Dizziness Handicap Inventory Research Articles

Comparison of depression, anxiety, sleep quality and quality of life among benign paroxysmal positional vertigo with or without tinnitus

Aim: Patients with benign paroxysmal positional vertigo (BPPV) may be accompanied by tinnitus, less frequently and mildly than vertigo secondary to other vestibular disorders. In this study, we aimed to separate patients with BPPV into two different groups, those with and without tinnitus, and to examine and compare depression, anxiety, disability, sleep quality, and quality of life in these patient groups.
 
 Methods: This cross-sectional study included 20 BPPV patients without an acute attack who were referred from the emergency department to the neurology outpatient clinic between April 2022 and July 2022. Beck anxiety scale was used for anxiety, Beck depression inventory was used for depression, Pitsburg sleep quality scale was used for sleep quality, the dizziness handicap inventory (DHI) was used for disability caused by dizziness, and 36-Item Short Form Health Survey (SF-36) was used for quality of life.
 
 Results: 20 BPPV patients were included in the study. While 12 of 20 patients (7 Female, 5 Male) were not accompanied by tinnitus, 8 (5F, 3M) were accompanied by tinnitus. No significant difference was detected between BPVV groups with and without tinnitus. A positive correlation was found between sleep quality and quality of life and its subparameters in BPPV patients. A direct relationship was observed between DHI and its subparameters, physical, functional, and emotional parameters, and quality of life.
 
 Conclusion: No significant relationship was found between the presence or absence of tinnitus and depression, anxiety, sleep quality, disability, and quality of life in BPVV patients.

Abnormal vestibular-evoked myogenic potentials as a risk factor for unpredicted falls in spinocerebellar ataxia: a preliminary study

ObjectiveThis study aimed to correlate the symptoms and signs with the findings of laboratory vestibular function tests in patients with spinocerebellar ataxia (SCA).MethodWe retrospectively recruited 26 patients with SCA (9 men, median age: 52, age range: 21–67). Assessments included Dizziness Handicap Inventory, EuroQoL Five-Dimension, symptom questionnaires manifesting during walking in daily life, the Scale for the Assessment and Rating of Ataxia (SARA), and vestibular function tests including 3D video-oculography, video head impulse test, subjective visual vertical, and cervical and ocular vestibular evoked myogenic potentials (VEMP).ResultsCross-analyses revealed that the patients with VEMP abnormalities showed higher SARA (p = 0.014) and prevalence of unpredictable falls (p = 0.046). The patients with SCA1 more frequently had unpredictable falls (75%, p = 0.038) and VEMP abnormalities (88%, p = 0.001) compared to SCA2 (29% falls, 17% VEMP abnormalities) and SCA6 (no falls or VEMP abnormalities).ConclusionAbnormal VEMPs are strongly associated with unpredicted falls in patients with SCA, particularly in those with SCA1. Impaired processing of otolithic information may contribute to falls in SCAs, and VEMP may help identifying the patients with a risk for unpredicted falls and preventing fall-related injuries in SCA. Limited number of patients with lower SARA scores warrant further confirmatory studies.

Clinical Efficacy and Metabolomics Modifications Induced by Polyphenol Compound Supplementation in the Treatment of Residual Dizziness following Semont Maneuver in Benign Paroxysmal Positional Vertigo (BPPV) of the Posterior Semicircular Canal (PSC): Preliminary Results.

Benign paroxysmal positional vertigo (BPPV) represents the most frequent cause of peripheral vertigo. In most cases, it is successfully treated using the canalith repositioning procedure, but it is often followed by continuous lightheadedness in the absence of vertigo or nystagmus (residual dizziness, RD). Our aim is to describe the clinical effectiveness and the urine metabolomics profile of treating these patients with polyphenol compound supplementation. We enrolled 30 patients reporting RD after BPPV of the posterior semicircular canal (PSC) successfully treated using the Semont maneuver. Supplementation with a polyphenol compound was administered for 60 days, and patients were evaluated after 30 and 60 days of treatment using self-administered questionnaires (Visual Analog Scales for Dizziness and Nausea, Dizziness Handicap Inventory, DHI) and urine metabolomics analysis performed using 1H-NMR spectroscopy and multivariate followed by univariate analysis. Most patients reported excellent or good efficacy in the treatment of RD with a significant decrease in VAS and DHI values. The metabolomics analysis identified six significant metabolites related to the treatment, namely 1-methylnicotinamide, anserine, hippurate, lysine, methyl succinate and urea, indicating the inflammatory activities and antioxidant properties of the polyphenol compound. These preliminary data suggest that supplementation with a polyphenol compound could induce some metabolic changes that can help in recovery from RD. However, future steps will require confirmation with a more significant cohort of patients and an extension of the metabolomics evaluation to other problems concerning the different clinical aspects of BPPV, such as the high rate of relapse.

A Novel Approach to Integrative Concussion Rehabilitation: A Pragmatic Study

Purpose: The purpose of this study is to evaluate the effectiveness of the novel Ziaks Integrative Neurological Concussion (ZINC) Protocol in evaluating and treating persistent post-concussion symptoms. Methods: Individuals with concussion were systematically evaluated for neurological impairments and subsequently received six modules of integrative and progressive therapies. Treatment addressed motor function impairment, oculomotor and binocular vision deficits, and central vestibular deficits while incorporating postural stability, dual task and cognitive loading skills and providing instruction in cardiovascular exercise to promote autonomic stability. Results: Of 30 patients, 15 completed all 6 protocol modules for inclusion in data analysis. Mean treatment duration was 6.6 (SD±.99) visits over 69.53 days (SD±21.92). The Post-Concussion Symptom Scale and Dizziness Handicap Inventory outcomes from pre- to post-treatment achieved clinical and statistical significance. Statistical significance was achieved for the Brain Injury Vision Symptom Survey, Brock String near point of convergence, King Devick and the novel binocular vision screening tool. Conclusions: A structured, integrative, and progressive rehabilitation program addressing the vestibulo-oculomotor and motor function domains of concussion may be effective in the management of persistent post-concussion symptoms. Impact Statement: This study details one potential comprehensive and sequential method to integrate the neurological domains of concussion rehabilitation while screening for impairments in the physical domains. There is a gap in knowledge regarding the most effective timing, sequencing, and implementation of intervention methods across the 4 concussion domains. This study provides the groundwork for future research to establish treatment protocols aimed to efficiently reduce symptoms associated with persistent post-concussion symptoms.

Dynamic change of vestibular function and the long-term prognosis of vestibular neuritis.

To comprehensively evaluate the dynamic change of vestibular function during long-term follow-up of vestibular neuritis, as well as the co-relationship with the outcomes of vestibular neuritis (VN), which provides the recommendations for vestibular function tests during the course of VN. A prospective cohort study was conducted on 16 patients with acute VN. Caloric test, vHIT, rotatory chair tests, VEMP, dizziness handicap inventory (DHI) score, and dynamic dizzy scales (VAS-DD) was first performed within 7 days of neuritis onset, which were further re-evaluated during the 6-12 months of follow-up. The dynamic changes on multiple objective vestibular examinations were analyzed during the acute and recovery stage of VN. We further evaluated the co-relationship between the vestibular dysfunction scales and the prognosis of VN. In more than 6 months of follow-up, 44% of the ultralow frequency, 94% of the low-to-mid frequency, and 44% of the high-frequency function of the horizontal semicircular canal returned to normal (p < 0.05). The change degree in symmetry of the rotatory chair test was correlated with the gain of the horizontal semicircular canal on the vHIT and the unilateral weakness (UW) value on the caloric test (p < 0.05). The change in DHI score was correlated with the phase; change in VAS-DD level correlated with the symmetry and TC of the rotatory chair test at VN recovery stage (p < 0.05). There was no significant correlation between the change in DHI score or change in VAS-DD and the degree of vestibular function recovery (p > 0.05). In general, vestibular function improved during the course of VN. The rotatory chair test can be used to evaluate the overall function of the vestibular system and the compensatory state in patients with VN.

Patient-Related Outcome Measures for Oculomotor Symptoms in the Cerebellar Ataxias: Insights from Non-Cerebellar Disorders

In patients with cerebellar ataxia (CA), symptoms related to oculomotor dysfunction significantly affect quality of life (QoL). This study aimed to analyze the literature on patient-related outcome measures (PROMs) assessing QoL impacts of vestibular and cerebellar oculomotor abnormalities in patients with CA to identify the strengths and limitations of existing scales and highlight any areas of unmet need. A systematic review was conducted (Medline, Embase) of English-language original articles reporting on QoL measures in patients with vertigo, dizziness or CA. Pre-specified parameters were retrieved, including diseases studied, scales applied and conclusions drawn. Our search yielded 3671 articles of which 467 studies (n = 111,606 participants) were deemed relevant. The most frequently studied disease entities were (a) non-specific dizziness/gait imbalance (114 studies; 54,581 participants), (b) vestibular schwannomas (66; 15,360), and (c) vestibular disorders not further specified (66; 10,259). The Dizziness Handicap Inventory (DHI) was the most frequently used PROM to assess QoL (n = 91,851), followed by the Penn Acoustic Neuroma Quality-of-Life Scale (n = 12,027) and the Activities-Specific Balance Confidence Scale (n = 2’471). QoL-scores capturing symptoms related to oculomotor abnormalities in CA were rare, focused on visual impairments (e.g., National-Eye-Institute Visual Function Questionnaire, Oscillopsia Functional Impact, oscillopsia severity score) and were unvalidated. The DHI remains the most widely used and versatile scale for evaluating dizziness. A lack of well-established PROMs for assessing the impact of oculomotor-related symptoms on QoL in CA was noted, emphasizing the need for developing and validating a new QoL-score dedicated to the oculomotor domain for individuals with CA.

Effects of nonprescription therapies on vestibular migraine: a questionnaire-based observational study.

Vestibular migraine (VM) is a common cause of recurrent vertigo. Migraine headache preventative therapies are currently prescribed to control vertigo symptoms in VM. Clinical trials of nutraceuticals for migraine headache prevention have shown positive outcomes, but, to date, there have been no studies to assess their effectiveness in the management of VM. To report the effects of nonprescription therapy management on VM symptoms. We undertook a prospective, questionnaire-based assessment of patients diagnosed with VM between November 2019 and August 2021 at two Sydney tertiary referral clinics. Patients were advised on optimising sleep, hydration, exercise and nutrition and instructed to use an over-the-counter combination product containing riboflavin 200 mg, magnesium 150 mg, coenzyme Q10 75 mg and feverfew 200 mcg. Symptom severity and frequency were assessed using the Dizziness Handicap Inventory (DHI), the Vertigo Symptom Score short-form (VSS-sf) and two visual analogue scales for severity (VAS-s) and frequency (VAS-f) before and 3 months after commencing treatment. In 82 participants (78% female;mean age, 44 ± 14 years) we recorded a decrease in DHI (mean, 16.8 [95% confidence interval (CI), 12.8-20.9], VSS-sf (9.3, 7.1-11.5), VAS-s (3.0, 2.2-3.8) and VAS-f (2.8, 2.1-3.4), equating to an improvement of 44.1%, 44.9%, 44.1% and 38.9% for each measure respectively. On the DHI and VSS-sf, 41 (50%) and 44 (53.7%) patients showed improvement in their symptoms; 39 (47.6%) and 36 (43.9%) patients noted no change and two patients reported worsening. The supplement was well-tolerated. The results provide preliminary evidence that VM symptom frequency and severity can be reduced by using nonprescription therapies.

New Dizziness Impact Measures of Positional, Functional, and Emotional Status Were Supported for Reliability, Validity, and Efficiency

ObjectiveTo calibrate the 25 items from the Dizziness Handicap Inventory (DHI) patient-reported outcome measure (PROM), using item response theory (IRT), into 1 or more item banks, and assess reliability, validity, and administration efficiency of scores derived from computerized adaptive test (CAT) or short form (SF) administration modes. DesignRetrospective cohort study. SettingOutpatient rehabilitation clinics. ParticipantsPatients (N=28,815; women=69%; mean age [SD]=60 [18]) included in a large national dataset and assessed for dizziness-related conditions who responded to all DHI items at intake. InterventionsNot applicable. Main Outcome MeasuresIRT model assumptions of unidimensionality, local item independence, item fit, and presence of differential item functioning (DIF) were evaluated. Generated scores were assessed for reliability, validity, and administration efficiency. ResultsPatients were treated in 976 clinics from 49 US states for either vestibular-, brain injury-, or neck-related impairments. Three unidimensional item banks were calibrated, creating 3 distinct PROMs for Dizziness Functional Status (DFS, 13 items), Dizziness Positional Status (DPS, 4 items), and Dizziness Emotional Status (DES, 6 items). Two items did not fit into any domain. A DFS-CAT and a DFS 7-item SF were developed. Except for 2 items by age groups and 1 item by main impairment, no items were flagged for DIF; DIF impact was negligible. Median reliability estimates were 0.91, 0.72, and 0.79 for the DFS, DPS, and DES, respectively. Scores discriminated between patient groups in clinically logical ways and had a large effect size (>0.8), with acceptable floor and ceiling effects (<15%), except for a floor effect for DPS (20.4%). DFS-CAT scores were generated using a median of 8 items; they correlated highly with full-bank scores (r=0.99). ConclusionThe 3 dizziness impact PROMs demonstrated moderate to high reliability, were valid, and highly responsive to change; thus, they are suitable for research and routine clinical administration.

Low-sodium diet with adequate water intake improved the clinical efficacy in Ménière’s disease

Background Ménière’s disease (MD) is a common idiopathic inner ear disorder in otorhinolaryngology characterized by recurrent episodes of vertigo, fluctuating sensorineural hearing loss, tinnitus and ear fullness. Objective To study the effects of low-sodium diet with adequate water intake on the clinical efficacy in MD. Methods Fifty patients diagnosed with stage-3 unilateral MD were randomly divided into control group(n = 25) and experimental group(n = 25). The control group was given routine medication therapy, and the experimental group was restricted to an sodium intake of 1500 mg/d and a water intake of 35 ml/kg/d based in addition to the routine medication therapy. The two groups were assessed using pure tone audiometry, electrocochleography, Tinnitus Handicap Inventory (THI), and Dizziness Handicap Inventory (DHI). Results The pure tone audiometry and electrocochleography showed better improvements after treatment in the experimental group than the control group (p < 0.05). The THI improved values in the experimental group were significantly higher than the control group (p < 0.001). The DHI improved values in the experimental group were significantly higher than the control group (p = 0.004). Conclusions and Significance Low-sodium diet with adequate water intake improved the hearing and alleviated vertigo and tinnitus in MD patients.

Tympanostomy tube placement for intractable Meniere’s disease in the elderly

Background The treatment of refractory elderly Meniere’s disease is a challenge. Aim To investigate the efficacy of tympanostomy tube placement in elderly patients with Meniere’s disease. Methods 31 patients over 60 years old with Meniere’s disease who had failed medical treatment and underwent tympanostomy tube placement. Vertigo control, hearing level, tinnitus, and ear fullness were recorded and analyzed preoperatively and postoperatively. Results All patients completed a 6-month follow-up. At 6 months postoperatively,complete control, substantial control and limited control of vertigo were achieved in 10 (32%), 13 (42%), and 6 (19%) patients respectively. Two patients (6%) reported no substantial improvement. Twelve patients completed a 2-year follow-up. At 2 years postoperatively, complete control, substantial control and limited control of vertigo were achieved in 3 (25%), 5 (42%), and 1 (8%) patients respectively. Three (25%) patients showed no significant improvement in vertigo. The majority of patients reported significant improvement in the functional level scale, the Dizziness Handicap Inventory scores, and ear fullness at 6 months and 2 years postoperatively. Conclusions and Significance Tympanostomy tube placement may reduce vertigo attacks and improved the quality of life in elderly patients with Meniere’s disease.

Impact of Concussions on Postural Stability Performance Using the Head Shake-Sensory Organization Test.

A concussion is a traumatic brain injury that can result in vestibular and oculomotor dysfunctions. The Head Shake-Sensory Organization Test was developed from the original Sensory Organization Test to measure a subject's ability to maintain balance while moving their head. The purpose of this study was to compare the performance of adults with no history of concussion to those with a history of concussion on the Head Shake-Sensory Organization Test to determine if long-standing balance deficits are present after concussion. Cross-sectional study. Subjects with a history of concussion and healthy normal controls completed the Dizziness Handicap Inventory, the Activities-Specific Balance Confidence Scale, the sensory organization test, the head shake SOT, and the Foam Head Shake-Sensory Organization test in a single testing session. Scores were analyzed for differences between the two groups. Twenty-five participants (nine patients with history of concussion and 16 healthy controls; mean age, 21.08±4.10 years) completed testing. The equilibrium scores in both groups significantly decreased with more complex tasks. Furthermore, the concussion group had significantly worse equilibrium scores than the control group during the Head Shake (p = 0.007) and Foam Head Shake-Sensory Organization Test (p = 0.002) tasks but not during the Sensory Organization Test task. Adding head shake and foam cushion conditions to postural stability tests improves sensitivity in detecting balance deficits in individuals with a concussion. 3.

Investigating health disparities in vestibular rehabilitation.

Health disparities (HD) impact care delivery and health outcomes in individuals with vestibular disorders (IVD). The purpose of this study is to identify whether health disparities (HD) exist in Vestibular Rehabilitation (VR) between individuals identifying as Caucasians or racial or ethnic minorities (REM). This study was a retrospective chart review of IVD who attended outpatient VR between 1/2014 and 9/2020. Data recorded included age, gender, race/ethnicity, vestibular diagnosis, VR interventions, and pre-post outcome measures such as Dizziness Handicap Inventory (DHI), and Activities-Specific Balance Confidence Scale (ABC), Gait speed (GS), and Functional Gait Assessment (FGA). Chi-squared tests, one-tailed, and two-tailed t-tests (α= 0.05) were utilized to compare Caucasian and REM groups. Three hundred and forty-three charts (N = 343) met inclusion/exclusion criteria. REM demonstrated higher median DHI scores (46 vs. 38, p = 0.008) and lower ABC scores (53.10% vs. 66.30%, p < 0.001) at VR evaluation compared to Caucasians. There were no statistically significant differences in DHI, ABC, FGA, and GS scores between Caucasians and REM at discharge. VR was able to equalize HD in DHI and ABC which initially existed between REM and Caucasians. VR therapists should work with public health and policy researchers to improve access to VR.

An Evaluation of the Vestibular System in Individuals Aged 40-65 Years with Sensorineural Hearing Loss.

Vestibular dysfunction occasionally accompanies sensorineural hearing loss (SNHL) due to anatomical proximity of cochlea and vestibule. The aim of the present study was to evaluate the vestibular system objectively and subjectively in 40-to 65-year-old individuals with and without SNHL. This study included participants of both sexes, between the ages of 40 and 65 years old. There were 31 participants with SNHL and 31 control participants. First of all, participants were grouped in the control and SNHL groups based on the results of their hearing test, which included audiometry and immitance evaluation. Subsequently, for vestibular evaluation, each participant was evaluated subjective with "Dizziness Handicap Inventory" (DHI) as well as with objective tests battery that included positional tests with videonystagmogrophy (VNG) and vestibuloocular reflex (VOR) assessment using the vestibular head impulse test (vHIT). Peripheral nystagmus was found to be significantly higher in patients with SNHL based on the head shake and positional tests (p<0.05). There was a positive correlation between DHI scores and positional test findings of the participants with SNHL (p<0.05). When the VHIT VOR gain values were compared between groups, there was no significant difference (p<0.05). In our study, vestibular involvement was frequently observed in 40- to 65-year-old individuals with SNHL. Therefore, vestibular evaluation should be considered along with the assessment of hearing in individuals with SNHL who are over 40 years old.

Early vestibular rehabilitation training of peripheral acute vestibular syndrome-a systematic review and meta-analysis.

This study aimed to investigate the impact of early vestibular rehabilitation training combined with corticosteroids initiated within 2 weeks, compared with corticosteroid treatment, after the peripheral acute vestibular syndrome (pAVS) onset. PubMed, CINAHL, EMBASE, and SCOPUS. From inception to January 24, 2024. The International Prospective Register of Systematic Reviews approved this study (CRD42023422308). Five studies involving 235 patients were included in this systematic review and meta-analysis. The subjective outcome measure Dizziness Handicap Inventory (DHI) was pooled for a meta-analysis and was statistically significantly in favor of early vestibular rehabilitation training (early VRT) plus corticosteroids compared with corticosteroids alone: at one-month follow-up (p = 0.00) and 12 months follow-up (p = 0.01). DHI was a critical outcome for measuring the differences in effect of early VRT. The objective outcome measures of caloric lateralization, cervical vestibular-evoked myogenic potentials, and posturography were gathered for a narrative synthesis. This meta-analysis showed that early VRT in combination with corticosteroids was more effective for treating pAVS than corticosteroid treatment alone. No adverse effects were reported for early VRT.

Brazilian Version of the Vestibular Activities and Participation Measure: Cross-Cultural Adaptation, Validity, and Reliability.

Vestibular Activities and Participation Measure (VAP) subscales assess the effect of vestibular disorders on activity and participation. This study aimed to perform the cross-cultural adaptation and assess the validity, internal consistency, reliability, and measurement error of the Brazilian version of VAP subscales. The cross-cultural adaptation followed the translation, synthesis, back-translation, review by a committee of experts, and pretesting phases. Structural validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), while Spearman's correlation between VAP subscales and the Dizziness Handicap Inventory (DHI) was used to assess construct validity. Cronbach's alpha measured internal consistency. Intraclass correlation coefficient (ICC) assessed intra- and inter-rater reliability, and measurement error was calculated by using the standard error of measurement (SEM) and minimal detectable change (MDC). Additional information was included in the Brazilian version of the Vestibular Activities and Participation measure (VAP-BR) after approval by one of the developers of the instrument to improve the understanding among individuals. One factor was found in the EFA for each subscale with 50% explained variance. Regarding CFA, the subscales 1 (S1) and 2 (S2) presented, respectively, adequate model fit indices (ie, comparative fit index of 0.99 and 0.97, and standardized root mean square residual of 0.04 for both subscales), but a very low factor load in item 6 of S1 (0.08). Chronbach's alpha was 0.80 (S1) and 0.82 (S2). For intra-rater assessment, the S1 and S2 presented an ICC of 0.87 and 0.90, SEM of 0.01 and 1.16, and MDC of 0.39 and 0.46, respectively. When assessed by 2 different raters, SEM values were 1.03 and 1.53, and MDC values were 2.85 and 4.23 for S1 and S2, respectively; both subscales showed an ICC of 0.92. Correlations between DHI and VAP subscales presented coefficients above 0.57. The Brazilian version of VAP subscales presents good measurement properties and may assist health professionals in identifying activity limitations and participation restrictions in individuals with vestibular disorders.

Triple semicircular canal occlusion with endolymphatic sac decompression for intractable Meniere's disease.

Meniere's disease (MD) is characterized by idiopathic endolymphatic hydrops (ELH). Frequent vertigo attacks is the most disabling symptom of MD. This study evaluated the efficacy of triple semicircular canal occlusion combined with endolymphatic sac decompression in the treatment of frequent vertigo in patients with MD. Eleven patients with complete medical records were included in this study conducted from May 2021 to April 2022. All patients were enrolled to undergo triple semicircular canal occlusion (TSCO) with endolymphatic sac decompression (ESD). Various tests including pure tone audiometry (PTA), vestibular evoked myogenic potentials (VEMPs), the video head impulse test (v-HIT), caloric test data, the Dizziness Handicap Inventory (DHI), the Berg Balance Scale (BBS), and the Tinnitus Handicap Inventory (THI) were performed both before and after the surgery. The successful control rate of vertigo was 100% (9/9) in the average 23-month postoperative follow-up period, with complete control rate of 88.89% (8/9) and substantial control rate of 11.11% (1/9). Triple semicircular canal occlusion combined with ESD may be an effective treatment option for managing frequent vertigo attacks in patients with MD. This combination therapy has the potential to become a significant addition to the treatment framework for MD.

Эффективность использования мобильного приложения в программе реабилитации пациентов с периферической вестибулярной дисфункцией

The evaluation of the efficiency of the application developed by the authors for a cell phone on the Android platform for the rehabilitation of patients with peripheral vestibular dysfunction is given. The description of the capabilities of the mobile application, methods of training oculomotor reactions, and methods of monitoring the effectiveness of exercises are presented. A comparison was made between a group of patients receiving rehabilitation using the traditional method and using a cell phone application. The effectiveness of rehabilitation was assessed using the DHI scale (Dizziness Handicap Inventory). In both groups, after the use of rehabilitation, there was a statistically significant decrease in the total scores on the DHI scale. There were no significant differences in DHI scores between the two groups of patients. Patients undergone rehabilitation using a mobile application showed greater commitment to treatment.

Ab. No. 15 Efficacy of ADL-Based Dynamic Postural Stability Exercises After Canalith Repositioning Maneuver in Benign Paroxysmal Positional Vertigo Patients

Introduction: CRP produces short-term effects, not sufficient to reactivate postural control in BPPV. Most studies prescribe balance training which is not well incorporated with ADL activities. Hence, this study aimed to find out the effectiveness of ADL-based dynamic postural stability exercises. Benign paroxysmal positional vertigo is a common peripheral vestibular disorder. Canalith repositioning manoeuvre is considered to be the gold standard method of treatment. Even after CRP 2/3rd of patients has postural instabilities, especially in dynamic conditions such as walking, sitting to standing, and in performing daily activities, which was not given attention in studies and treatment programs. Methods: 100 BPPV patients (50 each in interventional and control group) aged between‹18–60 years, positive for Dix Hallpike test/supine roll test confirmed by an ENT specialist and treated with CRP by random sampling. All patients were evaluated by the Berg balance scale, POMA (gait scale), and Dizziness Handicap Inventory on the third day of CRP. The control group received CRP with conventional balance training whereas the interventional group received ADL-based dynamic postural stability exercises (with more challenging environments involving various sensory inputs with postural strategies) along with CRP for 2 weeks. Data was analyzed using SPSS version 23; the Mann-Whitney U test (between group analysis) and Wilcoxon Signed Rank test (within group analysis) were used. Result: In the interventional group, there was greater improvement in balance in dynamic conditions, functional ability, and reduction in dizziness (p value‹0.05) in ADL activities. Conclusion: ADL-based exercises are beneficial for the improvement of balance, reduction in dizziness, and improving functional activities after CRP in BPPV patients. As this postural instability/residual dizziness has an impact on ADL in BPPV patients even after CRP, if untreated may lead to compensatory strategies that delay functional recovery. Hence, this instability period should be managed with ADL-based dynamic postural stability exercises.

Vestibulo-Ocular Reflex in the Aging Population.

The aim of this study was to evaluate vestibulo-ocular reflex (VOR) of individuals over 60 years of age who have not been diagnosed with a specific vestibular pathology. Bilateral six-semicircular canal video head impulse test (vHIT), Dizziness Handicap Inventory and European Evaluation of Vertigo scales were applied to participants. In total, 103 participants were included in the study (75 male, 28 female), and the mean age was 69.35 ± 7.41 years. The mean age of 7th decade group was 64.32±3.12 (59 participants; 38 male, 21 female), and the mean age of 8th decade and older group was 76.11±5.93 (44 participants; 37 male, 7 female). No significant differences were found between the VOR gains of the lateral or vertical semicircular canals between the 7th decade and 8th decade and older groups (p>0.05). In the 8th decade and older group, the presence of right lateral semicircular canal corrective saccade and left posterior semicircular canal corrective saccade showed a positively moderate correlation with VOR gains of the same semicircular canals (r=0.455, p=0.002, and r=0.518, p=0.001, respectively). No significant correlation was found between age and VOR gain in the 7th decade group, however, there was a negatively weak correlation between age and left lateral semicircular canal VOR gain (r=-0.366, p=0.017) in the 8th decade and older group. While assessing the age-related changes in VOR using vHIT, it must be considered that the changes related to aging of the vestibular system begin to emerge in the population over 70 years of age, and corrective saccade findings may be more informative than VOR gains in revealing these changes.

Zinc Deficiency: A Harbinger of Vestibular Dysfunction?

Background: Role of zinc in the maintenance of redox homeostasis have been explored &amp; is established to have antioxidant effects in the body. Presence of zinc in auditory system &amp; its role in deafness &amp; tinnitus is well established. Zinc supplementation has shown to not only improve tinnitus but also dizziness associated with it which marks the presence of zinc in vestibular system 4. The possible role of zinc in modulating neurotransmission across the glutaminergic synapses in vestibulo cerebellar, vestibulo-occular pathways are established. So, this study aims to assess serum zinc levels in vestibular disorder patients &amp; correlate with severity of the vestibular dysfunction Methodology: This was Cross sectional comparative study, 40 patients with vestibular disorders &amp; 40 subjects without vestibular dysfunction were included in the study. After thorough history taking, these patients were subjected to Dix Hallpike test, Head Impulse test Romberg test on foam with eyes closed /The Clinical Test of Sensory Interaction and Balance (CTSIB) to confirm vestibular dysfunction. After that, Dizziness handicap inventory (DHI) to assess the severity of the vestibular dysfunction. Serum zinc levels along with other, micronutrients like magnesium, calcium &amp; Serum vitamin B12 &amp; vitamin D were also assessed. Serum zinc levels were compared with age matched controls. Results: Out of 40 patients, 24 had mild &amp; 16 had moderate scores according to DHI. Serum zinc levels in study group was 60.63±10.10 which was significantly (p&lt;0.005) lower than compared control group 70.50±19.1. Also, Serum zinc levels were corelated with the severity of the vestibular dysfunction, (r=0.89, p&lt;0.00) which shows that more severe the dysfunction lesser the serum zinc levels. Conclusion: Role of zinc as an antioxidant is well established and deficiency of zinc is linked with the pathogenesis of various diseases. Since evidences suggest involvement of zinc in vestibular system, zinc supplementation in vestibular disorder patients can be considered as add on therapy, which might have a beneficial role with respect to cognitive function as well.