Paroxysmal Positional Vertigo Research Articles

Analysis of etiology and clinical features of spontaneous downbeat nystagmus: a retrospective study.

To investigate the topical diagnosis, possible etiology and mechanism of spontaneous downbeat nystagmus (sDBN) patients with dizziness/vertigo. The clinical features of dizziness/vertigo patients accompanied with DBN were retrospectively reviewed in the Vertigo Center of our hospital from January 2018 to March 2021. The clinical features of dizziness/vertigo patients accompanied with DBN were reviewed. Comprehensive VNG, bithermal caloric testing, video-head-impulse test (vHIT), vestibular-evoked myogenic potentials (VEMP), head magnetic resonance imaging (MRI), three-dimensional fluid-attenuated incersion recovery magnetic resonance imaging (3D-FLAIR MRI) in the inner ear, serum immunology and other examinations were to determine the lesion site, and analyze its possible etiology and mechanism. A total of 54 patients were included. Among them, 70.4% (n = 38) of DBN patients were diagnosed with episodic vestibular syndrome (EVS), 22.2% (n = 12) with chronic vestibular syndrome (CVS), and 7.4% (n = 4) with acute vestibular syndrome (AVS). Among all the patients, 51.9% of DBN patients had clear etiology, with central lesions of 29.6% and peripheral diseases of 22.2%. The most common diseases in DBN patients were cerebellar lesions (13.0%, n = 7) and vestibular migraine (13.0%, n = 7), followed by benign positional paroxysmal vertigo (7.4%, n = 4) and drug-related dizziness/vertigo (5.6%, n = 3). The other 48.1% of the patients had unknown etiology. 53.8% (14/26) of patients with idiopathic DBN had decreased semicircular canal function, with 42.9% (6/14) decreased posterior semicircular canal function. The posterior semicircular canal gain in DBN patients decreased compared to the anterior semicircular canal in the same conjugate plane. Patients with peripheral DBN were more prone to horizontal/torsional nystagmus during positional testing. In our study, DBN patients have a relative decrease in posterior semicircular canal gain, which is possibly a particular result found in a subset of downbeat nystagmus patients. The changes in nystagmus during positional testing may be helpful in distinguishing between peripheral and central causes.

Preceding Benign Paroxysmal Positional Vertigo as a Trigger for Persistent Postural-Perceptual Dizziness: Which Clinical Predictors?

Persistent postural-perceptual dizziness (PPPD) is a syndrome described as secondary, when it is the consequence of an organic disorder (s-PPPD), or primary, when no somatic triggers can be identified. We evaluated a group of patients diagnosed as s-PPPD, with Benign Positional Paroxysmal Vertigo (BPPV) as the main somatic trigger, with the aim of identifying the predictive clinical elements of evolution towards PPPD. Retrospective case review. Tertiary referral center. We evaluated 126 patients diagnosed with PPPD; 54 patients were classified as p-PPPD (43%) and 72 as s-PPPD (57%). Of these, 51 patients had BPPV as a somatic trigger of PPPD, and in this group, we evaluated the prevalence of some clinical features (age, sex, latency between the onset of BPPV and the final diagnosis, recurrence of BPPV and the presence of migraine headache) for comparison with a group of patients who suffered from BPPV without an evolution towards PPPD (control group). In the group with PPPD secondary to BPPV, we found a significantly higher mean age and a longer latency between the onset of BPPV and the final diagnosis compared to the control group. No difference between the two groups was found regarding sex, recurrence rate and the presence of migraine headache. The parameters most involved as potential precipitants of PPPD after BPPV were the age of the patients and a long latency between the onset of BPPV and the final diagnosis; the mean age of the subjects who developed PPPD following BPPV was significantly higher. These findings lead us to emphasize the importance of the early identification and treatment of BPPV, especially in older patients.

Abnormal Rhomboid Lip and Choroid Plexus Should be Valued in Microvascular Decompression for Vestibulocochlear Diseases

Surgical outcomes for functional vestibulocochlear diseases vary, and the influencing factors are not fully understood. The role of a rhomboid lip (RL) and choroid plexus (CP) in microvascular decompression (MVD) of the vestibulocochlear nerve has not been studied. This study aims to evaluate the surgical efficacy of MVD for vestibulocochlear diseases, with and without addressing the RL and CP, to enhance our understanding of their etiology. A total of 15 patients who underwent MVD for the vestibulocochlear nerve between 2013 and 2022 were retrospectively identified and followed up. The patients were classified into 4 categories: vestibular paroxysmia (VP), benign positional paroxysmal vertigo (BPPV), and Meniere disease (MD). The fourth was a "tinnitus" group. The relief of symptoms, recurrence, satisfaction after surgery, available relevant imaging studies, and intraoperative observation data were evaluated. Following MVD, 6 of the 7 patients in the VP group, the 1 patient in the BPPV group, and 1 of 2 patients in the MD group were completely relieved of vertigo. The seventh VP patient showed significant improvement. The 5 patients in the "tinnitus" group remained unchanged. Retrospectively, 4 patients from the VP, BPPV, and MD groups who underwent RL incision and CP excision were also free of vertigo, although vascular compression was not confirmed in these cases. MVD is generally considered a useful treatment for VP and could also be effective in managing recurrent vertigo caused by BPPV and MD. Our results highlight the potential role of an abnormal RL and CP in the development of vertigo symptoms. Patients presenting with "tinnitus" require further investigation and might not be suitable for MVD.

Awareness and attitude of ENT surgeons towards various dental implants or oral surgery procedures: a cross-sectional survey in the UK.

To assess the level of awareness and attitude of ENT surgeons towards dental implants and oral surgery procedures that involve the maxillary sinus. A cross-sectional survey was conducted using a closed-ended questionnaire on 40 UK-based ENT surgeons. Within the study population, 45 per cent of ENT surgeons were not aware of sinus lift augmentation in implant dentistry. Only 25 per cent of respondents were aware of the two subtypes of sinus lift techniques. Thirty per cent of the respondents were aware of or had heard of benign positional paroxysmal vertigo following dental treatment. Fifty-two per cent of respondents came across a dental foreign body, most commonly a tooth that had been displaced into the maxillary sinus. It was also reported that 82.5 per cent of respondents had liaised with an oral surgeon for an oroantral communication problem or a dental infection. Dental awareness among ENT surgeons needs to be raised for optimum interdisciplinary communication and patient safety.

Role of Vestibular Suppressants (B. Histine, Cinnarizine, Meclizine) after Successful Epley’s Maneuvers in Benign Paroxysmal Positional Vertigo

Background: Benign positional paroxysmal vertigo (BPPV) is one of the most prevalent causes of dizziness, affecting between 11 and 64 people per 100,000 each year and 2.4% of the population overall. Vestibular suppressants have been shown in recent studies to be effective in reducing residual symptoms after a successful Epley’s maneuvers, however to the best of our knowledge, very few research have analyzed the features of residual symptoms in BPPV patients following Epley’s maneuvers. There has been no definitive research on what causes symptoms duration, canal involvement, cumulative successful ratee, residual symptoms and dysregulation are among possibilities put up to explain the phenomenon. Objective: This research focused on role of vestibular suppressants including B.histine, cinnarizine, and meclizine after successful Epley’s maneuvers in benign paroxysmal positional vertigo Study Design: Cross-sectional study Study Setting: The study was conducted at department of ENT CMH, Multan from 01 January 2022 to 30th October 2022. Methodology: Total 135 patients were divided into two groups. In group A 60 patients were taking vestibular suppressants and in group B 75 patients were not taking any drugs, both groups had successful Epley’s maneuvers in benign paroxysmal positional vertigo Patients were considered for inclusion if they had idiopathic BPPV. A single doctor made the BPPV diagnosis after examining a patient's history and doing a hall pike test. The patients' symptoms duration, canal, cumulative success rate and residual symptoms were measured immediately after treatment, and two weeks. The statistical analysis was done by using SPSS version 20. Results: In group A out of which 24 were taking B.histine, 26 were taking cinnarizine, and 25 were taking meclizine as vestibular suppressants. In group B, 75 participants after successful Epley’s maneuver were not taking any vestibular suppressants. In this study there is 29 males and 31 females in group A and 37 males and 38 females in group B. Interestingly, the success rate with one treatment cycle was higher in the group A (p = 0.001). Further analysis of outcomes showed the residual symptoms in patients with a short (≤4 days) symptom duration revealed a correlation with the successful Epley’s maneuver in group A. Practical Implication: Vestibular suppressants have been standard practice in most hospitals for the treatment of severe vertigo for decades. Vertigo caused by vestibular imbalance can be treated with vestibular suppressants. When Epley's Maneuvers have been performed successfully in patients with BPPV, the efficacy of Vestibular Suppressants (B.Histine, Cinnarizine, Meclizine) has not been conclusively established. So, their role must be studied. Conclusion: Finally, we found that patients who used anti-vestibular suppression medication following an Epley's technique for treating and controlling BPPV symptoms fared better than those who did not. We advise the Epley method for BPPV therapy with the maintenance of suppressants for the better management. Keywords: B.histine, cinnarizine, meclizine, Epley’s maneuvers, paroxysmal positional virtigo

Altered visual conscious awareness in patients with vestibular dysfunctions; a cross-sectional observation study

BackgroundPatients with vestibular dysfunctions often experience visual-induced symptoms. Here we asked whether such visual dependence can be related to alterations in visual conscious awareness in these patients. MethodsTo measure visual conscious awareness, we used the effect of motion-induced blindness (MIB,) in which the perceptual awareness of the visual stimulus alternates despite its unchanged physical characteristics. In this phenomenon, a salient visual target spontaneously disappears and subsequently reappears from visual perception when presented against a moving visual background. The number of perceptual switches during the experience of the MIB stimulus was measured for 120 s in 15 healthy controls, 15 patients with vestibular migraine, 15 patients with benign positional paroxysmal vertigo (BPPV) and 15 with migraine without vestibular symptoms. ResultsPatients with vestibular dysfunctions (i.e., both vestibular migraine and BPPV) exhibited increased perceptual fluctuations during MIB compared to healthy controls and migraine patients without vertigo. In VM patients, those with more severe symptoms exhibited higher fluctuations of visual awareness (i.e., positive correlation), whereas, in BPPV patients, those with more severe symptoms had lower fluctuations of visual awareness (i.e., negative correlation). ImplicationsTaken together, these findings show that fluctuations of visual awareness are linked to the severity of visual-induced symptoms in patients with vestibular dysfunctions, and distinct pathophysiological mechanisms may mediate visual vertigo in peripheral versus central vestibular dysfunctions.

The Impact of the Angular Head Movement’s Velocity during Diagnostic Maneuvers on Proper Benign Positional Paroxysmal Vertigo Diagnosis and Therapy

Based on the current state of the BPPV field, there are no guidelines that specify an angular head movement's velocity (AHMV) during diagnostic maneuvers of BPPV. The aim of this study was to evaluate the impact of AHMV during diagnostic maneuvers on proper BPPV diagnosis and therapy. The analysis covered the results obtained in 91 patients with a positive result of the Dix-Hallpike (D-H) maneuver or the roll test. The patients were divided into four groups based on values of AHMV (high 100-200°/s and low 40-70°/s) and the BPPV type (posterior: PC-BPPV or horizontal: HC-BPPV). The parameters of the obtained nystagmuses were analyzed and compared to AHMV. There was a significant negative correlation between AHMV and latency of nystagmus in all study groups. Furthermore, there was a significant positive correlation between AHMV and both maximum slow phase velocity and average frequency of nystagmus in the PC-BPPV groups, whereas it was not observed in the HC-BPPV patients. Complete relief of symptoms was reported after 2 weeks and was better in patients diagnosed with maneuvers performed with high AHMV. High AHMV during the D-H maneuver allows the nystagmus to be more visible, increasing the sensitivity of diagnostic tests and is crucial for a proper diagnosis and therapy.

ПОД МАСКОЙ ПЕРИФЕРИЧЕСКОГО ВЕСТИБУЛЯРНОГО СИНДРОМА

The article highlights the problem of differential diagnosis of peripheral vestibular syndrome, which hides such pathological processes as benign positional paroxysmal vertigo, vestibular neuronitis, Meniere's disease. The lack of specification in the diagnosis in this category of patients leads to erroneous diagnosis, inadequate treatment, an increase in the duration of disability and the occurrence of anxiety and depressive disorders. The article presents the differential diagnosis of peripheral vestibular syndrome, examples of therapeutic maneuvers and cases from practice. For effective diagnosis and treatment, it is necessary to take into account the clinical signs of the onset and manifestations of peripheral vestibular disorders, pay special attention to the questioning and detailed description of the patient's complaints, conduct special positional tests and consult with specialized specialists.

Head shaking does not alter vestibulo ocular reflex gain in vestibular migraine.

Vestibular Migraine (VM) is the most common cause of non-positional episodic vestibular symptoms. Patients with VM commonly report increased motion sensitivity, suggesting that vestibular responses to head movement may identify changes specific to VM patients. Here we explore whether the vestibulo-ocular reflex (VOR) gain alters in response to a clinical “headshake” maneuver in patients with VM. Thirty patients with VM in the inter-ictal phase, 16 patients with Benign Positional Paroxysmal Vertigo (BPPV) and 15 healthy controls were recruited. Patients responded to the question “Do you feel sick reading in the passenger seat of a car?” and completed a validated motion sickness questionnaire as a measure of motion sensitivity. Lateral canal vHIT testing was performed before and after headshaking; the change in VOR gain was calculated as the primary outcome. Baseline VOR gain was within normal limits across all participants. There was no significant change in VOR gain after headshaking in any group (p = 0.264). Patients were 4.3 times more likely to be in the VM group than in the BPPV group if they reported nausea when reading in the passenger seat of a car. We postulate that a headshake stimulus may be insufficient to disrupt cortical interactions and induce a change in VOR gain. Alternatively, changes in VOR gain may only be apparent in the acute phase of VM. Reading in the passenger seat of a car was considered uncomfortable in all VM patients suggesting that this specific question may be useful for the diagnosis of VM.

Treatment of benign positional paroxysmal vertigo in clinical settings in India: a cross sectional pilot survey

Background: The usage pattern and effectiveness of various treatment strategies for benign positional paroxysmal vertigo (BPPV) have not been widely reported in routine clinical settings in India. The aim of the study was to understand treatment patterns and level of symptom improvement in Indian patients presenting with symptoms of BPPV in clinical practice.Methods: A cross-sectional pan-India survey was conducted with leading neurologists and otolaryngologists. A detailed questionnaire was shared with specialists which was followed by semi-structured telephonic interviews to gather a deeper understanding of their treatment practices. The obtained data was analyzed using appropriate statistical methods.Results: A total of 5 neurologists and 8 ENT specialists completed the survey. Physicians reported that age, but not gender, was an important factor when selecting appropriate treatment. Specialists reported that in their clinical practice symptom improvement is better with betahistine plus maneuvers compared to betahistine only alone (97% verses 90% cure rate) and is comparable with maneuvers (97% verses 98% cure rate, respectively). Dix Hallpike and supine roll test using videonystagmography were the most recommended tests used to diagnose BPPV. Betahistine plus maneuvers was the most commonly prescribed treatment for BPPV, and clinicians observed greater decrease in the severity of BPPV symptoms with betahistine plus maneuvers versus betahistine alone or maneuvers. The Visual analog scale (VAS) was the most widely used scale for assessing severity of BPPV symptoms.Conclusions: These findings indicate that betahistine plus maneuvers provides better control over symptom severity in patients with BPPV.

Prevalence of anxiety and depression in Meniere's disease; a comparative analytical study

BackgroundPsychological problems are of most significant issues in patients with Meniere's disease (MD). This study aimed to reveal the frequency of anxiety and depression in MD patients compared to healthy individuals and patients with benign positional paroxysmal vertigo (BPPV) referred to a university hospital. MethodsThis case-control study was conducted on individuals between 18 and 65 years old assigned to three groups: the control, MD, and BPPV groups. The data collecting instruments included a demographic information form, along with Beck Anxiety Inventory (BAI) and Beck Depression Inventory-II (BDI-II) questionnaires. Data were analyzed using SPSS software v.23, and the significance level was considered as p < 0.05. ResultsA total of 177 participants enrolled. The average scores of anxiety and depression and the severity of anxiety and depression were higher in MD and BPPV groups than in the control group (P < 0.001). The average anxiety score and anxiety severity in the MD group was higher than in the BPPV group (P < 0.001). However, in the case of depression, only severity was higher in the MD group (P < 0.001), and the average depression score showed no significant difference between MD and BPPV groups. After controlling for underlying variables, the impacts of MD (P < 0.001; regression coefficient = 16.5) and also BPPV (P = 0.025; regression coefficient = 4.6) on anxiety were significant compared to the control group. ConclusionOur results suggest that the prevalence of anxiety and depression is higher in MD and BPPV patients than the healthy people, and MD has a higher effect on the incidence of depression and anxiety compared to BPPV.

A balancing act: changing the referral pathway following remote consultations for dizziness during the coronavirus disease 2019 pandemic.

This paper reports our experience in managing dizzy patients remotely during the coronavirus disease 2019 pandemic, and explored its safety as an alternative to face-to-face consultations. Dizzy patients referred by their general practitioner were contacted to answer a validated questionnaire. Clinicians recorded the time needed for consultations, and the diagnosis at each of the following assessment stages: after review of the electronic general practitioner letter; following completion of the questionnaire; following the telephone consultation; and/or at follow up. Patients were telephoned no earlier than three months later to determine satisfaction with the service and symptom resolution. Electronic patient records were checked for presentation to hospital because of dizziness. Seventy patients had telephone consultations. None presented to the emergency department or were admitted. The majority of consultations took 15-30 minutes. The most diagnosed condition was benign positional paroxysmal vertigo. Seventy-nine per cent of patients were satisfied with the service. The questionnaire and telephone consultations demonstrated the greatest diagnosis agreement (κ = 0.40). Validated questionnaire and telephone consultations are a safe alternative to face-to-face consultations. Our patient referral pathway has now changed to include elements of the questionnaire.

Vestibular rehabilitation in patients with vestibular peripheral vertigo

Objective:To evaluate the efficacy of vestibular rehabilitation in patients with anterior peripheral vertigo and analyze its influencing factors. Methods:From January 2018 to June 2021, 153 cases with peripheral vertigo diseases（including 47 cases of benign positional paroxysmal vertigo, 38 cases of Meniere's disease, 26 cases of sudden deafness with vertigo, 23 cases of vestibular migraine and 19 cases of vestibular neuritis） were enrolled. One hundred and three cases were treated with vestibular rehabilitation combined with drugs, and 50 cases only treated with drugs were used as controls. Self-rating scale and vertigo disorder scale were evaluated at the beginning of treatment, 4 weeks and 8 weeks, respectively. The curative effects of the two groups were tested by t-test, and the independent risk factors affecting the curative effects were analyzed by multiple linear regression. Results:There was no difference in clinical data, self-assessment scale and vertigo disorder scale between the two groups（P>0.05）. At 4 and 8 weeks, the scores of self-assessment scale and vertigo disorder scale in the experimental group were better than those in the control group（all P<0.01）, and the curative effect at 8 weeks was better than that at 4 weeks, especially the decrease of emotional score during walking and the proportion of severe vertigo disability（all P<0.01）. The scores of self-rating scale and vertigo disorder scale of the cases with benign positional paroxysmal vertigo and vestibular neuritis were better than Meniere's disease, vestibular migraine and sudden deafness with vertigo（P<0.05）. Headache（P<0.05） and severe vertigo disorder before intervention（P<0.01） were independent risk factors affecting the efficacy of vestibular rehabilitation. Conclusion:Vestibular rehabilitation combined with anti-vertigo drugs in the treatment of vestibular peripheral vertigo is better than that of only using drugs, especially in improving the degree of emotional disorder and vertigo disability. It is more suitable for benign positional paroxysmal vertigo and vestibular neuritis, while the effect of combined headache or severe vertigo is relatively poor.

One Head Trauma, Three ENT Manifestations

It is well known that head trauma (HT) can cause hypoacusis; as well as benign positional paroxysmal vertigo (BPPV) and anosmia, which are frequently referred as sequelae of HY. However, the post-HT triad of BPPV, hypoacusis and anosmia is extremely rare to occur in the same patient, with only two cases reported in the literature.

Benign Paroxysmal Postural Vertigo (BPPV): A Review

Background: Benign paroxysmal postural vertigo is considered as the most frequent cause of vertigo worldwide because of which various times patient suffers the most dreaded complication which is not just because of vertigo but is due to the loss of balance during activities (such as driving and crossing the road,even while climbing up the stairs) and which is often misdiagnosed as a neurologic condition which further worsen the prognosis. This can be avoided by a simple OPD based manoeuver (series of movements) as a diagnostic procedure in most cases. Once diagnosed another series of movements (manoeuver) can be performed to afford symptomatic relief.&#x0D; Objective: To create a complete systematic review of the prevalent reason of dizziness i.e. benign paroxysmal postural vertigo (BPPV) along with its historic background, diagnostic modality (associated with various manoeuvers ). Also, alternative methods of management considering their success rate and prognosis associated with precautions and primary measures (I.e prevention or decrease of risk factors, precautions and even to educate the patient about the disease.&#x0D; Methodology: This article is reviewed from data taken from various articles found on various search engines like Google Scholars , PubMed , Research Gate along with the data taken from various books on he respective topics. Also, the data searched from various search engines using the terms like BPPV, Vertigo, VOR, Dix - Hallpike Maneuver, Posterior Semicircular Canal, Superior Semicircular Canal.&#x0D; Conclusion : BPPV is a simple disorder that can be misdiagnosed if the history is not taken properly or examination is not done correctly, it can severely affect the patients day to day activity and can be a very problematic condition if the attack is precipitated while activities like driving or crossing the road, or even climbing,which can lead to dreaded complications. Henceforth it is a great topic of concern to resolve this disease which can be usually resolved by a simple OPD based management and can bring a great difference in the patient’s life for GOOD.

A Nursing Care Experience of a Patient with an Empty Sella Syndrome Presenting Repetitive Vertigo, Tinnitus and Post-Operative Rhinorrhea

&lt;p&gt;本案例為一名56歲女性因反覆眩暈及耳鳴，經檢查後初步診斷為良性陣發性姿勢性眩暈（Benign Paroxysmal Positional Vertigo, BPPV），接受右耳耳石復位術（Canalith Reposition Procedure），然而，隨著病程進展，接續出現關鍵性的前額眉心處的頭痛及視力模糊的症狀，藉由詳細地病史詢問、身體評估、及相關的檢驗及影像檢查，採用排除及納入相關診斷的鑑別過程，最後確診為蝶鞍空洞症，在詳細地病情解釋後，病人接受經鼻腔內視鏡蝶竇蝶鞍減壓併自體脂肪填充及鼻中隔皮瓣重建手術。不幸地，術後產生腦脊髓液鼻漏的併發症，在及時地重新評估、鑑別診斷及處置，有效的控制併發症避免神經功能惡化，最後病人順利出院，因此引發筆者撰寫動機，期望分享此病例照護經驗，提醒同仁臨床照護病人時需要時刻保持警覺，確保病人回復健康。&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;&lt;p&gt;The case in this study is a 56-year-old woman who was initially diagnosed with benign paroxysmal postural dizziness because of repeated vertigo and tinnitus after serial examinations. She underwent reduction of otolith of right ear (Canalith Reposition Procedure). However, her symptoms remained and subsequent symptoms of frontal headache and blurred vision occurred. Although symptoms such as vertigo, tinnitus, and headache are common in Meniere&amp;rsquo;s disease, benign paroxysmal postural vertigo (BPPV), cerebral infarction, etc. eventually we revised the diagnosis to the Empty Sella Syndrome through detailed inquiry of medical history, physical assessment, and image examinations.After well-addressed explanation of the clinical condition, the patient received endoscopic transnasal transsphenoidal approach and packing sella with autologous fat, reconstruction by cartilage and nasal septal flap. Unfortunately, the sequel of cerebrospinal fluid rhinorrhea occurred after the operation. By promptly reassessment, differential diagnosis with proper treatment, the complication was effectively controlled to avoid neurological deterioration, and the patient was discharged without further complication. I sincerely share the experience of this specific case with my colleagues. Keeping vigilant in clinical care of patients to ensure they could return to health.&lt;/p&gt; &lt;p&gt;&amp;nbsp;&lt;/p&gt;

Dizziness and physical health are associated with pain in dizzy patients-A cross-sectional study.

Associations between dizziness, health-related quality of life, and musculoskeletal pain have not been systematically explored in patients with vestibular disorders. Such knowledge may be important for choice of treatments. The study objectives were to examine the extent and localization of musculoskeletal pain and explore whether pain was associated with dizziness and health-related quality of life. The cross-sectional study investigated anonymized data from an earlier survey on patients with long-lasting dizziness (>3months) examined in an oto-rhino-laryngological department. The sample includes patient between 18 and 70years with Ménière's disease, vestibular schwannoma, benign positional paroxysmal vertigo, vestibular neuritis, non-otogenic dizziness, and cervicogenic dizziness. General musculoskeletal, that is, pain in muscles, tendons, and joints was registered by a yes/no question. A pain drawing registered localization of pain. Multiple binary logistic regression models were used to determine the association between pain and vertigo-balance and autonomic-anxiety related dizziness by the short Vertigo Symptom Scale (VSS) and sub-scales (VSS-V, VSS-A), and between pain and health-related quality of life by the SF-36, mental and physical component summary scale (SF-36 MCS, SF-36 PCS). The sample consisted of 503 patients, 60.2% were women, the median age was 50years. General musculoskeletal pain was reported by 72.8% of patients, neck pain by 59.2% and widespread pain by 21.9%. Multiple binary logistic regression models demonstrated that all the pain measures were significantly associated with VSS-V and VSS-A and SF-36 PCS, but not SF-36 MCS. Musculoskeletal pain is prevalent in patients with long-lasting dizziness. The strong associations between pain, VSS, and SF-36 PCS could result in a self-sustaining complex condition. The findings imply that in addition to assessing and treating the vestibular symptoms, musculoskeletal symptoms and physical health should be addressed.

Influence of Fluid Effect on Virtual Simulation of Otolith Movement

More and more physics engines are used to simulate the dynamics between two rigid bodies. However, it is still unknown whether physics engine is suitable for computing the physical information of objects with fluid effect, such as the trajectory and collision dynamics of otolith in semicircular canal in benign paroxysmal postural vertigo (BPPV). The purpose of this study is to determine whether the fluid effect in Bullet physics engine has an impact on the movement data of otoliths in semicircular canal. Based on the experimental data obtained previously, we discuss the position and trajectory of the otolith when it falls in the Dix-Hallpike test. Root Mean Square Error (RMSE) is used to evaluate the static position of otolith under two conditions, and the RMSE is 0.716. We found that the initial position of otolith is affected by fluid effects, but the final static position and trajectory of otolith is similar (x=-5.838±0.294, y=19.348±0.143, z=-9.540±0.635). The experimental results show that the fluid effect does not affect the experimental results of the Dix-Hallpike test, and it has sufficient applicability for the evaluation of BPPV diagnostic methods.

Persistent postural perceptual dizziness following paroxysmal positional vertigo in migraine.

SUMMARYObjectiveThis prospective study aimed to investigate the role of migraine in favouring the onset of persistent postural perceptual dizziness (PPPD) following paroxysmal positional vertigo (PPV).MethodsA group of patients who came to our attention suffering of PPV with or without migraine and/or vestibular migraine (VM) was examined. Three months after the resolution, an anamnestic research was conducted aimed at establishing whether any patient-related dizziness could meet the diagnostic criteria for PPPD.Results12 of the 240 patients recruited met the diagnostic criteria for PPPD for an overall incidence of 5%, with 3 (1.85%) belonging to the non-migraine group and 9 (11.5%) to the migraine group. In the latter, 6 (28.6%) patients with VM and 3 (5.26%) without VM were affected.ConclusionsThe study shows a significant increase of PPPD diagnosis in migraine compared to patients without migraine (p = 0.003). Within migraine there was a significant increase in those with VM compared to patients without VM (p = 0.0016). No difference emerged between patients without migraine and migraine patients without VM (p > 0.05). The presence of VM in patient’s history, but not migraine without VM, appears to significantly increase the incidence of PPPD in patients with PPV.

The assessment of fukuda stepping test results in prognosis of benign paroxysmal postural vertigo

IntroductionBenign paroxysmal postural vertigo originating from the peripheral vestibular system is characterized by brief vertigo spells triggered by the sudden head motion. Usually, vestibular dysfunction in benign paroxysmal postural vertigo is unilateral. Fukuda stepping test which is helpful in the diagnosis of unilateral vestibular dysfunction, may also be valuable in the prediction of prognosis of benign paroxysmal postural vertigo. ObjectiveThe purpose of this study is to evaluate the relevance of Fukuda stepping test results with resistant and/or recurrent benign paroxysmal postural vertigo cases. MethodsWe evaluated 62 patients with unilateral, idiopathic benign paroxysmal postural vertigo of posterior and/or lateral canals. The Fukuda stepping test was performed prior to the Dix-Hallpike and head-roll tests. Two groups were created according to the Fukuda stepping test results. In Group 1 Fukuda stepping test results were positive with a deviation angle >45°, while in Group 2 the results were negative with no apparent deviation. Two groups were compared by the number of canalith repositioning manuevers performed and the frequency of recurrences. ResultsWe found Fukuda stepping test to be invaluable in the diagnosis of benign paroxysmal postural vertigo since the ratio of Fukuda stepping test positivity and negativity were similar in benign paroxysmal postural vertigo patients. However, the need for multiple canalith repositioning manuevers was significantly higher in Group 1 (p = 0.0103). In addition, the recurrence frequency was found significantly lower in the Group 2 (p = 0.0441). ConclusionAlthough the sensitivity of Fukuda stepping test in detecting mild/moderate unilateral vestibular dysfunction is poor, it may be valuable in prediction of the prognosis of benign paroxysmal postural vertigo. We suggest that positive Fukuda stepping test results in benign paroxysmal postural vertigo patients indicate poor prognosis, the need for multipl canalith repositioning manuevers and the higher possibility of recurrences.