Common Cause Of Vertigo Research Articles

2644 Falls and physical function in older patients with benign paroxysmal positional Vertigo (BPPV)

Abstract Introduction Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo in older adults. Due to the high incidence of BPPV in older adults presenting with falls, vestibular assessment, and diagnosis of BPPV and other vestibular disorders has become a recommendation in the World Guidelines for Falls Prevention. There has been a paucity of evidence in well conducted randomised controlled trials (RCTs) to evaluate vitamin D for prevention of BPPV recurrence and its relation to falls and function. Method This is a Phase IIa single centre, placebo controlled, double blind RCT to evaluate vitamin D supplementation together with diet and Canalith Repositioning Procedure [Group A] or diet alone combined with CRP [Gorup B] can reduce recurrence rates of BPPV. Post hoc analyses were performed evaluating BPPV recurrence, falls and function. 53 participants were recruited. 14 were vitamin D replete at baseline [Group C- diet alone], the remaining 39 were randomised into Groups A and B. Group A was associated with 0.75 fewer clinical BPPV recurrences per one person year (IRD -0.75, 95% CI -1.18 to −0.32, P = 0.035). Findings Older adults in the study who suffered a fall during the 12 month follow up had lower Activities of Daily Living scores. They also had poorer Short Physical Performance Battery scores at baseline. Participants in Group A had better 5x sit to stand time compared to Group B even accounting for underlying frailty scores. 25% of participants who fell in the 12 month follow up reported fear of falling compared to 43% in those with no falls in the 12 month follow up. Vitamin D supplementation improved physical performance in 5xchair stand test. Conclusion In this study population, more participants without an incident fall during follow up experience fear of falling, prompting further consideration into the complex concept that is fear of falling.

Bibliometric analysis of global research trends in vestibular neuritis (1980-2024).

Vestibular neuritis (VN) is a common cause of vertigo with significant impact on patients' quality of life. This study aimed to analyze global research trends in VN using bibliometric methods to identify key themes, influential authors, institutions, and countries contributing to the field. We conducted a comprehensive search of the Web of Science Core Collection database for publications related to VN from 1980 to 2024. Bibliometric data including publication year, keywords, citations, authors, journals, institutions, and countries were extracted and analyzed using VOSviewer software. A total of 624 publications were identified, showing a steady increase in VN research output, particularly after 2003. South Korea and the USA were the most prolific countries, while Acta Oto-Laryngologica and Otology & Neurotology were the leading journals in terms of publication count. Michael Strupp emerged as the most productive author. Keyword analysis revealed prominent research themes including diagnosis, treatment (vestibular rehabilitation, pharmacological interventions), pathophysiology, and the impact of VN on vestibular function. This bibliometric analysis provides a comprehensive overview of global VN research. The findings highlight the growing research interest in VN, with a focus on improving diagnostic accuracy, optimizing treatment strategies, and understanding the underlying mechanisms. This study can serve as a valuable resource for researchers, clinicians, and policymakers interested in the field of VN.

Is diagnostics of Benign Paroxysmal Positional Vertigo with a mechanical rotation chair superior to traditional manual diagnostics? A randomized controlled crossover study.

Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of vertigo. While various techniques and technologies have improved BPPV diagnostics and treatment, optimizing BPPV healthcare pathways requires a comprehensive understanding of the diagnostic modalities across diverse clinical settings. To compare traditional manual BPPV diagnostics (MD) with diagnostics done with the aid of a mechanical rotation chair (MRC) when using videonystagmography goggles with both modalities. This prospective, open-label, randomized diagnostic crossover study involved 215 adults with typical BPPV symptoms at a tertiary University Hospital-based outpatient clinic (Aalborg University Hospital, Denmark). Participants referred by general practitioners or otorhinolaryngologist clinics underwent both traditional manual and MRC diagnostics with the aid of videonystagmography goggles. The order of the diagnostic modalities was randomly assigned, and the two modalities were separated by a minimum of 30 min. The primary outcomes included sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of traditional MD compared to MRC diagnostics. The secondary outcome was the agreement between the two modalities. The MRC demonstrated a significantly higher sensitivity for BPPV detection in general for all participants (p = 0.00). Compared to MRC diagnostics, traditional MD displayed a sensitivity of 69.5% (95% confidence interval (CI): 59.8-78.1), specificity of 90.9% (95% CI: 83.9-95.6), PPV of 88.0% (95% CI: 83.9-95.6), and NPV of 75.8% (95% CI: 67.5-82.8). The overall inter-modality agreement was 80.5% (95% CI: 75.2-85.8, Cohen's kappa 0.61). While both modalities detected unilateral posterior canal BPPV equally good (p = 0.51), traditional MD underperformed for non-posterior BPPV (significantly) and in subgroups referred by ENTs (trend) or with impaired cooperation during traditional MD (significantly). Traditional manual BPPV diagnostics remains a valuable first-line approach for most patients. However, MRC diagnostics offers advantages for complex BPPV cases, patients with impaired cooperation, patients referred from otorhinolaryngologist clinics, and those with negative traditional MD but an evident BPPV history. MRC may be useful as a second opinion diagnostic tool for treatment-resistant BPPV. ClinicalTrials.gov identifier: NCT05846711.

Vestibular migraine management by the United Kingdom ear, nose and throat clinicians: a “snapshot”

Background: Vestibular migraine is a common cause of dizziness with various management options, similar to that of regular migraine treatments. This study aimed to characterise current practice in vestibular migraine (VM) management amongst ear, nose and throat (ENT) specialists across the United Kingdom (UK). Methods: A national survey of ENT UK members regarding their management of VM was conducted. Freedom of information requests were also sent to each integrated health board (IHB) to determine if they had a migraine and/or vestibular migraine protocols. Results: There was wide variability across ENT clinicians in their management of VM with 45.29% starting no treatment or lifestyle advice only before transferring the care of the patient to another provider. Only 4 IHBs had a migraine protocol that referenced VM. Conclusions: This study identifies the variation in the management of vestibular migraine across ENT clinicians. It also potentially highlights the need for improved education of ENT trainees about the condition. The authors would support ENT clinicians to become involved in writing migraine protocols for their trusts, to include vestibular migraine within these guidelines.

Comparative Study of Clinical Features of Patients with Different Types of Benign Paroxysmal Positional Vertigo.

Objectives: Even though BPPV is one of the most common causes of vertigo, it is often underdiagnosed and omitted in the diagnosis of patients reporting vertigo. The aim of the study was to establish a diagnostic pattern useful in patients admitted due to vertigo, based on the most common clinical characteristics of patients suffered from posterior canal BPPV (PC-BPPV), horizontal canal BPPV with geotropic (HCG-BPPV) and apogeotropic nystagmus (HCA-BPPV). Methods: The analysis covered the results obtained in 105 patients with a positive result of the Dix-Hallpike maneuver or the supine roll test. The patients were divided into 3 groups based on the BPPV type: gr.1:PC-BPPV (60%); gr.2: HCG-BPPV (27%); gr.3: HCA-BPPV (13%). Patients before the diagnostic maneuvers filled the questionnaire concerning their symptoms and previous diseases. Results: Almost all patients had vertigo during turning over in bed and the character of the symptoms was paroxysmal. The answers to questions about the type of head movement evoked vertigo and how long vertigo lasted were differentiating. The percentages of correct diagnosis speculated by the combined answers were 69.6% in PC-BPPV, 61.8% in HCG-BPPV, and 80% in HCA-BPPV. Conclusions: Basing on those observations there is presented the diagnostic schedule which could be useful in dizziness examination. The above results indicate that a properly collected interview with the patient allows for a high percentage of accurate diagnosis.

Lymphatic Vessels in the Inner Ear of Patients With Meniere Disease: A Novel Pathological Finding.

Meniere disease, characterized by intermittent episodes of vertigo, fluctuating sensorineural hearing loss, tinnitus, and aural pressure, is a common cause of vertigo in humans. The pathogenesis of Meniere disease remains unknown. The current study aimed to describe a novel pathological change discovered in the inner ears of patients with Meniere disease who underwent labyrinthectomy. This retrospective case-control study was conducted with 21 patients with MD who underwent labyrinthectomy. A total of 15 patients diagnosed with acoustic neuroma or glomus jugular tumor were review over the same period of time as control. The clinical information of the patients and the pathological features of the membrane are described. The new pathological tissue was a morbid membrane structure sealing the round window, characterized by the formation of lymphatic capillaries. Histochemical and immunofluorescent staining was positive for D2-40, LYVE-1, podoplanin, and PROX1, which are the classical markers of the lymphatic vessels. Transmission electron microscopy revealed that the lymph capillaries lacked a typical basement membrane and that their ends were blind, composed of a single layer of endothelial cells with valval connection structures between adjacent capillary epithelial cells. This is the first report of lymphatic vessels in the human inner ear, and this pathological structure is a completely new discovery. The lymphatic vessels may develop due to inflammation or decompensation of pressure in the inner ear, suggesting that the inner ear can reactively form lymphatic vessels in some inflammation and fluid flow-dependent pathological conditions. The current findings help in improving our understanding of the pathogenesis of Meniere disease.

Meniere’s disease – A century old mystery

Ménière’s disease, first described by the French physician Prosper Ménière, is one of the most common causes of dizziness. It can have a debilitating effect on patients, significantly impairing their ability to carry out normal daily activities. Despite been described over a century and a half ago, the disease is still poorly understood and there is no cure. However, it can be controlled with nonsurgical or surgical treatments. This review of Ménière’s disease is based on a literature survey and focuses on the pathophysiology, clinical features, and management options available.

Risk of Cervical Dizziness in Patients With Cervical Spondylosis

The dizziness associated with cervical spondylosis is a controversial topic given that many experts believe that cervical spondylosis is a common cause of dizziness, whereas others do not believe it exists. To compare the risk of dizziness between patients with cervical spondylosis and matched controls (ie, patients with lumbar spondylosis after propensity score matching [PSM]). This cohort study used medical claims data from the National Health Insurance Research Database of Taiwan for patients 60 years or older with cervical or lumbar spondylosis newly diagnosed in any outpatient department between January 1, 2010, and December 31, 2015. Patients diagnosed with cervical spondylosis were included as the study cohort, and those diagnosed with lumbar spondylosis who were matched to the study cohort via PSM were selected as the control cohort. Both cohorts were followed up for 1 year unless they were diagnosed with dizziness, censored by death, or withdrew from the health insurance program. Data analysis was performed from August 9 to September 20, 2022. The main outcome was the date of outpatient diagnosis of dizziness. The risks of dizziness were compared between groups. The relative risk and incidence rate difference were calculated. A total of 3638 patients with cervical spondylosis (mean [SD] age, 67.9 [7.1] years; 2024 [55.6%] male) and 3638 patients with lumbar spondylosis (mean [SD] age, 68.0 [7.1] years; 2024 [55.6%] male) after PSM were selected as the study and control cohorts, respectively. The patients with cervical spondylosis had higher risk of dizziness than matched controls, with a 1-year relative risk of 1.20 (95% CI, 1.03-1.39). The 1-year incidence of dizziness was 10.2% (95% CI, 9.2%-11.2%) in patients with cervical spondylosis and 8.6% (95% CI, 7.7%-9.5%) in the matched group of lumbar spondylosis. The incidence rate difference between the groups was 1.6% (95% CI, 0.3%-3.0%). These data support the association between dizziness and cervical spondylosis, but the small difference between groups reveals that dizziness associated with cervical spondylosis is uncommon. Clinicians should be wary of diagnosing a cervical cause for dizziness based on an actual history of cervical spondylosis.

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.

Vertigo and dizziness in children: When to consider a neurological cause

Vertigo is common in childhood and adolescence. Although children and adults share common causes of vertigo, epidemiology changes with aging. For instance, ischemic stroke is less frequent in childhood, whereas audiovestibular disorders, such as vestibular neuritis and the migraine equivalent, are the leading causes of vertigo. However, even if severe causes of vertigo are rare, clinicians must not miss them. In this review, we discuss the neurological causes of central vertigo in children. The diagnostic approaches reviewed here are focused on the search for signs of severity, such as an abrupt onset, infectious context, or intracranial hypertension, which may subsequently require brain imaging.

Long-Term Effects of Intervention on Vestibular Migraine: A Preliminary Study.

Vestibular migraine is a common cause of vertigo. Intervention often includes preventive and/or rescue medications. Lifestyle modifications are often used along with medications but can be used as the sole intervention. There is lack of clarity regarding the long-term benefits of these interventions. The purpose of this study was to determine long-term effects of intervention types on dizziness in patients with vestibular migraine. Twenty-three participants were grouped based on intervention into preventive medication plus lifestyle modifications, rescue medication plus lifestyle modifications, or lifestyle modifications only. Outcomes were determined at ~372 days post intervention by comparing pre- and post-Dizziness Handicap Inventory scores. A difference of ≥18 points was considered a change and we also evaluated change in severity scale on this measure. Using the group mean change score, only the rescue medication plus lifestyle modification group was significantly improved at 372 days of intervention. Considering all individual participants, 30% of the participants had improvement in dizziness at this point, regardless of intervention. Fifty percent of the rescue medication plus lifestyle modification group had significant reduction in dizziness, while the preventive medication plus lifestyle modification and the lifestyle modification only groups performed similarly using this criterion. Considering change in severity category, 43% of all participants improved by at least one category. The rescue medication plus lifestyle modifications and the lifestyle modifications only groups performed similarly with 50% of their respectively groups exhibiting improvement by at least one category. Notably, there was no worsening of dizziness for any participant in the lifestyle modification only group. Our findings suggest that improvement in dizziness is maintained at ~372days of intervention in patients with vestibular migraine. Intervention using rescue medications plus lifestyle modifications had the best outcomes, followed by lifestyle modifications only. There was no worsening in dizziness for the lifestyle modification only intervention. More work is needed to better understand intervention effects, but it is encouraging that effects are maintained at greater than one year.

Seasonality of benign paroxysmal positional vertigo : Aretrospective study from Central Europe.

Although benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo in clinical practice, factors influencing the pathophysiology remain not fully understood. Here we aim to investigate possible seasonal influences on the occurrence of BPPV in Vienna, acity located in aCentral European country with pronounced seasonal fluctuations. We retrospectively investigated data from 503patients presenting with BPPV to the outpatient clinics of the Medical University of Vienna between 2007 and 2012. Analyses included age, gender, type of BPPV, seasonal assignment, as well as daylight hours and the temperature in Vienna at symptom onset. Out of 503patients (159 male, 344 female, ratio 1:2.2; mean age 60 ± 15.80 years), most patients presented with posterior (89.7%) and left-sided (43.1%) BPPV. There was asignificant seasonal difference (χ2 p = 0.036) with the majority of symptoms occurring in winter seasons (n = 142), followed by springtime (n = 139). Symptom onset did not correlate with the average temperature (p = 0.24) but on the other hand very well with daylight hours (p < 0.05), which ranged from 8.4 h per day in December, to an average of 15.6 h in July. Our results show aseasonal accumulation of BPPV during winter and springtime, which is in line with previous studies from other climatic zones, suggesting an association of this seasonality with varying vitamin D levels.

Managing patients with positional vertigo: diagnostic pitfalls and treatment

The spectrum of diseases manifested by positional vertigo includes benign paroxysmal positional vertigo (BPPV), vestibular migraine, brain tumors, demyelinating and some other diseases.Objective: to study the common practice of managing patients with positional vertigo.Material and methods. 64 patients with complaints of positional vertigo were examined. Clinical and neurological examination, otoneurological examination, including positional diagnostic tests, assessment of spontaneous nystagmus in Frenzel video glasses, tests of smooth tracking, saccades, head shaking, Fukuda test were carried out.Results. In the majority (70%) of cases, the referral diagnoses for vertigo were chronic cerebral ischemia, vertebral artery syndrome, and vegetative-vascular dystonia. However, none of these diagnoses was confirmed as the leading cause of vertigo. The most common mistake (62.5%) was making a diagnosis only on the basis of complaints, without an otoneurological examination and positional tests. The most common causes of vertigo were BPPV (64.6%), vestibular migraine (20.3%) and vestibular neuronitis (12.5%).Conclusion. In the diagnosis of positional vertigo, the evaluation of clinical manifestations, otoneurological tests and characteristics of positional nystagmus plays a leading role.

Managing patients with positional vertigo: diagnostic pitfalls and treatment

The spectrum of diseases manifested by positional vertigo includes benign paroxysmal positional vertigo (BPPV), vestibular migraine, brain tumors, demyelinating and some other diseases.Objective: to study the common practice of managing patients with positional vertigo.Material and methods. 64 patients with complaints of positional vertigo were examined. Clinical and neurological examination, otoneurological examination, including positional diagnostic tests, assessment of spontaneous nystagmus in Frenzel video glasses, tests of smooth tracking, saccades, head shaking, Fukuda test were carried out.Results. In the majority (70%) of cases, the referral diagnoses for vertigo were chronic cerebral ischemia, vertebral artery syndrome, and vegetative-vascular dystonia. However, none of these diagnoses was confirmed as the leading cause of vertigo. The most common mistake (62.5%) was making a diagnosis only on the basis of complaints, without an otoneurological examination and positional tests. The most common causes of vertigo were BPPV (64.6%), vestibular migraine (20.3%) and vestibular neuronitis (12.5%).Conclusion. In the diagnosis of positional vertigo, the evaluation of clinical manifestations, otoneurological tests and characteristics of positional nystagmus plays a leading role.

The reliability of a subtype-determining questionnaire in efficient benign paroxysmal positional vertigo diagnosis in geriatrics.

Benign paroxysmal positional vertigo (BPPV), the most common cause of dizziness, especially for older adults, exposes patients to the lethal risk of falling. However, the diagnosis of BPPV in this population can be more elusive as they present few characteristic symptoms. Therefore, we explored the application of a subtype-determining questionnaire in BPPV diagnosis among the geriatric population. Patients were assigned to the aware and unaware groups. In the aware group, the technician would directly test the suspected canal indicated by the questionnaire, whereas, in the unaware group, the technician performed the regular positional test. The diagnostic parameters of the questionnaire were examined. The accuracy, sensitivity, and specificity of questions 1-3 for diagnosing BPPV were 75.8, 77.6, and 74.7%, respectively. Question 4 demonstrated an accuracy of 75.6% in ascertaining the BPPV subtype, question 5 showed an accuracy of 75.6% in determining the affected side, and question 6 yielded an accuracy of 87.5% in distinguishing canalithiasis or cupulolithiasis. Examination time was shorter in the aware group than that in the unaware group (P < 0.05). No difference was found between the two groups for treatment time (P = 0.153). This subtype-determining questionnaire is practical in daily use and capable of providing instructive information for an efficient diagnosis in geriatric patients with BPPV.

Assessment of Peripheral Vestibular Apparatus in Patients with Peripheral Vestibular Symptoms using Videonystagmography in Tertiary Care Center

Introduction: Vertigo, dizziness, giddiness, and unsteadiness are all quite frequent symptoms that affect a large proportion of the population. Due to the challenges associated with effectively diagnosing and documenting vestibular illnesses, figures on their prevalence, frequency of occurrence, and social impact vary greatly. Benign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo of vestibular origin. Positional nystagmus is most frequently seen in benign paroxysmal positional vertigo (BPPV) associated with peripheral vestibular diseases. Videonystagmography (VNG) tests are an excellent diagnostic tool for distinguishing peripheral from central vestibular abnormalities, provided they are conducted and interpreted by doctors rather than technicians. The current study utilized VNG to evaluate vestibular apparatus function in patients with peripheral vestibular symptoms (dizziness/imbalance/giddiness/vertigo). Methods: Prospective observational study comparing efficacy of assessment of vestibular apparatus using clinical vestibular assessment versus VNG in patients having vestibular symptoms. Results: With clinical vestibular assessment test, 13 out of 50 symptomatic patients had no nystagmus. When VNG was performed on these patients, 10 out of these 13 patients had shown positive findings, whereas only three patients had negative findings. Our study finds that VNG along with clinical evaluation is more effective in diagnosing vestibular disorders when compared with clinical evaluation alone and this was statistically significant. Conclusion: Based on our results, VNG is the better modality for the assessment of vestibular apparatus in patients with peripheral vestibular symptoms for diagnosis and treatment.

The Quix Test: Identifying Vestibular Dysfunction in the “Dizzy Patient” (P7-4.004)

<h3>Objective:</h3> Our objective was to validate the sensitivity and specificity of the Quix test in the identification of peripheral vestibular dysfunction in the “dizzy” patient and compare it to other conventional tests performed in the routine practice of the evaluation of “dizziness.” <h3>Background:</h3> The complaint of dizziness has ominous implications lending itself to accidental death and increased morbidity and mortality. The evaluation of a dizzy patient can be confounding due to its myriad of potential etiologies, many of which are present comorbidly. Acute peripheral vestibulopathy is a common cause of dizziness. Current conventional tests for vestibular dysfunction offer maximum sensitivity ranging from 50–75% (Cohen, 2019). We developed a modified version of the Quix test in an effort to increase sensitivity. <h3>Design/Methods:</h3> 158 patients were evaluated at a balance disorders clinic. Each patient underwent a comprehensive neurological examination and six assessments that detect vestibular dysfunction: a nystagmus test, a head impulse test, a Romberg test, a Quix test, a tandem stance/walk, and a sitting past-pointing test. Posturography, Dix-Hallpike maneuver, and videonystagmography were performed. Results were analyzed to determine the sensitivity of the vestibular tests in detecting dysfunction. <h3>Results:</h3> The association between the Quix test and vestibular dysfunction was assessed with a chi-square test. The model was statistically significant, χ2 = 4.3175 and p = 0.0377 &lt; .05 = α. The sensitivity was 85.7%, and the specificity was 33.3%. Although specificity was low, a number of patients were found to have benign positional vertigo on clinical examination by a balance therapist. Other conventional tests were not statistically significant predictor variables of vestibular abnormality. <h3>Conclusions:</h3> A positive Quix test helps identify vestibular dysfunction in the “dizzy patient.” It is cost-effective, time-efficient, and easily administered with minimal training. The Quix test is more sensitive than other conventional tests and can serve as a critical screening tool. <b>Disclosure:</b> Ms. Schusterman has nothing to disclose. Mr. Kuder has nothing to disclose. Miss Walker has nothing to disclose. Ms. Lee has nothing to disclose. Ms. Canut has nothing to disclose. Mr. Thompson has nothing to disclose. Charles Maitland has nothing to disclose. Dr. Gaillard has nothing to disclose. Dr. Solatikia has nothing to disclose.

Vertiginous dizziness: A primary care approach

Dizziness is an extremely common, yet complex neurological symptom that reflects a disturbance of normal balance perception and spatial orientation. Dizziness is a non-specific, catch-all term commonly used by patients to describe a wide array of symptoms, including a sensation of motion, weakness, light-headedness, unsteadiness, emotional upset and depression. The national 1-year prevalence of dizziness is around 50%, accounting for 4% of emergency department presentations and 1% of primary care consultations in South Africa. This article will focus on a diagnostic approach to the most common cause of dizziness (vertigo).

Role of Serum Markers in Benign Paroxysmal Positional Vertigo: Are They Useful?

Benign Paroxysmal Positional Vertigo is a peripheral labyrinthine disease and is one of the most common causes of dizziness in the general population. The proposed study was conducted in the Department of Otorhinolaryngology - Head and Neck Surgery at Indira Gandhi Medical College and Hospital, Shimla, Himachal Pradesh for a period of one year. About 44 patients aged between 14 and 60 years who came out positive on Dix Hallpike test and were willing for study were included in case group, whereas 44 patients aged 14-60 years who came out negative on Dix Hallpike test and with no complaint of vertiginous feeling were included in control group. Cases and controls were subjected to blood investigations like complete hemogram, calcium, vitamin D and uric acid. The mean Vitamin D was found to be significantly less in Case group (27.90 ± 15.89) compared to the Control group (39.05 ± 21.15) while no significant difference in mean Serum Calcium was observed between the Case group (8.48 ± 1.28) and Control group (8.88 ± 1.25). Serum uric acid levels were also compared and no significant difference was found between Case group (4.12 ± 1.15) and the Control group (4.06 ± 0.95). Our study found that there is relation between low vitamin D levels and occurrence of BPPV. Which supports the hypothesis that supplementation of Vitamin D might be helpful in preventing the occurrence and more frequent recurrence of BPPV. However in our study no association was found between serum calcium and uric acid levels with BPPV.

Vestibular, Central, and Non-Vestibular Etiologies of Vertigo and Disequilibrium: A Rural Hospital-Based Cross-Sectional Comparative Analysis.

Vertigo/dizziness is defined as disturbed postural awareness and could range from a feeling of sensation of spinning of self or surrounding. Dizziness or disturbed postural awareness is a common presentation in varying age groups. Vertigo has varied clinical presentations. Classically, there are four vertigo syndromes: vertigo, imbalance/disequilibrium, presyncope/lightheadedness, and psychogenic dizziness. The present study was conducted to examine the various etiologies involved in these syndromes and to help unmask the overlaps between them. This study also aimed to further classify the etiologies underlying these vertigo syndromes and overlaps into peripheral or vestibular, central, and non-vestibular. This would help develop a comprehensive management protocol for vertigo of any origin. A prospective observational cross-sectional study was undertaken in a rural hospital in Central India. We studied patients with giddiness and categorized them into vertigo syndromes according to the site of origin of vertigo. We also compared overlaps in the presentation of vertigo. Out of the 80 patients that were studied, vertigo with disequilibrium was observed in 72.50% of the patients. Non-vestibular vertigo of cervicogenic origin was the common cause of vertigo seen in 36.25% of the patients occurring alone or in association with vestibular vertigo. Among patients with overlaps, vestibular vertigo with non-vestibular vertigo was the most common etiology observed in 89.65% of the patients with overlaps. The syndrome of "vertigo with disequilibrium" was the commonest presentation in the patients studied, followed by "vertigo syndrome" as an isolated symptom, not associated with "disequilibrium."Ours is probably the first study to report this observation of overlaps of two syndromes, with diagnostic implications.