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Iwasaki S, Kawahara T, Miyashita T, Shindo S, Tsubota M, Inoue A, Sunami K, Shojaku H. Estimated incidence and characteristics of vestibular neuritis in Japan: A nationwide survey. Auris Nasus Larynx 2024; 51:343-346. [PMID: 37838569 DOI: 10.1016/j.anl.2023.09.009] [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: 08/23/2023] [Revised: 09/23/2023] [Accepted: 09/27/2023] [Indexed: 10/16/2023]
Abstract
OBJECTIVE To assess the annual incidence of vestibular neuritis (VN) in the Japanese population. METHODS We conducted a mail-based survey targeting otolaryngologic clinics and hospitals across Japan to estimate the annual number of patients who were newly-diagnosed with VN during the one-year period of 2021. Using a stratified sampling method, we selected 1,107 departments and asked them to report the number of new patients with VN and their demographics. The total number of VN patients was estimated by multiplying the reported numbers by the reciprocal of the sampling rate and response rate. RESULTS The overall survey response rate was 40.5 % (448 departments). The estimated number of newly-diagnosed VN patients in 2021 was 8,861 (95 % confidential interval [CI], 2,290-15,432) The annual incidence of VN was 7.05 per 100,000 population in Japan. The male-to-female ratio of VN patients was 0.96, and the mean age was 60.3 ± 16.1 years (range 11-94 years). CONCLUSIONS The annual incidence of VN in Japan in 2021 had almost doubled and the mean age had become older compared to the previous study in 1993 (annual incidence; 3.5 per 100,000 per year; mean age: 45 years).
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Affiliation(s)
- Shinichi Iwasaki
- Department of Otolaryngology & Head and Neck Surgery, Nagoya City University Graduate School of Medical Sciences.
| | - Takuya Kawahara
- Biostatistics Division, Clinical Research Promotion Center, The University of Tokyo Hospital
| | | | - Susumu Shindo
- Department of Otolaryngology, Saitama Medical University
| | - Masahito Tsubota
- Department of Otolaryngology, Kanazawa Medical University Himi Municipal Hospital
| | - Aki Inoue
- Department of Otolaryngology, Mitsui Memorial Hospital
| | - Kishiko Sunami
- Department of Otolaryngology, Faculty of Medicine, Osaka Metropolitan University
| | - Hideo Shojaku
- Department of Otolaryngology, Faculty of Medicine, Toyama University
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Shen B, Tong L, Qiu J, Zhong J, Tong Z, Li X. Suppurative Meningitis Complicated with Arthritis Caused by Streptococcus Suis Infection: A Case Report. Infect Drug Resist 2024; 17:561-569. [PMID: 38375100 PMCID: PMC10875338 DOI: 10.2147/idr.s416341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2023] [Accepted: 01/31/2024] [Indexed: 02/21/2024] Open
Abstract
Background Streptococcus suis (S. suis) is a common gram-positive bacterium in pigs. Its natural infection sites are the upper respiratory tract (especially tonsils and nasal cavity), reproductive tract and digestive tract of pigs. It is a new emerging human and animal disease. A co-morbid pathogen that can cause serious infections in humans, including meningitis, sepsis, septic arthritis, and sometimes deafness. No cases have been reported in Huzhou City, Zhejiang Province, China. Case Presentation A 50-year-old male patient who had Worked as a butcher in a slaughterhouse for 20 years. Admitted to the hospital due to abdominal pain, joint pain, fever, and headache.His condition rapidly worsened causing altered consciousness, drowsiness and developed hearing loss. S. suis induced pyogenic meningitis complicated by arthritis was suspected based on the results of biochemical and culture analysis of the cerebrospinal fluid, and metagenomic next-generation sequencing, The patient's symptoms significantly improved after treatment with antibiotics such as ceftriaxone, meropenem, and linezolid, as well as supportive therapies including steroids and hyperbaric oxygen therapy, and his hearing improved significantly.After about 2 years of follow-up, the hearing was significantly better than before, but hearing impairment still remained. Conclusion Streptococcus suis is endemic in pork-consuming and pig-raising countries, but can occur throughout the world, especially among individuals with occupational exposure to pigs and/or pork, such as slaughterhouse workers, butchers, farmers, etc. Strengthen science education among key groups. This case was diagnosed as Streptococcus suis meningitis combined with arthritis. However, abdominal pain in the early stage of the disease is very rare and is easy to be misdiagnosed. It is necessary to identify whether it is complicated by peritonitis. For hearing loss caused by Streptococcus suis infection, the use of hyperbaric oxygen chamber treatment has obvious therapeutic effects.
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Affiliation(s)
- Bin Shen
- Department of Infectious Diseases, Huzhou Central Hospital, Huzhou Key Laboratory of Precision Medicine Research and Translation for Infectious Diseases, Huzhou, Zhejiang Province, 313000, People’s Republic of China
| | - Luyuan Tong
- Department of Infectious Diseases, Huzhou Central Hospital, Huzhou Key Laboratory of Precision Medicine Research and Translation for Infectious Diseases, Huzhou, Zhejiang Province, 313000, People’s Republic of China
| | - Jia Qiu
- Department of Infectious Diseases, Huzhou Central Hospital, Huzhou Key Laboratory of Precision Medicine Research and Translation for Infectious Diseases, Huzhou, Zhejiang Province, 313000, People’s Republic of China
| | - Jianfeng Zhong
- Department of Infectious Diseases, Huzhou Central Hospital, Huzhou Key Laboratory of Precision Medicine Research and Translation for Infectious Diseases, Huzhou, Zhejiang Province, 313000, People’s Republic of China
| | - Zhaowei Tong
- Department of Infectious Diseases, Huzhou Central Hospital, Huzhou Key Laboratory of Precision Medicine Research and Translation for Infectious Diseases, Huzhou, Zhejiang Province, 313000, People’s Republic of China
| | - Xiaofeng Li
- Department of Infectious Diseases, Huzhou Central Hospital, Huzhou Key Laboratory of Precision Medicine Research and Translation for Infectious Diseases, Huzhou, Zhejiang Province, 313000, People’s Republic of China
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Hashimoto M, Koizuka I, Yamashita H, Suzuki M, Omori K, Origasa H, Takeda N, Shojaku H. Diagnostic and therapeutic strategies for vestibular neuritis of the Japan Society for Equilibrium Research. Auris Nasus Larynx 2024; 51:31-37. [PMID: 36581537 DOI: 10.1016/j.anl.2022.12.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Accepted: 12/15/2022] [Indexed: 12/29/2022]
Abstract
OBJECTIVE To provide diagnostic and therapeutic strategies for vestibular neuritis in accordance with the Japanese Clinical Practice Guidelines for Vestibular Neuritis 2021. METHODS The Committee for Clinical Practice Guidelines for Vestibular Neuritis was entrusted with a review of the relevant scientific literature on the above topic. Clinical Questions (CQs) concerning the treatment of vestibular neuritis were produced, and a search of the literature was conducted to identify studies related to the CQs. The recommendations were based on the literature review and the expert opinion of a subcommittee. RESULTS We proposed the diagnostic criteria for vestibular neuritis, as well as answers to CQs, recommendations, and evidence levels for the treatment of vestibular neuritis. CONCLUSION The diagnostic criteria for vestibular neuritis were based on clinical history and examination findings after completing the differential diagnosis process. The treatment of vestibular neuritis was divided into acute, subacute, and chronic stages. The Japanese Clinical Practice Guidelines for Vestibular Neuritis 2021 should be used as a reference in the diagnosis and treatment of vestibular neuritis.
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Affiliation(s)
- Makoto Hashimoto
- Department of Otolaryngology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Izumi Koizuka
- Department of Otolaryngology, St. Marianna University School of Medicine, Kawasaki, Japan.
| | - Hiroshi Yamashita
- Department of Otolaryngology, Yamaguchi University Graduate School of Medicine, Yamaguchi, Japan
| | - Mamoru Suzuki
- Department of Otolaryngology, Tokyo Medical University, Tokyo, Japan
| | - Koichi Omori
- Department of Otolaryngology-Head and Neck Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan
| | - Hideki Origasa
- Department of Biostatistics and Clinical Epidemiology, Faculty of Medicine, University of Toyama, Toyama, Japan
| | - Noriaki Takeda
- Department of Otolaryngology, University of Tokushima School of Medicine, Tokushima, Japan
| | - Hideo Shojaku
- Department of Otolaryngology, Head and Neck Surgery, Faculty of Medicine, University of Toyama, Toyama, Japan
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Li Q, Xu H, Chen W, Su A, Fu MJ, Walker MF. Short-term learning of the vestibulo-ocular reflex induced by a custom interactive computer game. J Neurophysiol 2024; 131:16-27. [PMID: 37964728 PMCID: PMC11305635 DOI: 10.1152/jn.00130.2023] [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: 03/28/2023] [Revised: 10/24/2023] [Accepted: 11/09/2023] [Indexed: 11/16/2023] Open
Abstract
Retinal image slip during head rotation drives motor learning in the rotational vestibulo-ocular reflex (VOR) and forms the basis of gaze-stability exercises that treat vestibular dysfunction. Clinical exercises, however, are unengaging, cannot easily be titrated to the level of impairment, and provide neither direct feedback nor tracking of the patient's adherence, performance, and progress. To address this, we have developed a custom application for VOR training based on an interactive computer game. In this study, we tested the ability of this game to induce VOR learning in individuals with normal vestibular function, and we compared the efficacy of single-step and incremental learning protocols. Eighteen participants played the game twice on different days. All participants tolerated the game and were able to complete both sessions. The game scenario incorporated a series of brief head rotations, similar to active head impulses, that were paired with a dynamic acuity task and with a visual-vestibular mismatch (VVM) intended to increase VOR gain (single-step: 300 successful trials at ×1.5 viewing; incremental: 100 trials each of ×1.13, ×1.33, and ×1.5 viewing). Overall, VOR gain increased by 15 ± 4.7% (mean ± 95% CI, P < 0.001). Gains increased similarly for active and passive head rotations, and, contrary to our hypothesis, there was little effect of the learning strategy. This study shows that an interactive computer game provides robust VOR training and has the potential to deliver effective, engaging, and trackable gaze-stability exercises to patients with a range of vestibular dysfunctions.NEW & NOTEWORTHY This study demonstrates the feasibility and efficacy of a customized computer game to induce motor learning in the high-frequency rotational vestibulo-ocular reflex. It provides a physiological basis for the deployment of this technology to clinical vestibular rehabilitation.
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Affiliation(s)
- Qi Li
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, Ohio, United States
| | - Honglu Xu
- Department of Computer and Data Sciences, Case Western Reserve University, Cleveland, Ohio, United States
| | - Weicong Chen
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, Ohio, United States
| | - Andrew Su
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, Ohio, United States
| | - Michael J Fu
- Department of Electrical, Computer, and Systems Engineering, Case Western Reserve University, Cleveland, Ohio, United States
- Functional Electrical Stimulation Center, VA Northeast Ohio Healthcare System, Cleveland, Ohio, United States
- MetroHealth Rehabilitation Institute, The MetroHealth System, Cleveland, Ohio, United States
| | - Mark F Walker
- Neurology Service, VA Northeast Ohio Healthcare System, Cleveland, Ohio, United States
- Department of Neurology, Case Western Reserve University, Cleveland, Ohio, United States
- Advanced Platform Technology Center, VA Northeast Ohio Healthcare System, Cleveland, Ohio, United States
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Huang HH, Chen CC, Lee HH, Chen HC, Lee TY, Tam KW, Kuan YC. Efficacy of Vestibular Rehabilitation in Vestibular Neuritis: A Systematic Review and Meta-analysis. Am J Phys Med Rehabil 2024; 103:38-46. [PMID: 37339059 DOI: 10.1097/phm.0000000000002301] [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: 06/22/2023]
Abstract
OBJECTIVE This study aimed to evaluate the efficacy of vestibular rehabilitation in vestibular neuritis. DESIGN A randomized controlled trial was collected from MEDLINE, Embase, Cochrane Library, PEDro, LILACS, and Google Scholar before May 2023. RESULTS This study included 12 randomized controlled trials involving 536 patients with vestibular neuritis. Vestibular rehabilitation was comparable with steroids in dizziness handicap inventory score at the first, sixth, and 12th months (pooled mean differences: -4.00, -0.21, and -0.31, respectively); caloric lateralization at the third, sixth, and 12th months (pooled mean difference: 1.10, 4.76, and -0.31, respectively); and abnormal numbers of vestibular-evoked myogenic potentials at the first, sixth, and 12th months. Patients receiving a combination of rehabilitation and steroid exhibited significant improvement in dizziness handicap inventory score at the first, third, and 12th months (mean difference: -14.86, pooled mean difference: -4.63, mean difference: -9.50, respectively); caloric lateralization at the first and third months (pooled mean difference: -10.28, pooled mean difference: -8.12, respectively); and numbers of vestibular-evoked myogenic potentials at the first and third months (risk ratios: 0.66 and 0.60, respectively) than did those receiving steroids alone. CONCLUSIONS Vestibular rehabilitation is recommended for patients with vestibular neuritis. A combination of vestibular rehabilitation and steroids is more effective than steroids alone in the treatment of patients with vestibular neuritis.
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Affiliation(s)
- Hsiao-Han Huang
- From the School of Medicine, Taipei Medical University, Taipei, Taiwan (H-HH); Dizziness and Balance Disorder Center, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan (C-CC, H-HL, T-YL); Department of Neurology, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan (C-CC, H-HL, T-YL, Y-CK); Taipei Neuroscience Institute, Taipei Medical University, Taipei, Taiwan (C-CC, H-HL, T-YL, Y-CK); Department of Neurology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (C-CC, H-HL, T-YL, Y-CK); Department of Neurology, Taipei Medical University Hospital, Taipei Medical University, Taipei, Taiwan (H-HL); Department of Physical Medicine and Rehabilitation, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan (H-CC); Center for Evidence-Based Health Care, Taipei Medical University-Shuang Ho Hospital, New Taipei City, Taiwan (H-CC, Y-CK); Department of Physical Medicine and Rehabilitation, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (H-CC); Cochrane Taiwan, Taipei Medical University, Taipei, Taiwan (K-WT); Department of Surgery, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan (K-WT); Division of General Surgery, Department of Surgery, Shuang-Ho Hospital, Taipei Medical University, New Taipei City, Taiwan (K-WT); and Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University, Taipei, Taiwan (Y-CK)
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Kamo T, Ogihara H, Azami M, Momosaki R, Fushiki H. Effects of Early Vestibular Rehabilitation in Patients With Acute Vestibular Disorder: A Systematic Review and Meta-Analysis. Otol Neurotol 2023; 44:e641-e647. [PMID: 37641214 DOI: 10.1097/mao.0000000000004006] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
OBJECTIVES To investigate the effect of early vestibular rehabilitation on physical function and dizziness in patients with acute vestibular disorders. DATABASES REVIEWED The electronic databases examined included PubMed (MEDLINE), Cochrane Central Register of Controlled Trials (CENTRAL), EMBASE (via Dialog), and PEDro. METHODS The inclusion criteria in terms of the study participants were patients 20 years and older with an acute unilateral peripheral vestibular disorder. We included individual randomized controlled trials (RCTs), cluster-RCTs, quasi-RCTs, and crossover trials. The outcomes were gait, balance (eyes open, eyes close), activities of daily living, dizziness, and vestibular function. Early vestibular rehabilitation was defined as rehabilitation within 14 days of vestibular disorder onset or surgery. Main outcome measures were gait, balance (eyes open, eyes close), activities of daily living, dizziness, and vestibular function. RESULTS Twelve trials involving 542 participants were included. Early vestibular rehabilitation improved the Dizziness Handicap Inventory by -7.18 (95% confidence interval [CI], -10.48 to -3.88), balance during eyes close by -1.40 (95% CI, -2.42 to -0.39), and dizziness by -1.47 (95% CI, -2.74 to -0.21) compared with no intervention or placebo. CONCLUSION The present study demonstrated that early vestibular rehabilitation improved the Dizziness Handicap Inventory, balance (eyes close), and subjective dizziness in a patient with acute vestibular disorders. This result indicates that early vestibular rehabilitation can promote vestibular compensation.
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Affiliation(s)
| | | | | | - Ryo Momosaki
- Department of Rehabilitation Medicine, Mie University Graduate School of Medicine, Mie, Japan
| | - Hiroaki Fushiki
- Otolaryngology, Mejiro University Ear Institute Clinic, Saitama
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Lacour M, Lopez C, Thiry A, Tardivet L. Vestibular rehabilitation improves spontaneous nystagmus normalization in patients with acute unilateral vestibulopathy. FRONTIERS IN REHABILITATION SCIENCES 2023; 4:1122301. [PMID: 37325127 PMCID: PMC10264803 DOI: 10.3389/fresc.2023.1122301] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/12/2022] [Accepted: 05/10/2023] [Indexed: 06/17/2023]
Abstract
Introduction Spontaneous nystagmus (SN) can be observed after acute unilateral vestibulopathy (AUVP). The slow phase eye velocity of the SN progressively decreases in darkness as the result of rebalanced neurophysiological activity between both vestibular nuclei, a process that can take several months. Although this compensatory process can occur spontaneously, there is poor evidence that vestibular rehabilitation (VR) can facilitate the process. Methods We documented the natural time course of SN reduction in patients with AUVP, as well as the effects of VR by means of a unilateral rotation paradigm. In a retrospective study (Study 1: n = 126 AUVP patients), we compared the time course of the SN reduction in patients with VR (n = 33) and without VR (n = 93). In a prospective study (Study 2: n = 42 AUVP patients), we compared the effects of early VR (n = 22; initiated within the first two weeks of symptoms onset) or late VR (n = 20; initiated after the second week of symptoms onset) on the time course of the SN reduction. Results Study 1 showed shorter median time of SN normalization in patients with VR compared to patients without VR (14 days and 90 days, respectively). Study 2 showed that AUVP patients with early and late VR had a similar median time of SN normalization. The SN slow phase eye velocity was significantly decreased as early as the end of the first VR session in both groups, and kept decreasing at each subsequent VR session. In the early VR group, 38% of the patients had slow phase eye velocity below 2°/s after the first VR session, 100% after the fifth session. Similar findings were observed in the late VR group. Discussion Taken together, these results indicate that VR with a unidirectional rotation paradigm speeds up the normalization of SN. This effect seems independent of the time between symptoms onset and commencement of VR, but early intervention is recommended to speed up the SN reduction.
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Affiliation(s)
- Michel Lacour
- Aix-Marseille University, CNRS, Laboratory of Cognitive Neuroscience (LNC), FR3C, Marseille, France
- Independent Researcher, Fuveau, France
| | - Christophe Lopez
- Aix-Marseille University, CNRS, Laboratory of Cognitive Neuroscience (LNC), FR3C, Marseille, France
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Villumsen M, Livbjerg AE, Grarup B, Kjeldal Skram C, Laessoe U. Implementation of a municipality-based rehabilitation program for patients with neuritis vestibularis: lessons learned and derived snowball effects. Physiother Theory Pract 2023; 39:761-771. [PMID: 35068327 DOI: 10.1080/09593985.2022.2030829] [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: 10/19/2022]
Abstract
BACKGROUND Patients with dizziness are severely affected in their daily life. The dizziness may be caused by vestibular neuritis and this condition may be severe and result in hospitalization. Qualified municipal rehabilitation services are warranted for these patients after edischarge from the hospital. However, very few specialized municipal initiatives in Denmark are targeting this patient group. METHODS This paper reports on the development of a clinically applicable municipality-based vestibular neuritis rehabilitation program and evaluates the acceptability of this initiative. RESULTS The study recognized the need for a rehabilitation program after hospital discharge. However, the program was not evaluated as acceptable for multiple reasons. The exercise program was applicable and feasible but was experienced as a limitation for the practitioner, when addressing other balance issues was needed. It proved challenging to inform both the administrative staff and the clinicians about the new rehabilitation service to allow for sufficient implementation. CONCLUSION Although the rehabilitation program was not considered an unequivocal success, there were several derived valuable snowball effects of the program. This paper advocates that focus should not only lie on the success of a single program, but also explore the derived benefits for patients and organizations, as well as the practice-oriented knowledge these programs generate.
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Affiliation(s)
- Morten Villumsen
- Department of Elderly and Health, Section of Training and Activity, Vodskov, Denmark
- SMI®, Department of Health Science and Technology, Aalborg University (AAU), Aalborg, Denmark
| | - Anna Emilie Livbjerg
- Department of Physiotherapy, University College of Northern Denmark (UCN), Aalborg East, Denmark
| | - Bo Grarup
- Department of Physiotherapy, University College of Northern Denmark (UCN), Aalborg East, Denmark
| | - Christine Kjeldal Skram
- Department of Elderly and Health, Section of Training and Activity, Vodskov, Denmark
- Department of Otolaryngology, Head and Neck Surgery and Audiology, Aalborg University Hospital, Aalborg, Denmark
| | - Uffe Laessoe
- Research and Development Department, University College of Northern Denmark (UCN), Aalborg, Denmark
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Hoppes CW, Lambert KH, Klatt BN, Harvard OD, Whitney SL. Vestibular Physical Therapy Treatment of Individuals Exposed to Directed Energy. Mil Med 2023; 188:e198-e204. [PMID: 34027970 DOI: 10.1093/milmed/usab202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Following suspected sonic attacks on U.S. Embassies, a subset of individuals presented with a unique cluster of symptoms believed to have resulted from exposure to directed energy. Directed energy has been described as exposure to a unique sound/pressure phenomenon such as infrasonic or ultrasonic acoustic or electromagnetic energy. The Joint Force does not have an established protocol to guide vestibular physical therapy for individuals exposed to directed energy. Therefore, we have provided evidence-based guidance for the treatment of oculomotor- and vestibular-related impairments from similar populations. MATERIALS AND METHODS Published evidence was used to inform suggestions for clinical best practice. We offer resources for the management of non-oculomotor- and non-vestibular-related impairments, before discussing physical therapy interventions for dizziness and imbalance. RESULTS The physical therapist should design a treatment program that addresses the individual's health condition(s), body structure and function impairments, activity limitations, and participation restrictions after suspected directed energy exposure. This treatment program may include static standing, compliant surface standing, weight shifting, modified center of gravity, gait, and gaze stabilization or vestibular-ocular reflex training. Habituation may also be prescribed. Interventions were selected that require little to no specialized equipment, as such equipment may not be available in all settings (i.e., operational environments). CONCLUSIONS Evidence-based guidance for prescribing a comprehensive vestibular physical therapy regimen for individuals exposed to directed energy may aid in their rehabilitation and return to duty. This standardized approach can help physical therapists to treat complaints that do not match any previously known medical conditions but resemble brain injury or vestibular pathology.
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Affiliation(s)
- Carrie W Hoppes
- U.S. Army Medical Center of Excellence, Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX 78234, USA
| | | | - Brooke N Klatt
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Orlando D Harvard
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15219, USA
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David EA, Shahnaz N. Durable improvement in participant-reported measures of disability and objective posturography after computerized vestibular retraining. NeuroRehabilitation 2022; 52:279-287. [PMID: 36565074 DOI: 10.3233/nre-220241] [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: 12/25/2022]
Abstract
BACKGROUND Unilateral vestibular deficits are associated with postural instability and loss of quality of life. Common treatments frequently fail to achieve satisfactory outcomes. OBJECTIVE To assess the durability of changes in participant-reported disability and objective posturography after computerized vestibular retraining. METHODS This was a single-group study. Individuals with persistent symptoms of an objectively determined unilateral vestibular deficit completed questionnaires and posturography assessments before and after twelve sessions of computerized retraining, and 4-6 months and 10-12 months after treatment. RESULTS 13 participants completed the post-treatment assessments; 9 completed the follow up. Mean improvements in perceived disability at 4-6 months after retraining were: DHI 14.3 points (95% confidence interval 4.0 to 24.5), ABC scale 14.9 points (4.3 to 25.6), FES-I 11.6 points (-3.2 to 26.5).The SOT composite score increased by 11.4 points (95% CI 1.9 to 20.9; p = 0.0175) immediately after treatment, 8.9 points (-2.9 to 20.7; p = 0.1528) at 4-6 months, and 10.6 points (2.2 to 19.0; p = 0.0162) after 10-12 months. At the 10-12 month time point, the areas of the functional stability region increased significantly for both endpoint excursion (p = 0.0086) and maximum excursion (p = 0.0025). CONCLUSION Computerized vestibular retraining was associated with improved participant reported disability and objective measures of postural stability.
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Affiliation(s)
- Eytan A David
- Otology, Neurotology, and Skull Base Surgery, Department of Surgery, University of British Columbia, Vancouver, BC, Canada
| | - Navid Shahnaz
- Audiology and Speech Sciences, University of British Columbia, Vancouver, BC, Canada
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Tanaka R, Kamo T, Ogihara H, Kato T, Azami M, Tsunoda R, Fushiki H. Efficacy of supervised vestibular rehabilitation on functional mobility in patients with chronic vestibular hypofunction. J Phys Ther Sci 2022; 34:584-589. [PMID: 35937631 PMCID: PMC9345747 DOI: 10.1589/jpts.34.584] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2022] [Accepted: 05/18/2022] [Indexed: 11/24/2022] Open
Abstract
[Purpose] This study aimed to compare the effects of different intervention frequencies
on walking ability and balance in patients with chronic unilateral vestibular
hypofunction. [Participants and Methods] Participants included in this case-control study
were assigned to one of two groups: the multiple-intervention (once a week) and
single-intervention groups. Results for the Timed Up and Go test, Dynamic Gait Index,
Functional Gait Assessment, and Activities-specific Balance Confidence scale were
determined at baseline and four weeks after initiating the vestibular rehabilitation
program. Thereafter, intra- and inter-group differences in the rates of change of these
parameters were determined. [Results] The Timed Up and Go test values, Dynamic Gait Index,
and Functional Gait Assessment scores improved significantly after four weeks in the
multiple-intervention group. The improvement rate in the Timed Up and Go test differed
significantly between the two groups. The Activities-specific Balance Confidence scale
scores did not significantly change in either group after four weeks. [Conclusion]
Compared to a single intervention, multiple interventions by a physical therapist produced
significantly greater benefits in a relatively shorter period of time in patients with
chronic unilateral vestibular hypofunction.
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Affiliation(s)
- Ryozo Tanaka
- Department of Physical Therapy, Faculty of Health Sciences, Mejiro University: 320 Ukiya, Iwatsuki-ku, Saitama-shi, Saitama 339-8501, Japan.,Division of Otolaryngology, Mejiro University Ear Institute Clinic, Japan
| | - Tomohiko Kamo
- Division of Otolaryngology, Mejiro University Ear Institute Clinic, Japan.,Department of Physical Therapy, Faculty of Rehabilitation, Gunma Paz University, Japan
| | - Hirofumi Ogihara
- Division of Otolaryngology, Mejiro University Ear Institute Clinic, Japan.,Division of Physical Therapy, Department of Rehabilitation, Faculty of Health Sciences, Nagano University of Health and Medicine, Japan
| | - Takumi Kato
- Division of Otolaryngology, Mejiro University Ear Institute Clinic, Japan
| | - Masato Azami
- Division of Otolaryngology, Mejiro University Ear Institute Clinic, Japan.,Department of Physical Therapy, Faculty of Health Sciences, Japan University of Health Sciences, Japan
| | - Reiko Tsunoda
- Division of Otolaryngology, Mejiro University Ear Institute Clinic, Japan
| | - Hiroaki Fushiki
- Division of Otolaryngology, Mejiro University Ear Institute Clinic, Japan
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Teh CSL, Abdullah NA, Kamaruddin NR, Mohd Judi KB, Fadzilah I, Zainun Z, Prepageran N. Home-based Vestibular Rehabilitation: A Feasible and Effective Therapy for Persistent Postural Perceptual Dizziness (A Pilot Study). Ann Otol Rhinol Laryngol 2022; 132:566-577. [PMID: 35794811 DOI: 10.1177/00034894221111408] [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: 11/16/2022]
Abstract
INTRODUCTION Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder where there is persistent dizziness or unsteadiness occurring on most days for more than 3 months duration. Treatment recommendations for PPPD include vestibular rehabilitation therapy (VRT) with or without medications and/or cognitive behavioral therapy. OBJECTIVES This paper is a pilot study designed to compare the effects of Bal Ex as a home-based VRT on the quality of life (EQ-5D), dizziness handicap (DHI) and mental health (DASS-21) against hospital-based VRT. DESIGN This was an assessor-blinded, randomized controlled pilot study where PPPD patients were randomly selected to undergo Bal Ex, the home-based VRT (intervention group) or hospital-based (control group) VRT. The participants were reviewed at 4 weeks and 12 weeks after the start of therapy to assess the primary endpoints using the subjective improvement in symptoms as reported by patients, changes in DHI scores, DASS-21 scores and EQ5D VAS scores. RESULTS Thirty PPPD patients successfully completed the study with 15 in each study group. Within 4 weeks, there were significant improvements in the total DHI scores as well as anxiety levels. By the end of 12 weeks, there were significant improvements in the DHI, DASS-21 and EQ5D. The degree of improvement between Bal Ex and the control was comparable. CONCLUSION VRT is an effective modality in significantly improving quality of life, dizziness handicap, depression, and anxiety levels within 3 months in PPPD. Preliminary results show Bal Ex is as effective as hospital-based VRT and should be considered as a treatment option for PPPD.
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Affiliation(s)
- Carren Sui-Lin Teh
- Department of Otorhinolaryngology, Hospital Sungai Buloh, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| | - Nurul Ain Abdullah
- Department of Otorhinolaryngology, Hospital Sungai Buloh, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| | - Noor Rafidah Kamaruddin
- Department of Otorhinolaryngology, Hospital Sungai Buloh, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| | - Kamariah Binti Mohd Judi
- Department of Otorhinolaryngology, Hospital Sungai Buloh, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| | - Ismail Fadzilah
- Department of Otorhinolaryngology, Hospital Sungai Buloh, Jalan Hospital, Sungai Buloh, Selangor, Malaysia
| | - Zuraida Zainun
- School of Health Sciences, Universiti Sains Malaysia, Kubang Kerian, Kelantan, Malaysia
| | - Narayanan Prepageran
- Department of Otorhinolaryngology, Faculty of Medicine, University of Malaya, Jalan University, Wilayah Persekutuan, Kuala Lumpur, Malaysia
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Bassiouni M, Häußler SM, Gräbel S, Szczepek AJ, Olze H. Lateralization Pattern of the Weber Tuning Fork Test in Longstanding Unilateral Profound Hearing Loss: Implications for Cochlear Implantation. Audiol Res 2022; 12:347-356. [PMID: 35892662 PMCID: PMC9326649 DOI: 10.3390/audiolres12040036] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2022] [Revised: 06/14/2022] [Accepted: 06/15/2022] [Indexed: 12/10/2022] Open
Abstract
The Weber tuning fork test is a standard otologic examination tool in patients with unilateral hearing loss. Sound should typically lateralize to the contralateral side in unilateral sensorineural hearing loss. The observation that the Weber test does not lateralize in some patients with longstanding unilateral deafness has been previously described but remains poorly understood. In the present study, we conducted a retrospective analysis of the medical records of patients with unilateral profound hearing loss (single-sided deafness or asymmetric hearing loss) for at least ten years. In this patient cohort, childhood-onset unilateral profound hearing loss was significantly associated with the lack of lateralization of the Weber tuning fork test (Fisher’s exact test, p < 0.05) and the absence of tinnitus in the affected ear (Fisher’s exact test, p < 0.001). The findings may imply a central adaptation process due to chronic unilateral auditory deprivation starting before the critical period of auditory maturation. This notion may partially explain the poor outcome of adult cochlear implantation in longstanding single-sided deafness. The findings may suggest a role for the Weber test as a simple, quick, and economical tool for screening poor cochlear implant candidates, thus potentially supporting the decision-making and counseling of patients with longstanding single-sided deafness.
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Affiliation(s)
- Mohamed Bassiouni
- Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Charitéplatz 1, Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (S.G.); (A.J.S.); (H.O.)
| | - Sophia Marie Häußler
- Department of Otorhinolaryngology, University Medical Center Hamburg-Eppendorf, Martinistraße 52, 20246 Hamburg, Germany;
| | - Stefan Gräbel
- Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Charitéplatz 1, Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (S.G.); (A.J.S.); (H.O.)
| | - Agnieszka J. Szczepek
- Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Charitéplatz 1, Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (S.G.); (A.J.S.); (H.O.)
| | - Heidi Olze
- Corporate Member of Freie Universität Berlin, Berlin Institute of Health, Charitéplatz 1, Humboldt-Universität zu Berlin, 10117 Berlin, Germany; (S.G.); (A.J.S.); (H.O.)
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Alyahya D, Kashoo FZ. Perception, knowledge, and attitude of medical doctors in Saudi Arabia about the role of physiotherapists in vestibular rehabilitation: a cross-sectional survey. PeerJ 2022; 10:e13035. [PMID: 35282282 PMCID: PMC8908887 DOI: 10.7717/peerj.13035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2021] [Accepted: 02/08/2022] [Indexed: 01/11/2023] Open
Abstract
Objectives There is compelling scientific evidence about the role of physiotherapists in vestibular rehabilitation. However, patients with vestibular-associated dizziness and balance disturbances are seldom referred to physiotherapists in Saudi Arabia. Therefore, this study aims to achieve insight into perceptions, knowledge, attitudes, and referral practices among Saudi Arabian medical doctors relating to the role of physiotherapists in vestibular rehabilitation. Methods A sample of 381 medical doctors practicing in Saudi Arabia participated in this nationwide cross-sectional study. The sample was obtained from 226 hospitals across 13 provinces of Saudi Arabia by stratified sampling method. The 23-item questionnaire developed by a team of experts was emailed to medical doctors practicing in various hospitals across Saudi Arabia. Results Out of 1,231 medical doctors invited, 381 medical doctors responded, giving a response rate of 30.9%. One hundred ninety-three (50.6%) medical doctors reported managing patients with vestibular rehabilitation. The most preferred specialist for managing patients with vestibular disorders was an Ear Nose Throat (ENT) specialist (n = 173, 89.6%). Related Sample Cochran's Q test showed statistically significant difference between preferred specialist for managing patients with vestibular disorders (ENT specialists, physiotherapists, nurses, occupational therapists and audiologists) (χ2(4) = 482.476, p = 0.001). Out of 193 medical doctors, 153 (79.2%) reported no role of the physiotherapist in vestibular rehabilitation. One hundred forty-five (75.1%) of medical doctors reported that they were not aware of the role of physiotherapists in vestibular rehabilitation. Only 27 (15.5%) medical doctors reported referring patients with vestibular disorders to physiotherapists. Conclusion The study reports that physiotherapy services are underutilized in vestibular rehabilitation due to limited referral from Saudi Arabian medical doctors. Therefore, there is a need to increase the awareness among Saudi Arabian doctors about the physiotherapist's role in vestibular rehabilitation.
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Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Updated Clinical Practice Guideline From the Academy of Neurologic Physical Therapy of the American Physical Therapy Association. J Neurol Phys Ther 2021; 46:118-177. [PMID: 34864777 PMCID: PMC8920012 DOI: 10.1097/npt.0000000000000382] [Citation(s) in RCA: 91] [Impact Index Per Article: 30.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
Background: Uncompensated vestibular hypofunction can result in symptoms of dizziness, imbalance, and/or oscillopsia, gaze and gait instability, and impaired navigation and spatial orientation; thus, may negatively impact an individual's quality of life, ability to perform activities of daily living, drive, and work. It is estimated that one-third of adults in the United States have vestibular dysfunction and the incidence increases with age. There is strong evidence supporting vestibular physical therapy for reducing symptoms, improving gaze and postural stability, and improving function in individuals with vestibular hypofunction. The purpose of this revised clinical practice guideline is to improve quality of care and outcomes for individuals with acute, subacute, and chronic unilateral and bilateral vestibular hypofunction by providing evidence-based recommendations regarding appropriate exercises. Methods: These guidelines are a revision of the 2016 guidelines and involved a systematic review of the literature published since 2015 through June 2020 across 6 databases. Article types included meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case-control series, and case series for human subjects, published in English. Sixty-seven articles were identified as relevant to this clinical practice guideline and critically appraised for level of evidence. Results: Based on strong evidence, clinicians should offer vestibular rehabilitation to adults with unilateral and bilateral vestibular hypofunction who present with impairments, activity limitations, and participation restrictions related to the vestibular deficit. Based on strong evidence and a preponderance of harm over benefit, clinicians should not include voluntary saccadic or smooth-pursuit eye movements in isolation (ie, without head movement) to promote gaze stability. Based on moderate to strong evidence, clinicians may offer specific exercise techniques to target identified activity limitations and participation restrictions, including virtual reality or augmented sensory feedback. Based on strong evidence and in consideration of patient preference, clinicians should offer supervised vestibular rehabilitation. Based on moderate to weak evidence, clinicians may prescribe weekly clinic visits plus a home exercise program of gaze stabilization exercises consisting of a minimum of: (1) 3 times per day for a total of at least 12 minutes daily for individuals with acute/subacute unilateral vestibular hypofunction; (2) 3 to 5 times per day for a total of at least 20 minutes daily for 4 to 6 weeks for individuals with chronic unilateral vestibular hypofunction; (3) 3 to 5 times per day for a total of 20 to 40 minutes daily for approximately 5 to 7 weeks for individuals with bilateral vestibular hypofunction. Based on moderate evidence, clinicians may prescribe static and dynamic balance exercises for a minimum of 20 minutes daily for at least 4 to 6 weeks for individuals with chronic unilateral vestibular hypofunction and, based on expert opinion, for a minimum of 6 to 9 weeks for individuals with bilateral vestibular hypofunction. Based on moderate evidence, clinicians may use achievement of primary goals, resolution of symptoms, normalized balance and vestibular function, or plateau in progress as reasons for stopping therapy. Based on moderate to strong evidence, clinicians may evaluate factors, including time from onset of symptoms, comorbidities, cognitive function, and use of medication that could modify rehabilitation outcomes. Discussion: Recent evidence supports the original recommendations from the 2016 guidelines. There is strong evidence that vestibular physical therapy provides a clear and substantial benefit to individuals with unilateral and bilateral vestibular hypofunction. Limitations: The focus of the guideline was on peripheral vestibular hypofunction; thus, the recommendations of the guideline may not apply to individuals with central vestibular disorders. One criterion for study inclusion was that vestibular hypofunction was determined based on objective vestibular function tests. This guideline may not apply to individuals who report symptoms of dizziness, imbalance, and/or oscillopsia without a diagnosis of vestibular hypofunction. Disclaimer: These recommendations are intended as a guide to optimize rehabilitation outcomes for individuals undergoing vestibular physical therapy. The contents of this guideline were developed with support from the American Physical Therapy Association and the Academy of Neurologic Physical Therapy using a rigorous review process. The authors declared no conflict of interest and maintained editorial independence. Video Abstract available for more insights from the authors (see the Video, Supplemental Digital Content 1, available at: http://links.lww.com/JNPT/A369).
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Marouane E, El Mahmoudi N, Rastoldo G, Péricat D, Watabe I, Lapôtre A, Tonetto A, Xavier F, Dumas O, Chabbert C, Artzner V, Tighilet B. Sensorimotor Rehabilitation Promotes Vestibular Compensation in a Rodent Model of Acute Peripheral Vestibulopathy by Promoting Microgliogenesis in the Deafferented Vestibular Nuclei. Cells 2021; 10:3377. [PMID: 34943885 PMCID: PMC8699190 DOI: 10.3390/cells10123377] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 11/26/2021] [Accepted: 11/29/2021] [Indexed: 12/16/2022] Open
Abstract
Acute peripheral vestibulopathy leads to a cascade of symptoms involving balance and gait disorders that are particularly disabling for vestibular patients. Vestibular rehabilitation protocols have proven to be effective in improving vestibular compensation in clinical practice. Yet, the underlying neurobiological correlates remain unknown. The aim of this study was to highlight the behavioural and cellular consequences of a vestibular rehabilitation protocol adapted to a rat model of unilateral vestibular neurectomy. We developed a progressive sensory-motor rehabilitation task, and the behavioural consequences were quantified using a weight-distribution device. This analysis method provides a precise and ecological analysis of posturolocomotor vestibular deficits. At the cellular level, we focused on the analysis of plasticity mechanisms expressed in the vestibular nuclei. The results obtained show that vestibular rehabilitation induces a faster recovery of posturolocomotor deficits during vestibular compensation associated with a decrease in neurogenesis and an increase in microgliogenesis in the deafferented medial vestibular nucleus. This study reveals for the first time a part of the underlying adaptative neuroplasticity mechanisms of vestibular rehabilitation. These original data incite further investigation of the impact of rehabilitation on animal models of vestibulopathy. This new line of research should improve the management of vestibular patients.
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Affiliation(s)
- Emna Marouane
- Aix-Marseille Université-CNRS, Laboratoire de Neurosciences Cognitives, LNC UMR 7291, Centre Saint-Charles Case C, 3 Place Victor Hugo, CEDEX 03, 13331 Marseille, France; (E.M.); (N.E.M.); (G.R.); (I.W.); (A.L.); (F.X.); (C.C.)
- BIOSEB ALLCAT Instruments, Couperigne, 13127 Vitrolles, France;
| | - Nada El Mahmoudi
- Aix-Marseille Université-CNRS, Laboratoire de Neurosciences Cognitives, LNC UMR 7291, Centre Saint-Charles Case C, 3 Place Victor Hugo, CEDEX 03, 13331 Marseille, France; (E.M.); (N.E.M.); (G.R.); (I.W.); (A.L.); (F.X.); (C.C.)
| | - Guillaume Rastoldo
- Aix-Marseille Université-CNRS, Laboratoire de Neurosciences Cognitives, LNC UMR 7291, Centre Saint-Charles Case C, 3 Place Victor Hugo, CEDEX 03, 13331 Marseille, France; (E.M.); (N.E.M.); (G.R.); (I.W.); (A.L.); (F.X.); (C.C.)
| | - David Péricat
- Institute of Pharmacology and Structural Biology (IPBS), University of Toulouse, CNRS, 31400 Toulouse, France;
| | - Isabelle Watabe
- Aix-Marseille Université-CNRS, Laboratoire de Neurosciences Cognitives, LNC UMR 7291, Centre Saint-Charles Case C, 3 Place Victor Hugo, CEDEX 03, 13331 Marseille, France; (E.M.); (N.E.M.); (G.R.); (I.W.); (A.L.); (F.X.); (C.C.)
| | - Agnès Lapôtre
- Aix-Marseille Université-CNRS, Laboratoire de Neurosciences Cognitives, LNC UMR 7291, Centre Saint-Charles Case C, 3 Place Victor Hugo, CEDEX 03, 13331 Marseille, France; (E.M.); (N.E.M.); (G.R.); (I.W.); (A.L.); (F.X.); (C.C.)
| | - Alain Tonetto
- Fédération de Recherche Sciences Chimiques Marseille FR 1739, Pôle 18 PRATIM, CEDEX 03, 13331 Marseille, France;
| | - Frédéric Xavier
- Aix-Marseille Université-CNRS, Laboratoire de Neurosciences Cognitives, LNC UMR 7291, Centre Saint-Charles Case C, 3 Place Victor Hugo, CEDEX 03, 13331 Marseille, France; (E.M.); (N.E.M.); (G.R.); (I.W.); (A.L.); (F.X.); (C.C.)
- GDR Physiopathologie Vestibulaire—Unité GDR2074, CNRS, 13003 Marseille, France;
| | - Olivier Dumas
- GDR Physiopathologie Vestibulaire—Unité GDR2074, CNRS, 13003 Marseille, France;
| | - Christian Chabbert
- Aix-Marseille Université-CNRS, Laboratoire de Neurosciences Cognitives, LNC UMR 7291, Centre Saint-Charles Case C, 3 Place Victor Hugo, CEDEX 03, 13331 Marseille, France; (E.M.); (N.E.M.); (G.R.); (I.W.); (A.L.); (F.X.); (C.C.)
- GDR Physiopathologie Vestibulaire—Unité GDR2074, CNRS, 13003 Marseille, France;
| | - Vincent Artzner
- BIOSEB ALLCAT Instruments, Couperigne, 13127 Vitrolles, France;
| | - Brahim Tighilet
- Aix-Marseille Université-CNRS, Laboratoire de Neurosciences Cognitives, LNC UMR 7291, Centre Saint-Charles Case C, 3 Place Victor Hugo, CEDEX 03, 13331 Marseille, France; (E.M.); (N.E.M.); (G.R.); (I.W.); (A.L.); (F.X.); (C.C.)
- GDR Physiopathologie Vestibulaire—Unité GDR2074, CNRS, 13003 Marseille, France;
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A Systematic Review on the Association Between Vestibular Dysfunction and Balance Performance in Children With Hearing Loss. Ear Hear 2021; 43:712-721. [PMID: 34611117 PMCID: PMC8958172 DOI: 10.1097/aud.0000000000001131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES The objective of this study was to understand the functional impact of vestibular dysfunction on balance control in children with hearing loss. The vestibular system is an important contributor to maintaining balance. In adults, vestibular dysfunction is known to lead to unsteadiness and falls. Considerably less is known about the effects of vestibular dysfunction in children with hearing loss. DESIGN We conducted a systematic review in concordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines. We included articles on children with hearing loss who underwent vestibular and balance testing. The Downs and Black checklist was used to assess the risk of bias. RESULTS A total of 20 articles were included in this systematic review, of which, 17 reported an association between vestibular dysfunction and balance abnormalities in children with hearing loss. Bias (as measured by the Downs and Black Checklist) was a concern, as most studies were nonblinded cohort studies or case series selected through convenience sampling. CONCLUSIONS Research to date has predominantly found that children with concomitant hearing loss and vestibular impairment tend to perform more poorly on balance measures than either children with hearing loss and normal vestibular function or children with both normal-hearing and normal vestibular function. A standardized approach to assessing both vestibular function and balance would better characterize the impact of vestibular dysfunction in children with hearing loss at the population level.
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Hösli S, Straumann D. Independent Measures of Utricular Function: Ocular Vestibular Evoked Myogenic Potentials Do Not Correlate With Subjective Visual Vertical or Fundus Photographic Binocular Cyclorotation. Front Neurol 2021; 12:658419. [PMID: 33935954 PMCID: PMC8079738 DOI: 10.3389/fneur.2021.658419] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 03/10/2021] [Indexed: 11/13/2022] Open
Abstract
Ocular vestibular evoked myogenic potentials (oVEMPs), subjective visual vertical (SVV), and fundus photographically measured binocular cyclorotation (BCR) are diagnostic tests to assess utricular function in patients with vertigo or dizziness. In 138 patients with chronic vertigo or dizziness, we asked whether the asymmetry ratio of oVEMP (normal, right side pathological, left side pathological) could predict the SVV deviation (normal, rightward deviation, leftward deviation) or BCR (normal, cyclorotation to the right, cyclorotation to the left). There was no correlation between oVEMP and SVV and between oVEMP and BCR, while SVV and BCR correlated highly. Although both oVEMP and SVV measure aspects of utricular function, our findings demonstrate that oVEMP and SVV are not redundant and may reflect different utricular pathologies. The role of fundus photographic BCR may be relegated to only confirm unclear SVV results in vestibular diagnostic workup.
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Affiliation(s)
- Sarah Hösli
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
| | - Dominik Straumann
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland.,Clinical Neuroscience Center, University Hospital Zurich, Zurich, Switzerland
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Ladda AM, Wallwork SB, Lotze M. Multimodal Sensory-Spatial Integration and Retrieval of Trained Motor Patterns for Body Coordination in Musicians and Dancers. Front Psychol 2020; 11:576120. [PMID: 33312150 PMCID: PMC7704436 DOI: 10.3389/fpsyg.2020.576120] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2020] [Accepted: 10/27/2020] [Indexed: 12/26/2022] Open
Abstract
Dancers and musicians are experts in spatial and temporal processing, which allows them to coordinate movement with music. This high-level processing has been associated with structural and functional adaptation of the brain for high performance sensorimotor integration. For these integration processes, adaptation does not only take place in primary and secondary sensory and motor areas but also in tertiary brain areas, such as the lateral prefrontal cortex (lPFC) and the intraparietal sulcus (IPS), providing vital resources for highly specialized performance. Here, we review evidence for the role of these brain areas in multimodal training protocols and integrate these findings into a new model of sensorimotor processing in complex motor learning.
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Affiliation(s)
- Aija Marie Ladda
- Functional Imaging Unit, Diagnostic Radiology and Neuroradiology, University of Greifswald, Greifswald, Germany
| | - Sarah B. Wallwork
- IIMPACT in Health, Allied Health and Human Performance, University of South Australia, Adelaide, SA, Australia
| | - Martin Lotze
- Functional Imaging Unit, Diagnostic Radiology and Neuroradiology, University of Greifswald, Greifswald, Germany
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Mitsutake T, Imura T, Tanaka R. The Effects of Vestibular Rehabilitation on Gait Performance in Patients with Stroke: A Systematic Review of Randomized Controlled Trials. J Stroke Cerebrovasc Dis 2020; 29:105214. [PMID: 33066892 DOI: 10.1016/j.jstrokecerebrovasdis.2020.105214] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 07/21/2020] [Accepted: 07/26/2020] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Patients with post-stroke hemiparesis have poor postural stability; nevertheless, it is unclear whether vestibular rehabilitation affects gait performance after a stroke or not. We performed a systematic review of randomized controlled trials to investigate the effects of vestibular rehabilitation on gait performance in patients with post stroke. METHODS The Medline, Cochrane Central Register of Controlled Trials, Physiotherapy Evidence Database, and Cumulative Index to Nursing and Allied Health Literature databases were comprehensively searched. All literature published from each source's earliest date to June 2019 was included. Study selection and data extraction were performed independently by paired reviewers. Outcomes of gait performance were the 10-Meter Walking Test, Timed Up and Go Test, and Dynamic Gait Index. We applied the Physiotherapy Evidence Database scale to evaluate the risk of bias and the Grading of Recommendations Assessment, Development and Evaluation system to evaluate the quality of a body of evidence. RESULTS Three studies were included, and two out of three trials showed beneficial effects of vestibular rehabilitation in post-stroke patients. Quality assessment using the Grading of Recommendations Assessment, Development and Evaluation criteria found very low-quality evidence of all included studies due to inadequate allocation concealment, low participant numbers, and lack of blinding. CONCLUSION This review found beneficial effects of vestibular rehabilitation on gait performance in patients with stroke. However, due to the very low-quality evidence of previous randomized controlled trials as assessed by the Grading of Recommendations Assessment, Development and Evaluation criteria, definitive conclusions on the effectiveness of vestibular rehabilitation cannot be made. Hence, more high-quality and large-scale randomized controlled trials of vestibular rehabilitation after stroke are needed.
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Affiliation(s)
- Tsubasa Mitsutake
- Department of Physical Therapy, Fukuoka International University of Health and Welfare, Fukuoka 814-0001, Japan.
| | - Takeshi Imura
- Department of Rehabilitation, Faculty of Health Sciences, Hiroshima Cosmopolitan University, Hiroshima, Japan
| | - Ryo Tanaka
- Graduate School of Integrated Arts and Sciences, Hiroshima University, Hiroshima, Japan
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Kim JS. When the Room Is Spinning: Experience of Vestibular Neuritis by a Neurotologist. Front Neurol 2020; 11:157. [PMID: 32194499 PMCID: PMC7062794 DOI: 10.3389/fneur.2020.00157] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Accepted: 02/19/2020] [Indexed: 01/22/2023] Open
Abstract
Vestibular neuritis (VN) is the most common cause of acute prolonged spontaneous vertigo, and is characterized by acute unilateral vestibular hypofunction, probably due to inflammation of the vestibular nerve. VN is diagnosed at the bedside when there is spontaneous horizontal-torsional nystagmus beating away from the side of the lesion, abnormal head impulse tests for the semicircular canals involved on the lesion side, and when other neurological symptoms and signs are absent. Here, as a neuro-otologist, I describe my experience during an attack of VN and discuss how it may help physicians to better understand why and what a patient feels during attacks of vertigo.
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Affiliation(s)
- Ji-Soo Kim
- Department of Neurology, Seoul National University College of Medicine, Seoul, South Korea
- Department of Neurology, Dizziness Center, Clinical Neuroscience Center, Seoul National University Bundang Hospital, Seongnam-si, South Korea
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Assessment of Vestibulo-ocular Reflex Gain and Catch-up Saccades During Vestibular Rehabilitation. Otol Neurotol 2019; 39:e1111-e1117. [PMID: 30303945 DOI: 10.1097/mao.0000000000002032] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
OBJECTIVE To assess, in patients referred to vestibular rehabilitation (VR) for persistence of disability after acute unilateral vestibulopathy (AUV), whether the video head impulse test (vHIT) can be a useful technique to define the efficacy of the treatment. STUDY DESIGN Prospective clinical study. SETTING Tertiary academic referral hospitals. PATIENTS Thirty patients with residual symptoms after AUV were included. INTERVENTION Patients underwent a 10-week VR program. MAIN OUTCOME MEASURES Evaluation of dizziness handicap inventory score, high-velocity vestibulo-ocular reflex gain, asymmetry index, and catch-up saccade parameters before and after VR. RESULTS All patients reported a clear clinical improvement after VR, also demonstrated by better dizziness handicap inventory scores (p < 0.001). A consistent increased gain and decreased asymmetry index were also observed (p < 0.001 for both). Patients did not show any change in covert catch-up saccades, while a statistically significant reduction of the number and amplitude of the overt catch-up saccades was interestingly detected (p = 0.009 and p = 0.030, respectively). CONCLUSION VR is a valid approach for patients with residual disability after AUV. A reduction in number and amplitude of overt catch-up saccades seems useful to evaluate the efficacy of VR and to be related to clinical improvement.
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van Vugt VA, van der Wouden JC, Essery R, Yardley L, Twisk JWR, van der Horst HE, Maarsingh OR. Internet based vestibular rehabilitation with and without physiotherapy support for adults aged 50 and older with a chronic vestibular syndrome in general practice: three armed randomised controlled trial. BMJ 2019; 367:l5922. [PMID: 31690561 PMCID: PMC6829201 DOI: 10.1136/bmj.l5922] [Citation(s) in RCA: 27] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
OBJECTIVE To investigate the clinical effectiveness and safety of stand alone and blended internet based vestibular rehabilitation (VR) in the management of chronic vestibular syndromes in general practice. DESIGN Pragmatic, three armed, parallel group, individually randomised controlled trial. SETTING 59 general practices in the Netherlands. PARTICIPANTS 322 adults aged 50 and older with a chronic vestibular syndrome. INTERVENTIONS Stand alone VR comprising a six week, internet based intervention with weekly online sessions and daily exercises (10-20 minutes a day). In the blended VR group, the same internet based intervention was supplemented by face-to-face physiotherapy support (home visits in weeks 1 and 3). Participants in the usual care group received standard care from a general practitioner, without any restrictions. MAIN OUTCOME MEASURES The primary outcome was vestibular symptoms after six months as measured by the vertigo symptom scale-short form (VSS-SF range 0-60, clinically relevant difference ≥3 points). Secondary outcomes were dizziness related impairment, anxiety, depressive symptoms, subjective improvement of vestibular symptoms after three and six months, and adverse events. RESULTS In the intention-to-treat analysis, participants in the stand alone and blended VR groups had lower VSS-SF scores at six months than participants in the usual care group (adjusted mean difference -4.1 points, 95% confidence interval -5.8 to -2.5; and -3.5 points, -5.1 to -1.9, respectively). Similar differences in VSS-SF scores were seen at three months follow-up. Participants in the stand alone and blended VR groups also experienced less dizziness related impairment, less anxiety, and more subjective improvement of vestibular symptoms at three and six months. No serious adverse events related to online VR occurred during the trial. CONCLUSION Stand alone and blended internet based VR are clinically effective and safe interventions to treat adults aged 50 and older with a chronic vestibular syndrome. Online VR is an easily accessible form of treatment, with the potential to improve care for an undertreated group of patients in general practice. TRIAL REGISTRATION Netherlands Trial Register NTR5712.
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Affiliation(s)
- Vincent A van Vugt
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Johannes C van der Wouden
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Rosie Essery
- Department of Psychology, University of Southampton, Southampton, UK
| | - Lucy Yardley
- Department of Psychology, University of Southampton, Southampton, UK
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam, Netherlands
| | - Henriëtte E van der Horst
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
| | - Otto R Maarsingh
- Department of General Practice and Elderly Care Medicine, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, de Boelelaan 1117, Amsterdam, Netherlands
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Müller-Barna P, Hubert ND, Bergner C, Schütt-Becker N, Rambold H, Haberl RL, Hubert GJ. TeleVertigo: Diagnosing Stroke in Acute Dizziness: A Telemedicine-Supported Approach. Stroke 2019; 50:3293-3298. [PMID: 31607244 DOI: 10.1161/strokeaha.119.026505] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Peter Müller-Barna
- From the Department of Neurology and Neurological Intensive Care, München Klinik Harlaching-Academic Teaching Hospital of the Ludwig-Maximilians-Universität München, Munich, Germany (P.M.-B., N.D.H., C.B., N.S.-B., R.L.H., G.J.H.)
| | - Nikolai Dominik Hubert
- From the Department of Neurology and Neurological Intensive Care, München Klinik Harlaching-Academic Teaching Hospital of the Ludwig-Maximilians-Universität München, Munich, Germany (P.M.-B., N.D.H., C.B., N.S.-B., R.L.H., G.J.H.)
| | - Christina Bergner
- From the Department of Neurology and Neurological Intensive Care, München Klinik Harlaching-Academic Teaching Hospital of the Ludwig-Maximilians-Universität München, Munich, Germany (P.M.-B., N.D.H., C.B., N.S.-B., R.L.H., G.J.H.)
| | - Nina Schütt-Becker
- From the Department of Neurology and Neurological Intensive Care, München Klinik Harlaching-Academic Teaching Hospital of the Ludwig-Maximilians-Universität München, Munich, Germany (P.M.-B., N.D.H., C.B., N.S.-B., R.L.H., G.J.H.)
| | - Holger Rambold
- Department of Neurology, County Hospitals of Altötting and Burghausen, Germany (H.R.)
- Department of Neurology, University of Regensburg, Germany (H.R.)
- MVZ Kliniken Mühldorf, Mühldorf am Inn, Germany (H.R.)
| | - Roman Ludwig Haberl
- From the Department of Neurology and Neurological Intensive Care, München Klinik Harlaching-Academic Teaching Hospital of the Ludwig-Maximilians-Universität München, Munich, Germany (P.M.-B., N.D.H., C.B., N.S.-B., R.L.H., G.J.H.)
| | - Gordian Jan Hubert
- From the Department of Neurology and Neurological Intensive Care, München Klinik Harlaching-Academic Teaching Hospital of the Ludwig-Maximilians-Universität München, Munich, Germany (P.M.-B., N.D.H., C.B., N.S.-B., R.L.H., G.J.H.)
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25
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Gaze stabilisation exercises in vestibular rehabilitation: review of the evidence and recent clinical advances. J Neurol 2019; 266:11-18. [DOI: 10.1007/s00415-019-09459-x] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2019] [Revised: 07/04/2019] [Accepted: 07/06/2019] [Indexed: 10/26/2022]
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26
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Ertugrul S, Soylemez E. Investigation of the factors affecting the success of vestibular rehabilitation therapy in patients with idiopathic unilateral vestibular hypofunction and idiopathic bilateral vestibular hypofunction. ENT UPDATES 2019. [DOI: 10.32448/entupdates.570136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
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Different Visual Weighting due to Fast or Slow Vestibular Deafferentation: Before and after Schwannoma Surgery. Neural Plast 2019; 2019:4826238. [PMID: 30911290 PMCID: PMC6398006 DOI: 10.1155/2019/4826238] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2018] [Accepted: 12/02/2018] [Indexed: 01/08/2023] Open
Abstract
Background Feedback postural control depends upon information from somatosensation, vision, and the vestibular system that are weighted depending on their relative importance within the central nervous system. Following loss of any sensory component, the weighting changes, e.g., when suffering a vestibular loss, the most common notion is that patients become more dependent on visual cues for maintaining postural control. Dizziness and disequilibrium are common after surgery in schwannoma patients, which could be due to interpretation of the remaining sensory systems involved in feedback-dependent postural control and spatial orientation. Objective To compare visual dependency in spatial orientation and postural control in patients suffering from unilateral vestibular loss within different time frames. Methods Patients scheduled for schwannoma surgery: group 1 (n = 27) with no vestibular function prior to surgery (lost through years), group 2 (n = 12) with remaining vestibular function at the time of surgery (fast deafferentation), and group 3 (n = 18) with remaining function that was lost through gentamicin installations in the middle ear (slow deafferentation). All patients performed vibratory posturography and rod and frame investigation before surgery and 6 months after surgery. Results Postural control improved after surgery in patients that suffered a slow deafferentation (groups 1 and 3) (p < 0.001). Patients that suffered fast loss of remaining vestibular function (group 2) became less visual field dependent after surgery (p ≤ 0.035) and were less able to maintain stability compared with group 1 (p = 0.010) and group 3 (p = 0.010). Conclusions The nature and time course of vestibular deafferentation influence the weighting of remaining sensory systems in order to maintain postural control and spatial orientation.
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Abstract
Dizziness can be due to pathology from multiple physiologic systems, the most common being vestibular. Dizziness may be categorized as vertigo, disequilibrium, lightheadedness, or oscillopsia. Vertigo is an illusion of motion often caused by asymmetrical vestibular input to the brainstem. To evaluate vertigo, it is essential to include the symptom's quality, timing, frequency, trigger, influence from positional changes, and other associations from the history. Oculomotor, otologic, balance testing, positional testing, and nystagmus testing are equally important components of the examination. Two of the most common diagnoses are readily treated with canalith repositioning maneuvers and vestibular rehabilitation exercises.
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Affiliation(s)
- Sharmeen Sorathia
- Ziauddin University College of Medicine, 4/B, Shahrah-e-Ghalib, Block 6, Clifton, Karachi 75600, Pakistan; Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Yuri Agrawal
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA
| | - Michael C Schubert
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA; Department of Physical Medicine and Rehabilitation, Johns Hopkins University School of Medicine, 601 North Caroline Street, Baltimore, MD 21287, USA.
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29
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[Dizziness - differential diagnosis and management]. MMW Fortschr Med 2018; 160:40-43. [PMID: 29619695 DOI: 10.1007/s15006-018-0380-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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30
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LAPENNA R, PELLEGRINO A, RICCI G, CAGINI C, FARALLI M. Binocular cyclotorsion in superior vestibular neuritis. ACTA OTORHINOLARYNGOLOGICA ITALICA : ORGANO UFFICIALE DELLA SOCIETA ITALIANA DI OTORINOLARINGOLOGIA E CHIRURGIA CERVICO-FACCIALE 2018; 38:138-144. [PMID: 29967552 PMCID: PMC6028823 DOI: 10.14639/0392-100x-1645] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Accepted: 06/06/2017] [Indexed: 11/23/2022]
Abstract
SUMMARY Conjugated cyclotorsion of the eyes toward the affected side can commonly be observed in vestibular neuritis. The aim of this study was to assess the differences in cyclotorsion between the ipsi- and contralesional eye during selective involvement of the superior branch of the vestibular nerve. We studied binocular cyclotorsion through ocular fundus photographs in 10 patients affected by acute superior vestibular neuritis (SVN). Cyclotorsion was also studied in 20 normal subjects. All SVN patients showed an ipsilesional cycloversion of the eyes. Normal subjects exhibited a constant mild excyclovergence (6.42 ± 2.34°). In SVN patients, contralateral incyclotorsion (8.4 ± 8.14°) was lower and not normally distributed compared to ipsilateral eye excyclotorsion (17.9 ± 4.36°) with no correlation between them. The interocular difference in cyclodeviation could be related to the starting physiological excyclovergence, to different tonic effects on the extraocular muscles of the two eyes and to the different influence of spontaneous nystagmus on cyclodeviation in the two eyes. We recommend referring only to ipsilateral excyclotorsion in the evaluation of utricular function during SVN and its subsequent compensation. Further studies are required to determine the binocular cyclotorsion in the case of other kinds of selective involvement of the vestibular nerve.
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Affiliation(s)
- R. LAPENNA
- Department of Surgical and Biomedical Sciences, Section of Otorhinolaryngology, University of Perugia, Italy
| | - A. PELLEGRINO
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, Italy
| | - G. RICCI
- Department of Surgical and Biomedical Sciences, Section of Otorhinolaryngology, University of Perugia, Italy
| | - C. CAGINI
- Department of Surgical and Biomedical Sciences, Section of Ophthalmology, University of Perugia, Italy
| | - M. FARALLI
- Department of Surgical and Biomedical Sciences, Section of Otorhinolaryngology, University of Perugia, Italy
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31
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Jeong J, Jung J, Lee JM, Suh MJ, Kwak SH, Kim SH. Effects of Saccular Function on Recovery of Subjective Dizziness After Vestibular Rehabilitation. Otol Neurotol 2018; 38:1017-1023. [PMID: 28562427 DOI: 10.1097/mao.0000000000001467] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE We attempted to investigate whether the integrity of saccular function influences the severity of subjective dizziness after vestibular rehabilitation in vestibular neuritis. STUDY DESIGN Retrospective analysis. SETTING Tertiary referral center. PATIENTS Forty-six patients with acute unilateral vestibular neuritis were included. INTERVENTIONS Diagnostic, therapeutic, and rehabilitative. MAIN OUTCOME MEASURES All the patients completed vestibular rehabilitation therapy until their computerized dynamic posturography and rotary chair test results were significantly improved. The rehabilitation patients were classified into the normal to mild subjective dizziness and moderate to severe subjective dizziness groups according to the dizziness handicap inventory score (cutoff of 40). Differences between the two groups were analyzed. RESULTS After rehabilitation, 32.6% of the patients still complained of moderate to severe dizziness. Age, sex distribution, the presence of comorbidities, caloric weakness, pre- and postrehabilitation gain values in rotary chair test, postrehabilitation composite scores in posturography, and the duration of rehabilitation were not significantly different between the two groups. However, initial dizziness handicap inventory (DHI) score and composite score in dynamic posturography were worse and the proportion of patients with absent cervical vestibular-evoked myogenic potential in the moderate to severe group was much higher (93.3% vs. 35.5%, p < 0.001). After multiple regression analysis of those factors, initial DHI score and absent cervical vestibular-evoked myogenic potential response were identified as being associated with higher postrehabilitation DHI score. CONCLUSION Saccular dysfunction in acute vestibular neuritis can contribute to persistent subjective dizziness, even after the objective parameters of vestibular function tests have been improved by vestibular rehabilitation.
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Affiliation(s)
- Junhui Jeong
- *Department of Otorhinolaryngology, National Health Insurance Service Ilsan Hospital, Goyang †Department of Medicine, The Graduate School, Yonsei University ‡Department of Otorhinolaryngology, Yonsei University College of Medicine, Seoul §Department of Otorhinolaryngology, Inje University College of Medicine, Ilsan Paik Hospital, Goyang
- The Airway Mucus Institute, Yonsei University College of Medicine, Seoul, Korea
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Zwergal A, Möhwald K, Dieterich M. [Vertigo and dizziness in the emergency room]. DER NERVENARZT 2018; 88:587-596. [PMID: 28484820 DOI: 10.1007/s00115-017-0342-y] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Vertigo and dizziness are among the most common chief complaints in the emergency department. Etiologies can be categorized into three subgroups: neurootological (vestibular), medical (especially cardiovascular, metabolic), and psychiatric disorders. The diagnostic approach in the emergency department is based on a systematic analysis of case history (type, time course of symptoms, modulating factors, associated symptoms), clinical examination of the vestibular, ocular motor, and cerebellar systems (head impulse test, nystagmus, skew deviation, positioning maneuver, test of gait and stance), as well as a basal monitoring (vital signs, 12-lead ECG, blood tests). For differentiation of peripheral and central etiologies in acute vestibular syndrome, the HINTS exam (head impulse test, nystagmus, test of skew) and examination of smooth pursuit and saccades should be applied. Nonselective use of neuroimaging is not indicated due to a low diagnostic yield. Cranial imaging should be done in the following constellations: (1) detection of focal neurological or central ocular motor and vestibular signs on clinical exam, (2) acute abasia with only minor ocular motor signs, (3) presence of various cardiovascular risk factors, (4) headache of unknown quality as an accompanying symptom. Besides the symptomatic therapy of vertigo and dizziness with antiemetics or analgesics, further diagnostic differentiation is urgent to guide proper treatment. Examples are the acute therapy in cerebral ischemia, the execution of positioning maneuvers in benign paroxysmal positional vertigo, the use of corticosteroids in acute unilateral vestibulopathy, as well as the readjustment of metabolic homeostasis in medical disorders.
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Affiliation(s)
- A Zwergal
- Neurologische Klinik und Poliklinik/ Deutsches Schwindel- und Gleichgewichtszentrum (DSGZ), Ludwig-Maximilians-Universität München, Klinikum Großhadern, Marchioninistraße 15, 81377, München, Deutschland.
| | - K Möhwald
- Deutsches Schwindel- und Gleichgewichtszentrum (DSGZ), Ludwig-Maximilians-Universität München, Klinikum Großhadern, Marchioninistraße 15, 81377, München, Deutschland
| | - M Dieterich
- Neurologische Klinik und Poliklinik/ Deutsches Schwindel- und Gleichgewichtszentrum (DSGZ), Ludwig-Maximilians-Universität München, Klinikum Großhadern, Marchioninistraße 15, 81377, München, Deutschland
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Tjernström F, Fransson PA, Kahlon B, Karlberg M, Lindberg S, Siesjö P, Magnusson M. PREHAB vs. REHAB – presurgical treatment in vestibular schwannoma surgery enhances recovery of postural control better than postoperative rehabilitation: Retrospective case series. J Vestib Res 2018; 27:313-325. [DOI: 10.3233/ves-170626] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- Fredrik Tjernström
- Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
| | - Per-Anders Fransson
- Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
| | - Babar Kahlon
- Department of Neurosurgery, Clinical Sciences, Skåne University Hospital, Lund, Sweden
| | - Mikael Karlberg
- Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
| | - Sven Lindberg
- Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
| | - Peter Siesjö
- Department of Neurosurgery, Clinical Sciences, Skåne University Hospital, Lund, Sweden
| | - Måns Magnusson
- Department of Otorhinolaryngology, Head and Neck Surgery, Skåne University Hospital, Lund, Sweden
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Young AS, Rosengren SM, Welgampola MS. Disorders of the inner-ear balance organs and their pathways. HANDBOOK OF CLINICAL NEUROLOGY 2018; 159:385-401. [PMID: 30482329 DOI: 10.1016/b978-0-444-63916-5.00025-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Disorders of the inner-ear balance organs can be grouped by their manner of presentation into acute, episodic, or chronic vestibular syndromes. A sudden unilateral vestibular injury produces severe vertigo, nausea, and imbalance lasting days, known as the acute vestibular syndrome (AVS). A bedside head impulse and oculomotor examination helps separate vestibular neuritis, the more common and innocuous cause of AVS, from stroke. Benign positional vertigo, a common cause of episodic positional vertigo, occurs when otoconia overlying the otolith membrane falls into the semicircular canals, producing brief spells of spinning vertigo triggered by head movement. Benign positional vertigo is diagnosed by a positional test, which triggers paroxysmal positional nystagmus in the plane of the affected semicircular canal. Episodic spontaneous vertigo caused by vestibular migraine and Ménière's disease can sometimes prove hard to separate. Typically, Ménière's disease is associated with spinning vertigo lasting hours, aural fullness, tinnitus, and fluctuating hearing loss while VM can produce spinning, rocking, or tilting sensations and light-headedness lasting minutes to days, sometimes but not always associated with migraine headaches or photophobia. Injury to both vestibular end-organs results in ataxia and oscillopsia rather than vertigo. Head impulse testing, dynamic visual acuity, and matted Romberg tests are abnormal while conventional neurologic assessments are normal. A defect in the bony roof overlying the superior semicircular canal produces vertigo and oscillopsia provoked by loud sound and pressure (when coughing or sneezing). Three-dimensional temporal bone computed tomography scan and vestibular evoked myogenic potential testing help confirm the diagnosis of superior canal dehiscence. Collectively, these clinical syndromes account for a large proportion of dizzy and unbalanced patients.
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Affiliation(s)
- Allison S Young
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Sally M Rosengren
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Sydney, NSW, Australia; Neurology Department, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Sydney, NSW, Australia
| | - Miriam S Welgampola
- Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Sydney, NSW, Australia; Neurology Department, Royal Prince Alfred Hospital, Central Clinical School, University of Sydney, Sydney, NSW, Australia.
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Cerchiai N, Navari E, Sellari-Franceschini S, Re C, Casani AP. Predicting the Outcome after Acute Unilateral Vestibulopathy: Analysis of Vestibulo-ocular Reflex Gain and Catch-up Saccades. Otolaryngol Head Neck Surg 2017; 158:527-533. [DOI: 10.1177/0194599817740327] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Objectives (1) To describe the relationships among the main instrumental features characterizing an acute unilateral vestibulopathy and (2) to clarify the role of the video head impulse test in predicting the development of chronic vestibular insufficiency. Study Design Case series with chart review. Setting Tertiary referral center. Subjects and Methods Sixty patients suffering from acute unilateral vestibulopathy were retrospectively analyzed: 30 who recovered spontaneously (group 1) and 30 who needed a vestibular rehabilitation program (group 2). The main outcome measures included Dizziness Handicap Inventory score, canal paresis, high-velocity vestibulo-oculomotor reflex gain, and catch-up saccade parameters. The tests were all performed between 4 and 8 weeks from the onset of symptoms. Results The high-velocity vestibulo-oculomotor reflex gain correlated with the Dizziness Handicap Inventory score ( P = .004), with the amplitude of covert and overt saccades ( P < .001), and with the prevalence of overt saccades ( P < .001). Patients in need for vestibular rehabilitation programs had a significantly lower gain ( P < .001) and a higher prevalence and amplitude of overt saccades ( P = .002 and P = .008, respectively). Conversely, we found no differences in terms of response to the caloric test ( P = .359). Conclusions Lower values of high-velocity vestibulo-oculomotor reflex gain and a high prevalence of overt saccades are related to a worse prognosis after acute unilateral vestibulopathy. This is of great interest to clinicians in identifying which patients are less likely to recover and more likely to need a vestibular rehabilitation program.
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Affiliation(s)
- Niccolò Cerchiai
- Otorhinolaryngology Unit, Department of Medical and Surgical Pathology, Pisa University Hospital, Pisa, Italy
| | - Elena Navari
- Otorhinolaryngology Unit, Department of Medical and Surgical Pathology, Pisa University Hospital, Pisa, Italy
| | | | - Chiara Re
- Otorhinolaryngology Unit, Department of Medical and Surgical Pathology, Pisa University Hospital, Pisa, Italy
| | - Augusto Pietro Casani
- Otorhinolaryngology Unit, Department of Medical and Surgical Pathology, Pisa University Hospital, Pisa, Italy
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Mitsutake T, Sakamoto M, Ueta K, Horikawa E. Transient Effects of Gaze Stability Exercises on Postural Stability in Patients With Posterior Circulation Stroke. J Mot Behav 2017; 50:467-472. [DOI: 10.1080/00222895.2017.1367639] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Affiliation(s)
- Tsubasa Mitsutake
- Department of Rehabilitation, Shiroishi Kyoritsu Hospital, Saga, Japan
- Research and Education Center for Comprehensive Community Medicine, Faculty of Medicine, Saga University, Japan
| | - Maiko Sakamoto
- Research and Education Center for Comprehensive Community Medicine, Faculty of Medicine, Saga University, Japan
| | - Kozo Ueta
- Neurorehabilitation Research Center, Kio University, Nara, Japan
| | - Etsuo Horikawa
- Research and Education Center for Comprehensive Community Medicine, Faculty of Medicine, Saga University, Japan
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Abstract
Cranial nerve lesions require a thorough diagnostic work-up and known etiologies have to be excluded before the term idiopathic can be considered. The focus of the present review is on idiopathic peripheral facial nerve paralysis (Bell's palsy) for which this terminology has been established. For all other cranial nerve lesions the typical clinical signs, established etiologies and possible diagnostic pitfalls are discussed.
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Affiliation(s)
- P Urban
- Neurologische Abteilung, Asklepios Klinik Barmbek, 22291, Hamburg, Deutschland.
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38
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Cassel R, Bordiga P, Pericat D, Hautefort C, Tighilet B, Chabbert C. New mouse model for inducing and evaluating unilateral vestibular deafferentation syndrome. J Neurosci Methods 2017; 293:128-135. [PMID: 28911857 DOI: 10.1016/j.jneumeth.2017.09.002] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 09/06/2017] [Accepted: 09/11/2017] [Indexed: 11/19/2022]
Abstract
BACKGROUND Unilateral vestibular deafferentation syndrome (uVDS) holds a particular place in the vestibular pathology domain. Due to its suddenness, the violence of its symptoms that often result in emergency hospitalization, and its associated original neurophysiological properties, this syndrome is a major source of questioning for the otoneurology community. Also, its putative pathogenic causes remain to be determined. There is currently a strong medical need for the development of targeted and effective countermeasures to improve the therapeutic management of uVDS. NEW METHODS The present study reports the development of a new mouse model for inducing and evaluating uVDS. Both the method for generating controlled excitotoxic-type peripheral vestibular damages, through transtympanic administration of the glutamate receptors agonist kainate (TTK), and the procedure for evaluating the ensuing clinical signs are detailed. COMPARISON WITH EXISTING METHODS Through extensive analysis of the clinical symptoms characteristics, this new animal model provides the opportunity to better follow the temporal evolution of various uVDS specific symptoms, while better appreciating the different phases that composed this syndrome. RESULTS The uVDS evoked in the TTK mouse model displays two main phases distinguishable by their kinetics and amplitudes. Several parameters of the altered vestibular behaviour mimic those observed in the human syndrome. CONCLUSION This new murine model brings concrete information about how uVDS develops and how it affects global behaviour. In addition, it opens new opportunity to decipher the etiopathological substrate of this pathology by authorizing the use of genetically modified mouse models.
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Affiliation(s)
- R Cassel
- Aix Marseille Université, CNRS, UMR 7260, Laboratoire de Neurosciences Intégratives et Adaptatives - Equipe physiopathologie et Thérapie des Désordres Vestibulaires, Marseille, France
| | - P Bordiga
- Aix Marseille Université, CNRS, UMR 7260, Laboratoire de Neurosciences Intégratives et Adaptatives - Equipe physiopathologie et Thérapie des Désordres Vestibulaires, Marseille, France
| | - D Pericat
- Aix Marseille Université, CNRS, UMR 7260, Laboratoire de Neurosciences Intégratives et Adaptatives - Equipe physiopathologie et Thérapie des Désordres Vestibulaires, Marseille, France
| | | | - B Tighilet
- Aix Marseille Université, CNRS, UMR 7260, Laboratoire de Neurosciences Intégratives et Adaptatives - Equipe physiopathologie et Thérapie des Désordres Vestibulaires, Marseille, France
| | - C Chabbert
- Aix Marseille Université, CNRS, UMR 7260, Laboratoire de Neurosciences Intégratives et Adaptatives - Equipe physiopathologie et Thérapie des Désordres Vestibulaires, Marseille, France.
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Effects of vestibular rehabilitation on gait performance in poststroke patients: a pilot randomized controlled trial. Int J Rehabil Res 2017; 40:240-245. [DOI: 10.1097/mrr.0000000000000234] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Recovery of Vestibulo-Ocular Reflex Symmetry After an Acute Unilateral Peripheral Vestibular Deficit: Time Course and Correlation With Canal Paresis. Otol Neurotol 2017; 37:772-80. [PMID: 27159843 DOI: 10.1097/mao.0000000000001054] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND We investigated how response asymmetries and deficit side response amplitudes for head accelerations used clinically to test the vestibular ocular reflex (VOR) are correlated with caloric canal paresis (CP) values. METHODS 30 patients were examined at onset of an acute unilateral peripheral vestibular deficit (aUPVD) and 3, 6, and 13 weeks later with three different VOR tests: caloric, rotating chair (ROT), and video head impulse tests (vHIT). Response changes over time were fitted with an exponential decay model and compared with using linear regression analysis. RESULTS Recovery times (to within 10% of steady state) were similar for vHIT-asymmetry and CP (>10 weeks) but shorter for ROT asymmetry (<4 weeks). Regressions with CP were similar (vHIT asymmetry, R = 0.68, ROT, R = 0.62). Responses to the deficit side were also equally well correlated with CP values (R = 0.71). Specificity for vHIT and 20 degrees/s ROT deficit side responses was 100% in comparison to CP values, sensitivity was 74% for vHIT, 75% for ROT. A decrease in normal side responses occurred for ROT but not for vHIT at 3 weeks. Normal side responses were weekly correlated with CP for ROT (R = 0.49) but not for vHIT (R = 0.17). CONCLUSIONS These results indicate that vHIT deficit side VOR gains are slightly better correlated with CP values than ROT, probably because of similar recovery time courses of vHIT and caloric responses and the lack of normal side vHIT changes. However, specificity and sensitivity is the same for vHIT and ROT tests.
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Vestibular Rehabilitation for Peripheral Vestibular Hypofunction: An Evidence-Based Clinical Practice Guideline: FROM THE AMERICAN PHYSICAL THERAPY ASSOCIATION NEUROLOGY SECTION. J Neurol Phys Ther 2017; 40:124-55. [PMID: 26913496 PMCID: PMC4795094 DOI: 10.1097/npt.0000000000000120] [Citation(s) in RCA: 254] [Impact Index Per Article: 36.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Uncompensated vestibular hypofunction results in postural instability, visual blurring with head movement, and subjective complaints of dizziness and/or imbalance. We sought to answer the question, "Is vestibular exercise effective at enhancing recovery of function in people with peripheral (unilateral or bilateral) vestibular hypofunction?" METHODS A systematic review of the literature was performed in 5 databases published after 1985 and 5 additional sources for relevant publications were searched. Article types included meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case control series, and case series for human subjects, published in English. One hundred thirty-five articles were identified as relevant to this clinical practice guideline. RESULTS/DISCUSSION Based on strong evidence and a preponderance of benefit over harm, clinicians should offer vestibular rehabilitation to persons with unilateral and bilateral vestibular hypofunction with impairments and functional limitations related to the vestibular deficit. Based on strong evidence and a preponderance of harm over benefit, clinicians should not include voluntary saccadic or smooth-pursuit eye movements in isolation (ie, without head movement) as specific exercises for gaze stability. Based on moderate evidence, clinicians may offer specific exercise techniques to target identified impairments or functional limitations. Based on moderate evidence and in consideration of patient preference, clinicians may provide supervised vestibular rehabilitation. Based on expert opinion extrapolated from the evidence, clinicians may prescribe a minimum of 3 times per day for the performance of gaze stability exercises as 1 component of a home exercise program. Based on expert opinion extrapolated from the evidence (range of supervised visits: 2-38 weeks, mean = 10 weeks), clinicians may consider providing adequate supervised vestibular rehabilitation sessions for the patient to understand the goals of the program and how to manage and progress themselves independently. As a general guide, persons without significant comorbidities that affect mobility and with acute or subacute unilateral vestibular hypofunction may need once a week supervised sessions for 2 to 3 weeks; persons with chronic unilateral vestibular hypofunction may need once a week sessions for 4 to 6 weeks; and persons with bilateral vestibular hypofunction may need once a week sessions for 8 to 12 weeks. In addition to supervised sessions, patients are provided a daily home exercise program. DISCLAIMER These recommendations are intended as a guide for physical therapists and clinicians to optimize rehabilitation outcomes for persons with peripheral vestibular hypofunction undergoing vestibular rehabilitation.Video Abstract available for more insights from the author (see Video, Supplemental Digital Content 1, http://links.lww.com/JNPT/A124).
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Gnanasegaram JJ, Parkes WJ, Cushing SL, McKnight CL, Papsin BC, Gordon KA. Stimulation from Cochlear Implant Electrodes Assists with Recovery from Asymmetric Perceptual Tilt: Evidence from the Subjective Visual Vertical Test. Front Integr Neurosci 2016; 10:32. [PMID: 27679562 PMCID: PMC5020067 DOI: 10.3389/fnint.2016.00032] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2016] [Accepted: 08/30/2016] [Indexed: 11/13/2022] Open
Abstract
Vestibular end organ impairment is highly prevalent in children who have sensorineural hearing loss (SNHL) rehabilitated with cochlear implants (CIs). As a result, spatial perception is likely to be impacted in this population. Of particular interest is the perception of visual vertical because it reflects a perceptual tilt in the roll axis and is sensitive to an imbalance in otolith function. The objectives of the present study were thus to identify abnormalities in perception of the vertical plane in children with SNHL and determine whether such abnormalities could be resolved with stimulation from the CI. Participants included 53 children (15.2 ± 4.0 years of age) with SNHL and vestibular loss, confirmed with vestibular evoked myogenic potential (VEMP) testing. Testing protocol was validated in a sample of nine young adults with normal hearing (28.8 ± 7.7 years). Perception of visual vertical was assessed using the static Subjective Visual Vertical (SVV) test performed with and without stimulation in the participants with cochleovestibular loss. Trains of electrical pulses were delivered by an electrode in the left and/or right ear. Asymmetric spatial orientation deficits were found in nearly half of the participants with CIs (24/53 [45%]). The abnormal perception in this cohort was exacerbated by visual tilts in the direction of their deficit. Electric pulse trains delivered using the CI shifted this abnormal perception towards center (i.e., normal; p = 0.007). Importantly, this benefit was realized regardless of which ear was stimulated. These results suggest a role for CI stimulation beyond the auditory system, in particular, for improving vestibular/balance function.
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Affiliation(s)
- Joshua J Gnanasegaram
- Archie's Cochlear Implant Laboratory, Department of Otolaryngology, The Hospital for Sick ChildrenToronto, ON, Canada; The Institute of Medical Science, University of TorontoToronto, ON, Canada
| | - William J Parkes
- Archie's Cochlear Implant Laboratory, Department of Otolaryngology, The Hospital for Sick ChildrenToronto, ON, Canada; Department of Otolaryngology-Head and Neck Surgery, University of TorontoToronto, ON, Canada
| | - Sharon L Cushing
- Archie's Cochlear Implant Laboratory, Department of Otolaryngology, The Hospital for Sick ChildrenToronto, ON, Canada; Department of Otolaryngology-Head and Neck Surgery, University of TorontoToronto, ON, Canada
| | - Carmen L McKnight
- Archie's Cochlear Implant Laboratory, Department of Otolaryngology, The Hospital for Sick Children Toronto, ON, Canada
| | - Blake C Papsin
- Archie's Cochlear Implant Laboratory, Department of Otolaryngology, The Hospital for Sick ChildrenToronto, ON, Canada; The Institute of Medical Science, University of TorontoToronto, ON, Canada; Department of Otolaryngology-Head and Neck Surgery, University of TorontoToronto, ON, Canada
| | - Karen A Gordon
- Archie's Cochlear Implant Laboratory, Department of Otolaryngology, The Hospital for Sick ChildrenToronto, ON, Canada; The Institute of Medical Science, University of TorontoToronto, ON, Canada
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Topuz O, Topuz B, Ardiç FN, Sarhuş M, Ogmen G, Ardiç F. Eficacy of vestibular rehabilitation on chronic unilateral vestibular dysfunction. Clin Rehabil 2016; 18:76-83. [PMID: 14763722 DOI: 10.1191/0269215504cr704oa] [Citation(s) in RCA: 57] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To assess the efficacy of vestibular rehabilitation exercises on patients with chronic unilateral vestibular dysfunction. Design: Prospective study. Setting: Physical Medicine and Rehabilitation Clinic and Otolaryngology Clinic of a tertiary referral hospital. Subjects: One-hundred and twenty-five patients with unilateral chronic vestibular dysfunction were included in the study. Interventions: Eight-week, two-staged (clinic and home) vestibular rehabilitation programme with components of Cawthorne-Cooksey and Norre exercises was applied. Main outcome measures: Dizziness Handicap Inventory (DHI) and visual analogue scale (VAS) were completed three times (at the beginning, end of the second week and end of the treatment). Results: Data for 112 patients in the first stage and 93 patients in the second stage were evaluated because of insufficient compliance of the other patients. The mean DHI score was decreased from 50.42 ± 24.12 points to 21.21 ± 15.97 points ( p < 0.001) at the end of first two weeks, and to 19.93 ± 19.33 points at the end of the whole treatment. The mean VAS score was decreased from 5.87 ± 2.27 to 2.02 ± 1.75 ( p < 0.001) at the end of second week, and to 1.51 ± 1.29 at the end of eighth week. In respect to both VAS and DHI scores, improvement was noted in 67 patients (77.4%). Age, gender and disability level had no predictive value about therapy outcome. Conclusions: There was a fast recovery in the supervised exercise session, whereas there was no significant difference in the home exercise session. These findings suggest that either supervised exercise is better than home exercise or that 10 supervised sessions are sufficient to get the end result.
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Affiliation(s)
- Oya Topuz
- Department of Physical Medicine and Rehabilitation, Pamukkale University, School of Medicine, Turkey.
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Kammerlind ASC, Ledin TEA, Odkvist LM, Skargren EIB. Effects of home training and additional physical therapy on recovery after acute unilateral vestibular loss- a randomized study. Clin Rehabil 2016; 19:54-62. [PMID: 15704509 DOI: 10.1191/0269215505cr830oa] [Citation(s) in RCA: 43] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Objective: To evaluate the effects of additional physical therapy on recovery after acute unilateral vestibular loss given to patients receiving home training. Design: Randomized controlled trial. Setting: Ear, nose and throat departments in three hospitals. Subjects: Fifty-four patients (mean age 52 years) with acute unilateral vestibular loss within the last week confirmed with electronystagmography testing were included. Patients with central neurologic or auditory symptoms or other vertigo disease were excluded. Interventions: Home training with or without additional physical therapy 12 times during 10 weeks. Main measures: Electronystagmography testing was performed before and after the training period. Clinical static (Romberg?s test, sharpened Romberg?s test, standing on foam and standing on one leg) and dynamic (walking forward and backward on a line) balance tests and subjective ratings of vertigo and balance problems on a visual analogue scale were done one week, 10 weeks and six months after the start of training. Results: Similar changes were seen in the two training groups. Conclusions: No significant differences in outcome regarding balance function or perceived symptoms were found between home training with or without additional physical therapy.
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Abstract
Normal vestibular end organs generate an equal resting-firing frequency of the axons, which is the same on both sides under static conditions. An acute unilateral vestibulopathy leads to a vestibular tone imbalance. Acute unilateral vestibulopathy is defined by the patient history and the clinical examination and, in unclear cases, laboratory examinations. Key signs and symptoms are an acute onset of spinning vertigo, postural imbalance and nausea as well as a horizontal rotatory nystagmus beating towards the non-affected side, a pathological head-impulse test and no evidence for central vestibular or ocular motor dysfunction. The so-called big five allow a differentiation between a peripheral and central lesion by the bedside examination. The differential diagnosis of peripheral labyrinthine and vestibular nerve disorders mimicking acute unilateral vestibulopathy includes central vestibular disorders, in particular "vestibular pseudoneuritis" and other peripheral vestibular disorders, such as beginning Menière's disease. The management of acute unilateral vestibulopathy involves (1) symptomatic treatment with antivertiginous drugs, (2) causal treatment with corticosteroids, and (3) physical therapy.
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Affiliation(s)
- Michael Strupp
- Department of Neurology, German Center for Vertigo and Balance Disorders, University Hospital Munich, Campus Grosshadern, Munich 81377, Germany.
| | - Mans Magnusson
- Department of Otolaryngology, Lund University, Lund 22100, Sweden
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Brodsky JR, Cusick BA, Zhou G. Vestibular neuritis in children and adolescents: Clinical features and recovery. Int J Pediatr Otorhinolaryngol 2016; 83:104-8. [PMID: 26968063 DOI: 10.1016/j.ijporl.2016.01.027] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/01/2015] [Accepted: 01/23/2016] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Describe the clinical presentation and recovery of vestibular neuritis in children and adolescents. STUDY DESIGN Retrospective case series. SETTING Pediatric tertiary care center. SUBJECTS AND METHODS Eleven patients diagnosed with vestibular neuritis were identified from a database of 301 patients evaluated at our pediatric vestibular clinic from January 2012 through January 2015. Medical records were reviewed to determine clinical presentation, vestibular testing results, treatment, and recovery. Incomplete recovery was defined as residual dizziness or imbalance at most recent follow-up >30 days from symptom onset. RESULTS Patients were 5-19 years old (mean 13.1±5.34) and included 6 boys and 5 girls. All presented with a sudden rotational vertigo, imbalance, and nausea for an average of 10 days without other associated symptoms. Testing included rotary chair (8 of 9 abnormal), caloric (2 of 2 abnormal), video head impulse (5 of 8 abnormal), subjective visual vertical (4 of 8 abnormal), and cervical vestibular evoked myogenic potential (0 of 6 abnormal) tests. All patients with incomplete recovery (n=4; 36%) were ≥15 years old at symptom onset. All patients with incomplete recovery that underwent vestibular rehabilitation (n=2) initiated it ≥90 days from symptom onset, while 3 out of 4 patients with complete recovery that underwent vestibular rehabilitation initiated it ≤14 days from symptom onset. Two patients received oral steroids, neither of whom had incomplete recovery. CONCLUSION Vestibular neuritis should be considered in pediatric patients with vertigo and may result in longstanding symptoms, particularly in adolescents. The treatment of pediatric vestibular neuritis with rehabilitation and steroids deserves further study.
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Affiliation(s)
- Jacob R Brodsky
- Department of Otolaryngology and Communication Enhancement (J.R.B., B.A.C., GW.Z.), Boston Children's Hospital, Boston, MA, USA; Department of Otology and Laryngology (J.R.B., GW.Z.), Harvard Medical School, Boston, MA, USA.
| | - Brandon A Cusick
- Department of Otolaryngology and Communication Enhancement (J.R.B., B.A.C., GW.Z.), Boston Children's Hospital, Boston, MA, USA; Department of Otology and Laryngology (J.R.B., GW.Z.), Harvard Medical School, Boston, MA, USA
| | - Guangwei Zhou
- Department of Otolaryngology and Communication Enhancement (J.R.B., B.A.C., GW.Z.), Boston Children's Hospital, Boston, MA, USA; Department of Otology and Laryngology (J.R.B., GW.Z.), Harvard Medical School, Boston, MA, USA
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Abstract
Data related to the efficacy of vestibular rehabilitation and its evolution as an intervention are provided. Concepts and various treatment strategies are described, with explanations of why people with uncompensated peripheral and central vestibular disorders might improve with rehabilitation. Various tests and measures are described that are commonly used to examine patients and determine their level of ability to participate in their environment. Factors that affect recovery, both positively and negatively, are described in order to better prognosticate recovery. A case utilizing many of the principles discussed is included to provide insight into how to utilize vestibular rehabilitation with a person with an uncompensated peripheral vestibular loss.
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Strupp M, Dieterich M, Zwergal A, Brandt T. [Peripheral, central and functional vertigo syndromes]. DER NERVENARZT 2015; 86:1573-84; quiz 1585-6. [PMID: 26643594 DOI: 10.1007/s00115-015-4425-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Depending on the temporal course, three forms of vertigo syndrome can be differentiated: 1) vertigo attacks, e.g. benign paroxysmal positional vertigo (BPPV), Menière's disease and vestibular migraine, 2) acute spontaneous vertigo lasting for days, e.g. acute unilateral vestibulopathy, brainstem or cerebellar infarction and 3) symptoms lasting for months or years, e.g. bilateral vestibulopathy and functional vertigo. The specific therapy of the various syndromes is based on three principles: 1) physical treatment with liberatory maneuvers for BPPV and balance training for vestibular deficits, 2) pharmacotherapy, e.g. for acute unilateral vestibulopathy (corticosteroids) and Menière's disease (transtympanic administration of gentamicin or steroids and high-dose betahistine therapy); placebo-controlled pharmacotherapy studies are currently being carried out for acute unilateral vestibulopathy, vestibular paroxysmia, prophylaxis of BPPV, vestibular migraine, episodic ataxia type 2 and cerebellar ataxia; 3) psychotherapy for functional dizziness.
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Affiliation(s)
- M Strupp
- Neurologische Klinik, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland. .,Deutsches Schwindel- und Gleichgewichtszentrum, Klinikum der Universität München, Campus Großhadern, München, Deutschland.
| | - M Dieterich
- Neurologische Klinik, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.,Deutsches Schwindel- und Gleichgewichtszentrum, Klinikum der Universität München, Campus Großhadern, München, Deutschland.,SyNergy, Munich Cluster for Systems Neurology, München, Deutschland
| | - A Zwergal
- Neurologische Klinik, Klinikum der Universität München, Campus Großhadern, Marchioninistr. 15, 81377, München, Deutschland.,Deutsches Schwindel- und Gleichgewichtszentrum, Klinikum der Universität München, Campus Großhadern, München, Deutschland
| | - T Brandt
- Deutsches Schwindel- und Gleichgewichtszentrum, Klinikum der Universität München, Campus Großhadern, München, Deutschland.,Institut für Klinische Neurowissenschaften, Klinikum der Universität München, Campus Großhadern, München, Deutschland
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Kim JC, Cha WW, Chang DS, Lee HY. The Effect of Intravenous Dexamethasone on the Nausea Accompanying Vestibular Neuritis: A Preliminary Study. Clin Ther 2015; 37:2536-42. [PMID: 26475420 DOI: 10.1016/j.clinthera.2015.09.010] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Revised: 08/25/2015] [Accepted: 08/25/2015] [Indexed: 10/22/2022]
Abstract
PURPOSE We undertook a preliminary assessment of the efficacy of administering intravenous dexamethasone (DEX) for relieving the nausea and dizziness accompanying vestibular neuritis (VN). METHODS Between November 2013 and October 2014, 26 patients with VN were prospectively enrolled in this study. The patients were randomly assigned to treatment with a combination of 20 mg/d of intravenous metoclopramide, 100 mg of oral dimenhydrinate, and 5 mg/d of intravenous DEX or 20 mg/d of intravenous metoclopramide, 100 mg of oral dimenhydrinate, and intravenous normal saline as a placebo therapy. Patients' subjective assessments of the severity of their nausea and dizziness were recorded using a visual analog scale on the day of admission and 2 days, 3 days, 1 month, and 3 months thereafter. Bedside examinations consisted of spontaneous nystagmus (SPN) assessment, the head shaking nystagmus test, and the head impulse test, which were performed at every follow-up visit. FINDINGS The severity of nausea and dizziness was significantly reduced over time (both P < 0.05). However, there was no significant effect of DEX injection on the severity of nausea or dizziness (P > 0.05). The presence of SPN was solely associated with nausea (hazard ratio = 3.34; 95% CI, 1.85-6.02). IMPLICATIONS The administration of intravenous DEX did not relieve nausea or dizziness any better than a placebo treatment. However, further research is required to confirm whether there is a dose-dependent effect of DEX on the control of nausea or dizziness in VN.
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Affiliation(s)
- Ji Chan Kim
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University, Daejeon, South Korea
| | - Wang Woon Cha
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University, Daejeon, South Korea
| | - Dong Sik Chang
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University, Daejeon, South Korea
| | - Ho Yun Lee
- Department of Otorhinolaryngology, Eulji University Medical Center, Eulji University, Daejeon, South Korea.
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Jung I, Kim JS. Approach to dizziness in the emergency department. Clin Exp Emerg Med 2015; 2:75-88. [PMID: 27752577 PMCID: PMC5052860 DOI: 10.15441/ceem.15.026] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Revised: 04/21/2014] [Accepted: 04/21/2014] [Indexed: 02/07/2023] Open
Abstract
Acute dizziness/vertigo is among the most common causes for visiting the emergency department. The traditional approach to dizziness starts with categorizing dizziness into four types: vertigo, presyncope, disequilibrium, and nonspecific dizziness. However, a recently proposed approach begins with classifying dizziness/vertigo as acute prolonged spontaneous dizziness/vertigo, recurrent spontaneous dizziness/vertigo, recurrent positional vertigo, or chronic persistent dizziness and imbalance. Vestibular neuritis and stroke are key disorders causing acute prolonged spontaneous dizziness/vertigo, but the diagnosis of isolated vascular vertigo has increased by virtue of developments in clinical neurotology and neuroimaging. However, a well-organized bedside examination appears more sensitive than brain imaging in diagnosing strokes presenting with acute dizziness/vertigo. A detailed history is vital to diagnose recurrent spontaneous dizziness/vertigo since confirmatory diagnostic tests are usually unavailable. Isolated positional vertigo is usually caused by benign paroxysmal positional vertigo, which can be treated at the bedside. In recent years, marked progress has occurred in the evaluation/management of acute dizziness/vertigo. However, even with developments in imaging technology, the diagnosis of acute dizziness/vertigo largely relies on bedside examination.
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Affiliation(s)
- Ileok Jung
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ji-Soo Kim
- Department of Neurology, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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