Prospective cohort study on the predictors of fall risk in 119 patients with bilateral vestibulopathy.

Bieke Dobbels,Florence Lucieer,Raymond Van De Berg,Angelica Pérez Fornos,Vincent Van Rompaey,Griet Mertens,Paul Van De Heyning,Olivier Vanderveken,Nils Guinand,Ann Hallemans,Julie Moyaert,Annick Gilles,Nolan Herssens,Luc Vereeck

doi:10.1371/journal.pone.0228768

Abstract

ObjectivesTo identify predictive factors for falls in patients with bilateral vestibulopathy (BV). Specific variables contributing to the general work-up of a vestibular patient were compared between BV patients experiencing falls and those who did not.DesignProspective multi-centric cohort study.SettingDepartment of Otorhinolaryngology & Head and Neck Surgery at two tertiary referral centers: Antwerp University Hospital and Maastricht University Medical Center.ParticipantsIn total, 119 BV patients were included. BV diagnosis was defined in accordance with the diagnostic BV criteria, established by the Bárány Society in 2017.Main outcome measuresPatients were divided into fallers and non-fallers, depending on the experience of one or more falls in the preceding 12 months. Residual vestibular function on caloric testing, rotatory chair testing, video head impulse test (vHIT) and cervical vestibular evoked myogenic potentials (cVEMP) was evaluated as a predictive factor for falls. Furthermore, hearing function (speech perception in noise (SPIN)), sound localization performance, etiology, disease duration, sport practice, scores on the Dizziness Handicap Inventory (DHI) and the Oscillopsia Severity Questionnaire (OSQ) were compared between fallers and non-fallers.ResultsForty-five (39%) patients reported falls. In a sub-analysis in the patients recruited at UZA (n = 69), 20% experienced three or more falls and three patients (4%) suffered from severe fall-related injuries. The DHI score and the OSQ score were significantly higher in fallers. Residual vestibular function, SPIN, sound localization performance, etiology, disease duration, age and sport practice did not differ between fallers and non-fallers.ConclusionsFalls and (severe) fall-related injuries are frequent among BV patients. A DHI score > 47 and an OSQ score > 27.5 might be indicative for BV patients at risk for falls, with a sensitivity of 70% and specificity of 60%. Residual vestibular function captured by single vestibular tests (vHIT, calorics, rotatory chair, cVEMP) or by overall vestibular function defined as the number of impaired vestibular sensors are not suitable to distinguish fallers and non-fallers in a BV population.

Highlights

Bilateral vestibulopathy (BV) is characterized by a bilateral loss of function of the peripheral vestibular organs, the vestibular nerves or both [1]
Speech audiometry in noise (SPIN), sound localization performance, etiology, disease duration, age and sport practice did not differ between fallers and non-fallers
Falls and fall-related injuries are frequent among BV patients

Summary

Introduction

Bilateral vestibulopathy (BV) is characterized by a bilateral loss of function of the peripheral vestibular organs, the vestibular nerves or both [1]. The most frequent reported etiologies of BV are ototoxic (aminoglycosides antibiotics), Menière’s disease and infections [2,3,4]. In Belgium and the Netherlands a relative higher proportion of genetic etiology is found due to a COCH mutation causing DFNA9 disease, which is the most common type of autosomal dominant non-syndromic deafness [5]. In about half of all BV patients no underlying etiology can be identified that caused their vestibular loss [2, 6]. In these patients, the disease is called ‘idiopathic BV’. Due to failure of the vestibulo-ocular reflex, BV patients might complain of instable gaze during head movements, called oscillopsia [1]

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