Dizziness Handicap Inventory Scores Research Articles

Personalized medicine to treat refractory benign paroxysmal positional vertigo, through computational fluid dynamics analysis from magnetic resonance image reconstructions

BackgroundBenign paroxysmal positional vertigo (BPPV) is the most common cause of vertigo, often effectively treated with standard canalith repositioning maneuvers (CRMs). However, approximately 12.5% of cases remain refractory, leading to persistent symptoms and increased healthcare burden. Variations in the anatomical orientation of the semicircular canals (SCCs) may explain the resistance to conventional maneuvers. This study explores a personalized medicine approach, utilizing computational fluid dynamics (CFD) based on MRI reconstructions to tailor CRMs with the help of mechanical rotation chair according to individual inner ear anatomy.MethodsWe conducted a randomized, multicenter, open-label study targeting patients with refractory posterior canal BPPV. Participants were allocated to either a control group (receiving repeated standard CRMs and Brandt-Daroff exercises) or an intervention group (receiving personalized CRMs based on CFD simulations derived from MRI scans). The intervention group’s maneuvers were executed using a mechanical rotational chair designed for precise angulation. Primary outcomes included resolution of nystagmus and vertigo symptoms, while secondary outcomes measured the reduction in healthcare visits and improved quality of life (Dizziness Handicap Inventory score).DiscussionPersonalized CRMs based on CFD models may enhance treatment efficacy for refractory BPPV by optimizing maneuver angles according to the specific SCC orientation. This approach could significantly reduce symptom persistence, decrease the need for repeated healthcare visits, and improve patient outcomes. The use of non-invasive MRI and CFD techniques represents a novel step toward individualized treatment in vestibular disorders, with potential for broader application in personalized otoneurology. Further analysis will determine the extent of clinical benefit and cost-effectiveness of this approach.Clinical trial registrationClinicalTrials.gov, Identifier: NCT06725966.

The Efficacy of the Gans Repositioning Maneuver in Comparison with the Epley Maneuver in Elderly Patients with Benign Paroxysmal Positional Vertigo

Background and Aim: Benign Paroxysmal Positional Vertigo (BPPV) impacts the quality of life of affected people, especially the elderly. The Epley maneuver and the Gans maneuver are used to treat Posterior Canal BPPV (PC-BPPV). The effectiveness of the Epley maneuver has been verified, but further studies are required to prove the effectiveness of the Gans maneuver. The main purpose of the current study was to compare the effectiveness of the Gans maneuver with the Epley maneuver in the treatment of the elderly with PC-BPPV, considering emotional, physical, and functional symptoms by assessing anxiety, dizziness, and quality of life after treatment. Methods: Sixty-three elderly patient (74.38±5.34 years) with unilateral PC-BPPV were recruited in this study. They were randomly assigned to two groups. The experimental group received the Gans maneuver, and the control group received the Epley maneuver. All patients completed the Persian version of the Dizziness Handicap Inventory (DHI) and Vestibular Rehabilitation Benefit Questionnaire (VRBQ) before, 48 hours and 1 month after treatment. Recurrence rate was assessed after the 2-month follow up. Results: Significant differences were observed between pre-treatment and post-treatment questionnaire outcomes for both study groups; nevertheless, in each phase of the study, there were no significant differences between the two groups in the DHI and VRBQ scores. Conclusion: Both the Gans maneuver and Epley maneuver were almost equally effective and made elderly with PC-BPPV report a better condition in terms of anxiety, emotional factors and quality of life after receiving the maneuvers. Keywords: Benign paroxysmal positional vertigo; Epley maneuver; Gans repositioning maneuver

Comparison of Postural Restriction with Cervical Soft Collar, Canalith Repositioning Procedure and Observation in the Initial Management of Benign Paroxysmal Positional Vertigo: A Randomized Control Trial

Background: Benign paroxysmal positional vertigo (BPPV) is a prevalent vestibular disorder often triggered by head position changes. While the canalith repositioning procedure (CRP) is a standard initial treatment, it has contraindications and potential complications. The present study investigated whether postural restriction with a cervical soft collar can serve as an equally effective initial management strategy for BPPV. Objective: To compare the effects of postural restriction with a cervical soft collar against CRP and observation in patients with BPPV. Materials and Methods: Seventy-five patients with a positive Dix-Hallpike test (DHT) were enrolled and randomly assigned to three groups, postural restriction with cervical soft collar, CRP, and observation. DHT results and Dizziness Handicap Inventory (DHI) scores were recorded. The presence of vertigo during CRP was assessed. Follow-ups were conducted in the first and second week. Results: The conversion rates from a positive to a negative DHT for the postural restriction group in the first and second week were 88% and 100%, and did not show statistically significant differences compared to the CRP group at 68% and 96%, but were significantly different from the observation group at 56% and 88% (p=0.0117 and 0.0184). DHI scores were similar between the soft collar and observation groups in the second week. Complications from CRP were noted in 12% of cases, with no complications reported in the other groups. Conclusion: Postural restriction with cervical soft collar may serve as an effective initial treatment for BPPV, comparable to CRP, without associated complications, and more effective than observation.

Emergency Department Vestibular Rehabilitation Therapy for Dizziness and Vertigo

Dizziness symptoms account for nearly 2 million annual emergency department (ED) visits and present a diagnostic challenge for clinicians. Most dizziness research has focused on improving guideline-concordant care among clinicians, with little focus on developing patient-centered interventions to improve dizziness-related disability. To examine the feasibility of ED vestibular rehabilitation therapy (ED-VeRT) using a protocolized diagnostic classification algorithm and collection of longitudinal patient-reported outcomes. A pilot nonrandomized clinical trial of ED-VeRT vs usual care for patients presenting to the ED with dizziness at a single urban US ED was conducted from November 16, 2021, to February 6, 2023, with collection of 3-month outcomes through May 1, 2023. Patients were allocated to ED-VeRT or usual care at the discretion of the treating physician. Use of ED-VeRT was delivered by an ED physical therapist via a protocolized diagnostic classification and treatment algorithm based on a diagnosis of benign paroxysmal positional vertigo, triggered undifferentiated dizziness, spontaneous undifferentiated dizziness, or unilateral peripheral hypofunction. Feasibility outcomes included participant screening, enrollment, and retention rates to inform the design of a future randomized clinical trial; retention was defined as completing any of 4 follow-up surveys over 3 months. The primary efficacy outcome was change in the Dizziness Handicap Inventory score; the secondary efficacy outcome was change in the Vestibular Activities Avoidance Inventory-9 score. Of 366 patients screened, 125 participants were enrolled (median age, 52 [IQR, 40-66] years, 73 [58%] female, 61 [49%] White), and 105 retained (84.0%) in longitudinal data collection. Sixty-three participants (50.4%) received ED vestibular therapy and were assigned to primary diagnostic classifications of benign paroxysmal positional vertigo (23 [37.1%]), triggered undifferentiated dizziness (14 [22.6%]), spontaneous undifferentiated dizziness (14 [22.6%]), or unilateral peripheral hypofunction (9 [14.5%]). Despite having higher Dizziness Handicap Inventory and Vestibular Activities Avoidance Inventory scores at baseline, ED-VeRT participants reported lower dizziness handicap (difference: -1.68; 95% CI, -11.30 to 7.90) and vestibular activities avoidance (difference: -2.27; 95% CI, -8.40 to 3.86) at 3 months, although these differences were not statistically significant. In this nonrandomized clinical trial, ED vestibular therapy was feasibly delivered to patients presenting to the ED with undifferentiated dizziness symptoms. For participants receiving vestibular therapy the findings for dizziness-related disability over 3 months were not statistically significant, pointing to the need for a fully powered randomized clinical trial. ClinicalTrials.gov Identifier: NCT05122663.

Effect of benign paroxysmal positional vertigo course on residual symptoms after successful canalith repositioning procedures: A prospective controlled trial.

Following successful canalith repositioning procedures (CRPs), some patients with benign paroxysmal positional vertigo (BPPV) may experience residual symptoms. There is currently no consensus on whether these residual symptoms are related to the disease duration. To examine the impact of BPPV duration on the persistence of residual symptoms following successful CRP. A total of 102 idiopathic BPPV patients were enrolled and categorized into short-course and long-course groups based on the duration of the disease. The course of disease in the short-course group was less than or equal to 7 days. The long course of disease was longer than 7 days. All patients underwent swivel-chair-assisted CRP and were followed up 7-10 days after successful CRP. The Dizziness Handicap Inventory (DHI) questionnaire was administered to all patients before and after CRP. Before CRP, significant differences were observed between the two groups in total DHI score and its subdomains: Physical (DHI-P), Functional (DHI-F), and Emotional (DHI-E) (p < 0.05), indicating that long disease duration significantly affected all patient aspects. After CRP, significant differences remained in total DHI, DHI-P, DHI-F, and DHI-E scores (p < 0.05), with the long-course group consistently scoring higher. However, no significant differences were found in the changes in DHI scores across dimensions before and after CRP between the two groups. The duration of BPPV did not influence CRP outcomes, but patients with a longer disease course were more likely to experience residual symptoms after successful CRP.

Quantifying the Relationship Between Clinician-Administered Measures of Vestibulo-Ocular Reflex and Oculomotor Function and Patient-Reported Outcome After Pediatric Mild Traumatic Brain Injury.

In pediatric mild traumatic brain injury (mTBI), high rates of abnormalities are observed in vestibulo-ocular reflex (VOR) and oculomotor (OM) function, but there is a lack of understanding of how these impairments may affect daily functioning. To determine the extent to which clinician-administered measures of VOR and OM function are associated with patient-reported levels of activity limitations and participation restriction in children and adolescents within 31days post-mTBI. Cross-sectional design. Tertiary care pediatric hospital. Participants with mTBI aged 7 to 17.99years. Participants were assessed on a battery of VOR and OM tests within 31days of injury. The Dizziness Handicap Inventory (DHI) and Cardiff Visual Ability Questionnaire (CVAQ) measured patient-reported dizziness and visual disability. The vestibular/ocular motor screening tool (VOMS), Head Thrust Test, computerized Dynamic Visual Acuity (DVA) Test, and video Head Impulse Test were administered to assess VOR and OM function. Linear regression examined the associations between clinician-administered measures of VOR and OM function and patient-reported functional outcomes. The sample consisted of 100 youth (54.4% female; mean age 13.92 [2.63]; mean time since injury: 18.26 [6.16] days). Associations were found between (1) DHI score and age (1.773 [0.473-3.073], P =.01), VOR symptom provocation (18.499 [11.312-25.686], P ≤.001), and DVA (-29.433 [-59.206 to -2.60], P =.03); and (2) CVAQ score and version symptom provocation (0.796 [0.185-1.406], P =.01). High abnormal proportions (up to 56.7%) were found in VOMS performance. The symptom provocation induced by VOR and OM tasks was associated with patient-reported dizziness and visual disability outcomes, highlighting the detrimental impact of symptoms on daily functioning. The findings of this study will assist clinicians when interpreting patient-reported measures of activity limitation and participation restriction.

Virtual reality-based vestibular rehabilitation therapy in patients with acute unilateral vestibulopathy: a randomized controlled trial.

Conventional vestibular rehabilitation therapy (VRT) requires significant time and resources, especially for patients with low compliance, limiting its effectiveness and accurate assessment. Studies have shown VRT using virtual reality (VR) to be effective, with meta-analyses confirming its superiority over conventional methods. However, methodological variations in VR remain a limitation. This study aimed to assess the effects of VRT using head-mounted display (HMD) VR technology in patients with acute unilateral vestibulopathy (AUVP) and compare the outcomes with conventional VRT. We conducted a single-blinded randomized controlled trial with 60 AUVP patients randomly assigned to VR or control groups. The VR group received VRT via VR, while the control group underwent conventional VRT. Both groups followed individual home-based programs for 8 weeks and visited the clinic every 2 weeks. Subjective dizziness symptoms were evaluated using the visual analog scale (VAS), dizziness handicap inventory (DHI), and Activities-specific Balance Confidence (ABC) scale. Compliance with home-based programs was assessed on a 0-2-point scale based on responses in a booklet guide. Seven patients were lost to follow-up, leaving 26 and 27 patients in the VR and control groups, respectively. The mean patient age was 56.91 ± 12.11 years; 22 men and 33 women were included. Two-way repeated measures analysis of variance showed significant improvement in both groups for DHI and ABC scores. However, changes in DHI, VAS, and compliance scores did not differ between groups. Improvement in the physical domain of the DHI and ABC scores was significantly faster in the VR group (p = 0.019 for DHI, p = 0.0020 for ABC). VRT using VR technology showed comparable efficacy to conventional VRT in AUVP patients. The VR group demonstrated greater improvement in the physical domain of the DHI and ABC scales, indicating enhanced confidence in movement and reduced perception of physical handicap due to dizziness.

Effects of a video-supported Cawthorne-Cooksey exercise program in older adults with balance deficits and dizziness: A preliminary randomised pilot study.

To determine the safety and efficacy of a video-supported Cawthorne-Cooksey exercise program (CCEP) in improving balance, dizziness and decreasing fear of falling in older adults with balance deficits and dizziness. Thirty-two older adults were divided into two groups (intervention and control). The intervention group followed a video-supported CCEP group, while the control group received written instructions to maintain their usual activity and counselling on fall prevention. Balance was assessed using the Berg Balance Scale (BBS), fear of falling with the Fall Efficacy Scale International (FES-I), and dizziness impact on daily life with the Dizziness Handicap Inventory (DHI) at baseline, the 4th week and at the 1-month follow-up. Analysis of variance with repeated measures was applied, and the level of significance was set at p < .05. Statistically significant differences were found between groups at the 4th week, with the CCEP group showing significant improvement in all outcome measures (BBS, FES-I, DHI scores) (p < .05). These differences remained statistically significant at the 1-month follow-up (p < .05). No adverse effects were detected. A 4-week video-supported CCEP is safe and effective in improving balance, dizziness impact on daily life and fear of falling in older adults with age-related dizziness and imbalance.

Abstract B033: Long-Term quality of life and hearing preservation after stereotactic radiosurgery for vestibular schwannoma

Abstract Purpose/Objective(s): The aim of this study is to evaluate the long-term quality of life (QOL) and hearing preservation outcomes following definitive single-fraction Gamma Knife stereotactic radiosurgery (GKSRS) for vestibular schwannoma (VS). Materials/Methods: Baseline and follow-up QOL and audiogram data were collected from our prospectively maintained institutional database of VS patients treated with single-fraction GKSRS from 2006 to 2023. QOL metrics included the Hearing Handicap Inventory (HHI), Dizziness Handicap Inventory (DHI), Tinnitus Handicap Inventory (THI), and the 36-Item Short-Form Survey (SF-36). Serviceable hearing preservation was classified according to the Gardner-Robertson scale using pure-tone average (PTA) and speech discrimination (SD). Linear mixed-effects models were constructed for each QOL metric over time. Results: A total of 388 patients (median age 61 years) were included with a median follow-up of 48 months. Median tumor size was 1.6 cm (interquartile range [IQR] 1.1-2.1 cm), with a median tumor volume of 0.6 cc (IQR 0.2-1.6 cc). Most patients received a prescription marginal dose of 12.5 Gy with a median cochlear mean dose of 2.7 Gy (IQR 1.9-3.8 Gy). Baseline median HHI, DHI, THI, and SF-36 scores were 28, 12, 12, and 73 respectively. Linear mixed-effects analyses indicated no statistically significant decline in any of these QOL metrics up to 7 years after GKSRS. Of patients with serviceable hearing at baseline, hearing preservation was maintained in 79% at 12 months, 67% at 2 years, and 68% at 3 years. Conclusion: GKSRS preserves long-term patient quality of life and serviceable hearing in the definitive management of VS. Citation Format: Shayzal Siddiqui, Joseph S. Lee, Julia Abbo, Jessica Cummings, Avi Desai, Inga S. Grills, Peter Y. Chen, Jeffrey Jacob, Kuei C. Lee. Long-Term quality of life and hearing preservation after stereotactic radiosurgery for vestibular schwannoma. [abstract]. In: Proceedings of the AACR Special Conference in Cancer Research: Translating Targeted Therapies in Combination with Radiotherapy; 2025 Jan 26-29; San Diego, CA. Philadelphia (PA): AACR; Clin Cancer Res 2025;31(2_Suppl):Abstract nr B033.

Abnormal neural circuits and altered brain network topological properties in patients with persistent postural-perceptual dizziness

Persistent Postural-Perceptual Dizziness (PPPD) is a common cause of chronic vestibular syndrome. Although previous studies have identified central abnormalities in PPPD, the specific neural circuits and the alterations in brain network topological properties, and their association with dizziness and postural instability in PPPD remain unclear. This study includes 30 PPPD patients and 30 healthy controls. Resting-state functional magnetic resonance imaging is used to construct whole-brain functional connectivity matrices, followed by network-based statistic and graph theoretical analysis. Network-based statistic results reveal an abnormal neural network in PPPD patients with key nodes in the occipital visual cortex, precuneus, sensorimotor cortex, multisensory vestibular cortex and cerebellum. The graph theoretical analysis shows less efficient information transmission at both local and global levels, indicating a state of disconnection between regions of the brain network. Decreased connections between the visual cortex, sensorimotor cortex, and multisensory vestibular cortex, and changes in brain network topological properties are correlated with the Dizziness Handicap Inventory score. Our study unveils the potential abnormal neural circuits, with the presence of multisensory and sensorimotor integration abnormalities and reveals altered brain network topological properties in PPPD patients. Our findings provide new insights for understanding the neural mechanisms of PPPD.

Influencing Factors for Residual Symptoms Following Canalith Repositioning Maneuver in Patients with Benign Paroxysmal Positional Vertigo.

Objectives: We aimed to analyze the influencing factors for residual symptoms following canalith repositioning maneuvers in patients with benign paroxysmal positional vertigo (BPPV). Methods: A total of 193 patients with BPPV who attended our hospital from July 2019 to December 2023 and were followed up in the outpatient clinic for 4 weeks after treatment were selected. The presence or absence of residual symptoms 4 weeks after repositioning was recorded, based on which the patients were assigned into a presence group (n = 72) and an absence group (n = 121). Their general data, incidence features, mental health, and sleep quality were compared. Results: After canalith repositioning maneuver and 4-week follow-up, the Dizziness Handicap Inventory (DHI) scores, Hospital Anxiety and Depression Scale (HADS) scores, and Pittsburgh Sleep Quality Index (PSQI) scores of the BPPV patients significantly decreased (P < .05). The presence of residual symptoms after repositioning in patients with BPPV had significant positive correlations with the time from onset to consultation, DHI score, HADS anxiety score, and PSQI score (P < .05). The area under the curve of the DHI score for predicting residual symptoms after repositioning in patients with BPPV was the largest (0.727), and the time from onset to consultation and the HADS anxiety score had the highest sensitivity (0.764) and specificity (0.801), respectively. Conclusions: Time from onset to consultation, DHI score, HADS anxiety score, and PSQI score are independent risk factors for and display significantly positive correlations with residual symptoms after canalith repositioning maneuver in patients with BPPV.

Altered amplitude of low-frequency fluctuation and functional connectivity in patients with acute unilateral vestibulopathy: a resting-state fMRI study.

To investigate changes of brain functional activity in patients with acute unilateral vestibulopathy (AUVP) using functional magnetic resonance imaging (fMRI). We studied 32 AUVP patients and 30 healthy controls (HC) who received resting-state fMRI scanning. Methods of voxel-based amplitude of low-frequency fluctuation (ALFF) and seed-based functional connectivity (FC) were adopted to compare the difference in brain function between the two groups. In addition, we evaluated the associations between abnormal neuroimaging results and clinical data in AUVP patients. Compared with HC, patients with AUVP showed lower ALFF in brain regions of bilateral insular, right precentral gyrus, left inferior frontal gyrus and right middle frontal gyrus, as well as higher ALFF in left cerebellar anterior lobe. Using these abnormal brain areas as seeds, we observed decreased FC between left insular and left precuneus in AUVP patients. Furthermore, AUVP patients showed increased FC between left insular and left supplementary motor area. Results of correlation analysis indicated that ALFF value (z-value) in left insular was negatively correlated with the canal paresis value (p = 0.005, r = -0.483), and the FC (z-value) between left insular and left precuneus was negatively correlated with dizziness handicap inventory score (p = 0.012, r = -0.438) in patients with AUVP. Patients with AUVP during acute period showed altered functional activity and connectivity in brain regions mainly involved in motor control and vestibular information processing. These changes in brain functional activity and connectivity were potentially attributed to decreased vestibular input resulting from unilateral peripheral vestibular impairment.

Clinical efficacy of Fu's subcutaneous needling based on "multi-joint muscle spiral balance chain" theory for cervical vertigo and its effect on blood flow velocity of vertebral artery

To observe the clinical efficacy of Fu's subcutaneous needling based on "multi-joint muscle spiral balance chain" theory for cervical vertigo (CV) and its effect on blood flow velocity of vertebral artery. A total of 60 patients with CV were randomized into a Fu's subcutaneous needling group and a medication group, 30 cases in each one. In the Fu's subcutaneous needling group, Fu's subcutaneous needling was delivered at Dazhui (GV14), the flexible tube was retained for 5 min after sweeping manipulation, and the treatment was given once every other day, 3 times a week for 3 weeks. In the medication group, betahistine mesylate tablet and diclofenac sodium dual-release enteric capsule were taken orally for continuous 3 weeks. Before treatment, after treatment, and in follow-up of one month after treatment completion, the scores of dizziness handicap inventory (DHI) and visual analogue scale (VAS) were observed; before and after treatment, the blood flow velocity of vertebral artery was measured by transcranial Doppler, and the clinical efficacy was evaluated after treatment in the two groups. After treatment and in follow-up, each item scores and total scores of DHI were decreased compared with those before treatment in the two groups (P<0.05); the VAS scores after treatment in the two groups, as well as the VAS score in follow-up of the Fu's subcutaneous needling group, were decreased compared with those before treatment (P<0.05). In the Fu's subcutaneous needling group, after treatment and in follow-up, the physical scores and the total scores of DHI, and the VAS scores were lower than those in the medication group (P<0.05); in follow-up, the emotional and functional scores of DHI were lower than those in the medication group (P<0.05). After treatment, the mean blood flow velocity (Vm) of the left vertebral artery (LVA) and the right vertebral artery (RVA) was increased compared with that before treatment in the two groups (P<0.05), and the Vm of LVA and RVA in the Fu's subcutaneous needling group was higher than that in the medication group (P<0.05). The total effective rate was 100.0% (30/30) in the Fu's subcutaneous needling group, which was superior to 73.3% (22/30) in the medication group (P<0.05). Fu's subcutaneous needling based on the "multi-joint muscle spiral balance chain" theory can effectively alleviate the vertigo and neck pain, and improve the blood flow velocity of vertebral artery in CV patients, and has a long-term therapeutic effect.

Longitudinal Evaluation of Vestibular Symptoms in Patients with Vestibular Schwannoma After Robotic-Guided Stereotactic Radiosurgery Using the Dizziness Handicap Inventory (DHI).

Background: Vestibular symptoms can severely affect patients with vestibular schwannomas (VSs). Studies assessing vestibular symptoms beyond clinical routine assessment in patients with VS treated by stereotactic radiosurgery (SRS) are scarce. Therefore, we employed the standardized questionnaire Dizziness Handicap Inventory (DHI) to systematically evaluate vestibular symptoms prior to and after SRS. Methods: For this retrospective single center study, we included patients who received Cyberknife® SRS for newly diagnosed unilateral VS between 2012 and 2022, and who had a minimum of two follow-up (FU) visits. Besides clinical assessment, the presence and severeness of vestibular symptoms before and after treatment was recorded by using the DHI. Overall DHI symptom scores (1-100) were classified into four grades (0 = "none", 1 = "mild", 2 = "moderate" and 3 = "severe"). The results were correlated with tumor-, patient-, and treatment-related characteristics. Results: We analyzed 128 patients with a median age of 60 years (range: 20-82) and a median FU of 36 months (range: 11-106 months). The median tumor volume was 0.99 cm3 (range: 0.04-7.1 cm3). A median marginal dose of 13 Gy (range: 12-14 Gy) was administered. The crude rate of local tumor control was 99.2%. The mean DHI total score at last follow-up (LFU, 25.5 ± 24.7; range 0-92) was significantly lower than before SRS (29.4 ± 25.3; range:0-92, p = 0.026), which was reflected in a higher proportion of patients with DHI grade "none" and a lower proportion of patients with DHI grade "severe" at LFU. Chi-square tests showed a significant correlation of the DHI grades (DHI 0-1 vs. DHI 2-3) with the absence or presence of vestibular symptoms both before SRS (p < 0.001, CI 95%) and at LFU (p = 0.038). Conclusions: The DHI is a feasible and valid instrument for measuring vestibular symptoms after SRS. In addition, the DHI enables the quantification of symptoms and can therefore serve as an important tool for outcome assessment after SRS of VS. In the present cohort, DHI scores improved significantly during FU.

Enhancing balance and auditory function in bilateral vestibulopathy through otolithic vestibular stimulation: insights from a pilot study on cochlea-vestibular implant efficacy.

This study evaluates cochleovestibular implants (CVI) for improving auditory and vestibular function in patients with bilateral vestibulopathy and severe-to-profound hearing loss. CVI uniquely combines auditory and vestibular stimulation, offering a potential solution for dual impairments in hearing and balance. Ten patients underwent CVI implantation. Auditory function was assessed with pure-tone audiometry (PTA) and speech recognition at baseline, 3, and 9 months post-implantation. Vestibular function was measured using the Dynamic Gait Index (DGI), Sensory Organization Test (SOT), posturography, and the Dizziness Handicap Inventory (DHI). Placebo-controlled tests verified cochleovestibular stimulation specificity. Auditory outcomes showed PTA improvements from 78 dB HL preoperatively to 34 dB HL at 3 months and 36 dB HL at 9 months, alongside speech recognition gains. Vestibular improvements included significant DGI (p < 0.05) and SOT score increases (33% to 68%, p < 0.05). DHI scores reflected reduced dizziness-related disability. Residual balance gains after device deactivation suggest neural adaptation, and placebo tests confirmed cochleovestibular stimulation specificity. CVI effectively restores auditory and vestibular function, with improvements in hearing, balance, and quality of life. Neural plasticity likely supports long-term benefits. Future research should refine device design and stimulation protocols to enhance outcomes further.

Dizziness and unstable gait in the older adults are associated with vestibular hypofunction, muscle dysfunction and sleep disturbance: impact on prevention of accidental falls

BackgroundDizziness and unstable gait with resultant falls are common symptoms among the older adults. Most of studies have focused on statistical analysis regarding single factor related to dizziness and unstable gait. On the other hand, there are very few comprehensive studies using a large number of patients except several review papers.MethodsWe retrospectively analyzed a total of 164 aged patients with dizziness and unstable gait. The patients underwent description of the Japanese version of the Dizziness Handicap Inventory (DHI), measurements of vestibular function, handgrip muscle strength, physical performance, height-adjusted appendicular skeletal muscle mass, and vitamin B1 and B12, a full-night polysomnography study, cognition test and visual test.ResultsAverage age was 80.5 ± 6.1 years and ranged from 59 to 91 years. Forty-eight were males and 116 females. Three causative factors, namely vestibular hypofunction, muscle dysfunction and sleep disturbance, were independently and combinedly associated with dizziness and unstable gait in over 93% of the patients. Patients with higher scores defined by these three causative factors had higher scores of DHI. 23% of the patients showed vitamin B1 and/or B12 deficiency, which was highly associated with sarcopenia/frailty. Cognitive and visual impairment were recognized in 4.9% and 5.0%, respectively.ConclusionDizziness and unstable gait were mainly associated with vestibular hypofunction, muscle dysfunction and sleep disturbance. In addition, vitamin B1 and B12 deficiency, and cognitive and visual impairment secondarily contribute to dizziness and unstable gait. Appropriate selection of treatment according to the underlying causes would prevent accidental falls among the older adults.

Associations between Dizziness Handicap Inventory scores and vestibular function tests: a cross-sectional survey

Associations between Dizziness Handicap Inventory scores and vestibular function tests: a cross-sectional survey

Revisiting Diagnostic Criteria for Bilateral Vestibulopathy: A New Comprehensive Instrumental Model.

Background: Bilateral vestibulopathy (BVP) is a disabling condition characterized by a deficit in vestibular function on both sides. Current diagnostic criteria consider instrumental data only from horizontal canals, excluding vertical canals and otolithic function, with the possibility of not including some variants of BVP. This study aims to evaluate vestibular functions in people with chronic vestibular syndrome through a comprehensive battery of tests. Methods: This diagnostic accuracy study included patients who met criteria for probable BVP. The index test included a thorough evaluation of the vestibular system, using the video Head Impulse Test (vHIT) to measure the gain of the angular vestibulo-ocular reflex (aVOR) in all six semicircular canals and the cervical and ocular vestibular-evoked myogenic potentials (VEMPs) to assess otolith function. The diagnostic criteria established by the Barany Society were considered the standard reference, including only the horizontal vHIT as an instrumental assessment. Results: 78 patients (41 male, age 61.40 ± 12.99) were enrolled. The Barany criteria showed a low ability to rule out BPV (sensitivity = 46%). The median Dizziness Handicap Inventory (DHI) varied from 66 to 69 among the models studied, and a significant difference in DHI scores between positive and negative tests was observed for the Barany criteria and the six-canals vHIT model. Conclusions: Our findings highlight the potential to transform BPV diagnostic criteria. The identification of new bilateral vestibular dysfunction variants through improved diagnostic tools calls for revising current criteria, with promising implications for patient care and understanding of etiological and prognostic aspects.

Rationale and design of the efficacy and safety of combination of cilostazol and gingko biloba extract EGb 761 in patients with acute non-cardioembolic ischemic stroke (RENEW): A pilot and feasibility randomized controlled trial

Rationale and design of the efficacy and safety of combination of cilostazol and gingko biloba extract EGb 761 in patients with acute non-cardioembolic ischemic stroke (RENEW): A pilot and feasibility randomized controlled trial

Dynamic postural stability, symmetry, and smoothness of gait in patients with persistent postural-perceptual dizziness.

Patients with persistent postural-perceptual dizziness (PPPD) exhibit altered postural and gait dynamics, but development of these changes following precipitating illnesses is poorly understood. To compare posture and gait metrics in patients with PPPD or subacute unilateral vestibulopathies (sAUVP) to healthy controls (HC). Ten patients with sAUVP, nine with PPPD, and eleven HC completed the 10 Meters Walk Test (10MWT) (an eyes open task) and Fukuda Stepping Test (FST) (an eyes closed task). Gait stability, symmetry, and smoothness were compared among groups and correlated with Dizziness Handicap Inventory (DHI) scores. 10MWT - Patients with PPPD had lower pelvis stability and gait symmetry than HCs. Patients with sAUVP had only lower pelvis stability. FST - Patients with PPPD and sAUVP had lower gait smoothness than HCs. Patients with sAUVP also had lower gait symmetry. Among patients with PPPD, DHI scores correlated positively with head stability. PPPD and sAUVP caused abnormal pelvis stability when walking and gait smoothness when stepping but differed in effects on gait symmetry with the presence/absence of visual inputs. For PPPD, visual stimuli had destabilizing effects, whereas for sAUVP vision aided stability. Symptom severity in patients with PPPD was related to head stability.