Management Of Vestibular Disorders Research Articles

Proceedings of the GDR Vertige 2019 annual meeting devoted to endolymphatic hydrops.

The GDR Vertige is a federative research group gathering the different components of the French neuro-otology community. The annual meeting of the GDR Vertige is an opportunity for interactive exchanges between scientists, clinicians and industrialists, on basic issues related to vestibular function, as well as translational questions regarding the management of vestibular disorders. For its fifth edition, the annual meeting of the GDR Vertige, which took place in September 2019 in Marseille (France), was devoted to one of the most peculiar phenomena of neuro-otology: endolymphatic hydrops. For two days, international scientists and clinicians presented the most recent advances regarding the biophysical correlates of endolymphatic hydrops, the genetic and endocrine tableaux that favor its manifestation, new methods of clinical imaging, and current and upcoming therapeutic strategies to overcome the associated clinical manifestations. This special issue of the Journal of Vestibular Research aims at providing the proceedings of this meeting.

Practice Patterns of Audiologists Involved in Assessment and Management of Vestibular Disorders: An Indian Cross-Sectional Survey.

As the incidence of vestibular disorders continues to rise, the role of the audiologists in assessing and providing effective intervention has become increasingly important. To date, there have been no studies investigating the practice patterns of Indian audiologists towards the assessment and management of vestibular disorders. An electronic survey consisting of 29 questions across demographics, vestibular assessment, and management emailed to 704 members of the Indian Speech and Hearing Association (ISHA). Additionally, the questionnaire was circulated to audiologists through social media groups. The participants were provided with a two weeks' time limit for completing the survey. 704 participants were contacted to take part in the survey, and only 243 responses were received resulting in a 34.66 % response rate. Among the 243 participants who responded, 127 participants were currently not involved in the assessment and/or management of vestibular disorders in India. The responses were analyzed descriptively according to each section of the questionnaire. The study also sheds light on vestibular assessment, rehabilitation trends, and perceived barriers/facilitators among Indian audiologists. We observed major discrepancies between practice patterns of audiologists in India. Like any other developing nation, India has challenges of its own. Proper planning in terms of resource allocation is needed to address the barriers in access to instrumentation, and limited workforce.

Artificial Intelligence Applications in Otology: A State of the Art Review.

Recent advances in artificial intelligence (AI) are driving innovative new health care solutions. We aim to review the state of the art of AI in otology and provide a discussion of work underway, current limitations, and future directions. Two comprehensive databases, MEDLINE and EMBASE, were mined using a directed search strategy to identify all articles that applied AI to otology. An initial abstract and title screening was completed. Exclusion criteria included nonavailable abstract and full text, language, and nonrelevance. References of included studies and relevant review articles were cross-checked to identify additional studies. The database search identified 1374 articles. Abstract and title screening resulted in full-text retrieval of 96 articles. A total of N = 38 articles were retained. Applications of AI technologies involved the optimization of hearing aid technology (n = 5; 13% of all articles), speech enhancement technologies (n = 4; 11%), diagnosis and management of vestibular disorders (n = 11; 29%), prediction of sensorineural hearing loss outcomes (n = 9; 24%), interpretation of automatic brainstem responses (n = 5; 13%), and imaging modalities and image-processing techniques (n = 4; 10%). Publication counts of the included articles from each decade demonstrated a marked increase in interest in AI in recent years. This review highlights several applications of AI that otologists and otolaryngologists alike should be aware of given the possibility of implementation in mainstream clinical practice. Although there remain significant ethical and regulatory challenges, AI powered systems offer great potential to shape how healthcare systems of the future operate and clinicians are key stakeholders in this process.

Vestibular assessment and management in adults: current practice by South African audiologists

Background: There is scarcity of research in vestibular assessment and management within the South African context.Methods: The current study explored the current practices of South African Audiologists in the assessment and management of vestibular disorders in adults. A survey research methodology with a cross-sectional research design was adopted. The current study made use of a 29 item web-based survey, and surveyed 32 audiologists from across the country on their practices around vestibular assessment and management in adults presenting with vestibular symptoms. Data were analyzed using descriptive statistics.Results: Current findings revealed that 53% of participants in the study were conducting vestibular assessments, even though 75% reported seeing patients presenting with vestibular symptoms in their practices. 34.4% of participants indicated using a core test battery adapted to the patient’s case history when assessing patients with vestibular disorders. The most common assessments performed were peripheral vestibular examinations and oculomotor tests. Furthermore, a majority (59.4%) of the participants do not have any high-tech equipment at their practice. Of the sample, 62.5% of the participants do not perform vestibular management. Of the individuals who do perform vestibular management, vestibular rehabilitation therapy and canalith repositioning maneuvers were the most common treatment procedures performed. The most commonly referred to professional is the Ear, Nose and Throat specialist, and 50% of participants make 0-5 referrals per week for patients with vestibular disorders. With regards to the facilitators and barriers to practice, 53% indicated that lack of vestibular equipment was the main barrier to practice, whereas 50% indicated that the main facilitator to practice was the fact that there were patients presenting with vestibular symptoms.Conclusion: Current findings raise implications about the provision of vestibular function services in both public and private sectors in South Africa. Implications for training and resource planning and allocation are highlighted.

Cinnarizine: A Contemporary Review.

Cinnarizine, is approved for nausea, vomiting, motion sickness, inner ear disorders and is considered as first-line pharmacotherapy for management of vertigo. It acts by anti-vasoconstrictor activity, reducing blood viscosity and reducing nystagmus in labyrinth. Lack of adequate literature on clinical evidence of cinnarizine and its combination (dimenhydrinate) in vertigo management prompted this review. A specific MEDLINE literature search strategy was designed combining Medical Subject Headings, free-text keywords (like cinnarizine and vertigo) using Boolean operators (1970-2016) for clinical studies, clinical reviews and meta-analyses of cinnarizine. Analyses of studies validated cinnarizine's efficacy in peripheral and central vertigo versus placebo or other therapies, and was well-tolerated by the patients recruited across different studies. Cinnarizineand/ or its combinations are favorable in management of vestibular disorders wherein cinnarizine acts predominantly peripherally on labyrinth and dimenhydrinate acts centrally on vestibular nuclei and associated centers in brainstem. Combination therapy of cinnarizineand/ or its combinations demonstrated a better safety profile than either of the mono-components, offering a viable therapeutic option in vertigo management.

Dizziness

<h2>Abstract</h2> Dizziness has many otological, neurological and medical causes, whereas the term ‘vertigo' is more specific and usually implies a vestibular disorder. Balance is maintained by sensory inputs from the visual, proprioceptive and vestibular systems. This information is integrated in the CNS and any mismatch between these sensory inputs can lead to vertigo. Dizziness from otological disorders often causes acute onset vertigo, whereas neurological causes often present with insidious imbalance. Common causes of dizziness include peripheral vestibular dysfunction, Benign positional paroxysmal vertigo, Ménière's syndrome and migraine. Clinical evaluation of dizziness should include otoscopy, tuning-fork tests, examination of eye movements, stance, gait and the Hallpike test. Investigations such as caloric testing and electro/videonystagmography help to confirm the presence of a lesion, lateralize it, and differentiate central from peripheral causes. After an acute vestibular insult, symptoms of dizziness get better by ‘compensation' that involves central mechanisms and substitution of sensory inputs. Acute vertigo is treated with vestibular sedatives, which should be tapered as soon as possible to allow vestibular compensation. Drug treatment is available for migraine-associated dizziness, Ménière's disease and central vestibular disorders causing oscillopsia. Dizziness from vestibular dysfunction can be effectively managed by vestibular rehabilitation exercises, either customized or generic (Cawthorne-Cooksey exercises). Recently, optokinetic stimulation has been used to promote compensation. Specific manoeuvres (Epley's) are very effective in benign positional paroxysmal vertigo. Management of vestibular disorders is now being consolidated in ‘one-stop' clinics that are piloted at various sites in the UK.

Prevalência das alterações metabólicas em pacientes portadores de queixas vestibulares

FORMA DE ESTUDO: Clínico prospectivo. MATERIAL E MÉTODO: Os autores avaliam a prevalência de alterações metabólicas em 325 pacientes que procuraram o Setor de Otoneurologia do Hospital das Clínicas da FMUSP com queixas vestibulares. Os pacientes foram consecutivamente atendidos entre janeiro de 1997 e janeiro de 2002. Foram avaliados os primeiros exames referentes ao protocolo clássico de investigação das tonturas, que compreende a dosagem de LDL colesterol, TSH, T3 e T4 e glicemia de jejum. As alterações encontradas foram então comparadas às observadas na população geral. As alterações mais significativas encontradas foram a elevação dos níveis de LDL colesterol, a presença de níveis alterados de hormônios tireoideanos e a maior freqüência do diabetes mellitus na população estudada. CONCLUSÃO: Conclui-se que é válida a investigação destes dados, visto que são mais freqüentes na população de risco e que a correta abordagem dessas alterações melhora o prognóstico e o controle da tontura.

Management of vestibular disorders.

Vertigo and dizziness are not disease entities but rather the outcome of many pathological or physiological processes. The prevailing good prognosis of vestibular disorders that manifest with vertigo must be emphasized. Most forms of vertigo have a benign cause and are characterized by spontaneous recovery of vestibular function or central compensation of a peripheral or central vestibular tone imbalance. Vertigo can be effectively relieved by pharmacological treatment (e.g., antiepileptic drugs for vestibular paroxysms), physical therapy (e.g., deliberate maneuvers for benign paroxysmal positioning vertigo), surgery (e.g., decompression of the eighth nerve), or psychotherapy (e.g., behavioral therapy for agoraphobia). There is, however, no common treatment, and vestibular suppressants provide only symptomatic relief of vertigo and nausea. A specific therapeutic approach thus requires recognition of the numerous particular pathomechanisms involved. Such therapy can include causative, symptomatic, or preventive approaches.

Evaluation and Management of Vestibular Disorders in Children

Educational objectives: To review the different causes of vestibular symptoms in children and to follow a proposed protocol to work up, diagnose, and treat.