação, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP - Campinas (SP), Brasil.
| | - Vanessa Brito Campoy Rocha
- Departamento de Otorrinolaringologia, Cabeça e Pescoço, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP - Campinas (SP), Brasil.
| | - Raquel Mezzalira
- Departamento de Otorrinolaringologia, Cabeça e Pescoço, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP - Campinas (SP), Brasil.
| | - Guita Stoler
- Departamento de Otorrinolaringologia, Cabeça e Pescoço, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP - Campinas (SP), Brasil.
| | - Maria Isabel Ramos do Amaral
- Departamento de Desenvolvimento Humano e Reabilitação, Faculdade de Ciências Médicas, Universidade Estadual de Campinas - UNICAMP - Campinas (SP), Brasil.
| |
Collapse
|
3
|
Chen X, Zheng X, Chen Y, Xu S. Otosyphilis as a rare cause of secondary benign paroxysmal positional vertigo: a case report. J Int Med Res 2023; 51:3000605231153317. [PMID: 37365906 DOI: 10.1177/03000605231153317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/28/2023] Open
Abstract
Otosyphilis is a rare cause of audiovestibular dysfunction that can easily be misdiagnosed. Here, we report a rare case in which a patient presented with secondary benign paroxysmal positional vertigo (BPPV) 2 weeks after symptoms of otosyphilis appeared. The Dix-Hallpike test showed a classical response in the head-hanging left position. The patient was treated with intravenous penicillin G and the canalith repositioning maneuver, which completely resolved the vertigo. The patient's audiovestibular symptoms resolved gradually. The elevated cerebrospinal fluid (CSF) white blood cell (WBC) count returned to normal and the results of the Treponema pallidum particle agglutination (TPPA) test were negative at the 3-month follow-up. This report suggests that otosyphilis should be considered in the differential diagnosis of audiovestibular dysfunction in patients at risk. Additionally, clinicians should remain vigilant about the possibility of secondary BPPV in patients with otosyphilis who report positional vertigo.
Collapse
Affiliation(s)
- Xiang Chen
- Department of Internal Medicine, Shengsi County People's Hospital, Zhoushan City, China
| | - Xiaofen Zheng
- Department of Internal Medicine, Shengsi County People's Hospital, Zhoushan City, China
| | - Yingzhi Chen
- Department of Internal Medicine, Shengsi County People's Hospital, Zhoushan City, China
| | - Shanhu Xu
- Department of Neurology, Zhejiang Hospital, Hangzhou City, China
| |
Collapse
|
4
|
Pérez-Fernández N, Saez Coronado S, Zulueta-Santos C, Neria Serrano F, Rey-Martinez J, Blanco M, Manrique-Huarte R. A Paradoxical Clinical Coincidence: Benign Paroxysmal Positional Vertigo and Bilateral Vestibulopathy. J Clin Med 2023; 12:jcm12103413. [PMID: 37240519 DOI: 10.3390/jcm12103413] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2023] [Revised: 04/30/2023] [Accepted: 05/02/2023] [Indexed: 05/28/2023] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) and bilateral vestibulopathy (BVL) are two completely different forms of vestibular disorder that occasionally occur in the same patient. We conducted a retrospective review searching for that coincidence in our database of the patients seen over a 15-year period and found this disorder in 23 patients, that is 0.4%. More frequently they occurred sequentially (10/23) and BPPV was diagnosed first. Simultaneous presentation occurred in 9/23 patients. It was subsequently studied, but in a prospective manner, in patients with BPPV on all of whom a video head impulse test was performed to search for bilateral vestibular loss; we found it was slightly more frequent (6/405). Both disorders were treated accordingly, and it was found that the results follow the general trend in patients with only one of those disorders.
Collapse
Affiliation(s)
- Nicolás Pérez-Fernández
- Department of Otorhinolaryngology, Marquesado de Santa Marta 1, Clínica Universidad de Navarra, 28047 Madrid, Spain
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| | - Sara Saez Coronado
- Department of Otorhinolaryngology, Hospital Universitario de Móstoles, 28938 Madrid, Spain
| | - Cristina Zulueta-Santos
- Department of Otorhinolaryngology, Marquesado de Santa Marta 1, Clínica Universidad de Navarra, 28047 Madrid, Spain
| | - Fernando Neria Serrano
- Department of Otorhinolaryngology, Facultad de Medicina, Universidad Francisco de Vitoria, 28223 Madrid, Spain
| | - Jorge Rey-Martinez
- Department of Otorhinolaryngology, Hospital Universitario Donostia, 20014 San Sebastian, Spain
| | - Melisa Blanco
- Department of Otorhinolaryngology, Marquesado de Santa Marta 1, Clínica Universidad de Navarra, 28047 Madrid, Spain
| | - Raquel Manrique-Huarte
- Department of Otorhinolaryngology, Clínica Universidad de Navarra, 31008 Pamplona, Spain
| |
Collapse
|
5
|
Evaluation of a questionnaire as a screening tool for benign paroxysmal position vertigo. Eur Arch Otorhinolaryngol 2023; 280:1919-1926. [PMID: 36422670 DOI: 10.1007/s00405-022-07744-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Accepted: 11/07/2022] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To determine the value of a questionnaire as a screening tool for benign paroxysmal position vertigo (BPPV). STUDY DESIGN Retrospective chart review. SETTING Tertiary care centers. METHODS A total of 520 vertigo adults completed the questionnaire before the diagnosis was confirmed. After vestibular function examination and other diagnostic examination, the diagnosis of all participants was confirmed by experts. By validating valuable items from the questionnaire with 47 items, a new questionnaire of 5 items was formed to quickly diagnose BPPV. The internal consistency of the new questionnaire and validity were evaluated. The correlation between the score obtained from the new questionnaire and diagnosis was investigated. The mean score was also compared between groups with and without BPPV and diagnostic precision measures were calculated. RESULTS 520 vertigo participants answered all the question completely and BPPV was identified in 138 participants (26.5%). The responses to questionnaire revealed preferable reproducibility (r = 0.898, P < 0.05) and internal consistency (Cronbach's α = 0.702) as well as the validity (Kaiser-Meyer-Olkin, KMO = 0.731). The higher the individual score, the more likely to be BPPV (B = 2.082; P < 0.05). The mean score of answers was greater in the group with a clinical diagnosis of BPPV compared to those without BPPV (F = 58.459, P < 0.05). The sensitivity of the screening tool was 92.8% and specificity was 88.5%, with an area under the ROC curve of 0.946 (95% confidence interval 0.926-0.965; P < 0.05). CONCLUSION The questionnaire proved to be of great value to screen for individuals with possible BPPV.
Collapse
|
6
|
Bradshaw S, Graco M, Holland A. Barriers and facilitators to guideline-recommended care of benign paroxysmal positional vertigo in the ED: a qualitative study using the theoretical domains framework. Emerg Med J 2023; 40:335-340. [PMID: 36792342 DOI: 10.1136/emermed-2022-212585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2022] [Accepted: 01/31/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Benign paroxysmal positional vertigo (BPPV) is a common presentation to the ED. Evidence suggests low adherence to guideline-recommended care, but the reasons underlying this are poorly understood. This study used the theoretical domains framework (TDF) to explore the barriers and facilitators to medical and physiotherapy clinical practices in the management of BPPV in an Australian metropolitan ED. METHODS From May to December 2021, semistructured interviews were conducted with 13 medical staff and 13 physiotherapists who worked at an ED in Melbourne, Australia. Interviews used the TDF to explore the perceived barriers and facilitators to the delivery of guideline-recommended assessment and treatment techniques for BPPV. Data were analysed thematically to identify relevant domains and generate themes and belief statements. RESULTS Fifteen belief statements representing eight domains of the TDF were identified as key factors in the management of BPPV in the ED. The most prominent domains were knowledge and skills due to their conflicting belief statements between professions concerning education, skill development and self-confidence; memory, attention and decision processes for the perceived complexity of the presentation including difficulty recalling diagnostic and treatment techniques; and environmental context and resources for their shared belief statements concerning time and workload pressures. The availability of vestibular physiotherapy was considered both a barrier and facilitator to the delivery of recommended care by medical staff, but a barrier to independent practice as it unintentionally limited the opportunities for skill development in medical staff. CONCLUSION Several modifiable barriers and facilitators to the management of BPPV in the ED have been identified. Differences were observed between the professional groups, and these findings will guide a future intervention to improve the use of guideline-recommended assessment and treatment techniques for BPPV in ED.
Collapse
Affiliation(s)
- Sally Bradshaw
- Emergency and Trauma Centre, Alfred Health, Melbourne, Victoria, Australia .,School of Allied Health, La Trobe University, Bundoora Campus, Melbourne, Victoria, Australia.,Physiotherapy Department, Alfred Health, Melbourne, Victoria, Australia
| | - Marnie Graco
- Physiotherapy Department, Alfred Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.,Department of Physiotherapy, School of Health Sciences, University of Melbourne, Melbourne, Victoria, Australia
| | - Anne Holland
- Physiotherapy Department, Alfred Health, Melbourne, Victoria, Australia.,Institute for Breathing and Sleep, Austin Health, Heidelberg, Victoria, Australia.,Respiratory Research, Central Clinical School, Monash University, Melbourne, Victoria, Australia
| |
Collapse
|
7
|
Thompson-Harvey A, Friedland DR, Adams JA, Tong L, Osinski K, Luo J. The Demographics of Menière's Disease: Selection Bias or Differential Susceptibility? Otol Neurotol 2023; 44:e95-e102. [PMID: 36477093 PMCID: PMC9839510 DOI: 10.1097/mao.0000000000003780] [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] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To clarify whether the reported lack of racial and ethnic diversity among Menière's disease (MD) patients is representative of selection bias or disease susceptibility. STUDY DESIGN Retrospective medical record review and population-level analyses. SETTING Tertiary referral center. PATIENTS Cohort of 1091 patients diagnosed with MD by the tertiary otology service. MAIN OUTCOME MEASURE Demographic and population-level characteristics (age, sex, race, insurance status, ZIP code, median income, education level) compared with local, regional, health system, and otolaryngology clinic demographics. RESULTS Patients seen for MD were significantly older than those seen throughout the otolaryngology clinic (median, 65.0 versus 58.8 yr) or health system (65.0 versus 50.8 yr). A majority of patients with MD were of White race (92%), compared with 2.7% Black race and 0.5% Asian. Using population-level data, median income and having medical insurance were significantly correlated with care for MD. A disproportionate rate of care for MD was seen in ZIP codes outside urban areas as compared with other otologic and otolaryngologic conditions seen in the same clinic. CONCLUSION Patients with MD are of older age, more likely to be of White race, and disproportionately from rural locales. The demographic profile of patients diagnosed with MD by tertiary otology is better explained by differential susceptibility to MD than by selection bias.
Collapse
Affiliation(s)
- Adam Thompson-Harvey
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin
| | - David R. Friedland
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin
| | - Jazzmyne A. Adams
- Department of Otolaryngology and Communication Sciences, Medical College of Wisconsin
| | - Ling Tong
- Department of Health Informatics and Administration, University of Wisconsin – Milwaukee
| | - Kristen Osinski
- Clinical and Translational Science Institute, Medical College of Wisconsin
| | - Jake Luo
- Department of Health Informatics and Administration, University of Wisconsin – Milwaukee
| |
Collapse
|
8
|
Gerlier C, Fels A, Vitaux H, Mousset C, Perugini A, Chatellier G, Ganansia O. Effectiveness and reliability of the four-step STANDING algorithm performed by interns and senior emergency physicians for predicting central causes of vertigo. Acad Emerg Med 2023; 30:487-500. [PMID: 36628557 DOI: 10.1111/acem.14659] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/17/2022] [Revised: 12/20/2022] [Accepted: 01/06/2023] [Indexed: 01/12/2023]
Abstract
BACKGROUND For emergency physicians (EPs), acute vertigo is a challenging complaint and learning a reliable clinical approach is needed. STANDING is a four-step bedside algorithm that requires (1) identifying spontaneous nystagmus with Frenzel glasses or, alternatively, a positional nystagmus; (2) characterizing the nystagmus direction; (3) assessing the vestibuloocular reflex (head impulse test); and (4) assessing the gait. The objective was to determine its accuracy for diagnosing central vertigo when using by naïve examiners as such as interns and its agreement with senior EPs. METHODS This was a prospective 1-year diagnostic cohort study among patients with vertigo, vestibulovisual symptoms, or postural symptoms seen by 20 interns trained in the four-step examination. The algorithm was performed first by an intern and second by a senior EP and categorized as either worrisome when indicating a central diagnosis and benign or inconclusive when indicating a peripheral diagnosis. The reference test was diffusion-weighted brain magnetic resonance imaging. RESULTS Among 312 patients included, 57 had a central diagnosis including 33 ischemic strokes (10.5%). The main etiology was benign paroxysmal positional vertigo (32.7%). The likelihood ratios were 4.63 and 10.33 for a worrisome STANDING, 0.09 and 0.01 for a benign STANDING, and 0.21 and 0.35 for an inconclusive STANDING, for interns and senior EPs, respectively. The algorithm showed sensitivities of 84.8% (95% CI 75.6%-93.9%) and 89.8% (95% CI 82.1%-97.5%), negative predictive values of 96.2% (95% CI 93.7%-98.6%) and 97.5% (95% CI 95.5%-99.5%), specificities of 88.9% (95% CI 85.1%-92.8%) and 91.3% (95% CI 87.8%-94.8%), and positive predictive values of 64.1% (95% CI 53.5%-74.8%) and 70.7% (95% CI 60.4%-81.0%), respectively. The agreement between interns and senior EPs was very substantial (B-statistic coefficient: 0.77) and almost perfect for each step: (1) 0.87, (2) 0.98, (3) 0.95, and (4) 0.99. CONCLUSIONS With a single training session, the algorithm reached high accuracy and reliability for ruling out central causes of vertigo in the hands of both novices and experienced EPs. A future multicenter randomized controlled trial should further its impact on unnecessary neuroimaging use and patient's satisfaction.
Collapse
Affiliation(s)
- Camille Gerlier
- Department of Emergency, Paris Saint Joseph Hospital Group, Paris, France
| | - Audrey Fels
- Department of Clinical Research, Paris Saint Joseph Hospital Group, Paris, France
| | - Hélène Vitaux
- Department of Otolaryngology, Paris Saint Joseph Hospital Group, Paris, France
| | - Carole Mousset
- Department of Otolaryngology, Paris Saint Joseph Hospital Group, Paris, France
| | - Alberto Perugini
- Department of Emergency, Paris Saint Joseph Hospital Group, Paris, France
| | - Gilles Chatellier
- Department of Clinical Research, Paris Saint Joseph Hospital Group, Paris, France.,University of Paris-Cité, Paris, France
| | - Olivier Ganansia
- Department of Emergency, Paris Saint Joseph Hospital Group, Paris, France
| |
Collapse
|
9
|
Jeong SS, Simpson KN, Johnson JM, Rizk HG. Assessment of the Cost Burden of Episodic Recurrent Vestibular Vertigo in the US. JAMA Otolaryngol Head Neck Surg 2022; 148:2797389. [PMID: 36227614 PMCID: PMC9562102 DOI: 10.1001/jamaoto.2022.3247] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Accepted: 08/26/2022] [Indexed: 01/25/2023]
Abstract
Importance Understanding of the economic burden of recurrent vestibular causes of vertigo and areas contributing to the cost is needed. Objective To analyze and identify the factors contributing to the direct medical costs associated with Ménière disease (MD), vestibular migraine (VM), and benign paroxysmal positional vertigo (BPPV). Design, Setting, and Participants This economic evaluation used MarketScan Commercial Database claims data from 2018 to identify the non-Medicare patient population with the diagnoses of MD, VM, or BPPV. Data were analyzed January 1 to December 31, 2018. Main Outcomes and Measures The total direct medical costs associated with MD, VM, and BPPV. Results A total of 53 210 patients (mean [SD] age, 47.8 [11.8] years; 67.6% female) were included in this study, with 34 738 normal comparisons. There were 5783 (10.9%) patients with MD, 3526 (6.6%) patients with VM, and 43 901 (82.5%) patients with BPPV in the data set. Mean age and sex were different across the different vestibular disorders. Across the different groups, patients with no comorbidities or with a Charlson Comorbidity Index score of zero ranged from 98.4% to 98.8%. Around 5% of patients were hospitalized with inpatient stay lasting between 4.6 and 5.2 days. After adjusting for age, sex, and comorbidities, there were large differences in mean adjusted annual payments/direct costs across the different groups (MD, $9579; VM, $11 371; and BPPV, $8247). This equated to a total incremental estimated cost of $60 billion compared with the normal population. The number of outpatient brain magnetic resonance imaging or computed tomography scans per patient ranged anywhere from 1 to 20, while the number of inpatient brain magnetic resonance imaging or computed tomography scans per patient ranged anywhere from 1 to 6. A heat map of the total cost expenditure indicated that the costs were concentrated around the Midwest, Lake Michigan, and the East Coast. Conclusions and Relevance In this economic evaluation, the 3 most common causes of recurrent vertigo-MD, VM, and BPPV-had considerable medical costs associated with them. Extraneous imaging orders and vestibular testing are factors to consider for cost reduction. However, further research and widespread education is needed to optimize the diagnosis, treatment, and care of patients presenting with vestibular disorders or dizziness.
Collapse
Affiliation(s)
- Seth S. Jeong
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Medical University of South Carolina, Charleston
- Albert Einstein College of Medicine, Bronx, New York
| | - Kit N. Simpson
- Comparative Effectiveness Data Analytic Resource Core, College of Health Professions, Medical University of South Carolina, Charleston
| | - Jada M. Johnson
- Comparative Effectiveness Data Analytic Resource Core, College of Health Professions, Medical University of South Carolina, Charleston
| | - Habib G. Rizk
- Department of Otolaryngology–Head and Neck Surgery, College of Medicine, Medical University of South Carolina, Charleston
| |
Collapse
|
10
|
Yu F, Wu P, Deng H, Wu J, Sun S, Yu H, Yang J, Luo X, He J, Ma X, Wen J, Qiu D, Nie G, Liu R, Hu G, Chen T, Zhang C, Li H. A Questionnaire-Based Ensemble Learning Model to Predict the Diagnosis of Vertigo: Model Development and Validation Study. J Med Internet Res 2022; 24:e34126. [PMID: 35921135 PMCID: PMC9386585 DOI: 10.2196/34126] [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: 10/12/2021] [Revised: 02/14/2022] [Accepted: 06/13/2022] [Indexed: 11/29/2022] Open
Abstract
Background Questionnaires have been used in the past 2 decades to predict the diagnosis of vertigo and assist clinical decision-making. A questionnaire-based machine learning model is expected to improve the efficiency of diagnosis of vestibular disorders. Objective This study aims to develop and validate a questionnaire-based machine learning model that predicts the diagnosis of vertigo. Methods In this multicenter prospective study, patients presenting with vertigo entered a consecutive cohort at their first visit to the ENT and vertigo clinics of 7 tertiary referral centers from August 2019 to March 2021, with a follow-up period of 2 months. All participants completed a diagnostic questionnaire after eligibility screening. Patients who received only 1 final diagnosis by their treating specialists for their primary complaint were included in model development and validation. The data of patients enrolled before February 1, 2021 were used for modeling and cross-validation, while patients enrolled afterward entered external validation. Results A total of 1693 patients were enrolled, with a response rate of 96.2% (1693/1760). The median age was 51 (IQR 38-61) years, with 991 (58.5%) females; 1041 (61.5%) patients received the final diagnosis during the study period. Among them, 928 (54.8%) patients were included in model development and validation, and 113 (6.7%) patients who enrolled later were used as a test set for external validation. They were classified into 5 diagnostic categories. We compared 9 candidate machine learning methods, and the recalibrated model of light gradient boosting machine achieved the best performance, with an area under the curve of 0.937 (95% CI 0.917-0.962) in cross-validation and 0.954 (95% CI 0.944-0.967) in external validation. Conclusions The questionnaire-based light gradient boosting machine was able to predict common vestibular disorders and assist decision-making in ENT and vertigo clinics. Further studies with a larger sample size and the participation of neurologists will help assess the generalization and robustness of this machine learning method.
Collapse
Affiliation(s)
- Fangzhou Yu
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Peixia Wu
- Nursing Department, Eye & ENT Hospital, Fudan University, Shanghai, China
| | - Haowen Deng
- Department of Information Management and Information Systems, Fudan University, Shanghai, China
| | - Jingfang Wu
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China.,State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, China.,National Health Commission Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Shan Sun
- National Health Commission Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China.,Institutes of Brain Science and the Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China
| | - Huiqian Yu
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China.,State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, China.,National Health Commission Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China
| | - Jianming Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, The Second Affiliated Hospital of Anhui Medical University, Hefei, China
| | - Xianyang Luo
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital, Medical College, Xiamen University, Xiamen, China
| | - Jing He
- Department of Otolaryngology-Head and Neck Surgery, The First Affiliated Hospital, Medical College, Xiamen University, Xiamen, China
| | - Xiulan Ma
- Department of Otolaryngology-Head and Neck Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Junxiong Wen
- Department of Otolaryngology-Head and Neck Surgery, Shengjing Hospital of China Medical University, Shenyang, China
| | - Danhong Qiu
- Department of Otolaryngology, Shanghai Pudong Hospital, Shanghai, China
| | - Guohui Nie
- Department of Otolaryngology, Shenzhen Second People's Hospital, Shenzhen, China
| | - Rizhao Liu
- Department of Otolaryngology, Shenzhen Second People's Hospital, Shenzhen, China
| | - Guohua Hu
- Department of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Tao Chen
- Department of Otolaryngology, The First Affiliated Hospital of Chongqing Medical University, Chongqing, China
| | - Cheng Zhang
- Department of Information Management and Information Systems, Fudan University, Shanghai, China
| | - Huawei Li
- Department of Otorhinolaryngology, Eye & ENT Hospital, Fudan University, Shanghai, China.,State Key Laboratory of Medical Neurobiology and Ministry of Education Frontiers Center for Brain Science, Fudan University, Shanghai, China.,National Health Commission Key Laboratory of Hearing Medicine, Fudan University, Shanghai, China.,Institutes of Brain Science and the Collaborative Innovation Center for Brain Science, Fudan University, Shanghai, China.,Institutes of Biomedical Sciences, Fudan University, Shanghai, China
| |
Collapse
|
11
|
Teh C, Iffah S, Prepageran N. Persistent postural-perceptual dizziness: A multispecialty survey of clinician awareness and practices in Malaysia. INDIAN JOURNAL OF OTOLOGY 2022. [DOI: 10.4103/indianjotol.indianjotol_149_21] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
12
|
Capturing vertigo in the emergency room: three tools to double the rate of diagnosis. J Neurol 2022; 269:294-306. [PMID: 34398269 DOI: 10.1007/s00415-021-10627-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 05/23/2021] [Accepted: 05/24/2021] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Many patients attending the emergency room (ER) with vertigo, leave without a diagnosis. We assessed whether the three tools could improve ER diagnosis of vertigo. METHODS A prospective observational study was undertaken on 539 patients presenting to ER with vertigo. We used three tools: a structured-history and examination, nystagmus video-oculography (VOG) in all patients, additional video head-impulse testing (vHIT) for acute-vestibular-syndrome (AVS). RESULTS In the intervention-group (n = 424), case-history classified AVS in 34.9%, episodic spontaneous-vertigo (ESV 32.1%), and episodic positional-vertigo (EPV 22.6%). In AVS, we employed "Quantitative-HINTS plus" (Head-Impulse, Nystagmus and Test-of-Skew quantified by vHIT and VOG, audiometry) to identify vestibular-neuritis (VN) and stroke (41.2 and 31.1%). vHIT gain ≤ 0.72, catch-up saccade amplitude > 1.4○, saccade-frequency > 154%, and unidirectional horizontal-nystagmus, separated stroke from VN with 93.1% sensitivity and 88.5% specificity. In ESV, 66.2 and 14% were diagnosed with vestibular migraine and Meniere's Disease by using history and audiometry. Horizontal-nystagmus velocity was lower in migraine 0.4 ± 1.6○/s than Meniere's 5.7 ± 5.5○/s (p < 0.01). In EPV, benign positional vertigo (BPV) was identified in 82.3% using VOG. Paroxysmal positional-nystagmus lasting < 60 s separated BPV from non-BPV with 90% sensitivity and 100% specificity. In the control group of ER patients undergoing management-as-usual (n = 115), diagnoses included BPV (38.3%) and non-specific vertigo (41.7%). Unblinded assessors reached a final diagnosis in 90.6 and 30.4% of the intervention and control groups. Blinded assessors provided with the data gathered from each group reached a diagnosis in 86.3 and 41.1%. CONCLUSION Three tools: a structured-assessment, vHIT and VOG doubled the rate of diagnosis in the ER.
Collapse
|
13
|
Bertholon P, Thai-Van H, Bouccara D, Esteve-Fraysse MJ, Wiener-Vacher S, Ionescu E. Conseils de bonnes pratiques de la Société française d’ORL et de chirurgie cervico-faciale (SFORL) pour la téléconsultation du patient vertigineux en pandémie COVID. ANNALES FRANÇAISES D'OTO-RHINO-LARYNGOLOGIE ET DE PATHOLOGIE CERVICO-FACIALE 2021. [PMCID: PMC8628166 DOI: 10.1016/j.aforl.2020.10.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|
14
|
Bertholon P, Thai-Van H, Bouccara D, Esteve-Fraysse MJ, Wiener-Vacher SR, Ionescu E. Guidelines of the French Society of Otorhinolaryngology (SFORL) for teleconsultation in patients with vertigo during the COVID-19 pandemic. Eur Ann Otorhinolaryngol Head Neck Dis 2021; 138:459-465. [PMID: 33334700 PMCID: PMC7833948 DOI: 10.1016/j.anorl.2020.11.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVES In the context of the SARS-CoV-2 pandemic, patients may have been dissuaded from seeking consultation, thus exposing themselves to a risk of loss of chance. This guide aims to define how teleconsultation can assist in assessing vertiginous adults or children, and to gather the information needed to provide quick medical care. METHODS These recommendations rely on the authors' experience as well as on literature. A survey on otoneurologic approach via telemedicine has been conducted based on a literature search until March 2020. RESULTS The first clinical assessment of the vertiginous patient via teleconsultation can only be successful if the following conditions are met: initial contact to verify the feasibility of the assessment at a distance, the presence of a caregiver in order to assist the patient, the possibility of making video recordings. Medical history via telemedicine, as in a face-to-face assessment, allows to assess the characteristics, duration, frequency, and potential triggering factors of the vertigo, in both children and adults. During teleconsultation, the following tests can be carried out: oculomotricity evaluation, assessment of balance, simple neurological tests, checking for positional vertigo/nystagmus and, eventually to perform canalith-repositioning procedures. In children, the following should be searched for: history of hearing or visual impairment, a context of fever or trauma, otorrhea, signs of meningeal irritation. CONCLUSION The neurotologic telemedicine relies on the accuracy of the clinical assessment, which is based on history taking and a few simple tests, encouraging the development of a decision-making algorithm adapted for teleconsultation. However, the latter has its limitations during an emergency examination of a new patient presenting vertigo, and, at least in some cases, cannot replace a face-to-face consultation. Teleconsultation is often adapted for follow-up consultations of previously selected vertiginous patients during face-to-face assessment.
Collapse
Affiliation(s)
- P Bertholon
- Service d'ORL et de Chirurgie Cervico-Faciale, Hôpital Nord, CHU Saint-Étienne, Avenue A Raimond, 42270 Saint Priest en Jarez, France
| | - H Thai-Van
- Service d'Audiologie et d'Explorations Otoneurologiques, Hôpital Edouard Herriot, 69003 Lyon, France; Hôpital Femme Mère Enfant, 69500 Bron, France; Université Claude Bernard Lyon 1, 69100 Villeurbanne, France; Institut de l'Audition, Centre de recherche de l'Institut Pasteur, Inserm U1120, 75012 Paris, France.
| | - D Bouccara
- Service d'ORL et de Cancérologie Cervico-Faciale, AP-HP, Hôpitaux Universitaires Paris-Ouest, Hôpital européen Georges-Pompidou, 20, rue Leblanc, 75015 Paris, France
| | - M-J Esteve-Fraysse
- Service d'ORL et de Chirurgie Cervico-Faciale, Hôpital Purpan, 1, place du Docteur Baylac, 31300 Toulouse, France
| | - S R Wiener-Vacher
- Service d'ORL et de Chirurgie Cervico-Faciale, Centre d'exploration de l'équilibre de l'enfant (EFEE), Hôpital Universitaire Robert Debré, 48, boulevard Sérurier, 75019 Paris, France
| | - E Ionescu
- Service d'Audiologie et d'Explorations Otoneurologiques, Hôpital Edouard Herriot, 69003 Lyon, France; Hôpital Femme Mère Enfant, 69500 Bron, France; Institut de l'Audition, Centre de recherche de l'Institut Pasteur, Inserm U1120, 75012 Paris, France
| |
Collapse
|
15
|
Völter* C, Peter Thomas* J, Maetzler W, Guthoff R, Grunwald M, Hummel T. Sensory Dysfunction in Old Age. DEUTSCHES ARZTEBLATT INTERNATIONAL 2021; 118:512-520. [PMID: 34158149 PMCID: PMC8476826 DOI: 10.3238/arztebl.m2021.0212] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/14/2020] [Revised: 04/14/2020] [Accepted: 04/14/2021] [Indexed: 11/27/2022]
Abstract
BACKGROUND The senses serve as the crucial interface between the individual and the environment. They are subject to aging and disease processes. METHODS This review is based on pertinent publications retrieved by a selective search in the Medline and Cochrane Library databases. RESULTS Approximately 40% of persons aged 70 to 79 manifest dysfunction in at least one, and more than 25% in multiple senses. Sensory changes are accompanied by diverse comorbidities which depend on the particular sense(s) affected. The presence of sensory deficits is associated with an increased risk of developing dementia (OR: 1.49 [95% confidence interval: 1.12; 1.98] for dysfunction in a single sensory modality, 2.85 [1.88; 4.30] for dysfunction in three or more sensory modalities). The risk of developing depressive symptoms is elevated as well (OR 3.36 [2.28; 4.96]). The individual's ability to cope with the demands of everyday life is largely determined by the ability to carry out multisensory integration, in which the perceptions of the different senses are bound together. This function itself is subject to age-related changes that can be either adaptive or maladaptive; it can, therefore, serve as an indicator for pathological aging processes. CONCLUSION Sensory dysfunction in old age should be detected as early as possible. This implies the need for close collaboration of all of the involved disciplines. It would be desirable to develop sensory screening tests as well as a procedure for testing multisensory integration in routine clinical practice.
Collapse
Affiliation(s)
- Christiane Völter*
- * Joint first authors
- Hearing Competence Center, St. Elisabeth- Hospital, Department of Otorhinolaryngology, Head and Neck Surgery, Ruhr University of Bochum
| | - Jan Peter Thomas*
- * Joint first authors
- Department of Otorhinolaryngology, Head and Neck Surgery, St.-Johannes-Hospital, Dortmund
| | - Walter Maetzler
- Department of Neurology, Faculty of Medicine, University of Kiel
| | - Rainer Guthoff
- Department of Ophthalmology, Düsseldorf University Hospital
| | - Martin Grunwald
- Haptic Research Lab, Paul Flechsig Institute of Brain Research, Medical Faculty of the Universität Leipzig
| | - Thomas Hummel
- Otorhinolaryngology, Head and Neck Surgery, Universitätsklinikum Carl Gustav Carus, Dresden
| |
Collapse
|
16
|
Bi J, Liu B, Zhang Y, Zhou Q. Study on the Bone Metabolism Indices and Otoconin-90 in Benign Paroxysmal Positional Vertigo. Otol Neurotol 2021; 42:e744-e749. [PMID: 33606471 DOI: 10.1097/mao.0000000000003087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To investigate the correlation between benign paroxysmal positional vertigo (BPPV) and abnormal bone metabolism and to evaluate the value of otoconial protein otoconin-90 in the pathogenesis research and clinical treatment of BPPV. STUDY DESIGN Prospective pilot clinical trial (Level of Evidence: 2b). SETTING Outpatient otolaryngologic department. PATIENTS Twenty seven patients with a diagnosis of BPPV referred to the otolaryngologic department and 25 controls with no history of dizziness from 2018.4 to 2018.9 were reviewed. INTERVENTIONS No. MAIN OUTCOME MEASURES Dual-energy x-ray absorptiometry scanning (DEXA), bone mineral density (BMD) measurement, and assessment of serum levels of otoconin-90 and bone metabolism indices (osteocalcin, OC; 25-OH Vitamin D; total procollagen type 1 N-peptide, TP1NP; β-C-terminal telopeptide of type 1 collagen, β-CTX). RESULTS 1) The average serum level of otoconin-90 in the BPPV group was significantly higher than that in the control group (p < 0.05), whereas both the BMD T scores and serum 25-OH Vitamin D levels of the BPPV group were significantly lower than those of the control group (p < 0.05). 2) There was a strong positive correlation between serum otoconin-90 and age (r = 0.44, p < 0.05) and a moderate negative correlation between otoconin-90 and the bone metabolism indices OC (r = -0.33, p > 0.05), 25-OH Vitamin D (r = -0.35, p > 0.05), and TP1NP (r = -0.30, p > 0.05). 3) Logistic regression analysis showed that serum otoconin-90 level was an independent risk factor for BPPV (odd ratio = 0.998, 95% confidence interval 0.997-0.999, p < 0.01). CONCLUSION A correlation between BPPV and abnormal bone metabolism was found. Moreover, otoconin-90 could serve as a research tool for BPPV.
Collapse
Affiliation(s)
- Jingtao Bi
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University.,Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Bo Liu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University.,Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Yi Zhang
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University.,Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Qian Zhou
- Department of Otolaryngology, Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University.,Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| |
Collapse
|
17
|
Dmitriew C, Regis A, Bodunde O, Lepage R, Turgeon Z, McIsaac S, Ohle R. Diagnostic Accuracy of the HINTS Exam in an Emergency Department: A Retrospective Chart Review. Acad Emerg Med 2021; 28:387-393. [PMID: 33171003 DOI: 10.1111/acem.14171] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/24/2020] [Revised: 11/02/2020] [Accepted: 11/04/2020] [Indexed: 12/12/2022]
Abstract
INTRODUCTION The HINTS exam is a series of bedside ocular motor tests designed to distinguish between central and peripheral causes of dizziness in patients with continuous dizziness, nystagmus, and gait unsteadiness. Previous studies, where the HINTS exam was performed by trained specialists, have shown excellent diagnostic accuracy. Our objective was to assess the diagnostic accuracy of the HINTS exam as performed by emergency physicians on patients presenting to the emergency department (ED) with a primary complaint of vertigo or dizziness. METHODS A retrospective cohort study was performed using data from patients who presented to a tertiary care ED between September 2014 and March 2018 with a primary complaint of vertigo or dizziness. Patient characteristics of those who received the HINTS exam were assessed along with sensitivity and specificity of the test to rule out a central cause of stroke. RESULTS A total of 2,309 patients met criteria for inclusion in the study. Physician uptake of the HINTS exam was high, with 450 (19.5%) dizzy patients receiving all or part of the HINTS. A large majority of patients (96.9%) did not meet criteria for receiving the test as described in validation studies; most often this was because patients lacked documentation of nystagmus or described their symptoms as intermittent. In addition, many patients received both HINTS and Dix-Hallpike exams, which are intended for use in mutually exclusive patient populations. In no case was dizziness due to a central cause identified using the HINTS exam. CONCLUSIONS Our results suggest that despite widespread use of the HINTS exam in our ED, its diagnostic value in that setting was limited. The test was frequently used in patients who did not meet criteria to receive the HINTS exam (i.e., continuous vertigo, nystagmus, and unsteady gait). Additional training of emergency physicians may be required to improve test sensitivity and specificity.
Collapse
Affiliation(s)
- Cait Dmitriew
- From the Department of Undergraduate Medicine Northern Ontario School of Medicine Sudbury Ontario Canada
| | - Aaron Regis
- From the Department of Undergraduate Medicine Northern Ontario School of Medicine Sudbury Ontario Canada
| | - Oluwadamilola Bodunde
- From the Department of Undergraduate Medicine Northern Ontario School of Medicine Sudbury Ontario Canada
| | - Rory Lepage
- From the Department of Undergraduate Medicine Northern Ontario School of Medicine Sudbury Ontario Canada
| | - Zachary Turgeon
- From the Department of Undergraduate Medicine Northern Ontario School of Medicine Sudbury Ontario Canada
| | - Sarah McIsaac
- the Department of Critical Care Department of Anesthesia Northern Ontario School of Medicine Sudbury OntarioCanada
| | - Robert Ohle
- and the Department of Emergency Medicine Health Science North Research InstituteNorthern Ontario School of Medicine Sudbury Ontario Canada
| |
Collapse
|
18
|
Ruthberg JS, Rasendran C, Kocharyan A, Mowry SE, Otteson TD. The economic burden of vertigo and dizziness in the United States. J Vestib Res 2021; 31:81-90. [PMID: 33285661 DOI: 10.3233/ves-201531] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Vertigo and dizziness are extremely common conditions in the adult population and therefore place a significant social and economic burden on both patients and the healthcare system. However, limited information is available for the economic burden of vertigo and dizziness across various health care settings. OBJECTIVE Estimate the economic burden of vertigo and dizziness, controlling for demographic, socioeconomic, and clinical comorbidities. METHODS A retrospective analysis of data from the Medical Expenditures Panel Survey (2007-2015) was performed to analyze individuals with vertigo or dizziness from a nationally representative sample of the United States. Participants were included via self-reported data and International Classification of Diseases, 9th Revision Clinical Modification codes. A cross-validated 2-component generalized linear model was utilized to assess vertigo and dizziness expenditures across demographic, socioeconomic and clinical characteristics while controlling for covariates. Costs and utilization across various health care service sectors, including inpatient, outpatient, emergency department, home health, and prescription medications were evaluated. RESULTS Of 221,273 patients over 18 years, 5,275 (66% female, 34% male) reported either vertigo or dizziness during 2007-2015. More patients with vertigo or dizziness were female, older, non-Hispanic Caucasian, publicly insured, and had significant clinical comorbidities compared to patients without either condition. Furthermore, each of these demographic, socioeconomic, and clinical characteristics lead to significantly elevated costs due to having these conditions for patients. Significantly higher medical expenditures and utilization across various healthcare sectors were associated with vertigo or dizziness (p < 0.001). The mean incremental annual healthcare expenditure directly associated with vertigo or dizziness was $2,658.73 (95% CI: 1868.79, 3385.66) after controlling for socioeconomic and demographic characteristics. Total annual medical expenditures for patients with dizziness or vertigo was $48.1 billion. CONCLUSION Vertigo and dizziness lead to substantial expenses for patients across various healthcare settings. Determining how to limit costs and improve the delivery of care for these patients is of the utmost importance given the severe morbidity, disruption to daily living, and major socioeconomic burden associated with these conditions.
Collapse
Affiliation(s)
- Jeremy S Ruthberg
- Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | | | - Armine Kocharyan
- Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Sarah E Mowry
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| | - Todd D Otteson
- Case Western Reserve University School of Medicine, Cleveland, OH, USA.,Department of Otolaryngology-Head and Neck Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA
| |
Collapse
|
19
|
Dmitriew C, Bodunde O, Regis A, Lepage R, Turgeon Z, Johns P, McIsaac S, Ohle R. The use and misuse of the Dix-Hallpike test in the emergency department. CAN J EMERG MED 2021; 23:613-616. [PMID: 33677822 DOI: 10.1007/s43678-021-00110-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/04/2020] [Accepted: 02/12/2021] [Indexed: 12/01/2022]
Abstract
OBJECTIVES A simple bedside test, the Dix-Hallpike test (DHT), can reliably diagnose benign paroxysmal positional vertigo (BPPV) in patients with acute onset dizziness or vertigo. We evaluated patterns of DHT use by emergency physicians in patients presenting with dizziness and vertigo. Our objective was to assess the frequency and clinically appropriate use of the DHT in an emergency department. METHODS A health records review was performed using data from patients who presented to a tertiary care emergency department between September 2014 and March 2018 with a primary complaint of vertigo or dizziness. Patient records were reviewed for documentation of symptoms consistent with BPPV and DHT usage. RESULTS A total of 2309 patients met inclusion criteria. Of all dizzy patients who had complete documentation of signs and symptoms consistent with BPPV, 53% were assessed with a DHT. Of 469 patients who received a DHT, 134 (29%) of tests were done on patients who had documentation of at least one characteristic that was inconsistent with a diagnosis of BPPV. Eight patients who received a DHT were ultimately diagnosed with a central cause for their vertigo. CONCLUSIONS The DHT is both underutilized and frequently applied to patients whose symptoms are not consistent with BPPV. This may result in prolonged patient discomfort and increased resource utilization, as well as increasing the risk of misdiagnosing central vertigo.
Collapse
Affiliation(s)
- Cait Dmitriew
- Department of Undergraduate Medicine, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Oluwadamilola Bodunde
- Department of Undergraduate Medicine, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Aaron Regis
- Department of Undergraduate Medicine, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Rory Lepage
- Department of Undergraduate Medicine, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Zachary Turgeon
- Department of Undergraduate Medicine, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Peter Johns
- Department of Emergency Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Sarah McIsaac
- Department of Critical Care, Northern Ontario School of Medicine, Sudbury, ON, Canada.,Department of Anesthesia, Northern Ontario School of Medicine, Sudbury, ON, Canada
| | - Robert Ohle
- The Department of Emergency Medicine, Health Science North Research Institute, Northern Ontario School of Medicine, 41 Ramsey Lake Rd, Sudbury, ON, P3E 5J1, Canada.
| |
Collapse
|
20
|
Choi HG, Kim G, Kim BJ, Hong SK, Kim HJ, Lee HJ. How rare is benign paroxysmal positional vertigo in children? A review of 20 cases and their epidemiology. Int J Pediatr Otorhinolaryngol 2020; 132:110008. [PMID: 32240880 DOI: 10.1016/j.ijporl.2020.110008] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2019] [Revised: 02/07/2020] [Accepted: 03/12/2020] [Indexed: 02/08/2023]
Abstract
OBJECTIVE The clinical features and incidence of benign paroxysmal positional vertigo (BPPV) are not well known in pediatric populations. The aim of this study was to describe the clinical characteristics of pediatric BPPV and to estimate the frequency of pediatric BPPV in the general population. METHODS We retrospectively reviewed the medical records of 20 children (6-14 years old) diagnosed with BPPV between 2007 and 2017. The age/sex distribution of BPPV for all ages at our hospital and in the Korean Health Insurance Review and Assessment Service-National Patient Sample (HIRA-NPS) database were compared. The annual incidence and proportion of children with BPPV were calculated. RESULTS BPPV occurred 1.86 times more frequently in girls than in boys. Nine children (45%) had associated comorbidities, such as inner ear disorders and recent head trauma. The posterior and lateral semicircular canals were most commonly involved (n = 9 for each), and recurrence was observed in two patients (10%). Children younger than 15 years accounted for approximately 1% of all BPPV cases. The annual incidence of BPPV was 171.5/100,000 for all ages and 9.5/100,000 in the pediatric population. CONCLUSIONS Our findings suggest that pediatric BPPV is a relatively uncommon cause of vertigo in children and that the rates of related illness and recurrence are high.
Collapse
Affiliation(s)
- Hyo Geun Choi
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Republic of Korea; Laboratory of Brain and Cognitive Sciences for Convergence Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Gibbeum Kim
- Laboratory of Brain and Cognitive Sciences for Convergence Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Byeong Joon Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Sung Kwang Hong
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Republic of Korea; Laboratory of Brain and Cognitive Sciences for Convergence Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Hyung-Jong Kim
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Republic of Korea
| | - Hyo-Jeong Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Hallym University College of Medicine, Chuncheon, Republic of Korea; Laboratory of Brain and Cognitive Sciences for Convergence Medicine, Hallym University College of Medicine, Chuncheon, Republic of Korea.
| |
Collapse
|
21
|
Bedel C, Korkut M. The relationship of clinical and laboratory factors with acute isolated vertigo and cerebellar infarction. INDIAN JOURNAL OF MEDICAL SPECIALITIES 2020. [DOI: 10.4103/injms.injms_14_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
|
22
|
Hanna J, Malhotra A, Brauer PR, Luryi A, Michaelides E. A comparison of benign positional vertigo and stroke patients presenting to the emergency department with vertigo or dizziness. Am J Otolaryngol 2019; 40:102263. [PMID: 31358317 DOI: 10.1016/j.amjoto.2019.07.007] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2019] [Revised: 07/07/2019] [Accepted: 07/07/2019] [Indexed: 11/19/2022]
Abstract
PURPOSE To compare imaging utilization between patients presenting to the emergency department (ED) with vertigo and dizziness (VDS) who are diagnosed with stroke and benign paroxysmal positional vertigo (BPPV). METHODS All patients presenting to the ED with VDS (January 2014-June 2018) were identified. Those with a discharge diagnosis of stroke and BPPV were analyzed. RESULTS 17,884 patients presented to with VDS. 452 were diagnosed with BPPV and 174 with acute stroke. 55.7% of stroke patients had at least one neurologic symptom beyond VDS, 63.8% had a positive neurologic exam, and 80.5% had either; 90.2% had at least one stroke risk factor (RF). 42.0% of BPPV patients received imaging, of which 24.7% had neurologic symptoms beyond VDS, 16.3% had neurologic exam findings, and 34.2% had either (P < 0.001, as compared to stroke). 43 patients (22.6%) lacked neurologic symptoms, exam findings, and stroke RFs; 40 had an adequate HINTS (head impulse, nystagmus, skew) exam. The most common imaging modality received by BPPV patients was plain CT Head (54.2%), followed by CT/CTA (43.7%), and MRI brain (26.3%). CT head was the initial imaging of choice in 44.7% and CT/CTA in 42.6%. CONCLUSIONS Imaging utilization in BPPV patients presenting with VDS is high. The profile of patients with BPPV that received imaging was substantially more benign than that of stroke patients (a quarter had no neurologic symptoms, exam findings, or stroke RFs). The HINTS exam was underutilized, and computed tomography was heavily utilized despite well-established limitations in diagnosing posterior circulation strokes. This study highlights the need for increased training in the HINTS exam, narrowing of the scope for computed tomography, and a higher threshold for imaging patients with isolated VDS.
Collapse
Affiliation(s)
- Jonathan Hanna
- Yale University School of Medicine, New Haven, CT, United States of America
| | - Ajay Malhotra
- Department of Radiology and Biomedical Imaging, Yale University School of Medicine, Yale-New Haven Hospital, Yale Cancer Center, New Haven, CT, United States of America
| | - Philip R Brauer
- Yale University School of Medicine, New Haven, CT, United States of America
| | - Alexander Luryi
- Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, Yale-New Haven Hospital, Yale Cancer Center, New Haven, CT, United States of America
| | - Elias Michaelides
- Department of Surgery, Section of Otolaryngology, Yale University School of Medicine, Yale-New Haven Hospital, Yale Cancer Center, New Haven, CT, United States of America.
| |
Collapse
|
23
|
Bi J, Liu B, Zhang Y, Duan J, Zhou Q. Caloric tests in clinical practice in benign paroxysmal positional vertigo. Acta Otolaryngol 2019; 139:671-676. [PMID: 31099297 DOI: 10.1080/00016489.2019.1614220] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
Background: The value of caloric tests in benign paroxysmal positional vertigo (BPPV) patients is unclear. Objectives: To analyze the features and clinical significance of caloric tests in BPPV patients. Materials and methods: About 2192 patients (256 BPPV and 1936 non-BPPV) who complained of dizziness triggered by movement, accompanied by the symptom of hearing loss or a history of vertigo, participated in this prospective clinical study. All subjects received a caloric test, 213 BPPV patients underwent follow-up for at least 6 months after canalith repositioning procedures (CRPs). Results: (1) The abnormal canal paresis (CP) prevalence of BPPV was 57%. (2) The curative rate of single CRP decreased during follow-up from 90.1% after 7 days to 61% after 6 months and was significantly lower in patients with (54.1%) than in those without (70.1%) an abnormal CP at 6 months post-treatment (p = .01). (3) The recurrent rate was significantly higher in BPPV patients with abnormal CP (25.2%) than with normal CP (12.5%; p = .017). Conclusions and significance: Patients with abnormal CP needed more CRPs and were more prone to relapse. The value of the caloric test in treatment planning and predicting recurrence in BPPV patients should be emphasized.
Collapse
Affiliation(s)
- Jingtao Bi
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Bo Liu
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Yi Zhang
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Jinping Duan
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| | - Qian Zhou
- Department of Otolaryngology Head and Neck Surgery, Beijing Tongren Hospital, Capital Medical University, Beijing, China
- Beijing Institute of Otolaryngology, Key Laboratory of Otolaryngology Head and Neck Surgery (Capital Medical University), Ministry of Education, Beijing, China
| |
Collapse
|
24
|
Smith PF, Agrawal Y, Darlington CL. Sexual dimorphism in vestibular function and dysfunction. J Neurophysiol 2019; 121:2379-2391. [PMID: 31042453 DOI: 10.1152/jn.00074.2019] [Citation(s) in RCA: 30] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
It has been recognized for some time that females appear to be overrepresented in the incidence of many vestibular disorders, and recent epidemiological studies further support this idea. While it is possible that this is due to a reporting bias, another possibility is that there are actual differences in the incidence of vestibular dysfunction between males and females. If this is true, it could be due to a sexual dimorphism in vestibular function and therefore dysfunction, possibly related to the hormonal differences between females and males, although the higher incidence of vestibular dysfunction in females appears to last long after menopause. Many other neurochemical differences exist between males and females, however, that could be implicated in sexual dimorphism. This review critically explores the possibility of sexual dimorphism in vestibular function and dysfunction, and the implications it may have for the treatment of vestibular disorders.
Collapse
Affiliation(s)
- Paul F Smith
- Department of Pharmacology and Toxicology, School of Biomedical Sciences and the Brain Health Research Centre, University of Otago Medical School , Dunedin , New Zealand.,Brain Research New Zealand.,Eisdell Moore Centre for Hearing and Balance Research, University of Auckland , Auckland , New Zealand
| | - Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins School of Medicine, Baltimore, Maryland
| | - Cynthia L Darlington
- Department of Pharmacology and Toxicology, School of Biomedical Sciences and the Brain Health Research Centre, University of Otago Medical School , Dunedin , New Zealand.,Brain Research New Zealand.,Eisdell Moore Centre for Hearing and Balance Research, University of Auckland , Auckland , New Zealand
| |
Collapse
|