Psychometric Properties and Concurrent Validity of a 10-Item Questionnaire for Patients With Vestibular Disorders

OBJECTIVE

This study aimed to investigate the psychometric properties and concurrent validity of the Haukeland Dizziness Questionnaire (HDQ-10), a 10-item questionnaire designed for simplified assessment of symptom severity and emotional effects in patients with vestibular disorders.

STUDY DESIGN

Cross-sectional study.

SETTING

Secondary referral hospital.

METHODS

Out of 238 consecutive patients examined for suspected vestibular disease at an otolaryngology clinic, 201 completed the questionnaire. The psychometric properties of the HDQ-10 were examined by exploratory factor analysis and analysis of internal consistency. Concurrent validity was determined in comparison with the Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale-Short Form (VSS-SF), and the Hospital Anxiety and Depression Scale.

RESULTS

The factor analysis revealed 3 subscales of the questionnaire covering "function," "unsteadiness," and "emotion." The examination of the total scale (α = .866) and its subscales indicated satisfactory psychometric properties. The HDQ-10 correlated highly with both DHI (r = .732. P < .001) and VSS-SF (r = .720. P < .001) indicating good concurrent validity.

CONCLUSION

The HDQ-10 is a 10-item questionnaire designed for simplified assessment of symptom severity and emotional effects in patients with vestibular disorders. It has satisfactory psychometric properties and good concurrent validity compared to existing dizziness questionnaires.

Congruence and incongruence on the radiological and functional examination of inner ear hemorrhage

BACKGROUND

Inner ear hemorrhage (IEH) is an increasingly recognized cochlear lesion that can cause sensorineural hearing loss (SNHL). Magnetic resonance imaging (MRI) is known to be the best imaging modality for clarifying the causes of SNHL and providing images that point to those causes.

AIMS

Evaluate the lesional patterns in patients with presumed Inner ear hemorrhage (IEH) from radiological and functional aspects.

MATERIAL AND METHODS

We retrospectively reviewed 10 patients performed in our institution from 2014 to 2020, with suspected labyrinthine hemorrhage based on radiological and functional examination.

RESULTS

We included 8 patients with IEH and sensorineural hearing loss (SNHL). The median age was 55 years (range: 3 months - 78 years). The results from the MRI and functional tests were compared for each end-organ. Only three cases (37.5%) showed a correlation between signal abnormalities and dysfunction in the labyrinthine apparatus.

CONCLUSIONS

In patients with SNHL inner ear hemorrhage needs to be ruled out in the differential diagnosis, so specific MRI sequences should be requested. It represents a way to a better understanding of the disorder and the variety of findings claim for a complete auditory and vestibular testing.

Specific and individualized instructions improve the efficacy of booklet-based vestibular rehabilitation at home - a randomized controlled trial (RCT)

BACKGROUND

Vestibular rehabilitation therapy (VRT) is effective for most patients with dizziness and imbalance. Home exercise programs are widely used. It is unknown, however, how specific the instructions for exercises have to be.

OBJECTIVE

To evaluate the effects of expert assessment and instructions in a booklet-based home VRT program for patients with chronic dizziness.

METHODS

Randomized controlled study on 74 participants with disabling dizziness for >3 months. All study participants received a booklet-based VRT for training at home. Participants were prescribed 20 minutes of exercise, twice a day. The intervention group (n = 37) received specific instructions (expert physiotherapist). The control group (n = 37) practiced without specific instructions. Primary outcome was the total score of the Dizziness Handicap Inventory (DHI-G). All outcomes were assessed at baseline, after 4 weeks, and at follow up 4 weeks later.

RESULTS

Both groups improved (DHI-G 43.94±18.89 at inclusion to 33.06±19.67 at follow-up in controls and 42.82±16.60 to 22.65±19.12 in the intervention group). The intervention group, however, improved more (p = 0.014).

CONCLUSIONS

We show a significant effect of expert physiotherapy guidance in home-based VRT. This strengthens the role of the physiotherapist in VRT: Tailored, personalized instructions are needed to get the best effect of VRT.

Case Report: Suppurative Labyrinthitis Induced by Chronic Suppurative Otitis Media

A discussion on suppurative labyrinthitis associated with chronic suppurative otitis media (CSOM) may seem to be an outdated issue due to the advent of antibiotics in the last century. In previous literature, limited cases of suppurative labyrinthitis have been reported. This case, therefore, is an excellent and rare opportunity to study its clinical symptoms, diagnoses, and treatments. This report described the case of a 39-year-old female with a history of CSOM for 20 years, and she often presented with otorrhea, vestibular disorder, and hearing impairment. CT of the temporal bone revealed fistulae in both the basal turn of the cochlea and the horizontal semicircular canal. Combined with the otolaryngology examination results, suppurative labyrinthitis was considered. During a three-month follow-up, her symptoms were improved significantly after surgery. In conclusion, suppurative labyrinthitis must not be overlooked and neglected; early diagnosis and treatments are of vital importance.

Vestibular Disorders after Kidney Transplantation: Focus on the Pathophysiological Mechanisms Underlying the Vertical Nystagmus Associated with Tacrolimus-Related Hypomagnesamia

The purpose of this paper is to present the case of a patient undergoing kidney transplantation who developed limb tremor dizziness and vertical nystagmus (ny) during Tacrolimus (TAC) therapy and to investigate the pathophysiological mechanisms underlying the balance disorder. This case study regards a 51-year old kidney transplant male patient with hand tremors and lower limbs asthenia associated with dizziness and nausea. The symptoms started two months after the beginning of intravenous TAC for renal transplantation. The pure-tone audiometry showed a mild symmetrical high-frequencies down-sloping sensorineural hearing loss. Acoustic emittance measures showed a normal tympanogram; stapedial reflexes were normally elicited. The Auditory Brainstem Responses (ABR) and Cervical Vestibular Evoked Myogenic Potentials (c-VEMPs) were bilaterally normally evoked. The bedside vestibular examination showed spontaneous down-beating stationary persistent, omni-positional nystagmus, not inhibited by fixation. The Head-Shaking Test accentuates the spontaneous ny. The horizontal clinical head impulse test was negative, bilaterally. A biochemical blood test revealed a decrease in Magnesium (Mg) levels (0.8 mg/dL; normal range 1.58–2.55). The integration of Mg induced both a plasma levels normalization and an improvement of clinical symptoms. This case suggests that TAC treatment can induce a Mg depletion that caused the transient cerebellar lesion. Therefore, the monitoring of serum electrolytes during immunosuppressive treatment appears to be a useful tool in order to reduce the central system symptomatology.

Risk of Vestibulocochlear Disorders in Patients with Migraine or Non-Migraine Headache

Headaches, especially migraines, have been associated with various vestibular symptoms and syndromes. Tinnitus and hearing loss have also been reported to be more prevalent among migraineurs. However, whether headaches, including migraine or non-migraine headaches (nMH), are associated with vestibular and cochlear disorders remains unclear. Thus, we sought to investigate possible associations between headache and vestibulocochlear disorders. We analyzed 10 years of data from the Smart Clinical Data Warehouse. In patients with migraines and nMH, meniere’s disease (MD), BPPV, vestibular neuronitis (VN) and cochlear disorders, such as sensorineural hearing loss (SNHL) and tinnitus, were collected and compared to clinical data from controls who had health check-ups without headache. Participants included 15,128 with migraines, 76,773 patients with nMH and controls were identified based on propensity score matching (PSM). After PSM, the odds ratios (OR) in subjects with migraine versus controls were 2.59 for MD, 2.05 for BPPV, 2.98 for VN, 1.74 for SNHL, and 1.97 for tinnitus, respectively (p < 0.001). The OR for MD (1.77), BPPV (1.73), VN (2.05), SNHL (1.40), and tinnitus (1.70) in patients with nMH was also high after matching (p < 0.001). Our findings suggest that migraines and nMH are associated with an increased risk of cochlear disorders in addition to vestibular disorders.

Climatic Variations as Indicators of Vitamin D Levels and Benign Paroxysmal Positional Vertigo

Objective

To investigate the possible correlation between benign paroxysmal positional vertigo (BPPV), seasonality, and climatic variations as indicators of vitamin D deficiency, since otoconia are calcium carbonate crystals.

Methods

This is a study of patients who received the diagnosis of BPPV from September 2015 to August 2019. Gender, age, and month of diagnosis were factors recorded and analyzed. The cut-off age of 50 years is used to include osteoporotic patients and postmenopausal women. Meteorological and climatic data of latitude, temperature, sunshine hours, humidity, precipitation, wind force, atmospheric pressure, and horizontal solar irradiance were collected.

Results

Four hundred and eighty-five patients were included in the study; 206 were male (42%) and 279 were female (58%). The mean age was 57.8±15.4 and 54.9±13.9, respectively; 192 patients were ≤50 years old (121 female and 71 male) and 293 patients were over 50 years old (135 male and 158 female). A statistical significance in seasonal variation during autumn months was demonstrated (p-value= 5.2 e-05, z-statistic: 9.8164). There was no statistical correlation between the median number of BPPV patients and the median sunshine hours per month, horizontal solar irradiance, or other climatic variables.

Conclusions

Our study demonstrates seasonality in BPPV patients in Greece but no correlation between BPPV and climatic variations as a proxy for Vitamin-D levels was documented.

Changing Paradigm for Vertigo/Dizziness Patients: a Retrospective Before-After Study from Tertiary Hospitals in Northwestern China

BACKGROUND

Single disciplinary management of patients with vertigo and dizziness is an important challenge for most physicians in China.

OBJECTIVE

To assess the impact of a new paradigm of practice (Clinic for Vertigo and Dizziness, CVD) performed by a multidisciplinary team (MDT) on diagnostic spectrum, medical costs, and patient satisfaction.

DESIGN

Retrospective before-after study.

PARTICIPANTS

Sample of 29,793 patients with vertigo/dizziness as primary complaint.

MEASURES

Changes in diagnostic spectrum, medical costs, and patient satisfaction before and after the establishment of a CVD based on a 4-year database in three tertiary hospitals in northwestern China.

KEY RESULTS

The most common diagnoses of patients with vertigo and dizziness were Meniere's disease (25.77%), cervical disease (25.00%), cerebral vascular disease (13.96%), vestibular syndrome (10.57%), and other etiologies (6.34%) before the CVD establishment. In contrast, after the CVD establishment, the most common diagnoses were BPPV (23.92%), vestibular migraine (15.83%), Meniere's disease (14.22%), CSD/PPPD (11.61%), and cerebral vascular diseases (4.45%). Extended implementation of a structured questionnaire for vertigo/dizziness and vestibular-oriented examinations (nystagmus, positional tests, HINTS) at the CVD resulted in a remarkable decline in the utility of CT/MRI and X-ray examination (p < 0.001). Meanwhile, medical costs in patients with vertigo/dizziness dropped by 11.5% (p < 0.001), with a significant improvement in patient satisfaction after the establishment of CVD (p < 0.001).

CONCLUSIONS AND RELEVANCE

Our study suggested that the MDT paradigm of CVD practice may facilitate the medical management of patients with vertigo/dizziness and improve patient satisfaction.

Evaluation on Effectiveness of a New System as well as Analysis on Optimal Horizontal Eye Position for Vertical Video Head Impulse Test

OBJECTIVE

To compare the performances among three different systems for video head impulse test (vHIT), and to identify an optimal target angle for precisely evaluating the function of vertical semicircular canals in vHIT.

METHODS

A two-center prospective study was done. Participants were sit 1.2 m away from the wall in a noise-proved room that dedicated for vHIT experiments. During the comparison experiments, similar settings were ensured in both hospitals, with the same distance to wall and angle of staring. For each equipment, the procedures followed the developers' recommendations. The same examiner performed the comparison between two systems in one location. For the eye-position projects, targets were placed on the wall sequentially at the pre-marked lines for different angles. For the comparison projects, 9 and 13 participants were recruited, respectively. Any participant with otologic or vestibular disorders was excluded. A total of 26 healthy participants were recruited in the eye-position experiments, 16 of which were further involved in inter-examiner tests.

RESULTS

Our evaluations of three different systems showed that a new vHIT system, VertiGoggles® ZT-VNG-I (VG) performed as good as the long-tested Otometrics® ICS impulse (Oto) and EyeSeeCam® (ESC). During the comparison, we validated 25-degree, instead of right ahead at 0 degree, is a better place to set the targets when torsion was applied at vertical semicircular canal planes.

CONCLUSION

The new VG system is good for clinical practices. Furthermore, we proposed a new protocol to set the targets 25 degrees from right ahead after tilting head 45 degrees to evaluate vertical canals during vHIT.

No evidence for a specific vitamin D deficit in benign paroxysmal positional vertigo

BACKGROUND AND PURPOSE

The aim was to investigate whether there is a difference in serum 25-hydroxyvitamin D (25(OH)D) concentration between patients with benign paroxysmal positional vertigo (BPPV), patients with other vestibular diseases and patients with other neurological non-vestibular diseases presenting in a tertiary neurological academic outpatient clinic.

METHODS

The serum 25(OH)D concentration was measured in 680 patients (368 male, mean age ± SD 58 ± 17 years, 661 Caucasian) without vitamin D supplementation. 158 patients had BPPV; 221 had other vestibular diseases (including 122 with peripheral vestibular disorders, such as unilateral vestibulopathy or Ménière's disease; 46 with central vestibular disorders, such as vestibular migraine or cerebellar dizziness; 53 with functional dizziness); and 301 patients with other neurological non-vestibular diseases.

RESULTS

There was no significant difference in the serum 25(OH)D concentration between patients with BPPV (mean ± SD 23.4 ± 9.4 ng/ml) and those with other vestibular disorders (24.9 ± 10.1 ng/ml, p = 0.324). Patients with other neurological disorders had even lower concentrations (21.4 ± 10.6 ng/ml) than patients with BPPV (p < 0.005), patients with other vestibular disorders (p < 0.005) and all patients with vestibular disorders (24.9 ± 10.1 ng/ml, p < 0.005).

CONCLUSION

Our analysis does not support the theory of a specific relationship between serum 25(OH)D concentration and the occurrence of BPPV or other vestibular disorders.

Genetics and the Individualized Therapy of Vestibular Disorders

Background: Vestibular disorders (VDs) are a clinically divergent group of conditions that stem from pathology at the level of the inner ear, vestibulocochlear nerve, or central vestibular pathway. No etiology can be identified in the majority of patients with VDs. Relatively few families have been reported with VD, and so far, no causative genes have been identified despite the fact that more than 100 genes have been identified for inherited hearing loss. Inherited VDs, similar to deafness, are genetically heterogeneous and follow Mendelian inheritance patterns with all modes of transmission, as well as multifactorial inheritance. With advances in genetic sequencing, evidence of familial clustering in VD has begun to highlight the genetic causes of these disorders, potentially opening up new avenues of treatment, particularly in Meniere's disease and disorders with comorbid hearing loss, such as Usher syndrome. In this review, we aim to present recent findings on the genetics of VDs, review the role of genetic sequencing tools, and explore the potential for individualized medicine in the treatment of these disorders.

Methods: A search of the PubMed database was performed for English language studies relevant to the genetic basis of and therapies for vestibular disorders, using search terms including but not limited to: “genetics,” “genomics,” “vestibular disorders,” “hearing loss with vestibular dysfunction,” “individualized medicine,” “genome-wide association studies,” “precision medicine,” and “Meniere's syndrome.”

Results: Increasing numbers of studies on vestibular disorder genetics have been published in recent years. Next-generation sequencing and new genetic tools are being utilized to unearth the significance of the genomic findings in terms of understanding disease etiology and clinical utility, with growing research interest being shown for individualized gene therapy for some disorders.

Conclusions: The genetic knowledge base for vestibular disorders is still in its infancy. Identifying the genetic causes of balance problems is imperative in our understanding of the biology of normal function of the vestibule and the disease etiology and process. There is an increasing effort to use new and efficient genetic sequencing tools to discover the genetic causes for these diseases, leading to the hope for precise and personalized treatment for these patients.

Visual Fixations and Motion Sensitivity: Protocol for an Exploratory Study

Background

Motion sensitivity after vestibular disorders is associated with symptoms of nausea, dizziness, and imbalance in busy environments. Dizziness and imbalance are reported in places such as supermarkets and shopping malls which have unstable visual backgrounds; however, the mechanism of motion sensitivity is poorly understood.

Objective

The main aim of this exploratory observational study is to investigate visual fixations and postural sway in response to increasingly complex visual environments in healthy adults and adults with motion sensitivity.

Methods

A total of 20 healthy adults and 20 adults with motion sensitivity will be recruited for this study. Visual fixations, postural sway, and body kinematics will be measured with a mobile eye tracker device, force plate, and 3D motion capture system, respectively. Participants will be exposed to experimental tasks requiring visual fixation on letters, projected on a range of backgrounds on a large screen during quiet stance. Descriptive statistics (mean and standard deviation) will be calculated for each of the variables. One-way independent-measures analyses of variance will be performed to investigate the differences between groups for all variables.

Results

Data collection was started in May 2019 and was completed by February 2020. It was approved by Health and Disability Ethics Committees, Ministry of Health, New Zealand on November 2, 2018 (Ethics ref: 18/CEN/193). We are currently processing the data and will begin data analysis in July 2020. We expect the results to be available for publication by the end of 2020. The trial was funded by the Neurology Special Interest Group, Physiotherapy New Zealand, and the Eisdell Moore Centre in November 2018.

Conclusions

This study will provide a detailed investigation of visual fixations in response to increasingly complex visual environments. Investigating characteristics of visual fixations in healthy adults and those with motion sensitivity will provide insight into this disabling condition and may inform the development of new intervention strategies which explicitly cater to the needs of this population.

Trial Registration

Australian New Zealand Clinical Trials Registry, ACTRN12619000254190; https://tinyurl.com/yxbn7nks

International Registered Report Identifier (IRRID)

PRR1-10.2196/16805

Using Inertial Sensors to Quantify Postural Sway and Gait Performance during the Tandem Walking Test

Vestibular dysfunction typically manifests as postural instability and gait irregularities, in part due to inaccuracies in processing spatial afference. In this study, we have instrumented the tandem walking test with multiple inertial sensors to easily and precisely investigate novel variables that can distinguish abnormal postural and gait control in patients with unilateral vestibular hypofunction. Ten healthy adults and five patients with unilateral vestibular hypofunction were assessed with the tandem walking test during eyes open and eyes closed conditions. Each subject donned five inertial sensors on the upper body (head, trunk, and pelvis) and lower body (each lateral malleolus). Our results indicate that measuring the degree of balance and gait regularity using five body-worn inertial sensors during the tandem walking test provides a novel quantification of movement that identifies abnormalities in patients with vestibular impairment.

Vestibular functions in patients with tinnitus only

OBJECTIVE

Tinnitus is the perception of sound in the ears or head without any external or internal acoustic stimulation, and it is usually associated with hearing loss. In addition, it has been reported that there is a relationship between vestibular problems and sensorineural hearing loss. The aim of this study was to evaluate the vestibular function in patients with tinnitus without hearing loss.

METHODS

A total of 32 patients who complained only of tinnitus without hearing loss and 30 control subjects without tinnitus or hearing loss were included in this study. Oculomotor and caloric tests were performed on all subjects with videonystagmography. The tinnitus handicap inventory questionnaire, side and duration of tinnitus were recorded in all patients.

RESULTS

The caloric test was abnormal in 13 of 32 (40.6%) patients in the tinnitus group and was normal in all of the control group. Abnormal caloric responses in patients with severe tinnitus were more frequent than in patients with mild or moderate tinnitus. There was a statistically significant difference in the optokinetic gain values between the tinnitus and control groups.

CONCLUSION

A relationship between tinnitus and abnormal caloric responses was determined. Tinnitus may be the first symptom of vestibular dysfunction.

Living with Ménière's disease: an interpretative phenomenological analysis

Purpose: To explore the meanings of Ménière's disease from the perspective of people living with this condition and to understand what was considered significant and important in participants' everyday lives.Materials and methods: Four women with Ménière's disease participated in face-to-face semi-structured interviews. Accounts were recorded, transcribed, and analysed using an iterative process integral to Interpretative Phenomenological Analysis.Results: Three interconnected themes were identified. "You have no control whatsoever" conveys participants' perceptions of vertigo as having a disruptive and ongoing impact on physical and psychosocial function in everyday life. "Ménière's takes away your life completely" describes Ménière's as impinging on participants' most meaningful activities and relationships, and as restricting their ability to live their lives on their own terms. "You get on with life" recounts participants' efforts to refashion their lives whilst living with this condition and manage its most harmful effects. The psychosocial impact of living with Ménière's disease and its relevance to rehabilitation is discussed.Conclusions: Ménière's disease has an enduring physical and psychosocial impact. Clinicians who acknowledge and respond to an individual's subjective experience of their condition may be key to their engagement in therapy. Service users should have a voice in health service design and delivery.Implications for rehabilitationMénière's disease is a long-term disabling condition that not only impacts on physical and psychosocial functioning but also restricts quality of life through stigmatisation.Fear of triggering an attack of vertigo may prevent people with Ménière's disease from engaging with rehabilitation.Therapists who adopt a biopsychosocial approach and who recognise patients' efforts to control their symptoms as a positive form of resistance may be better equipped to empathetically support patients to engage in new activities that may be vital to improving their lives.

An attempt to measure the diametric relationship between slow and quick phases of nystagmus

OBJECTIVE

To investigate whether our original method can precisely evaluate the angle between slow and quick phases of nystagmus (vector angle) and to determine whether vector angle analysis is helpful in differentiating between horizontal nystagmus and mixed nystagmus with horizontal and vertical components.

METHODS

We included 20 healthy volunteers, 17 patients with horizontal nystagmus, and 15 patients with mixed nystagmus. Caloric nystagmus was recorded in healthy volunteers; positional nystagmus was recorded in each patient. We extracted the velocity of nystagmus from eye movement of each subject and analysed the vector angle.

RESULTS

In caloric nystagmus, the vector angle approached 180 degrees as slow-phase velocity increased, suggesting that our vector angle measurement is more reliable with faster nystagmus. Importantly, in horizontal nystagmus from peripheral vestibular disease, the vector angle similarly approached 180 degrees as slow-phase velocity increased; in contrast, the vector angle in cases of mixed nystagmus from vertebrobasilar insufficiency or spinocerebellar degeneration significantly differed from the angle of caloric nystagmus.

CONCLUSIONS

Vector angle analysis using our original algorithm can precisely evaluate the diametric relationship in vestibular nystagmus; it may be helpful in diagnosis of non-peripheral vestibular disorders.

International Clinical Protocol on Vestibular Disorders (Dizziness)

26-28 May at 43 Congress of Neurootological and Equilibriometric Society (Budapest, Hungary) International Clinical Protocol on Vestibular Disorders (Dizziness) being discussed and accepted as Consensus Document. Cochrane reports estimates that dizziness has prevalence of 22.9% in the last 12 months and an incidence of 3.1%. Only 1.8% of adults consulted a physician in the last 12 months. Cochrane reviews suggest that the evidence base for dizziness evaluation is weak, thus necessitates the creation of evidence-based document. Protocol is based at the new concept of vestibular system, which involves the vestibular peripheral sensors, space orientation tetrad, vestibular presentations in the brain cortex and vestibular effectory projections in the brain. Labyrinth consists of sensors, for which six modalities are adequate: 1. acceleration, 2. gravitation, 3. low frequency whole-body vibration, 4. Infrasound, 5. magnetic impulse, 6. metabolic changes. Vestibular system from rhomboid fosse gets the inputs from visual, acoustic, somatosensory organs, integrating them and forming space perception and orientation. Interaction with space is realized through sensory, motor, vegetative and limbic projections. So, vestibular disturbances may manifest as paropsia, tinnitus, numbness. Vestibular evoked potentials (not VEMP) and craniocorpography have highest sensitivity (90% and more). As vestibular dysfunction has recurrent character patients need monitoring.

Clinical criteria of positional vertical nystagmus in vestibular migraine

OBJECTIVES

The goal of this study was to identify key diagnostic criteria for positional vertical nystagmus caused by vestibular migraine (VM).

MATERIALS AND METHODS

The study group included a case series of 13 subjects with VM (10 females and three males with age 38.6 ± 8.9 years); they were complaining of positional vertigo. They were subjected to thorough audiovestibular examination and treated with cinnarizine or topiramate Results: The entire study group demonstrated positional vertical nystagmus (eight patients had up-beating nystagmus and five patients had down-beating nystagmus). The vertigo and nystagmus were elicited in one or more of the following positions: the right & left Dix-Hallpike, supine with head center, head right, and head left positions. The nystagmus had no latency period. It was persistent, non-fatigable and markedly reduced by visual fixation. Prophylactic therapy of VM (topiramate or cinnarizine) cured the positional vertigo in 92% of the study group. Neither the positional vertigo nor the nystagmus recurred in a 3-6 months follow-up period.

CONCLUSIONS

VM can induce characteristic form of vertical positional nystagmus and vertigo, which would be treated by medications used for controlling the VM.

Secondary Endolymphatic Hydrops

HYPOTHESIS

A review of the most recent literature will provide clinicians with an update of secondary endolymphatic hydrops, aiding in diagnosis and treatment of affected patients.

BACKGROUND

Secondary endolymphatic hydrops is a pathologic finding of the inner ear resulting in episodic vertigo and intermittent hearing loss. It is a finding for which extensive research is being performed.

METHODS

A review of the most recent literature on secondary endolymphatic hydrops was performed using PubMed literature search.

RESULTS

Recent investigation of secondary endolymphatic hydrops has brought attention to traumatic and inflammatory insults as causes for secondary endolymphatic hydrops. Such etiologies, including postsurgical effects of cochlear implantation and endolymphatic sac ablation; otosclerosis and its operative intervention(s); acoustic and mechanical trauma; medications; and systemic inflammatory processes, have been determined as causes of secondary lymphatic hydrops. Histopathological slides for many of the etiologies of secondary endolymphatic hydrops are presented.

CONCLUSION

Through an understanding of the pathophysiology and etiologies of secondary endolymphatic hydrops, clinicians will gain a better understanding of this complex disease process, which will aid in treatment of patients with this disease process.

Impaired mental rotation in benign paroxysmal positional vertigo and acute vestibular neuritis

Vestibular processing is fundamental to our sense of orientation in space which is a core aspect of the representation of the self. Vestibular information is processed in a large subcortical–cortical neural network. Tasks requiring mental rotations of human bodies in space are known to activate neural regions within this network suggesting that vestibular processing is involved in the control of mental rotation. We studied whether mental rotation is impaired in patients suffering from two different forms of unilateral vestibular disorders (vestibular neuritis – VN – and Benign Paroxysmal positional Vertigo – BPPV) with respect to healthy matched controls (C). We used two mental rotation tasks in which participants were required to: (i) mentally rotate their own body in space (egocentric rotation) thus using vestibular processing to a large extent and (ii) mentally rotate human figures (allocentric rotation) thus using own body representations to a smaller degree. Reaction times and accuracy of responses showed that VN and BPPV patients were impaired in both tasks with respect to C. Significantly, the pattern of results was similar in the three groups suggesting that patients were actually performing the mental rotation without using a different strategy from the control individuals. These results show that dysfunctional vestibular inflow impairs mental rotation of both own body and human figures suggesting that unilateral acute disorders of the peripheral vestibular input massively affect the cerebral processes underlying mental rotations.

Diagnosis and treatment of vertigo and dizziness

INTRODUCTION

Vertigo is not a separate disease process, but a multisensory and sensorimotor syndrome with various etiologies and pathogeneses. It is among the commonest symptoms presented to doctors, with a lifetime prevalence of around 20% to 30%. Patients have often consulted multiple physicians before a diagnosis is made and therapy initiated.

METHODS

Selective literature research and review of the guidelines of the German Neurological Society.

RESULTS

A careful history remains the cornerstone of diagnosis. Once the correct diagnosis is made, specific and effective treatments are available for most peripheral, central, and psychogenic forms of dizziness. Treatment may include medication, physiotherapy, and psychotherapy; a few limited cases may require surgical treatment. The treatment of choice for acute vestibular neuritis is the administration of corticosteroids. Menière's disease is treated with high-dose, long-term betahistine. A new approach to the management of downbeat and upbeat nystagmus, and of episodic ataxia type 2, involves the use of aminopyridines as potassium-channel blockers. Close multidisciplinary cooperation is essential in dizziness, and further multicenter studies are needed.

Impaired navigation skills in patients with psychological distress and chronic peripheral vestibular hypofunction without vertigo

Few studies have focused on the role of the vestibular system for navigation and spatial memory functions in humans, with controversial results. Since most experimental settings were based on magnetic resonance imaging volumetry of the hippocampus and virtual navigation task on a PC, aim of this study was to investigate whether a well-compensated unilateral peripheral vestibular hypofunction in humans could interfere with navigation tasks while walking on memorized routes. A series of 50 unilateral labyrinthine-defective patients, without vertigo at the time of examination, and 50 controls were invited to visually memorize 3 different routes (a triangle, a circle and a square) on a grey carpet and then to walk along them clockwise and counter-clockwise (mental map navigation) with eyes closed. The same test was then repeated with eyes open (actual navigation) and a second time with eyes closed (mental navigation). Execution time was recorded in each test. In the same session, working spatial memory was assessed by the Corsi block test and all subjects completed the Symptom Check List (SCL-90) to assess depression and anxiety levels. Results showed that labyrinthine-defective patients presented higher levels of anxiety and depression and performed the Corsi block test with more difficulties than controls. All differences reached statistically significant level (p < 0.05). Moreover, patients needed more time than controls in the first and third navigation tasks (eyes closed). No difference was observed between clockwise and counter-clockwise walking, on all routes, either in patients or controls. Patients showed a greater improvement in the third navigation task, with respect to the first test, than controls, with no side-effect in relation to labyrinthine hypofunction. These data demonstrate that walking along memorized routes without vision is impaired by peripheral vestibular damage even if vestibular compensation prevents patients from suffering from vertigo and balance disturbances. This impairment could be due to a permanent deficit of visuo-spatial short-term memory as suggested by the Corsi block test results even if a residual sensori-motor impairment and/or an interference of psychological distress could not be excluded.

Biomechanics of horizontal canal benign paroxysmal positional vertigo

Horizontal canal (HC) benign paroxysmal positional vertigo (HC-BPPV) is a vestibular disorder characterized by bouts of horizontal ocular nystagmus induced during reorientation of the head relative to gravity. The present report addresses the application of a morphologically descriptive 3-canal biomechanical model of the human membranous labyrinth to study gravity-dependent semicircular canal responses during this condition. The model estimates dynamic cupular and endolymph displacements elicited during HC-BPPV provocative diagnostic maneuvers and canalith repositioning procedures (CRPs). The activation latencies in response to an HC-BPPV provocative diagnostic test were predicted to vary depending upon the initial location of the canalith debris (e.g. within the HC lumen vs. in the ampulla). Results may explain why the onset latency of ocular nystagmus evoked by the Dix-Hallpike provocative maneuver for posterior canal BPPV are typically longer than the latencies evoked by analogous tests for HC-BPPV. The model was further applied to assess the efficacy of a 360 degrees -rotation CRP for the treatment of canalithiasis HC-BPPV.