Positional Vertigo Research Articles

Impact of Vertigo on Quality of Life

Abstract Vertigo is a dynamic symptom that can evolve over time and can represent a sign of complex and or serious diseases. Vertigo is a frequent medical symptom in the population where an individual needs an urgent consultation with the clinician. Vertigo is a symptom of vestibular disorders that may lead to physical disability and poor quality of life (QoL). There is a wide range of pathologies for manifesting vertigo. The patient who suffers from vertigo often consults several clinicians before getting a final diagnosis and effective treatment. There is limited knowledge regarding vestibular illnesses, which cause disruptions in daily activities, despite the fact that some particular problems are connected to sleep, work, leisure, and emotional impairment. Patients with vertigo often present psychological manifestations such as panic attacks, postural phobic vertigo, agoraphobia, anxiety, and depression. A vicious cycle may happen, in which vertigo acts as a source of anxiety, which in turn causes dizziness, even after vertigo has disappeared. In this review paper, we analyze the most recent research on the link between vertigo and life quality, as well as its effects and impending difficulties. Different articles related to the impact of vertigo on QoL were analyzed for this review. The objective of this review article is to provide awareness among general practitioners, otolaryngologists, neurologists, and neuro-otologists about QoL affected by vertigo symptoms.

Circulating levels of micronutrients and the risk of benign paroxysmal positional vertigo: A Mendelian randomization study

BackgroundBenign paroxysmal positional vertigo (BPPV) is a typical vestibular disease characterized by recurrent episodes of vertigo. The role of micronutrients in BPPV pathogenesis has not been extensively studied, prompting this investigation into the relationship between circulating micronutrients and BPPV risk. This research aimed to explore the relationship between blood micronutrient levels and BPPV risk via Mendelian randomization (MR) analysis, a robust method for inferring causality from observational data. MethodsA total of 15 circulating micronutrients were assessed for their association with BPPV risk. MR analysis was conducted via the following methods: MR‒Egger, weighted median, simple model, inverse variance weighting (IVW), and weighted mode. Sensitivity analyses were performed to assess heterogeneity and pleiotropy. A multivariate MR analysis was also conducted, incorporating potential confounders such as trauma, chronic otitis media, hearing loss, peripheral atherosclerosis, ageing, and osteoporosis. ResultsMR analysis revealed an obvious association between selenium and BPPV risk (OR 1.074, 95 % CI 1.005 to 1.148; P = 0.035). Folate was negatively related (OR 0.694, 95 % CI 0.501 to 0.962, P = 0.028) but was excluded because of inconsistent OR values across methods. Sensitivity analysis supported the IVW results, and there was no evidence of significant heterogeneity among the selenium-related instrumental variables included in the study, nor was horizontal pleiotropy detected among the instrumental variables. Multivariate MR analysis confirmed that selenium was an independent risk factor for BPPV (OR 1.22, 95 % CI 1.059 to 1.406, P = 0.006), with no significant associations observed for other micronutrients or exposure factors. ConclusionThis study provides evidence that blood selenium levels are positively associated with the risk of BPPV, suggesting a potential role for selenium in the pathogenesis of this disorder. These findings are robust to various sensitivity analyses and support the use of MR analysis to identify novel risk factors for BPPV. The identification of selenium as an independent risk factor for BPPV has implications for the development of preventive strategies and targeted interventions. It is necessary to analyse the biological mechanisms of this association and determine the therapeutic value of limiting selenium intake for BPPV to provide support for the treatment of such patients.

Brain Functional Alterations in Patients With Benign Paroxysmal Positional Vertigo Demonstrate the Visual-Vestibular Interaction and Integration.

This study aimed to analyze the features of resting-state functional magnetic resonance imaging (rs-fMRI) and clinical relevance in patients with benign paroxysmal positional vertigo (BPPV) that have undergone repositioning maneuvers. A total of 38 patients with BPPV who have received repositioning maneuvers and 38 matched healthy controls (HCs) were enrolled in the present study from March 2018 to August 2021. Imaging analysis software was employed for functional image preprocessing and indicator calculation, mainly including the amplitude of low-frequency fluctuation (ALFF), fractional ALFF (fALFF), percent amplitude of fluctuation (PerAF), and seed-based functional connectivity (FC). Statistical analysis of the various functional indicators in patients with BPPV and HCs was also conducted, and correlation analysis with clinical data was performed. Patients with BPPV displayed decrease in ALFF, fALFF, and PerAF values, mainly in the bilateral occipital lobes in comparison with HCs. Additionally, their ALFF and fALFF values in the proximal vermis region of the cerebellum increased relative to HCs. The PerAF values in the bilateral paracentral lobules, the right supplementary motor area (SMA), and the left precuneus decreased in patients with BPPV and were negatively correlated with dizziness visual analog scale (VAS) scores 1 week after repositioning (W1). In addition, in the left fusiform gyrus and lingual gyrus, the PerAF values show a negative correlation with dizziness handicap inventory (DHI) scores at initial visit (W0). Seed-based FC analysis using the seeds from differential clusters of fALFF, ALFF, and PerAF showed reductions between the left precuneus and bilateral occipital lobe, the left precuneus and left paracentral lobule, and within the occipital lobes among patients with BPPV. The spontaneous activity of certain brain regions in the bilateral occipital and frontoparietal lobes of patients with BPPV was reduced, whereas the activity in the cerebellar vermis was increased. Additionally, there were reductions in FC between the precuneus and occipital cortex or paracentral lobule, as well as within the occipital cortex. The functional alterations in these brain regions may be associated with the inhibitory interaction and functional integration of visual, vestibular, and sensorimotor systems. The functional alterations observed in the visual cortex and precuneus may represent adaptive responses associated with residual dizziness.

Identifying Locations Where Self-Reported Dizziness Occurs In Patients With Vestibular Disorders In A Day Hospital Setting

Abstract Background World falls guidelines recommended that where vestibular issues are identified such as Benign Paroxysmal Positional Vertigo (BPPV), therapeutic interventions should always be sought, as potential benefits to health-related quality of life are high (Montaro-Odasso et al., 2022). Identifying potential BPPV in older adults, however, can be challenging, as many older adults experience BPPV as vague unsteadiness rather than dizziness, leading to under diagnosis of the condition (Li et al., 2023). This audit aimed to identify the locations where patients with self- reported dizziness and falls experienced dizziness, and if they subsequently were diagnosed with vestibular disorders. If potential high-risk locations for experiencing dizziness with vestibular issues are identified, this may aid in the timely identification of vestibular disorders. Methods A retrospective chart audit was undertaken in a multidisciplinary day hospital setting, where patients aged 75 years and older attend for assessments. Paper charts of patients discharged from the day hospital between January and March 2024 were reviewed. A Microsoft excel sheet was used to track data. Data on self-reported dizziness and falls as well as the location of dizziness occurring was gathered. Results A total of 103 patient charts were reviewed. Of those, 39 reported experiencing dizziness, with 90% of those patients also reporting a history of falls. 18 of these patients were subsequently diagnosed with vestibular disorders. 78% of patients diagnosed with BPPV reported experiencing dizziness getting out of bed or in their bedroom with 28% also reporting dizziness on getting up from a chair. However, 100% of patients with dizziness and falls without vestibular disorders reported dizziness on getting out of their bed. Conclusion People with all cause dizziness reported dizziness on getting out of bed. Based on the results of this audit, vestibular screening is not aided by questions surrounding location of dizziness occurring.

Vestibular Assessment In Patients With Self-Reported Dizziness And A History Of Falls

Abstract Background World Falls Guidelines recommend that any patient with a history of falls and reporting dizziness should be screened for Benign Paroxysmal Positional Vertigo (BPPV) (Montero-Odasso et al.,2022). Diagnosing and treating BPPV in particular has been shown to reduce the incidence of falls in older adults, however, it is widely underdiagnosed (Li et al., 2023). This audit explored compliance with falls guidelines in a day hospital setting where falls work up assessments take place on older patients (75 years and older). It aimed to identify reasons why vestibular assessments may not have been undertaken and establish methods to improve compliance with the undertaking of vestibular assessments where indicated. Methods A retrospective chart was undertaken for patients who attended a day hospital service for older adults between January and April 2023. A Microsoft excel sheet was used to track data. All data was anonymised and stored on a password encrypted HSE networked drive accessed in the day hospital. Results A total of 97 charts were reviewed, with 31 patients reporting to have experienced dizziness with falls. For 33% of those patients (n=10), a vestibular screen was not carried out. For 7 out of 10 of these patients a screen was not carried out due to insufficient staff training in the area, with one patient not having been referred to physiotherapy, also secondary to insufficient staff training. Conclusion Facilitating adequate access to training in vestibular rehab for healthcare professionals is an essential part of ensuring BPPV and other vestibular disorders are diagnosed and treated in patients with self-reported dizziness and falls. Training as part of undergraduate degrees could be considered to ensure BPPV is diagnosed and treated in a timely manner. Additional staff training was provided in the day hospital setting in question and a re-audit of vestibular screening will take place in summer 2024.

Incidence of Vestibular Dysfunction in Frail Older Adults Attending an Integrated Care Programme for Older Persons (ICPOP)

Abstract Background The World Falls Guidelines (2022) recommend a vestibular assessment as part of a multifactorial falls risk assessment in older adults. There is a possibility however, of vestibular dysfunction being overlooked because of no subjective complaints in older fallers i.e. vestibular agnosia. This study aimed to determine the prevalence of vestibular dysfunction in older adults presenting to physiotherapy in Integrated Care Programme for Older Persons (ICPOP) regardless of complaints of dizziness. Methods This was a retrospective observational study of frail older adults attending physiotherapy in ICPOP over a 4-month period. Patients with a falls history or indicators of vestibular dysfunction (e.g. dizziness, reduced balance on turning) were identified for vestibular assessment. Data was collected from a hospital clinical system using Microsoft Excel. This was a retrospective observational study of frail older adults attending physiotherapy in ICPOP over a 4-month period. Patients with a falls history or subjective indicators of vestibular dysfunction (e.g. dizziness, reduced balance on turning) were identified for vestibular assessment. Data was collected from a hospital clinical system using Microsoft Excel. Results A vestibular assessment was carried out on 69% (n=52) of physiotherapy patients with a mean age of 80.9 years and mean Clinical Frailty Score of 5. 75% of patients that underwent a vestibular assessment had vestibular dysfunction with the most prevalent diagnoses being Benign Paroxysmal Positional Vertigo (40%), Unilateral Vestibular Hypofunction (13%) & reduced gain of Vestibulo-Ocular Reflex (13%). 77% of those who tested positively for vestibular dysfunction had a fall within the last 12 months. 48% of those patients that had vestibular dysfunction did not complain of dizziness. Conclusion Almost half of patients with vestibular dysfunction had no dizziness highlighting the incidence of vestibular agnosia. This study highlights the high prevalence of vestibular dysfunction amongst older adults and supports vestibular assessments in older fallers regardless of the presence of dizziness.

Dizziness and vertigo sick leave before and after insurance restrictions – a descriptive Swedish nationwide register linkage study

BackgroundVertigo and dizziness can be disabling symptoms that result in sick leave. Research regarding sickness absence due to dizziness has focused on specific vestibular diagnoses rather than the nonspecific vertigo/dizziness diagnoses. Strict sick leave regulations were introduced in Sweden in 2008. The aim of this study was to describe the vertigo/dizziness sick leave prevalence and duration considering both specific and nonspecific diagnoses according to International Classification of diseases 10th revision (ICD-10) on the 3-digit level, including the less specific “R” diagnoses.MethodsThrough Swedish nationwide registers we identified individuals aged 16–64 years who during the years 2005–2018 were sickness absent > 14 consecutive days – minimum register threshold – due to vertigo/dizziness diagnoses according to ICD10 codes: specific diagnoses (H81.0, H81.1, H81.2, H81.3, H81.4, G11x) and nonspecific (R42, R26, R27, H81.9). We described the demographic characteristics, prevalence and duration of such sick-leave spells. Data were stratified according to diagnostic groups: ataxias, vestibular and nonspecific.ResultsWe identified 52,179 dizziness/vertigo sick leave episodes > 14 days in 45,353 unique individuals between 2005–2018, which constitutes 0.83% from all sick leave episodes in the given period.The nonspecific diagnoses represented 72% (n = 37741) of sick leave episodes and specific vestibular H-diagnoses 27% (n = 14083). The most common specific vestibular codes was Benign paroxysmal positional vertigo (BPPV) 9.4% (n = 4929). The median duration of sick leave was 31 days (IQR 21–61). Women on sick leave were younger than men (47 vs 51 years, p < 0.05) and had a higher proportion of nonspecific diagnoses compared with men (74% vs 70%, p < 0.05).ConclusionsThe vast majority of vertigo/dizziness sick leave episodes were coded as nonspecific diagnoses and occurred in women. BPPV, a curable vestibular condition, was the most common specific diagnosis. This suggests a potential for improved diagnostics. Women on sick leave due to dizziness/vertigo were younger and more often received nonspecific diagnostic codes. Future studies should determine the frequency of use of evidence based therapies and investigate further the gender differences.

R-cVR, a two-step bedside algorithm for the differential diagnosis of acute dizziness and vertigo

BackgroundThe ability to quickly and accurately differentiate between peripheral and central dizziness or vertigo is vital. We developed the R-cVR algorithm for the early identification of central-type dizziness or vertigo. MethodsIn this single-center, retrospective cohort study, we assessed patients with isolated dizziness or vertigo between December 10, 2023, and February 28, 2024. Classification into central or peripheral types was based on magnetic resonance imaging (MRI)-diffusion-weighted imaging (DWI) results. We reevaluated the diagnostic value of the Romberg test for acute dizziness or vertigo by quantifying the duration of standing and created the R-cVR algorithm. The algorithm's accuracy was subsequently validated against the MRI-DWI results. ResultsAfter screening, 109 patients were recruited and divided into central (n = 25) and peripheral (n = 84) groups. The central group had a high incidence of cerebral infarction (88.0 %), whereas the peripheral group included patients with vestibular neuronitis, benign paroxysmal positional vertigo, and Meniere's disease (96.4 %). Significant disparities in the incidence of balance disorders were noted between the groups (92.0 % vs. 15.5 %, p < 0.001). Multivariate logistic regression revealed an odds ratio of 61.82 for balance disorders (p < 0.001). The R-cVR algorithm, which integrates the Romberg test and the V-shaped stance with closed-eyes protocol, was tested against MRI-DWI and yielded high diagnostic agreement (kappa = 0.80), with a sensitivity and specificity of 88.0 % and 94.0 %, respectively. There was no significant difference in the diagnostic efficacy of this algorithm for acute dizziness or vertigo with or without nystagmus. ConclusionThe R-cVR algorithm effectively identifies central-type dizziness or vertigo and is simple for general practitioners to use without specialized equipment, which may be valuable in various clinical settings.

Evaluation of serum vitamin D3 and total serum calcium in patients with posterior canal benign paroxysmal positional vertigo

BackgroundBenign paroxysmal positional vertigo is the most common neurootologic disorder, characterized by brief attacks of vertigo aggravated by certain head positions. During the last two decades, several studies were performed in different countries trying to find a relationship between benign paroxysmal positional vertigo and vitamin D3 (25 hydroxyvitamin D) deficiency.ObjectivesThis study aimed to find the relationship between vitamin D3 deficiency and total serum calcium with benign paroxysmal positional vertigo.Patients and methodsA case–control study conducted from January 2021 to December 2021, consisted of 62 participants; 30 patients with posterior canal benign paroxysmal positional vertigo and 32 healthy persons considered as a control group. The age and sex of both groups were matched, and diagnosis was made by history and examination (Dix-Hallpike’s maneuver). A blood sample was taken to evaluate serum vitamin D level and total serum calcium. The results were compared between both groups.ResultsThe mean levels of vitamin D3 in patients and control groups were 18.57 ± 9.88 ng/ml and 64.12 ± 24.64 ng/ml, respectively, with a statistically significant difference at p ≤ 0.0001. Moreover, regarding vitamin D3 deficiency below 20 ng/ml between patients and control groups, there was a statistically significant difference p = 0.001. Furthermore, there was no significant difference regarding total serum calcium between the two groups, the mean of both groups was 8.57 ± 0.68 mg/dl and 8.93 ± 0.92 mg/dl for patients and control, respectively, at p = 0.084.ConclusionThere might be an association between benign paroxysmal positional vertigo and vitamin D3 deficiency. Moreover, there was no significant difference concerning total serum calcium levels between the patient and control groups.

Chronic Unilateral Vestibular Hypofunction: Insights into Etiologies, Clinical Subtypes, Diagnostics and Quality of Life.

Background/Objectives: Chronic unilateral vestibular hypofunction (UVH) can lead to disabling vestibular symptoms and a decrease in quality of life. The aim of this study was to investigate etiologies, clinical subtypes, symptoms, and quality of life (QoL) in patients with chronic UVH. Methods: A retrospective study was performed on 251 UVH patients in a tertiary referral center. Inclusion criteria comprised reduced or absent caloric responses, with a caloric asymmetry ratio ≥25%. Patients with central vestibular pathology, symptom duration <3 months, and incomplete responses to questionnaires were excluded. Patient records were assessed for etiologies, secondary vestibular diagnoses, clinical subtypes, and questionnaires related to QoL. Additionally, multiple linear regression analysis was performed to evaluate factors influencing QoL. Results: Thirteen different etiologies were identified, with Menière's Disease as the most prevalent (31%, n = 79). The most frequently reported secondary vestibular diagnoses were benign paroxysmal positional vertigo (BPPV) (21%, n = 54) and persistent postural perceptual dizziness (PPPD) (19%, n = 47). Five distinct clinical subtypes were identified: recurrent vertigo with UVH (47%), rapidly progressive UVH (25%), idiopathic/unknown UVH (18%), slowly progressive UVH (8%), and congenital UVH (2%). Over 80% of UVH patients experienced moderate-to-severe handicap, as indicated by the Dizziness Handicap Inventory. Approximately 20-25% of UVH patients exhibited moderate-to-severe depression and anxiety, based on the Hospital Anxiety and Depression Scale. Multiple linear regression analyses demonstrated that the presence of PPPD significantly reduced QoL in chronic UVH patients. Conclusions: Chronic UVH is a heterogeneous disorder. Secondary vestibular diagnoses like BPPV and PPPD often co-exist and can significantly impact QoL. A structured diagnostic approach and tailored interventions are crucial to address the diverse needs of UVH patients.

Association of Young-Onset Dementia with Pre-Existing Peripheral Vestibular Disorders.

The relationship between young-onset dementia and peripheral vestibular disorders remained largely unknown although this association was observed in the older population. This case-control study aims to investigate the association of young-onset dementia with a pre-existing diagnosis of peripheral vestibular disorders using a population-based data from Taiwan's Longitudinal Health Insurance Database 2010. This study included 989 patients with young-onset dementia and 2967 propensity-score-matching controls. Differences in baseline characteristic between patients with young-onset dementia and controls were investigated using chi-square tests or t-tests. Multiple logistic regression models were employed to assess the association of young-onset dementia (outcome) with pre-existing peripheral vestibular disorders (predictor). Compared to patients without young-onset dementia, those affected by this condition exhibited a statistically significantly higher rate of peripheral vestibular disorders (18.3% versus 8.2%, p < 0.001). Furthermore, our analysis found notable between-group disparities in the rates of Meniere's Disease (3.5% versus 2.0%, p= 0.015), benign paroxysmal positional vertigo (2.4% versus 1.1%, p= 0.006), and vestibular neuritis (2.4% versus 1.1%, p= 0.003). Multiple logistic regression analysis showed that the presence of prior peripheral vestibular disorders increased the odds of young-onset dementia [2.603 (95% CI = 2.105∼3.220)] after adjusting for age, sex, monthly income, geographic location, urbanization level, hyperlipidemia, diabetes, coronary heart disease, hearing loss, and hypertension. The study findings demonstrate a notable association between young-onset dementia and pre-existing peripheral vestibular disorders, suggesting that vestibular malfunction could play a role in the development of young-onset dementia.

New- and early-onset benign paroxysmal positional vertigo after otologic surgery.

To determine the frequency and clinical features of new- and early-onset benign paroxysmal positional vertigo (BPPV) after different otologic surgical operations with and without surgical drilling. All unilateral otologic operations performed at the otolaryngology clinic of a tertiary university hospital between January 2021 and May 2023 were screened, and 437 adult cases were included in the study. Of these patients, those who were diagnosed with BPPV within the first month postoperatively were examined. The overall incidence of BPPV after otologic operations was 2.28% (10 out of 437 patients). This incidence was 3% (8/266 patients) in cases where a drill was used and 1.16% (2/171 patients) in those where a drill was not used. There was no significant difference between the two groups (p > 0.05). Clinical symptoms related to BPPV appeared on average in 13.3 ± 6.8 (range: 3-25) days following surgery and presented as canalolithiasis. All cases involved the posterior semicircular canal (SCC) on the operated side. In addition, one patient with a cochlear implant had involvement of both the posterior and lateral SCCs. All patients responded well to repositioning maneuvers during follow-up. Otologic surgery, especially operations involving drilling, is a potential risk factor for the development of BPPV. Postoperative BPPV, primarily presenting as canalolithiasis in the posterior SCC on the operated side, can be effectively managed with repositioning maneuvers. Clinicians should be vigilant for BPPV in patients experiencing vertigo/dizziness within four weeks following otologic surgery.

The Effect of Different Sensory Perturbations on Postural Control and Fall Risk in Benign Paroxysmal Positional Vertigo Patients.

Benign paroxysmal positional vertigo (BPPV) patients may experience balance problems in various environmental conditions other than positional dizziness. Therefore, there is a need to investigate the postural control abilities and the ability to use sensory inputs in BPPV patients in different conditions. The aim of this study was to examine the postural control performance of middle-aged adult BPPV patients in easy and difficult balance tasks, the effect of vestibular stimulation on the maintenance of balance, and the risk of falling, by posturographic evaluation in various conditions. A total of 26 patients diagnosed with posterior canal BPPV and 26 controls were included in the study. Sensory Organization Test (SOT), Vestibular Stimulation Test (VST), and fall risk assessment (FRA) were applied to the participants, respectively. Significant difference was observed in SOT medio-lateral (ML) plane in Conditions 2 and 5 (p < .05). A significant difference was observed in the vestibular score in the SOT ML plane. No significant difference was observed in VST test scores (p > .05). In the FRA test, a significant difference was observed in the energy and gain parameters in the anterio-posterior plane (p < .05). The current study examined postural control abilities of patients with BPPV in extensive external conditions and in both planes, using various sensory perturbations and stimulation. It was thought that while BPPV patients were in the active phase of the disease, their postural control skills in the ML plane decreased and they might be at risk of falling.

A Comparison of the Efficacy of Four Repositioning Maneuvers in the Treatment of Posterior Benign Paroxysmal Positional Vertigo.

The purpose of the present review was to report the effectiveness of Epley maneuver compared to other manual repositioning maneuvers (RM) for treatment of posterior benign paroxysmal positional vertigo (P-BPPV). A systematic search of PubMed, Embase, and the Cochrane Library was conducted up until June 30, 2023. Primary outcomes focused on complete resolution of vertiginous symptoms measured by either a Visual Analog Scale (VAS) or the Dix-Hallpike (DH) test. Secondary outcomes included conversion of a positive DH test to a negative DH test exclusively looking at positional nystagmus and assessment of side effects (cervical/back pain, posttreatment dizziness, and nausea). Both outcomes were assessed within a maximum of 4-week follow-up. Following systematic search and review, nine randomized controlled trials (RCTs; p = .413) were found. The studies reported on the effectiveness of the Epley maneuver compared to three other specific RM: Semont, Li, and Gans maneuvers. Results revealed a low to very low certainty of evidence. With the primary outcomes, Epley maneuver was superior to Gans maneuver 24-hr posttreatment but not after 1 week. No significant differences were found between the remaining maneuvers. In summary, evidence of low to very low certainty indicates that Epley maneuver is comparable with Semont, Gans, and Li maneuvers for vertiginous symptoms in patients with P-BPPV. Further high-quality studies are needed.

Association between sleep disorders and vestibular vertigo

Sleep disorders have a high comorbidity rate with vestibular diseases. The results of some small sample clinical studies have confirmed the effect of sleep deprivation on vestibular function. However, the mechanism of the effect of sleep disorder on vestibular system is still unclear. This article analyzes the possible mechanism of the effect of sleep disorders on vestibular function from the aspects of neuroanatomy and neurotransmitters, and summarizes the relationship between sleep disorder and benign paroxysmal positional vertigo, Meniere's disease, vestibular migraine and other diseases.

Is the Epley maneuver the most effective technique for improving symptoms in benign paroxysmal peripheral vertigo?

Is the Epley maneuver the most effective technique for improving symptoms in benign paroxysmal peripheral vertigo?

A comprehensive diagnosing of benign paroxysmal positional vertigo: experience of a single institution

A comprehensive diagnosing of benign paroxysmal positional vertigo: experience of a single institution

Positional End-Point Nystagmus in Patients with Diagnosis of Acute Unilateral Vestibulopathy.

Recently, end-point nystagmus, traditionally observed in an upright position, has been identified in the Dix-Hallpike position among healthy subjects, suggesting a physiological origin.However, its characteristics in individuals with vestibular hypofunction remain unexplored. To elucidate the impact of vestibular hypofunction on the characteristics of positional end-point nystagmus. Thirty-one patients diagnosed with acute unilateral vestibulopathy according to Bárány Society criteria were selected. A video head impulse test was conducted in all participants, followed by McClure and Dix-Hallpike maneuvers with and without gaze fixation, and with the initial position of the eye in the straight-ahead position or in the horizontal end-point position. Nystagmus direction, sense, latency, slow-phase velocity, and duration were recorded. The relationship between these characteristics and video head impulse test values was analyzed. Positional end-point nystagmus was observed in 92.6% of subjects with vestibular hypofunction, significantly more than in healthy individuals. Nystagmus direction varied depending on the performed positional test and on the vestibulo-ocular reflex gains. Gaze occlusion and the initial horizontal end-point position increased its frequency. Vestibular hypofunction influences the manifestation of positional end-point nystagmus. Recognizing this nystagmus can aid in resolving diagnostic uncertainties and preventing the misdiagnosis of benign paroxysmal positional vertigo in subjects with acute unilateral vestibulopathy.

Dizziness and Imbalance Across the Lifespan: Findings of a Pediatric and Adult Vestibular Clinic.

To evaluate diagnostic trends in pediatric and adult patients presenting for multidisciplinary subspecialty evaluation of dizziness and imbalance across the lifespan. Retrospective chart review. Single pediatric and single adult academic tertiary care hospital. Retrospective review of electronic health record for patients presenting to an adult or pediatric multidisciplinary vestibular clinic from 2017 to 2020, including clinical data, physical therapy evaluation, and audiovestibular testing. A total of 1934 patients aged 1 to 95 were evaluated. Most patients were female (n = 1188, 61%); the largest cohort was in the fifth decade of life (n = 321, 17%). Seventy-six percent of patients (n = 1470) were assigned a pathologic diagnosis. Central causes of dizziness were most common in children and young adults, comprising 38% to 54% of all diagnoses in ages 1 to 30. The proportion of peripheral vestibular disorders increased with age, peaking at 32% in ages 61 to70. Vestibular migraine was the most common pathologic diagnosis in ages 6 to 20 (n = 110, 39%) and 31 and 50 (n = 69, 17%) regardless of gender, but was more prevalent in females (21% vs 14%; P < .0001). The prevalence of benign paroxysmal positional vertigo (BPPV) increased throughout the lifespan, peaking at age 71 to 80. Meniere's disease (MD) did not occur within the first decade of life, but increased thereafter, peaking at ages 51 to 60. Multidisciplinary vestibular evaluation resulted in a diagnosis for the majority of patients. Vestibular diagnoses vary across the lifespan however among most age groups, central disorders, including migraine disorders, outnumber peripheral vestibulopathies. The prevalence of peripheral vestibular disorders such as BPPV and MD increased with age. Level IV.

Exploring the Association of Serum Uric Acid Levels with Benign Paroxysmal Positional Vertigo: A Systematic Review and Meta-Analysis.

Objectives: The role of uric acid in pathogenesis of benign paroxysmal positional vertigo (BPPV) is not fully understood. It is aimed to assess the serum uric acid levels in BPPV patients compared to healthy controls. Study design: Systematic review and meta-analysis. Methods: Web of science, PubMed, Scopus, Google Scholar, Embase, Medline, and Cochrane library were systematically searched. The Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) and Problem/Population, Intervention, Comparison, and Outcome (PICO) guidelines were used. Results: In total, 20 studies including 3967 participants met the inclusion criteria. Ten studies (50%) reported higher uric acid (UA) levels in BPPV patients, 4 studies (20%) indicated lower UA levels in BPPV patients, while 6 studies (30%) found no significant difference in UA levels between BPPV patients and healthy controls. The overall mean serum levels of UA (SMD: 0.265, [-0.163 to 0.693]) were higher in BPPV patients than control group. However, this difference was not statistically significant (P-value: .225). Conclusion: There is no significant difference in serum level of UA between BPPV patients and healthy controls. It means that serum level of UA (whether low or high) is not likely the underlying factor of development of BPPV.