Cause Of Vertigo Research Articles

Authors' reply to Sabour S. "The 4-step STANDING algorithm for predicting central causes of vertigo; methodological issues on reliability, validity, and prediction".

The authors declare no potential conflict of interest.

Evaluation of Types of Vertigo With Electronystagmography: An Experience From a Tertiary Care Hospital in West Bengal, India.

Background Electronystagmography (ENG) is a diagnostic test that measures the electrical activity of the muscles that control eye movements. ENG has the potential to identify the cause of vertigo by assessing the function of the vestibular system. Vertigo can be of two types - peripheral or central. In addition, a combination of peripheral and central types may coexist. Peripheral vertigo is caused by pathology in the inner ear and central vertigo is caused by pathology in the brainstem or cerebellum. Objective This study aimed to evaluate the applicability of ENG in assisting the diagnosis of the type of vertigo in a remote tertiary care center in West Bengal, India. Materials and methods This cross-sectional study was conducted in tertiary care hospital in West Bengal, India. Any patient presenting first time with a complaint of vertigo was approached and recruited for the study after taking written informed consent. We collected demographics and conducted a complete ear, nose, and throat examination, including otoscopy and audiological evaluation. A consensus between two expert otorhinolaryngologists was reached for the categorization of vertigo. Then, ENG was performed to assess the vestibular function to help aid the categorization. Magnetic resonance imaging (MRI) and computed tomography (CT) scans were done in central vertigo patients according to the necessity to diagnose the cause. Data were presented in descriptive statistical terms and categorical data were compared by Chi-square test. Result A total of 84 patients (male 31, female 53) with a median age of 25 years (Q1-Q3: 21-30.25) participated in the study. We found 75% of the patients were complaining of instability, 50% rotatory objective vertigo, 29.76% falling tendency, 22.62% blackout, and 2.38% sinking sensation. The majority of the patients (63%) had two or more symptoms. A total of 68 (80.95%) patients could be categorized into peripheral (46 [54.76%]) and central (22 [26.19%]) types. When we added ENG to the tests, we could categorize all the patients and found that 48 (57.14%) had peripheral, 27 (32.14%) had central, and nine (10.71%) had mixed lesions. Conclusion ENG when used in conjunction with clinical examination, otoscopy, and an audiological examination can help to categorize all patients into peripheral, central, or mixed lesion types of vertigo. Hence, ENG can be an important tool in identifying the type of vertigo and can aid in appropriate treatment decisions.

Treating Vestibular Migraine When Pregnant and Postpartum: Progress, Challenges and Innovations.

Vestibular migraine is a leading cause of vertigo in pregnancy and, although not a distinct migraine subtype, is an episodic syndrome associated with migraine. Vestibular migraine is associated with diverse symptoms such as vertigo, aura, allodynia, osmophobia, nausea, vomiting and tinnitus, many of which may be exacerbated by, masked or even dismissed in pregnancy. Vestibular migraine is likely an underdiagnosed and undertreated condition in pregnancy. The aetiology of vestibular migraine remains incompletely understood, although various theories have been proposed, including genetic predisposition, neurochemical dysregulation and pro-inflammatory mechanisms, all of which are derived from the pathophysiology of classical migraine. Physiologic changes to the endocrine, haematologic and vascular systems in pregnancy may affect pathophysiological processes in vestibular migraine, and can alter the course of symptoms experienced in pregnancy. These changes also predispose to secondary headache disorders, which may have similar presentations. There has been considerable progress in therapeutic advances in vestibular migraine prophylaxis and treatment outside of pregnancy. There is currently no significant evidence base for acute treatment or prophylaxis for pregnant patients, with treatment recommendations extrapolated from studies on classical migraine, and offered on a benefit versus risk basis. Challenges commonly encountered include difficulty establishing a diagnosis, in addition to recognising and treating neuropsychiatric and gestational co-morbidities. Anxiety, depression, hypertensive disorders and cardiovascular disease are closely associated with migraine, and important contributors to morbidity and mortality during pregnancy. Identifying and treating vestibular migraine during pregnancy offers a unique opportunity to impact future patient health through screening and early treatment of associated co-morbidities. There have been innovations in classical migraine therapy that may confer benefit in vestibular migraine in pregnancy, with emphasis on lifestyle modification, effective prophylaxis, abortive therapies, cognitive behaviour therapy and management of vestibular migraine-related comorbidities.

Vertical Nystagmus Recognition Based on Deep Learning.

Vertical nystagmus is a common neuro-ophthalmic sign in vestibular medicine. Vertical nystagmus not only reflects the functional state of vertical semicircular canal but also reflects the effect of otoliths. Medical experts can take nystagmus symptoms as the key factor to determine the cause of dizziness. Traditional observation (visual observation conducted by medical experts) may be biased subjectively. Visual examination also requires medical experts to have enough experience to make an accurate diagnosis. With the development of science and technology, the detection system for nystagmus can be realized by using artificial intelligence technology. In this paper, a vertical nystagmus recognition method is proposed based on deep learning. This method is mainly composed of a dilated convolution layer module, a depthwise separable convolution module, a convolution attention module, a Bilstm-GRU module, etc. The average recognition accuracy of the proposed method is 91%. Using the same training dataset and test set, the recognition accuracy of this method for vertical nystagmus was 2% higher than other methods.

Dizziness from an internistic perspective

Dizziness is a common symptom with many potential causes. Medical and especially cardiac aetiologies are associated with a poor overall prognosis such that identification of the underlying cause is essential. This article gives an overview of possible causes of dizziness, how the differential diagnoses should be investigated, and describes potential therapeutic approaches to the treatment of the most important underlying conditions.

Correlation between serum vitamin D level and benign paroxysmal positional vertigo recurrence

ObjectiveBenign paroxysmal positional vertigo (BPPV) is the most common cause of dizziness in the general population. BPPV is known to be closely related to the serum vitamin D level. This study aimed to examine the relationship between serum vitamin D levels and BPPV recurrence. MethodsA retrospective chart review was conducted on 50 patients diagnosed with posterior and lateral canal BPPV. The diagnosis of BPPV was based on the finding of vertigo and nystagmus induced by certain head positions (The Dix–Hallpike maneuver and head roll tests). The patients were classified into BPPV recurrence (Group A) and non-recurrence groups (Group B). Otolith function was assessed by cervical vestibular evoked myogenic potential (cVEMP) and ocular vestibular evoked myogenic potential (oVEMP), and their association with vitamin D levels was evaluated. ResultsThere were 19 subjects in Group A and 31 in Group B. There were no significant differences in age, sex, cVEMP, and oVEMP between the two groups. The average vitamin D level was 12.9 ± 8.0 ng/mL for Group A and 19.2 ± 8.2 ng/mL for Group B, and the difference between the groups was significant (p = 0.011). In the receiver operating characteristic curve analysis for BPPV recurrence with the best sensitivity and specificity, the optimal cut-off value of total serum vitamin D was determined as 12.74 ng/mL. Furthermore, reclassifying the patients based on the cut-off value showed a significantly higher recurrence rate in the group with a lower serum vitamin D level (70.5% vs. 22.5%, p = 0.007). ConclusionThis complex finding highlights the importance of measuring serum vitamin D levels to monitor and evaluate patients at risk of BPPV recurrence.

Effect of Self-treatment of Recurrent Benign Paroxysmal Positional Vertigo

Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo with frequent recurrences. To determine the efficacy of a web-based diagnosis and treatment of BPPV when it recurs in patients with confirmed and treated BPPV. This randomized, controlled, parallel-group, double-blind trial took place in multiple referral-based university hospitals in South Korea between July 2017 and February 2020. Of 728 patients (age ≥20 years) with diagnosed and treated BPPV, 585 were enrolled after excluding 143 who declined participation, could not use the internet, or had spinal problems, multicanal BPPV, or cognitive dysfunction. Patients were followed up for recurrence at least for 2 years until February 2022. Patients were randomly assigned (1:1) to the treatment or control group. The patients in the treatment group completed a questionnaire for diagnosis and received a video clip for self-administration of canalith repositioning maneuver (CRM) according to the type of BPPV diagnosed when they experienced positional vertigo again. Patients in the control group received a video clip for self-administration of CRM according to the type of BPPV that had been diagnosed on enrollment. The primary outcome was self-reported resolution of positional vertigo post-CRM. Secondary outcomes included difficulties and requirement for assistance when using the program and any falls or other adverse events related to CRM. The primary outcome was analyzed using both intention-to-treat and per-protocol methods. Of 585 patients enrolled, 292 were randomized to the treatment group (mean [SD] age, 60.3 [12.8] years, 37 [64%] women) and 293 were randomized to the control group (mean [SD] age, 61.1 [13.2] years; 50 [71%] women). Overall, 128 (21.9%) had recurrence (58 in the treatment group and 70 in the control group), and 109 (85.2%) successfully used the web-based system. In the intention-to-treat analysis, 42 of 58 individuals (72.4%) in the treatment group and 30 of 70 individuals (42.9%) in the control group reported vertigo resolution (χ2 test: 95% CI, 0.13-0.46; P < .001). This trial proved the efficacy of a web-based system for the diagnosis and treatment of recurrent BPPV. Use of this system may play an important role in telemedicine for vestibular disorders. Clinical Research Information Service Identifier: KCT0002364.

STUDY OF DEMOGRAPHIC FEATURES, CLINICAL CHARACTERISTICS AND RISK FACTORS IN PATIENTS OF BENIGN PAROXYSMAL POSITIONAL VERTIGO (BPPV)

Introduction BPPV is the most common peripheral vertiginous disorder in the community.Due to overlapping clinical features, this condition may be misdiagnosed and erroneously treated. Clear understanding of the demographic characteristics and clinical features may help in correct diagnosis and optimal management. Method 100 diagnosed patients of BPPV were prospectively studied. Parameters studied and analysed were:- age group and gender,affected ear and Semi circular canal(SCC), clinical features, various diagnostic and therapeutic manoeuvres, , associated comorbidities, treatment efficacy and recurrence rate. Results BPPV was most commonly seen in 4th decade with a significant female preponderence(M38/F62 ). Posterior-SCC (P-SCC) is most commonly involved(82%) followed by Horizontal-SCC (H-SCC)(17%) and Superior-SCC (S-SCC) (01%). Low serum vitamin-D3 was most commonly associated comorbidity(34%). 84% were primary BPPV while head trauma was the most common secondary cause . Remission rate on repositioning manoeuvre was 73%, recurrence rate 16% and failure rate was 11%. Conclusion Undiagnosed vertigo may significantly impacts the quality of life of a person. BPPV, in spite of being one of the commonest cause of vertigo is often misdiagnosed. If accurately diagnosed, BPPV repositioning manoeuvres have a high cure rate

Quantifying the direct cost benefits of vestibular telemetry using the CAVA system to diagnose the causes of dizziness

BackgroundIt can be challenging to diagnose the cause of a patient’s dizziness. Patients face significant delays before receiving a correct diagnosis as they will undergo many diagnostic tests under several different medical specialities. As well as prolonging the suffering of patients, these problems place a significant financial burden on health services worldwide. We have developed a wearable medical device which has the potential to diagnose the cause of a patient’s dizziness using vestibular telemetry captured over a thirty-day period. We sought to quantify the potential direct cost savings of an alternative diagnostic pathway using our diagnostic device.MethodsIn this work, we identified the existing diagnostic pathways followed by patients reporting dizziness to their General Practitioner, and modelled the best and worst-case direct costs of providing a patient with a correct diagnosis. We estimated the potential cost of our alternative pathway, and calculated the cost savings this could provide to the NHS.ResultsThe results show that our alternative diagnostic pathway could reduce the time and direct cost associated with providing a correct diagnosis. We present a potential indicative cost-saving of between £631 and £1305, per patient.ConclusionOur alternative diagnostic pathway would reduce the time taken to correctly diagnose patients with vertigo. This in turn would facilitate faster access to targeted treatments, reduce unnecessary interventions, and reduce the suffering of patients. These improvements would also lead to other savings, such as reducing the amount of sick leave taken by patients to attend appointments, and freeing up of NHS time to see other patients.

Migraine Associated Vertigo in Children and Teenagers Epidemiology and Treatment .

Objective: describe the symptoms and outcome of vertigo in a pediatric population. Patients. The study included all children and teenagers who presented with dizziness in the otoneurology northwest general hospital Peshawar department from 2014 to 2021. Study design:A retrospective observational study Place and duration of study: from 02 jan 2014 to 02 jan 2021department of ENT kth hospital peshawar Material And Methods: the study was carried out between 02 jan 2014 to 02 jan 2021 in the ENT KTH hospital in Peshawar. Children under the age of 13 who had normal otoscopy, a least one dizziness attack, and no prior neurological evaluation were included in the research. Children who have severe otitis media or otitis media with fluid experience dizziness. The current research concentrated on kids and teenagers who experienced dizziness despite having acceptable orthoscopic findings. Using SPSS 24, the sample number was determined. Results: Seventy-four young participants, with ages averaging 10.5 years, partook in the investigation. Table 1 illustrates the profiles and clinical signs of these individuals. Remarkably, four patients showed location nystagmus, five had post-head-shaking nystagmus, and ten tested positive on the head impulse test. Spontaneous nystagmus occurred in 30% of the sample. Fifty-four reported using English as their primary language. Twenty-three children completed the research, with an 18% dropout rate. Notably, as per Jongkees' equation, 68% of ENG patients manifested aberrant caloric examination results, classified as canal paresis exceeding 26% or orientation preponderance over 30%. Additionally, aberrant spatial nystagmus appeared in six cases. The research uncovered an assorted range of causes for vertigo in youngsters, with comparable symptomatic demonstrations. The outcomes differed depending on the etiology, underscoring the significance of tailored analysis, treatment, and follow-up care. Collaborative efforts with medical professionals are absolutely crucial for accurate diagnosis and effective remedial approaches, minimizing the necessity for unnecessary laboratory testing. Conclusion: Numerous causes of vertigo in children may manifest similar symptoms. Hospitals And Clinical Results Vary Based On Etiology. In each case, the diagnosis should direct treatment and follow-up. Close coordination with medical professionals is frequently required to get the right diagnosis and treatment without undergoing unnecessary lab testing. Keywords: Vertigo, Children, Teenagers, Epidemiology, Treatment

Persistent postural perceptual vertigo and vestibular migraine. Case report

Persistent postural perceptual vertigo (PPPV) and vestibular migraine (VM) are common causes of vertigo. However, despite the typical clinical presentation of PPPV and VM, these diagnoses are rarely made, and dizziness is considered a consequence of other diseases, such as cerebrovascular disorders (chronic cerebral ischemia, vertebrobasilar insufficiency), cervical spine instability, or the manifestation of vegetative dystonia syndrome. This article describes a clinical case of a patient with PPPV and VM. The diagnosis is based on the clinical presentation matched with the diagnostic criteria and an in-depth examination using additional methods to rule out other causes of dizziness. Current evidence on clinical and instrumental diagnostics of the disorders is presented.

The Epley Maneuver versus Betahistine in Treatment of Benign Paroxysmal Positional Vertigo

Background: Benign paroxysmal positional vertigo (BPPV) is considered the most common cause of vertigo. The necessity for early and effective management resulted in the improvement of the patient’s life quality. The objective was to compare the efficacy between Epley’s maneuver and betahistine dihydrochloride in BPPV treatment. Patients and Methods: A prospective follow-up comparative study on 60 patients with BPPV, who diagnosed with a positive Dix–Hallpike test, were divided equally and randomly into two groups; Group “A” treated with Epley’s maneuver and Group “B” treated with betahistine dihydrochloride. The efficacy of each modality was assessed, regarding the sense of vertigo and its associated symptoms, data of vertigo scales as the Visual Analog Scale (VAS), and Dizziness Handicap Inventory (DHI). Results: There were 23 males (38.33%), and 37 females (61.66%), with mean age (54 ± 7.521) years. The total vertigo improvement was (78.33%); being (93.33%) in group “A” and (63.33%) in group “B”, nausea and vomiting symptoms improvement was (76.66%) in group “A”, and (70%) in group “B”. The baseline VAS score in Group “A” (7.69 ± 1.235 SD) and in Group “B” (6.35 ± 3.267 SD) after treatment improved to 0.56 ± 0.731 SD and 1.86 ± 1.375 SD, respectively, as well as the baseline DHI value in Group “A” (51.86 ± 23.583 SD) and in Group “B” (49.37 ± 18.152 SD) then improved to 2.31 ± 3.986 and 7.98 ± 9.512 SD, respectively. Conclusions: The Epley maneuver was more effective and “statistically significant” in relieving vertigo, and both the VAS and DHI scales compared to betahistine, while regarding associated nausea and vomiting symptoms, it shows no statically significant difference.

Effect of Selected Group of Asanas on the Patients with Cervical Vertigo

One of the most prevalent issues among patients in their middle years is vertigo. The existence of so-called cervical vertigo among the different causes of dizziness is still debatable. Based on the research of cervical vertigo was once believed to be caused by aberrant input from cervical sympathetic nerves. Later studies discovered that sympathetic stimulation has no effect on cerebral blood flow. Some studies made the hypothesis that diseases of vertigo of cervical origin can be associated to aberrant sensory input from the damaged joint receptors of upper cervical areas. Additional research revealed that cervical intervertebral disc disease appears to be the source of cervical vertigo. According to recent studies, vertigo of cervical origin may be associated to the in growth of many Ruffini corpuscles into degenerative cervical discs. Generally, the symptoms of Vertigo are not visible at the initial time, some time people consider it as epilepsy or brain related disease, first of all, it is necessary to diagnose and treat it properly. Yoga is an alternative therapy for any kind of cervical related problems, in which some special Asanas like Bhujangasana, Dhanurasana, Makarasana, Ardhamatsyendrasana, Akaranadhanurasana and Pranayama such as NadiShodhan, Bhramari, and Udgeetha. Which is helpful in this type of pain, it has been seen from many studies that yoga may work as a shield for spinal card related problems.

Investigating the Role of Oxidative Stress in Benign Paroxysmal Positional Vertigo with Spot Urine.

The objectives of this study were to evaluate the role of oxidative stress in benign paroxysmal positional vertigo (BPPV) by measuring urinary 8-hydroxy-2'-deoxyguanosine (8-OHdG), 8-hydroxy-guanosine (8-OHG), and 8-hydroxy-guanine levels. Thirty-one adult female patients diagnosed with BPPV were included in this study. Patients with central pathologies and other peripheral causes of vertigo were excluded from the study. The patients were evaluated for oxidative stress during and after the BPPV attack with blood samples and spot urine tests. Depression, anxiety, and stress scale (DASS) questionnaire was used to evaluate emotional stress. A control group consisting of 30 age-matched healthy women was formed. Urinary oxidative stress values during the attack were significantly higher than the post-treatment group and the healthy control group (p<0.05). There was no significant difference between the urinary oxidative stress values of the BPPV group after treatment and the healthy control group (p>0.05). DASS scores were significantly higher during the attack and after the treatment compared to the healthy control group (p<0.05). The increase in spot urinary 8-OHdG, 8-OHG, and 8-hydroxy-guanine levels can be used as a biomarker for oxidative stress in patients with BPPV. Furthermore, emotional stress can also trigger BPPV attacks by increasing oxidative stress.

Brandt-Daroff Exercise versus Standard Technique on Symptoms Experienced by Patients with Benign Paroxysmal Positional Vertigo in a tertiary Care hospital: A Comparative Study

INTRODUCTION: Benign paroxysmal positional vertigo (BPPV) is one of the most common causes of vertigo. It’s considered to be the most common cause of vertigo among the elderly, since 30% of the people reported to have suffered from it at least once in their lifetime.Several studies have indicated that physical therapy, including rehabilitative exercises and physical maneuvers, is an effective treatment for BPPV. Therefore, the objectives of the study was designed to compare Brandt-Daroff exercise versus standardized technique on symptoms experienced by patients with Benign paroxysmal positional vertigo (BPPV) in a selected hospital of Bangalore, India. MATERIALS AND METHODS: The post-test only group design was adopted for this study. The setting was ENT OPD of St. John’s Medical College Hospital. A sample of 20 BPPV patients in each Group 1 and Group 2 were taken using purposive sampling technique. A dizziness handicap inventory scale, a visual analogue scale and a checklist was used to assess the symptoms of patients with BPPV. RESULTS: Median score of dizziness in group 1 was 37 and in group 2 was 16, the obtained Mann Whitney value was 13, which is statistically significant at p&lt;0.001. Likewise, median score for nausea in group 1 was 3 and in group 2 was 0, the obtained Mann Whitney value was 108.5 which is statistically significant at p&lt;0.0001. Further, finding depicts that there was no statistically significant difference of vomiting between group 1 and group 2. CONCLUSIONS: there was a substantial difference in the degree of nausea and dizziness between groups 1 and 2. Group 1 had higher median scores for nausea and dizziness when compared to group 2. However, the frequency of vomiting did not differ substantially between the two groups.

Dizziness in a tertiary neurological department: A cross-sectional study.

Dizziness is a common and challenging symptom, which can be caused by different pathophysiological mechanisms and might affect a large number of population. However, up to now, there have been limited research on the characteristics of dizziness as the chief complaint in hospitalized patients in the Department of Neurology. Thus, the aim of this study was to investigate the hospitalized patients with dizziness as their chief complaint in the Department of Neurology. In this cross-sectional study, we conducted a retrospective document analysis of hospitalized patients admitted to a tertiary neurological department with the symptom of dizziness during the period of September 2019 to December 2020. We included 211 patients with dizziness as their chief complaint from 1841 patients admitted to this tertiary neurological department during that period. Of all 1841 hospitalized patients, those with dizziness as the chief complaint accounted for 11.5% and most of their past medical history included hypertension, diabetes, cerebrovascular diseases, dyslipidemia, and coronary heart disease. Among these 211 patients, dizziness was more common in women than in men (p = .004). More patients presented with vertigo (40.8%) and light-headedness (39.8%) than disequilibrium (17.1%) and pre-syncope (2.4%). Nausea (48.3%), vomiting (34.1%), headache (13.3%), walking unsteadily (13.3%), and ear symptoms (12.8%) were the most common concomitant symptoms. Dix-Hallpike test (24.6%) and Romberg's sign (11.4%) were positive in these dizzy patients. Nystagmus (2.4%), vision changes (1.4%), and hearing disorders (8.5%) were relatively rare symptoms. Common auxiliary examinations were performed, such as magnetic resonance imaging (60.2%), computed tomography (31.8%), carotid duplex ultrasound (30.8%), and echocardiography (28.0%). Benign paroxysmal positional vertigo (24.2%) and stroke/transient ischemic attack (19.0%) were confirmed to be common causes of dizziness. Note that 97.2% of dizzy patients were in improved recovery after treatment. The diagnosis and management of dizziness remain a challenge for clinicians. Vertigo and light-headedness were the most common symptoms among different types of dizziness. Benign paroxysmal positional vertigo and stroke/transient ischemic attack were among the leading causes for common dizziness disorders. The prognosis of most dizzy patients was good.

Flunarizine as prevention of vestibular migraine crisis: sistematic review of the literature.

OBJECTIVES: Vestibular migraine is the leading cause of episodic vertigo and the second most common cause of dizziness in adults, due to its high prevalence, negative impacts on individual health, and increased public health expenditures, preventive treatment should be implemented early. This paper aimed to evaluate the efficacy of Flunarizine as a preventive for vestibular migraine crises in comparison to other drugs. METHODS: We searched the databases for scientific articles using the terms (vestibular migraine OR migrainous vertigo) AND (Flunarizine) AND (prophylaxis). Subsequently, a systematic literature review and meta-analysis was performed, with the inclusion of 3 randomized clinical trials. The studies were analysed by making a ROB table, analysis using the GRADE method, and meta-analysis. RESULTS: Qualitatively, the analysis showed that Flunariniza was positive for decreasing the frequency of vertigo in cases of vestibular migraine, with moderate degree of evidence, relative risk of 0.34 and confidence interval 0.15 to 0.76. The meta-analysis showed a positive result of Flunarizine as a preventive drug for the study population. No serious side effects were reported from the use of the medication, which makes it safe for use by patients. CONCLUSION: Flunarizine is a good drug for prevention of vestibular migraine.

Insights into Benign Paroxysmal Positional Vertigo in the Elderly

Vertigo, the illusion of movement of oneself or one’s surroundings in the absence of actual movement, is a common symptom in older adults and, as such, is commonly regarded as an age-related normal or part of the aging process itself, as its incidence increases with age. In neurology and otorhinolaryngology, benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo. BPPV is a brief, recurrent episode of vertigo caused by changes in head position relative to the direction of gravity. The symptoms of peripheral vestibular disease are vertigo and characteristic nystagmus. The prevalence of undiagnosed BPPV is high due to the fact that many elderlies tolerate vertigo symptoms. According to etiology, it can be subdivided into idiopathic BPPV and secondary BPPV, and according to location, it can be subdivided into posterior semicircular canal BPPV, horizontal semicircular canal BPPV, and anterior semicircular canal BPPV.

An evaluation of patients who present to the emergency department with dizziness

This study aimed to analyze the data of patients presenting with dizziness at our hospital’s emergency department (ED) by determining the etiology of dizziness and to contribute to the medical data of our country and the literature. This prospective study was conducted with 116 volunteering patients who presented to the Emergency Department of Afyon Kocatepe University, Faculty of Medicine for one year with dizziness complaints. After the anamnesis, physical examination, diagnostic tests (blood tests, Dix-Hallpike maneuver, audiological-vestibular tests, carotid-vertebral artery color Doppler ultrasonography, and computerized brain tomography), and psychiatric interrogation, the patients were divided into four etiology groups: Peripheral, central, psychogenic, and other causes of dizziness. Clinical features were compared between peripheral and central dizziness groups. A total of 116 (3.4%) of patient admissions to the emergency department complained of dizziness. Forty-nine (42.2%) of these patients were male, 67 (57.8%) were female. In the cohort, 33.9% were under 40, and dizziness increased with older age. Seventy (60.3%) patients had no formal education or were primary school graduates. The initial evaluation at the ED revealed that dizziness mostly shifted with the position (71.6%) and was mainly accompanied by headache (67.2%). Based on their diagnosis, 50 patients (43.1%) were in the peripheral group, 30 patients (25.8%) were in the central group, 22 patients (19%) were in the psychogenic dizziness group, and 14 patients (12%) were in the other causes group. Intergroup analysis between peripheral and central vertigo groups identified that the hearing loss, ear fullness, recent upper respiratory tract infection (URTI), nausea, vomiting, and shifting position was statistically significant (p&lt;0.05). Dizziness is one of the common complaints of admission to the ED and may arise from different etiologies. Our study demonstrated that psychogenic dizziness was common in this patient cohort.

Assessment of the Cost Burden of Episodic Recurrent Vestibular Vertigo in the US

Understanding of the economic burden of recurrent vestibular causes of vertigo and areas contributing to the cost is needed. To analyze and identify the factors contributing to the direct medical costs associated with Ménière disease (MD), vestibular migraine (VM), and benign paroxysmal positional vertigo (BPPV). This economic evaluation used MarketScan Commercial Database claims data from 2018 to identify the non-Medicare patient population with the diagnoses of MD, VM, or BPPV. Data were analyzed January 1 to December 31, 2018. The total direct medical costs associated with MD, VM, and BPPV. A total of 53 210 patients (mean [SD] age, 47.8 [11.8] years; 67.6% female) were included in this study, with 34 738 normal comparisons. There were 5783 (10.9%) patients with MD, 3526 (6.6%) patients with VM, and 43 901 (82.5%) patients with BPPV in the data set. Mean age and sex were different across the different vestibular disorders. Across the different groups, patients with no comorbidities or with a Charlson Comorbidity Index score of zero ranged from 98.4% to 98.8%. Around 5% of patients were hospitalized with inpatient stay lasting between 4.6 and 5.2 days. After adjusting for age, sex, and comorbidities, there were large differences in mean adjusted annual payments/direct costs across the different groups (MD, $9579; VM, $11 371; and BPPV, $8247). This equated to a total incremental estimated cost of $60 billion compared with the normal population. The number of outpatient brain magnetic resonance imaging or computed tomography scans per patient ranged anywhere from 1 to 20, while the number of inpatient brain magnetic resonance imaging or computed tomography scans per patient ranged anywhere from 1 to 6. A heat map of the total cost expenditure indicated that the costs were concentrated around the Midwest, Lake Michigan, and the East Coast. In this economic evaluation, the 3 most common causes of recurrent vertigo-MD, VM, and BPPV-had considerable medical costs associated with them. Extraneous imaging orders and vestibular testing are factors to consider for cost reduction. However, further research and widespread education is needed to optimize the diagnosis, treatment, and care of patients presenting with vestibular disorders or dizziness.