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van Stiphout L, Szmulewicz DJ, Guinand N, Fornos AP, Van Rompaey V, van de Berg R. Bilateral vestibulopathy: a clinical update and proposed diagnostic algorithm. Front Neurol 2023; 14:1308485. [PMID: 38178884 PMCID: PMC10766383 DOI: 10.3389/fneur.2023.1308485] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2023] [Accepted: 11/29/2023] [Indexed: 01/06/2024] Open
Abstract
Bilateral vestibulopathy (BVP) is characterized by its heterogeneous and chronic nature with various clinical presentations and multiple etiologies. This current narrative review reflects on the main insights and developments regarding clinical presentation. In addition, it proposes a new diagnostic algorithm, and describes available and potential future therapeutic modalities.
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Affiliation(s)
- Lisa van Stiphout
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
| | - David J. Szmulewicz
- Royal Victorian Eye and Ear Hospital, University of Melbourne, Melbourne, VIC, Australia
- Bionics Institute, Melbourne, VIC, Australia
| | - Nils Guinand
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Angélica Pérez Fornos
- Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology, Head and Neck Surgery, Antwerp University Hospital, Antwerp, Belgium
- Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Raymond van de Berg
- Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
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Melliti A, van de Berg M, van de Berg R. Capturing nystagmus during vertigo attacks using a smartphone: adherence, characteristics, pearls and pitfalls. J Neurol 2023; 270:6044-6056. [PMID: 37653139 PMCID: PMC10632223 DOI: 10.1007/s00415-023-11965-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/22/2023] [Revised: 08/19/2023] [Accepted: 08/21/2023] [Indexed: 09/02/2023]
Abstract
OBJECTIVE To investigate adherence, characteristics, and first clinical experiences of capturing ictal nystagmus at home, which can be performed to complement the diagnostic process in patients with episodic vestibular symptoms. METHODS Patients were recruited at a tertiary referral center in case capturing ictal nystagmus could contribute to the diagnostic process (e.g., to detect or rule out BPPV). They were asked to capture ictal nystagmus with their own smartphone at home, using a smartphone-based adapter (Nystagmocatcher, Balansdiagnos, Stockholm, Sweden). All recordings were analyzed by the last author (RvdB), and the adherence, characteristics, and first clinical experiences were evaluated. RESULTS Seventy patients with vestibular symptoms were asked to participate in this study. Sixty-two (89%) agreed to participate. The median period of participation was 86 days. Fifty-one patients experienced attacks during the study period. Eventually, 51% of them provided eye movement recordings sufficient for analysis. Different types of nystagmus were observed: positional nystagmus related to BPPV, positional nystagmus not related to BPPV, functional eye movements, and the absence of nystagmus or functional eye movements. Capturing ictal nystagmus could contribute to the diagnostic process in several ways, including to detect or rule out BPPV, to detect or rule out vestibular origin of symptoms, to determine the affected side, telemedicine, to monitor attack frequency, and to detect malingering. Furthermore, strict guidance of patients was necessary, which could be time-consuming. CONCLUSION Capturing ictal nystagmus can contribute to the diagnostic process in several ways, which motivates to rethink current clinical workflow in vestibular medicine. However, strict guidance is necessary and not all patients provide ictal recordings. In an outpatient setting, it would be advised to use ictal nystagmus recordings on indication, to complement the diagnostic process.
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Affiliation(s)
- Ali Melliti
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands.
| | - Maurice van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
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Ngo HTN, Maarsingh OR, van de Berg R, Blanker MH, Bruintjes TD, Castien R, Dijkstra R, Rutgers S, Slottje P, Twisk JWR, Yardley L, Bont J, van Vugt VA. Study protocol for a nationwide implementation of internet-based vestibular rehabilitation for patients with chronic vestibular symptoms (I-RECOVER). Implement Sci Commun 2023; 4:147. [PMID: 37993954 PMCID: PMC10666423 DOI: 10.1186/s43058-023-00524-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 11/01/2023] [Indexed: 11/24/2023] Open
Abstract
BACKGROUND Vestibular rehabilitation is a safe and effective exercise-based treatment for patients with chronic vestibular symptoms. However, it is underused in general practice. Internet-based vestibular rehabilitation (Vertigo Training), which has proven to be effective as well, was developed to increase uptake. We now aim to improve the quality of care for patients with vestibular symptoms by carrying out a nationwide implementation of Vertigo Training. We will evaluate the effect of this implementation on primary care. METHODS Our implementation study consists of three successive phases: 1) We will perform a retrospective observational cohort study and a qualitative interview study to evaluate the current management of patients with vestibular symptoms in primary care, in particular anti-vertigo drug prescriptions, and identify areas for improvement. We will use the results of this phase to tailor our implementation strategy to the needs of general practitioners (GPs) and patients. 2) This phase entails the implementation of Vertigo Training using a multicomponent implementation strategy, containing: guideline adaptations; marketing strategy; pharmacotherapeutic audit and feedback meetings; education; clinical decision support; and local champions. 3) In this phase, we will evaluate the effect of the implementation in three ways. a. Interrupted time series. We will use routine primary care data from adult patients with vestibular symptoms to compare the number of GP consultations for vestibular symptoms, referrals for vestibular rehabilitation, prescriptions for anti-vertigo drugs, and referrals to physiotherapy and secondary care before and after implementation. b. Prospective observational cohort study. We will extract data from Vertigo Training to investigate the usage and the characteristics of participants. We will also determine whether these characteristics are associated with successful treatment. c. Qualitative interview study. We will conduct interviews with GPs to explore their experiences with the implementation. DISCUSSION This is one of the first studies to evaluate the effect of a nationwide implementation of an innovative treatment on Dutch primary care. Implementation strategies have been researched before, but it remains unclear which ones are the most effective and under what conditions. We therefore expect to gain relevant insights for future projects that aim to implement innovations in primary care.
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Affiliation(s)
- Hà T N Ngo
- Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands.
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands.
| | - Otto R Maarsingh
- Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Raymond van de Berg
- Department of Otorhinolaryngology and Head and Neck Surgery, Maastricht University Medical Centre, Maastricht, The Netherlands
| | - Marco H Blanker
- Department of Primary and Long-Term Care, University Medical Centre Groningen, Hanzeplein 1, Groningen, The Netherlands
| | - Tjasse D Bruintjes
- Department of Otorhinolaryngology, Leiden University Medical Centre, Leiden, The Netherlands
- Department of Otorhinolaryngology, Gelre Hospital Apeldoorn, Apeldoorn, The Netherlands
| | - René Castien
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
- Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Program Musculoskeletal Health, Amsterdam, The Netherlands
| | - Rob Dijkstra
- Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
| | - Sandra Rutgers
- Patient Association Hoormij•NVVS, Houten, The Netherlands
| | - Pauline Slottje
- Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Jos W R Twisk
- Department of Epidemiology and Biostatistics, Amsterdam UMC, Vrije Universiteit Amsterdam, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Lucy Yardley
- School of Psychology, University of Southampton, Southampton, UK
- School of Psychological Science, University of Bristol, Bristol, UK
| | - Jettie Bont
- Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
| | - Vincent A van Vugt
- Department of General Practice, Amsterdam UMC, Location Vrije Universiteit Amsterdam, Boelelaan 1117, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Pérez-Fernández N, Ramos-Macías A. Recent Advances in the Diagnosis and Treatment of Vestibular Disorders. J Clin Med 2023; 12:5281. [PMID: 37629323 PMCID: PMC10455078 DOI: 10.3390/jcm12165281] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Accepted: 07/06/2023] [Indexed: 08/27/2023] Open
Abstract
Vestibular medicine "embraces a wide approach to the potential causes of vestibular symptoms, acknowledging that vertigo, dizziness, and unsteadiness are non-specific symptoms that may arise from a broad spectrum of disorders, spanning from the inner ear to the brainstem, cerebellum and supratentorial cerebral networks, to many disorders beyond these structures" [...].
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Affiliation(s)
| | - Angel Ramos-Macías
- Department of Otolaryngology, Head and Neck Surgery, Complejo Hospitalario Universitario Insular Materno Infantil de Gran Canaria, 35001 Las Palmas, Spain;
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Karabulut M, Van Laer L, Hallemans A, Vereeck L, Van Rompaey V, Viechtbauer W, Melliti A, van Stiphout L, Mohamad A, Pérez Fornos A, Guinand N, van de Berg R. Chronic symptoms in patients with unilateral vestibular hypofunction: systematic review and meta-analysis. Front Neurol 2023; 14:1177314. [PMID: 37483440 PMCID: PMC10360052 DOI: 10.3389/fneur.2023.1177314] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2023] [Accepted: 06/19/2023] [Indexed: 07/25/2023] Open
Abstract
Objective To systematically evaluate the full spectrum of self-reported chronic symptoms in patients with unilateral vestibular hypofunction (UVH) and to investigate the effect of interventions on these symptoms. Methods A systematic review was conducted following the guidelines of the Preferred Reporting Items for Systematic Review and Meta-Analysis Statement (PRISMA). A literature search was performed in Pubmed, Web of Science, Embase, and Scopus to investigate self-reported symptoms and self-report questionnaires in patients with UVH. All original studies ranging from full-text clinical trials to case reports, written in English, German, and French, were included. The frequency of self-reported symptoms was presented. For self-report questionnaires, a meta-analysis was carried out to synthesize scale means by the pre- and post-intervention means and mean changes for studies that investigated interventions. Results A total of 2,110 studies were retrieved. Forty-seven studies were included after title-abstract selection and full-text selection by two independent reviewers. The symptoms of UVH patients included chronic dizziness (98%), imbalance (81%), symptoms worsened by head movements (75%), visually induced dizziness (61%), symptoms worsened in darkness (51%), and oscillopsia (22%). Additionally, UVH could be accompanied by recurrent vertigo (77%), tiredness (68%), cognitive symptoms (58%), and autonomic symptoms (46%). Regarding self-report questionnaires, UVH resulted on average in a moderate handicap, with an estimated mean total score on the Dizziness Handicap Inventory (DHI) and the Vertigo Symptom Scale (VSS) of 46.31 (95% CI: 41.17-51.44) and 15.50 (95% CI: 12.59-18.41), respectively. In studies that investigated the effect of vestibular intervention, a significant decrease in the estimated mean total DHI scores from 51.79 (95% CI: 46.61-56.97) (pre-intervention) to 27.39 (95% CI: 23.16-31.62) (post intervention) was found (p < 0.0001). In three studies, the estimated mean total Visual Analog Scale (VAS) scores were 7.05 (95% CI, 5.64-8.46) (pre-intervention) and 2.56 (95% CI, 1.15-3.97) (post-intervention). Finally, a subgroup of patients (≥32%) persists with at least a moderate handicap, despite vestibular rehabilitation. Conclusion A spectrum of symptoms is associated with UVH, of which chronic dizziness and imbalance are most frequently reported. However, semi-structured interviews should be conducted to define the whole spectrum of UVH symptoms more precisely, in order to establish a validated patient-reported outcome measure (PROM) for UVH patients. Furthermore, vestibular interventions can significantly decrease self-reported handicap, although this is insufficient for a subgroup of patients. It could therefore be considered for this subgroup of patients to explore new intervention strategies like vibrotactile feedback or the vestibular implant. Systematic review registration [https://www.crd.york.ac.uk/prospero/], identifier [CRD42023389185].
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Affiliation(s)
- Mustafa Karabulut
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
| | - Lien Van Laer
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Ann Hallemans
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Luc Vereeck
- Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Science, University of Antwerp, Antwerp, Belgium
| | - Vincent Van Rompaey
- Department of Otorhinolaryngology and Head & Neck Surgery, Antwerp University Hospital, Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Wolfgang Viechtbauer
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| | - Ali Melliti
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
| | - Lisa van Stiphout
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
| | - Alfarghal Mohamad
- Department of Psychiatry and Neuropsychology, Maastricht University, Maastricht, Netherlands
| | | | - Nils Guinand
- Department of Ear Nose Throat, King Abdul Aziz Medical City, Jeddah, Saudi Arabia
| | - Raymond van de Berg
- Division of Balance Disorders, Department of Otorhinolaryngology and Head and Neck Surgery, School for Mental Health and Neuroscience, Maastricht University Medical Center, Maastricht, Netherlands
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Pawar V, Ashraf H, Dorsala S, Mary P, Hameed N, H DN, Adatia SP, Raj L, Ananthu VR, Shouka M. Motorist's Vestibular Disorientation Syndrome (MVDS)-Proposed Diagnostic Criteria. J Pers Med 2023; 13:jpm13050732. [PMID: 37240902 DOI: 10.3390/jpm13050732] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 03/31/2023] [Accepted: 04/11/2023] [Indexed: 05/28/2023] Open
Abstract
Motorist's vestibular disorientation syndrome (MVDS) is a disorder in which patients experience dizziness while driving. MVDS is under-reported in the literature, and in clinical practice, it often goes unrecognized. We identified clinical characteristics of patients with MVDS using data from 24 patients who faced difficulties while driving and were diagnosed with MVDS. Their symptoms, duration of illness, precipitating factors, co-morbidities, history of other neuro-otological disorders, severity of symptoms, and associated anxiety and depression were reviewed. Ocular motor movements were recorded using video-nystagmography. Patients with vestibular disorders that can cause similar symptoms while driving were excluded. The mean age of the patients was 45.7 ± 8.7 years, and most were professional drivers (90.5%). The duration of the illness ranged from eight days to ten years. Most patients presented with disorientation (79.2%) exclusively while driving. The most common triggers for symptoms were higher speeds, i.e., >80 km/h (66.7%), multi-lane roads (58.3%), bends and turns (50%), and looking at other vehicles or signals while driving (41.7%). A history of migraines was reported in 62.5% of the patients, and motion sickness was reported in 50% of the patients. Anxiety was reported in 34.3% of patients, and 15.7% had depression. The video-nystagmography did not show any specific abnormalities. Patients responded to drugs used in prophylactic treatments for migraines such as Amitriptyline, Venlafaxine, Bisoprolol, and Magnesium, and to Pregabalin and Gabapentin. Based on these findings, a classification system and a diagnostic criterion for MVDS were proposed.
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Affiliation(s)
- Vishal Pawar
- Neurology Department, Aster Gardens Specialty Clinic, Building 10, Zen Cluster, Street 1, Discovery Gardens, Dubai P.O. Box 8703, United Arab Emirates
| | - Hanaan Ashraf
- Al Rafa Polyclinic-International City, Internal Medicine Department, Aster DM Healthcare, Dubai P.O. Box 8703, United Arab Emirates
| | - Srinivas Dorsala
- Ear, Nose and Throat (ENT) Department, Jawaharlal Nehru Medical College (JNMC), Belagavi 500010, Karnataka, India
| | - Preethy Mary
- Medical Trust Hospital, Department of Otolaryngology, Cochin 682016, Kerala, India
| | - Nazrin Hameed
- Medical Trust Hospital, Department of Otolaryngology, Cochin 682016, Kerala, India
| | - Divya Nair H
- Indian Institute of Public Health Gandhinagar, Gandhinagar 382042, Gujarat, India
| | - Sweta Prakash Adatia
- Department of Neurology, RAK Hospital, Ras-Al-Khaimah P.O. Box 11393, United Arab Emirates
| | - Leya Raj
- Public Health Consultant, Karipuram 673121, Kerala, India
| | - V R Ananthu
- Al Sharq Hospital Fujairah, ENT Department, Al Sharq Healthcare, Fujairah P.O. Box 8505, United Arab Emirates
| | - M Shouka
- Audiologist, Neurology Department, Garden's Specialty Clinic, Aster DM Healthcare, Dubai P.O. Box 8704, United Arab Emirates
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Dlugaiczyk J. [The "difficult" patient-Vestibular testing under difficult conditions : Part 1: History taking and clinical neurotological examination]. HNO 2022; 70:485-495. [PMID: 35585190 PMCID: PMC9160150 DOI: 10.1007/s00106-022-01179-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2022] [Indexed: 11/14/2022]
Abstract
Der Patient mit dem Leitsymptom Schwindel stellt häufig eine Herausforderung für den Hals-Nasen-Ohren-Arzt dar. Die folgende Artikelserie beleuchtet unterschiedliche Aspekte des „schwierigen“ Schwindelpatienten. Der vorliegende erste Teil widmet sich den Besonderheiten und Fallstricken bei der Anamneseerhebung und der klinisch-neurootologischen Untersuchung. Dabei werden situationsspezifische Lösungsansätze zu folgenden Themen der Anamneseerhebung aufgezeigt: Definition von Erwartungen und Zielen, „ausschweifende“ Anamnese, Beschreibung des Symptoms Schwindel, mehrere Schwindelentitäten bei einem Patienten, Diskrepanz zwischen Symptomschwere und vestibulären Befunden, kognitive Verzerrungen und der Umgang mit Emotionen. Des Weiteren werden praxisbezogene Hinweise für die neurootologische Untersuchung von Patienten mit Halswirbelsäulenproblemen und Augenbewegungsstörungen sowie bei ängstlichen Patienten gegeben.
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Affiliation(s)
- Julia Dlugaiczyk
- Klinik für Ohren‑, Nasen‑, Hals- und Gesichtschirurgie & Interdisziplinäres Zentrum für Schwindel und neurologische Sehstörungen, Universitätsspital Zürich (USZ), Universität Zürich (UZH), Frauenklinikstrasse 24, 8091, Zürich, Schweiz.
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