Dizziness Handicap Inventory Scores Research Articles

Aberrant dynamic functional network connectivity in vestibular migraine patients without peripheral vestibular lesion.

This study aimed to investigate changes in dynamic functional network connectivity (FNC) in patients with vestibular migraine (VM) and explore their relationship with clinical manifestations. Resting-state functional magnetic resonance imaging (rs-fMRI) data were scanned from 35 VM patients without peripheral vestibular lesion and 40 age-, sex- and education-matched healthy controls (HC). Independent component analysis (ICA), sliding window (SW) and k-means clustering analysis were performed to explore the difference in FNC and temporal characteristics between two groups. Additionally, Pearson's partial correlation analysis was adopted to investigate the relationship between clinical manifestations and rs-fMRI results in patients with VM. Compared with HC, patients with VM showed increased FNC in pairs of extrastriate visual network (eVN)-ventral attention network (VAN), eVN-default mode network (DMN) and eVN-left frontoparietal network (lFPN), and exhibited decreased FNC in pairs of VAN-auditory network (AuN). The altered FNC was correlated with clinical manifestations of patients with VM. Additionally, we found increased mean dwell time and fractional windows in state 2 in VM patients compared with HC. Mean dwell time was positively correlated with headache impact test-6 (HIT-6) scores, fractional windows was positively associated with dizziness handicap inventory (DHI) scores. Our results indicated that patients with VM showed altered FNC primarily between sensory networks and networks related to cognitive, emotional and attention implementation, with more time spent in a state characterized by positive FNC between sensor cortex system and dorsal attention network (DAN). These findings could help reinforce the understanding on the neural mechanisms of VM.

COVID-19 and Spectrum of Vestibular Dysfunctions: A Case Report

COVID-19 infection had shown to affect multiple systems. A positive COVID-19 case with multiple vestibular problems, its management and a review of the literature were reported. A 63-year-old lady who was a Category 5 COVID-19 infection patient, complicated by mild frontal stroke, left isolated mononeuropathy causing foot drop, had persistent dizziness lasting hours to days in the first month after being extubated. She underwent vestibular rehabilitation which did not resolve her vertigo. Upon presentation to the vestibular clinic at 3-months post-extubation, she complained of vertigo on changing positions lasting a few seconds with dizziness in between. Her Dizziness Handicap Inventory (DHI) was severe, with severe abnormal Depression Anxiety Stress Scale 21 (DASS 21). Vestibular assessments showed oculomotor abnormalities with positive left posterior Benign Paroxysmal Positional Vertigo (BPPV) on Dixhallpike test. During Epley maneuver, there was canal conversion to the anterior canal which was resolved with a deep head hanging maneuver. The canal repositioning maneuver was done in serial, and her vertigo reduced tremendously. Her Video Head Impulse Test showed abnormalities in all semicircular canals bilaterally, rotatory chair showed lateral vestibular weakness and videonystagmography showed abnormal smooth pursuit, saccade and optokinetic suggesting central lesion. Her cervical and ocular vestibular evoked myogenic potential were normal reflecting normal saccular and utricular function. Tympanometry showed type A bilaterally with right mild and left mild to moderate sensorineural hearing loss. Magnetic resonance imaging of the Internal Acoustic Meatus showed bilateral vascular loop with no cerebellopontine angle tumour. Upon review three months later, the patient was asymptomatic of vestibular complaint with normal DHI and DASS21 score. Her foot drop had also resolved. Evidence in the literature showed up to 16.8% of COVID-19 patients reported vestibular symptoms. The mechanism of this vestibular neuritis is unclear but may be similar to the pathogenesis causing anosmia or vasculopathy. International Journal of Human and Health Sciences Supplementary Issue: 2023 Page: S26

Anterior cervical discectomy and fusion to treat cervical instability with vertigo and dizziness: A single center, retrospective, observational study.

The current study attempts to investigate the role of anterior cervical discectomy and fusion (ACDF) in alleviating symptoms in patients with cervical vertigo associated with cervical instability. The patients of cervical instability with vertigo and dizziness who underwent ACDF between January 2011 and December 2019 were followed-up for more than two years. Demographic data (age, sex, follow up period and levels of instable cervical segments) were assessed; Symptoms of vertigo and dizziness before and after surgery were assessed by the 15-item version of the Vertigo Symptom Scale (VSS) and the 25-item Dizziness Handicap Inventory (DHI). The severity and frequency of other symptoms like neck and occipital pain, gastrointestinal discomfort, nausea, vomiting, tinnitus, palpitations, headache, diplopia and blurring of vision before and after surgery were also assessed. A total of 92 patients underwent ACDF for cervical instability with vertigo and dizziness between January 2011 and December 2019, of which 79 patients were included in the final analysis. The number of instable levels had no correlation with VSS and DHI scores before surgery (p > 0.05), while patients with C3/4 instability suffering a severer vertigo than other levels. Both DHI and VSS scores were significantly reduced after ACDF and this was sustained within two years after surgery (p < 0.001). Although there was no statistical difference in the ratio of patients with vertigo relief, patients with one-level cervical instability demonstrated a more rapid recovery than patients with multi-level cervical instability (p = 0.048). Also, there was improvement in other symptoms such as neck and occipital pain, gastrointestinal discomfort, nausea, vomiting, tinnitus, palpitations, headache and blurring of vision after surgery. Vertigo caused by C3/4 instability was severer than other levels such as C4/5 and C5/6. During 2 years' follow-up the significant relief of vertigo and dizziness was observed after anterior cervical surgery. Other accompanying symptoms except hypomnesia were also extenuated in follow-up period.

Evaluation of Vestibular Function in Sleep Disorders

Objectives: The aim of this study was to evaluate dizziness in patients with sleep disorders, objectively identify vestibular function through the vestibulo-ocular reflex (VOR) using the video Head Impulse Test (vHIT), and evaluate the association between these findings.Methods: Among the patients who visited the sleep clinic from June to October 2021, 69 who underwent both polysomnography (PSG) and vHIT were included. Participants completed questionnaires including the Dizziness Handicap Inventory (DHI), Beck Anxiety Inventory, Korean-Beck Depression Inventory-II, Epworth Sleepiness Scale, Insomnia Severity Index (ISI), and Pittsburgh Sleep Quality Index (PSQI). The subjects were classified into four groups: insomnia (n=4), rapid eye movement sleep behavior disorder (RBD) (n=13), obstructive sleep apnea syndrome (OSAS) (n=34), and RBD and OSAS (n=18). Moderate to severe OSAS (n=49) was compared with no OSAS and mild OSAS (n=20).Results: In comparison of the four groups according to sleep disorders, the OSAS patients showed the highest DHI scores and the lowest VOR gain, but statistical significance was not found. Although all VOR gains were within the normal range, the VOR gain of the left posterior semicircular canal was significantly lower in the moderate to severe OSA group than in the no OSA and mild OSA groups (1.02±0.18 vs. 0.94±0.10, &lt;i&gt;p&lt;/i&gt;=0.019). DHI total scores showed no correlation with VOR gain but showed a positive correlation with ISI (r=0.422, &lt;i&gt;p&lt;/i&gt;=0.001) and PSQI (r=0.287, &lt;i&gt;p&lt;/i&gt;=0.022). Among PSG parameters, lowest oxygen saturation (SaO&lt;sub&gt;2&lt;/sub&gt;) and percentage of time with SaO&lt;sub&gt;2&lt;/sub&gt; less than 90% were correlated with the emotional score of DHI (r=-0.245, &lt;i&gt;p&lt;/i&gt;=0.043 and r=0.311, &lt;i&gt;p&lt;/i&gt;=0.010, respectively).Conclusions: Although our study could not objectively confirm vestibular dysfunction in patients with sleep disorders, we found that subjective sleep complaints were associated with dizziness and hypoxic conditions during sleep were associated with emotional aspects of dizziness. This suggests that the treatment of concomitant sleep disorders may improve dizziness.

Comparative Effectiveness Research: Betahistine add-on Therapy with Epley's Manoeuvre Versus Epley's Manoeuvre Alone in Treating Posterior BPPV Patients.

Benign paroxysmal positional vertigo is one of the common vestibular disorders encountered in ENT clinics with accompanying vertigo. Study to evaluate the additive effects of betahistine on Epley's manoeuvre in treating posterior BPPV patients. Prospective study was conducted on 50 patients of posterior BPPV diagnosed by the Dix Hallpike test. Subjects were divided into Group A which received the Betahistine therapy along with the canalith repositioning technique (Epley's manoeuvre) and the second group (Group B) which received the Epley's manoeuvre alone. The patients were assessed at 1 week and 4 weeks by Visual Analogue Scale (VAS), Dizziness Handicap Inventory (DHI) and Short Form 36 (SF-36). At the end of 4 weeks, 2 patients in group A (E + B) had positive Dix-Hallpike and 23(92%) had negative Dix-Hallpike, while 11 patients in group B (E) had positive Dix-Hallpike and 14 (56%) had negative Dix-Hallpike with P value < 0.001. The Mean baseline (T0) Visual Analogue Scale (VAS) score in group A (E + B) was 8.60 ± 1.080 and in group B (E) was 8.92 ± 0.996. Post-treatment VAS score was significantly lower in both the groups and was significantly lower in group A(E + B) than in group B (E) (0.680 ± 1.930 vs. 3.96 ± 3.587, respectively, p-value < 0.001). The Mean baseline (T0) Dizziness Handicap Inventory (DHI) scores were similar in groups A and B (77.36 ± 9.49 vs. 80.00 ± 8.9, respectively, p = 0.271). After treatment, the DHI values were significantly lower in both groups. Group A had a better DHI score than group B (10.56 ± 17.12 vs. 44.72 ± 27.35, p < 0.001). The mean baseline (T0) Short Form 36 (SF-36) scores were also similar in groups A and B (19.53 ± 6.85 vs. 18.79 ± 5.50, p = 0.823). Post-treatment of 4 weeks, the SF-36 score significantly improved in both the groups and significantly improved in group A than group B (84.27 ± 17.28 vs. 46.53 ± 24.53, p < 0.001). Betahistine therapy in conjunction with Epley's manoeuvre leads to better symptom control and is more effective than Epley's alone in treating BPPV patients.

Effectiveness and acceptance of Vestibulo-Ocular Reflex adaptation training in children with recurrent vertigo with unilateral vestibular dysfunction and normal balance function.

This was a block randomized controlled study to evaluate the effectiveness and acceptance of Vestibulo-Ocular Reflex (VOR) adaptation training in children with recurrent vertigo with unilateral vestibular dysfunction (UVD) and normal balance function. Thirty children, aged 4-13 years, diagnosed with recurrent vertigo of childhood (RVC) with UVD (according to a caloric test) and normal balance function were analyzed. These 30 children were divided into 10 blocks based on similar age and severity of vertigo. Three children in each block were randomly assigned to one of three groups to receive 1 month of treatment. Group A received vestibular-ocular reflex (VOR) adaptation training, Group B received Cawthorne-Cooksey training, and a control group received no training. All children were administered pharmacotherapy [Ginkgo biloba leaf extract (drops)]. The Dizziness Handicap Inventory (DHI), Visual Analog Scale of Quality of Life with Vertigo (VAS-QLV), and canal paralysis (CP) on the caloric test were recorded before and after treatment, and the effectiveness of treatment was evaluated. The Visual Analog Scale of Acceptance (VAS-A) was used to evaluate the acceptance of the training in the two groups that received training. There were 10 children each in Group A, Group B, and the control group; the male to female ratio was 1, and the average age in each group was 9.0 ± 3.2, 8.4 ± 3.0, and 8.3 ± 2.6 years, respectively. The effective rate was 100% in Group A, 65% in Group B, and 60% in Group C. The recovery rate on caloric testing after treatment was 100, 70, and 50%, respectively. DHI scores before and after training were 56.8 ± 12.4 and 8.8 ± 6.1 in Group A, 57.8 ± 12.6 and 18.8 ± 9.7 in Group B, and 56.8 ± 12.4 and 24.0 ± 15.3 in Group C (all P = 0.000). VAS-QLV scores before and after training were 7.5 ± 1.0 and 0.9 ± 0.9 in Group A, 6.4 ± 2.2 and 2.7 ± 1.1 in Group B, and 6.6 ± 1.6 and 2.6 ± 1.4 in Group C (all P < 0.05). The CP values before and after training were 35.7 ± 15.1 and 12.9 ± 8.7 in Group A, 33.6 ± 20.1 and 23.6 ± 19.3 in Group B, and 38.6 ± 21.1 and 24.8 ± 17.9 in Group C (P = 0.001, P = 0.015, and P = 0.050, respectively). Between-group comparisons showed that the decreases in DHI and VAS-QLV scores after training were significantly different (P = 0.015, P = 0.02), while CP values were not (P = 0.139). After training, the DHI value had decreased significantly more in Group A compared with Group C (P < 0.05), but there were no other differences. After training, VAS-QLV scores in Group A had decreased significantly more compared with Group B and C (P < 0.05). In terms of acceptance, the VAS-A score was 7.6 ± 2.2 in Group A and 3.1 ± 2.8 in Group B (P =0.004), The acceptance rate was 70% in group A and 10% in group B. there was no significant correlation between age and VAS-A in either group A or group B (P > 0.05). This study strongly suggests that vestibular rehabilitation training should be performed in children with vertigo to improve symptoms. For children with RVC with UVD but normal balance function, a single VOR adaptation program can effectively improve vertigo symptoms, and given its simplicity, time-effectiveness, and excellent outcomes, it is associated with better acceptance in children compared to classic Cawthorne-Cooksey training.

Effects of noise on the vestibular system of normal-hearing workers.

Studies in noise-exposed animals have shown changes in vestibular structures. Likewise, studies in humans have been suggesting that noise can damage the vestibular system, even with normal assessment results. To assess the vestibular system of workers exposed to noise and to compare with individuals not exposed. Twenty normal-hearing male adults were divided in the study group (SG), exposed to occupational noise, and control group (CG). We conducted the following procedures: medical history, Dizziness Handicap Inventory (DHI), Dix-Hallpike maneuver, and electronystagmography (eye and caloric tests). The DHI score did not differ between groups. The Dix-Hallpike maneuver was normal for both groups. All individuals had normal responses in the eye tests. 50% of the SG had hyperreflexia in the caloric tests, with a significant difference between the groups. There was a trend towards a statistical significance in the absolute values of angular speed of the slow component in the cold-air test, which were higher in the SG. There was a significant difference between the groups in the relative values of labyrinthine preponderance, which were higher in the SG. Our findings showed that 70% of the workers exposed to occupational noise had vestibular alterations identified with electronystagmography, whereas 100% of the individuals in the CG had normal results in the vestibular assessment. Moreover, only 20% of the sample in both groups had vestibular complaints, indicating the presence of subclinical vestibular changes in 50% of the individuals exposed to occupational noise.

Altered brain function in patients with vestibular migraine: a study on resting state functional connectivity.

To characterize the altered brain function in patients with vestibular migraine (VM) using resting-state functional magnetic resonance imaging (fMRI). In this prospective study, fMRI images as well as clinical characteristics and behavioral scales were collected from 40 VM patients and 40 healthy controls (HC). All patients received neurological, neuro-otological, and conventional MRI examinations to exclude peripheral vestibular lesions, focal lesions, and other neurological diseases. Seed-based (bilateral parietal operculum cortex 2, OP2) functional connectivity (FC) and independent component analysis (ICA)-based functional network connectivity (FNC) were performed to investigate the brain functional changes in patients with VM. Additionally, the correlations between the altered FC/FNC and behavioral results were analyzed. Compared with HC, patients with VM showed increased FC between the left OP2 and right precuneus and exhibited decreased FC between the left OP2 and left anterior cingulate cortex. We also observed increased FC between the right OP2 and regions of the right middle frontal gyrus and bilateral precuneus, as well as decreased FC between the bilateral OP2. Furthermore, patients with VM showed decreased FNC between visual network (VN) and networks of auditory and default mode, and exhibited increased FNC between VN and executive control network. A correlation analysis found that FC between the left OP2 and right precuneus was positively correlated with scores of dizziness handicap inventory (DHI) in patients with VM. The present study demonstrated altered brain function in patients with VM.

Correlation between video head impulse test parameters and DHI score in patients with vestibular neuritis

Objective:To explore the correlation between the parameters of video head impulse test （vHIT）and dizziness handicap inventory （DHI） score in patients with vestibular neuritis. Methods:Clinical data of 46 patients with vestibular neuritis were retrospectively analyzed. All the patients underwent DHI evaluation and vHIT examination. They were divided into mild handicap group, moderate handicap group and severe handicap group according to DHI score. The correlations between the parameters of vHIT and DHI score were compared among the three groups. The important parameters of vHIT were compared including vestibulo-ocular reflex （VOR） gain, gain asymmetry ratio （GA）, abnormal saccade dispersion （PR%）. Results:Of the 46 patients, 10 were in the mild handicap group, 21 in the moderate handicap group, and 15 in the severe handicap group. ①In the comparison of the mean value of lateral semicircular canal VOR gain, the vHIT gain of patients with mild, moderate and severe handicap were 0.64±0.06, 0.53±0.11 and 0.37±0.10, respectively, the mean value of VOR gain was negatively correlated with DHI score among the three groups（r=-0.545, P<0.001）, and the pairwise comparisons among the three groups was statistically significant（P<0.05）. In comparison of the mean values of lateral semicircular canal GA, the GA values of mild, moderate and severe handicap groups were 46.40±21.81, 47.59±15.17 and 56.57±17.39, respectively, there was no significant linear correlation between GA values and DHI scores among the three groups（r=0.246, P>0.05）, there was no significant difference between the three groups（P>0.05）. In comparison of the mean PR% of the lateral semicircular canal, the mean PR% of patients with mild, moderate and severe handicap group were 32.00±10.62, 53.82±17.09 and 76.00±10.01, respectively, PR% was positively correlated with DHI score（r=0.726, P<0.001）, and the comparison among the three groups was statistically significant（P<0.05）. ②The vertical semicircular canal vHIT gain of patients with mild, moderate and severe handicap was 0.63±0.06, 0.52±0.15 and 0.38±0.16, respectively, the mean of VOR gain was negatively correlated with DHI score among the three groups（r=-0.487, P<0.01）, the comparison of mild-severe and moderate-severe group was statistically significant（P<0.05）, while there was no significant difference between the mild and moderate group（P>0.05）. In the comparison of the mean values of vertical semicircular canal GA, the GA values of mild, moderate and severe handicap groups were 40.40±15.31, 46.10±19.59 and 47.87±18.05, respectively, there was no significant linear correlation between GA values and DHI scores among the three groups（r=0.047, P>0.05）, there was no significant difference in GA among the three groups（P>0.05）. The PR% of patients with mild, moderate and severe handicap were 42.40±15.39, 54.14±17.60 and 64.93±10.95, respectively, there was a positive significant correlation between PR% and DHI score（r=0.454, P<0.05）, there was statistically significant in the comparison of mild-severe group（P<0.05）, while there was no statistical significance between the other groups（P>0.05）. Conclusion:The VOR gain and PR% value of vHIT in patients with vestibular neuritis are closely related to the DHI score, which can evaluate the vestibular function and the degree of vertigo.

Evaluation of postural stability and vestibulo-ocular reflex in adults with chronic suppurative otitis media

PurposeTo evaluate the vestibulospinal reflex and vestibulo-ocular reflex (VOR) in patients with chronic suppurative otitis media (CSOM) using posturography and the video head impulse test (vHIT).MethodsSixty-five patients with CSOM and 65 healthy participants as controls were included. Patients with CSOM were instructed to complete the dizziness handicap inventory (DHI). All participants underwent otoscopy, pure-tone audiometry, posturography sensory organization test (SOT), and vHIT.ResultsPatients with CSOM exhibited a high prevalence of dizziness. The CSOM group had poor SOT vestibular scores compared to the control group. Patients with CSOM had worse sways in the antero-posterior and mediolateral planes. The CSOM group was divided into two subgroups according to the type of hearing loss. SOT vestibular scores were significantly poorer in the mixed hearing loss group than those in the conductive hearing loss group. We found a positive correlation between disease duration and poor SOT vestibular scores. Moreover, poor SOT vestibular scores correlated with high DHI scores. We found abnormalities in the vHIT results in the CSOM group in the form of low VOR gain and corrective saccades.ConclusionOur study provides clinical evidence of dizziness, poor postural control, and VOR abnormalities in patients with CSOM. The presence of sensory elements of hearing loss in patients with CSOM appears to be positively associated with vestibular dysfunction.

The correlation between anxiety, depression, and vertigo: a cross-sectional study

BackgroundDizziness, including vertigo, affects approximately 15% to over 20% of adults each year. A significant proportion of patients with vertigo develop secondary psychiatric disorders throughout their disease. On the other hand, patients with psychiatric disorders frequently report dizziness as a co-occurring symptom of their illness. The purpose of this study was to screen the prevalence of depression and anxiety indices in dizzy patients and their relation to the severity of their dizziness handicap by administering two different questionnaires: The dizziness handicap inventory (DHI) and the Hospital Anxiety and Depression Scale (HADS). ResultsPsychological assessments revealed that 49% of the study group was normal, 29% had anxiety, 7% had depression, and 15% had both anxiety and depression. Besides, vestibular neuritis was associated with a higher mean anxiety score, whereas Meniere's disease was associated with a higher mean depression score. ConclusionAs this study has shown, there was a statistically significant positive correlation between anxiety and depression scores and physical, emotional, functional, and total DHI scores. Screening and treatment of co-morbid mental health disorders are critical for appropriate management of vertigo disability that leads to a higher quality of life and fewer complications.

Relationships between the Pittsburgh Sleep Quality Index (PSQI) and vertigo outcome

ABSTRACT Objective This retrospective cohort study aimed to investigate the association of sleep characteristics measured by the Pittsburgh Sleep Quality Index (PSQI) with the vertigo outcome in vertiginous patients with comorbid cardiometabolic diseases. Methods Four hundred and thirteen patients with comorbid cardiometabolic diseases who consecutively visiting vertigo and dizziness clinic were enrolled between October 2018 and January 2020 in a tertiary teaching medical center. Regression analyses and stratified analyses were used to explore the relationship between PSQI and vertigo outcome, which was measured by the visual analogue scale (VAS) score. Results In the study sample, 73.8% (305/413) were defined as ‘poor sleep’ (PSQI>5). Participants with better recovery tended to have better baseline PSQI global score, PSQI sleep quality, PSQI sleep onset latency, PSQI daytime dysfunction, less severe baseline vertigo symptoms indicated by VAS, Vertigo Symptom Scale (VSS) and Dizziness Handicap Inventory (DHI) scores. Moreover, baseline PSQI global score and PSQI daytime dysfunction score were independently associated with the vertigo VAS scores at the last follow-up. Conclusion The present results clearly indicated that poor sleep is common and inversely associated with vertigo outcome in vertiginous patients with co-morbid cardiometabolic diseases. Therefore, sleep deserves greater attention in the total medical care in specific subgroup of vertiginous patients.

A systematic review and meta-analysis of prophylactic medication of vestibular migraine.

Vestibular migraine is in the process of recognition as an individual clinical entity. At present, no guidelines exist for its management. This study aimed to conduct a systematic review and meta-analysis to determine the effectiveness of available prophylactic medication. A literature search was performed using PubMed, Ovid and Embase databases. Qualitative and quantitative analysis were performed as well as risk of bias analysis. Meta-analysis for the mean differences for pre- and post-treatment impact based on Dizziness Handicap Inventory and Vertigo Symptom Scale were performed. Proportionate transformation meta-analysis for the successful event rate based on complete symptoms control was explored. Thirteen publications were identified: 3 were randomised, controlled trials and 10 were non-randomised, controlled trials. Propranolol and venlafaxine improved the Vertigo Symptom Scale score by -13.31 points and -4.16 points, respectively, and the Dizziness Handicap Inventory score by -32.24 and -21.24, respectively. Only propranolol achieved statistically significant impact with 60 per cent of patients achieving complete symptom control. Propranolol should be offered as the first-line treatment for vestibular migraine followed by venlafaxine. Amitriptyline, flunarizine and cinnarizine showed a trend for symptom improvement, but this was not statistically significant.

Microstructural changes of the vestibulocochlear nerve in patients with Ménière's disease using diffusion tensor imaging.

ObjectiveTo evaluate the microstructural changes of the vestibulocochlear nerve in patients with Ménière's disease.MethodsA total of 26 subjects, 13 patients with MD and 13 healthy controls, underwent diffusion tensor imaging (DTI) on a 3T scanner. The independent sample t-test was used to compare the differences in fractional anisotropy (FA) and apparent diffusion coefficient (ADC) between the two groups. A Pearson correlation was used between DTI and the dizziness handicap inventory (DHI) scores.ResultsThere was a significant decrease in FA and an increase in ADC of the vestibulocochlear nerve in MD patients compared with healthy controls (P = 0.04, P = 0.001). FA had negative correlations with the DHI score (r = −0.62, P = 0.02) and DHI-functional score (r = −0.64, P = 0.02).ConclusionThese results are the first evidence of possible changes in the microstructure of the vestibulocochlear nerves in patients with MD. DTI is a potential technique for evaluating the vestibulocochlear nerve in patients with MD.

Assessment of Saccular and Semicircular Canal’s Function in Behcet’s Disease

Background and Aim: Behcet’s disease (BD) is a multisystemic, chronic and progressive disorder with a relatively high prevalence in Iran. Therefore, this study aimed to compare the vestibular function between Iranian BD patients and normal subjects using cervical vestibular- evoked myogenic potentials (cVEMPs) and video head impulse test (vHIT). Methods: In this cross-sectional study, 44 patients with definitive BD in the inactive stage of disease and 30 age and sex matched normal subjects were evaluated via cVEMP and vHIT tests and dizziness handicap inventory (DHI). Then the parameters of the tests were compared between the two groups by statistical methods. Moreover, the effects of DHI scores and other contextual variables on the test results were examined. Results: In terms of the cVEMP test, the response rate and mean latency of p13 in the left ear were significantly lower, the amplitude of the cVEMP wave in the left ear and the amplitude asymmetry ratio were significantly higher in BD patients compared to normal subjects (p&lt;0.05). Fifteen BD patients had abnormal amplitude and nine patients had abnormal latency of cVEMP responses. In terms of the vHIT test, the mean vestibule-ocular reflex gain of the left posterior semicircular canal and the mean gain asymmetry ratio of lateral canals were significantly higher in BD patients than in the controls (p&lt;0.05). Conclusion: the vestibular system of some patients with BD is disturbed and the results of this study indicate the presence of unilateral vestibular weakness in BD. So vestibular assessment can be helpful for these patients. Keywords: Cervical vestibular evoked myogenic potentials; video head impulse test; saccule; semicircular canals; behcet’s disease

Risk Factors of Residual Dizziness After Successful Treatment for Benign Paroxysmal Positional Vertigo in Middle-Aged and Older Adults.

ObjectiveThe purpose of this study was to analyze risk factors of residual dizziness (RD) after successful treatment for benign paroxysmal positional vertigo (BPPV) in middle-aged and older adults.Methods181 patients with BPPV, after successful canalith repositioning maneuver (CRM) treatment, were recruited. All patients were divided into the middle-aged group (aged 45–59 years, n = 101) and the older group (over 60 years, n = 80). The clinical characteristics were recorded, including age, gender, numbers of maneuvers, involved canal, affected side, RD, comorbidities, dizziness handicap inventory score, and generalized anxiety disorder's 7-item scale score.ResultsThe incidence of RD in the older group was significantly higher than that of the middle-aged group (p = 0.033). Multivariate logistic regression analysis shows that age (odds ratio = 1.042, p = 0.006), moderate to severe dizziness (odds ratio = 2.017, p = 0.034), and moderate to severe anxiety (odds ratio = 2.228, p = 0.017) were independently associated with RD in middle-aged and older adults.ConclusionOlder adults exhibited higher incidence of RD after successful treatment for BPPV. Age, moderate to severe dizziness, and moderate to severe anxiety were independent risk factors of RD in middle-aged and older adults.

Determinants of functioning and health-related quality of life after vestibular stroke.

BackgroundStroke accounts for 5–10% of all presentations with acute vertigo and dizziness. The objective of the current study was to examine determinants of long-term functioning and health-related quality of life (HRQoL) in a patient cohort with vestibular stroke.MethodsThirty-six patients (mean age: 66.1 years, 39% female) with an MRI-proven vestibular stroke were followed prospectively (mean time: 30.2 months) in the context of the EMVERT (EMergency VERTigo) cohort study at the Ludwig-Maximilians Universität, Munich. The following scores were obtained once in the acute stage (<24 h of symptom onset) and once during long-term follow-up (preferably >1 year after stroke): European Quality of Life Scale-five dimensions-five levels questionnaire (EQ-5D-5L) and Visual Analog Scale (EQ-VAS) for HRQoL, Dizziness Handicap Inventory (DHI) for symptom severity, and modified Rankin Scale (mRS) for general functioning and disability. Anxiety state and trait were evaluated by STAI-S/STAI-T, and depression was evaluated by the Patient Health Questionnaire-9 (PHQ-9). Voxel-based lesion mapping was applied in normalized MRIs to analyze stroke volume and localization. Multiple linear regression models were calculated to determine predictors of functional outcome (DHI, EQ-VAS at follow-up).ResultsMean DHI scores improved significantly from 45.0 in the acute stage to 18.1 at follow-up (p < 0.001), and mean mRS improved from 2.1 to 1.1 (p < 0.001). Mean HRQoL (EQ-5D-5L index/EQ-VAS) changed from 0.69/58.8 to 0.83/65.2 (p = 0.01/p = 0.11). Multiple linear regression models identified higher scores of STAI-T and DHI at the time of acute vestibular stroke and larger stroke volume as significant predictors for higher DHI at follow-up assessment. The effect of STAI-T was additionally enhanced in women. There was a significant effect of patient age on EQ-VAS, but not DHI during follow-up.ConclusionThe average functional outcome of strokes with the chief complaint of vertigo and dizziness is favorable. The most relevant predictors for individual outcomes are the personal anxiety trait (especially in combination with the female sex), the initial symptom intensity, and lesion volume. These factors should be considered for therapeutic decisions both in the acute stage of stroke and during subsequent rehabilitation.

Vestibular Rehabilitation Therapy and Corticosteroids for Vestibular Neuritis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials.

Background and Objectives: Besides corticosteroids, clinicians found that vestibular rehabilitation therapy (VRT) has a potential effect on vestibular neuritis (VN) improvement. This study aimed to investigate the efficacy of both corticosteroid therapy (CT) compared to VRT, and each group compared to their combination (CT vs. (CT+VRT) and VRT vs. (CT + VRT). Materials and Methods: Systematic searches were performed in PubMed, CINAHL, and Scopus for randomized controlled trials (RCTs) reporting the administration of at least CT and VRT for VN. The outcome of interest was VN’s subjective and objective improvement parameters. Results: Four RCTs involving a total of 182 patients with VN were eligible for systematic review and meta-analysis. The weighted mean difference (WMD) of canal paresis (objective parameter) in the CT group is significantly lower than in the VRT group after a 1 month follow-up (8.31; 95% CI: 0.29, −16.32; p = 0.04; fixed effect). Meanwhile, the WMD of Dizziness Handicap Inventory (DHI) (subjective parameter) in the VRT group is significantly lower than in the CT group after a 1 month follow-up (−3.95; 95% CI: −7.69, −0.21; p = 0.04; fixed effect). Similarly, the WMD of DHI in the combination group (CT+VRT) is significantly lower than in the CT group after a 3 month follow-up (3.15; 95% CI: 1.50, 4.80; p = 0.0002; fixed effect). However, there is no significant difference in all outcomes after 12 months of follow-ups in all groups (CT vs. VRT, CT vs. combination, and VRT vs. combination). Conclusions: This study indicates that CT enhances the earlier canal paresis improvement, as the objective parameter, while VRT gives the earlier DHI score improvement, as the subjective parameter. However, their long-term efficacy does not appear to be different. VRT has to be offered as the primary option for patients with VN, and corticosteroids can be added to provide better recovery in the absence of its contraindication. However, whether to choose VRT, CT, or its combination should be tailored to the patient’s condition. Future studies are still needed to revisit this issue, due to the small number of trials in this field. (PROSPERO ID: CRD42021220615).

The effectiveness of vestibular rehabilitation in Ménière's disease patients with chronic imbalance

Objective:To observe the effectiveness of vestibular rehabilitation in Ménière's disease patients with chronic imbalance. Methods:Forty-five Ménière's disease patients with chronic imbalance treated in vertigo specialist clinic of Eye and ENT Hospital of Fudan University from December 2020 to December 2021 were enrolled. Patients were divided randomly into two groups, 23 patients in experimental group and 22 patients in control group. Both groups received routine outpatient treatment, and the experimental group received an additional vestibular rehabilitation for 8 weeks. All patients were evaluated with dizziness handicap inventory （DHI） at baseline and 8-week follow-up, and the incidence of fall was calculated. The occurrence of adverse events during the study was also recorded. Results:There was no significant difference in baseline data between the two groups （P>0.05）. During the study, 1 patient were lost to follow-up and 2 patients dropped out. A total of 42 patients completed the study. Intentionality analysis was performed on lost follow-up patients. After 8 weeks of the treatment, there were significant statistically differences in difference values of DHI and DHI-F scores（d₁=-30.22±3.78, d₂=-13.09±4.85, t=-2.799, P<0.05; d₁=-12.43±1.46, d₂=-4.55±2.17, t=-3.043, P<0.05）, while no significant difference was showed in the difference values of DHI-P and DHI-E scores（P>0.05）. There was no significant difference in incidence of fall between two groups（P>0.05）, but the incidence of experimental group decreased significantly compared with that before treatment（4.35% vs 34.78%, χ²=4.973, P<0.05）. No serious adverse event was reported in the two groups. Conclusion:Vestibular rehabilitation can improve the balance function and reduce risk of fall in Ménière's disease patients with chronic imbalance. Therefore, it is worthy of clinical application.

Subjective perception of activity level: A prognostic factor for developing chronic dizziness after vestibular schwannoma resection?

IntroductionA vestibular schwannoma (VS) resection causes an acute unilateral vestibular deafferentation resulting in acute postoperative symptoms. Despite the expected resolution of most of the symptoms, due to central vestibular compensation, more than one out of four patients develop chronic dizziness. Several predictive factors, such as age and tumor size, have been suggested. Despite its potential effect on the process of central vestibular compensation, the level of physical activity after VS resection was not yet considered. Therefore, the association between the level of physical activity and chronic dizziness after VS resection will be investigated.MethodsThis retrospective cohort study included 66 patients who underwent a retro-sigmoid VS resection between October 2001 and February 2007. Patients were assessed before surgery and at 9 weeks and 6 months postoperatively. At 9 weeks, patients were asked to report their level of physical activity (PA) during the past week by using a visual analogue scale and their balance performance was assessed by four standing balance conditions with eyes closed and the Timed Up and Go test (TUG). Based on the Dizziness Handicap Inventory (DHI) score at 6 months, patients were divided in a chronic dizziness group (DHI > 30) and non-chronic dizziness group (DHI-score ≤ 30). Age, sex, Koos classification, preoperative vestibular function, treatment group, balance performance, and level of PA were compared between both groups and used as independent variables in linear regression analyses with the DHI score at 6 months as dependent variable.ResultsThe chronic dizzy patients revealed to have significantly lower levels of PA (p < 0.001) and worse static and dynamic balance performance (p = 0.023 and p = 0.041, respectively) 9 weeks after surgery. After elimination, the multiple regression analysis resulted in a model with two variables (PA level, TUG) which significantly predicted the DHI score (F2,42 = 6.581; R2 = 0.239; p = 0.003).ConclusionThis study revealed associations between (1) the level of PA and balance performance in the subacute phase and (2) chronic dizziness after VS resection. Assessment of the level of PA and balance performance during the subacute phase, which can be performed in a non-invasive and non-time-consuming way, might therefore provide prognostic information after VS resection.