Vertigo Symptom Scale-Short Form Research Articles

Psychometric Properties and Concurrent Validity of a 10-Item Questionnaire for Patients With Vestibular Disorders.

This study aimed to investigate the psychometric properties and concurrent validity of the Haukeland Dizziness Questionnaire (HDQ-10), a 10-item questionnaire designed for simplified assessment of symptom severity and emotional effects in patients with vestibular disorders. Cross-sectional study. Secondary referral hospital. Out of 238 consecutive patients examined for suspected vestibular disease at an otolaryngology clinic, 201 completed the questionnaire. The psychometric properties of the HDQ-10 were examined by exploratory factor analysis and analysis of internal consistency. Concurrent validity was determined in comparison with the Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale-Short Form (VSS-SF), and the Hospital Anxiety and Depression Scale. The factor analysis revealed 3 subscales of the questionnaire covering "function,""unsteadiness," and "emotion."The examination of the total scale (α = .866) and its subscales indicated satisfactory psychometric properties. The HDQ-10 correlated highly with both DHI (r = .732. P < .001) and VSS-SF (r = .720. P < .001) indicating good concurrent validity. The HDQ-10 is a 10-item questionnaire designed for simplified assessment of symptom severity and emotional effects in patients with vestibular disorders. It has satisfactory psychometric properties and good concurrent validity compared to existing dizziness questionnaires.

Dizziness-Related Disability One Year after a Mild-to-Moderate TBI-A Follow-Up Study.

Persisting dizziness and balance problems after mild-to-moderate traumatic brain injury (mmTBI) may result in considerable disability. The primary aim of this study was to explore the factors associated with dizziness-related disability one year post-injury. Data from 64 participants (mean age 39.4 [SD 13.0] years; 45 [70.3%] women) with mmTBI from a previous randomised controlled trial were analysed using simple and multiple regression analyses (Clinical Trials Registry #NCT01695577). The Dizziness Handicap Inventory one year (12.1, [SD1.6] months) post-injury was the dependent variable. Demographic and injury-related variables, clinical findings, and measures of post-injury symptoms and functioning (Rivermead Post-Concussion Symptoms Questionnaire, RPQ; Vertigo Symptom Scale-short form, VSS-SF; Hospital Anxiety and Depression Scale; Balance Error Scoring System; and High-Level Mobility Assessment Tool, HiMAT) at baseline (3.5 [SD 2.1] months post-injury) were the independent variables. Dizziness-related disability at one year was associated with pre-injury comorbidity, neck pain, higher RPQ, higher VSS-SF, and lower HiMAT scores (adjusted R2 = 0.370, F = 6.52 p < 0.001). In conclusion, the factors associated with dizziness-related disability one year post-injury, such as pre-injury comorbidity, neck pain, increased post-concussion symptom burden, increased dizziness symptom severity, and reduced balance and mobility, should be addressed early in the rehabilitation process to reduce patient burden.

Effectiveness of Epley-Canalith Repositioning Procedure versus Vestibular Rehabilitation Therapy in Diabetic Patients with Posterior Benign Paroxysmal Positional Vertigo: A Randomized Trial.

Benign paroxysmal positional vertigo (BPPV) is a common inner ear disorder, characterized by brief episodes of vertigo caused by changes in head position. The condition can cause significant functional impairment and reduced quality of life. BPPV is especially common among diabetic patients. The Epley-canalith repositioning procedure (CRP) and vestibular rehabilitation therapy (VRT) are two commonly used interventions for the treatment of BPPV. The objective of this study is to compare the effectiveness of Epley-canalith repositioning procedure (ECRP) and Vestibular Rehabilitation (VR) therapy in the management of vertigo among Type 2 Diabetes Mellitus patients. A total of 30 subjects with Type 2 diabetes mellitus, aged between 40 and 65 years, were randomly allocated to either the ECRP or VR therapy groups using a lottery method, and then underwent Epley-canalith repositioning procedure or vestibular rehabilitation therapy, respectively. The outcomes measured by the study were Vertigo Symptom Scale-Short Form (VSS-sf) score and Berg Balance Scale (BBS) score, assessed pre-treatment (pre) and 4 weeks post-treatment (post). The results demonstrated that both ECRP and VR therapy led to improvements in VSS-sf and BBS scores. However, VR therapy was found to be more effective, resulting in a 13.6% higher improvement in VSS-sf scores (p = 0.03) and a 5.1% higher improvement in BBS scores (p = 0.51) compared to ECRP. Both Epley-canalith repositioning procedure and vestibular rehabilitation therapy are effective in managing BPPV in diabetic patients. Although the differences in BBS scores are not statistically significant, VRT demonstrated a trend towards greater improvement. Vestibular rehabilitation therapy can be used by clinicians as another rehabilitation technique for improving vertigo, postural stability, and activity of daily living in diabetic patients with BPPV.

3D Virtual Reality Rehabilitation Therapy for Patients with Vertigo Due to Peripheral Vestibular Dysfunction.

This study aimed to evaluate 3D virtual reality rehabilitation therapy in patients with vertigo due to peripheral vestibular dysfunction. The subjects were 20 patients with peripheral vestibular dysfunction confirmed by Videonystagmography, Divided into 2 groups: Group 1 (study group) underwent vestibular rehabilitation therapy using 3D virtual reality in a customised VR lab with specific headset (Oculus rift and htc vive) with software application, which allows vestibular rehabilitation treatment using high quality immersive virtual reality console in which environment appears real and in 3D. The exercises are designed for gaze stability, increase postural stability, improve vertigo and daily activities, through sensory stimuli and in addition to conventional Cawthorne-Choksey exercises. Group 2 (control group) are treated by conventional Cawthorne-Choksey exercises alone. A VSS-SF (Vertigo Symptom Scale-short form) questionnaire and VAS (Visual Analog Scale) were used to assess the levels of patient satisfaction compared before and after each treatment session in both groups. A significant higher level of subjective satisfaction was observed in patients who underwent 3D virtual reality rehabilitation therapy with conventional therapy (group 1) compared to patients who underwent conventional cawthorne-Choksey exercises alone (group 2). The study gave a substantial subjective satisfaction in patients using 3D virtual reality rehabilitation therapy with conventional therapy (group1) than conventional Cawthorne-Choksey exercises alone (group 2). Future of VR rehabilitation therapy brings a revolutionary novelty in field of rehabilitation therapy were it involves real time stimulation and interaction between sensory, motor and cognitive channels.

Investigation of coronavirus anxiety, health anxiety, and anxiety symptom levels in vertigo patients during COVID-19 pandemic.

The COVID-19 pandemic adversely affects the mental health of vertigo patients. Thus, this study aimed to investigate the effects of coronavirus anxiety, health anxiety, anxiety symptom levels, and demographic variables on vertigo and its severity in vertigo patients during the pandemic. This cross-sectional study was conducted from May 15 to November 15, 2021. In total, 118 patients with vertigo and 82 healthy controls participated in the study. Besides demographic and clinical data, Coronavirus Anxiety Scale (CAS), Hospital Anxiety Depression Scale-Anxiety Subscale (HAD-A), and Short Health Anxiety Inventory (SHAI) were applied to all participants. Additionally, Vertigo Symptom Scale-Short Form (VSS-SF) was administered to vertigo patients. According to the findings, vertigo patients experienced higher levels of coronavirus anxiety, health anxiety, and anxiety disorder compared to the healthy controls. In vertigo patients, the rate of coronavirus anxiety was 20.3%, and the rate of anxiety disorder was 32.2%. Majority of the patients (80.5%) were found to have severe-level vertigo. Additionally, most of the patients (82.1%) reported that the severity of vertigo during the pandemic was higher than before the pandemic. The COVID-19 pandemic causes serious mental health problems in vertigo patients, and pathological levels of these problems increase the discomfort of vertigo. Therefore, psychological assessment should be considered in these patients, and required psychological support and guidance services should be provided.

Assessment of Quality of Life in Patients with Balance Disorders Using Vertigo Symptom Scale–Short Form and Dizziness Handicap Inventory

Background: Dizziness is a common complaint presenting in general practice of ears, nose, and throat (ENT). Vertigo constitutes approximately 54% of cases of dizziness. This study aims at evaluating balance disorders with the aid of Vertigo Symptom Scale and Dizziness Handicap Inventory (DHI) to assess the quality of life in patients. Materials and Methods: This cross-sectional study was carried out on subjects that presented with complaints of vertigo to the ENT indoor patient department and outpatient department at the Yenepoya Medical College Hospital in Mangalore. Patients with known case of head injury, cardiovascular disease, seizure, and cervical spondylosis were excluded from the study. The patients were assessed for Vertigo Symptom Scale- Short Form vertigo balance subscale score (VSS-sf-V), Vertigo Symptom Scale-Short form autonomic anxiety subscale score (VSS-sf-A)and DHI questionnaire. Data obtained were recorded into MS Excel work sheets, and statistical analysis was done using IBM SPSS version 23 program running on windows operating system. P &lt; 0.05 was considered statistically significant. Results: A total of 49 patients fulfilling the inclusion criteria were included, with a mean age of 44.16 ± 11.78 years, and among them, 25 were male and 24 were female patients. Diabetes was observed in 6.1% (n = 3), while 14.3% (n = 7) had diabetes and hypertension. Nearly 73.5% (n = 36) of the participants had no comorbidities. There was a significant association between complaints and DHI with P = 0.001. Whereas, there was no association between comorbidities and DHI with P = 0.334. Conclusion: The present study evaluated the participants based on Vertigo Symptom Scale–Short Form and DHI to assess the impact of vertigo on quality of life. The study showed a good utility of these questionnaires in assessing the quality of life.

Using Wearable Inertial Sensors to Assess Mobility of Patients With Hematologic Cancer and Associations With Chemotherapy-Related Symptoms Before Autologous Hematopoietic Stem Cell Transplant: Cross-sectional Study.

Wearable sensors could be a simple way to quantify and characterize mobility in patients with hematologic cancer scheduled to receive autologous hematopoietic stem cell transplant (autoHSCT) and how they may be related to common treatment-related symptoms and side effects of induction chemotherapy. We aimed to conduct a cross-sectional study comparing mobility in patients scheduled to receive autoHSCT with that in healthy, age-matched adult controls and determine the relationships between patient mobility and chemotherapy-related symptoms. Patients scheduled to receive autoHSCT (78/156, 50%) and controls (78/156, 50%) completed the prescribed performance tests using wearable inertial sensors to quantify mobility including turning (turn duration and number of steps), gait (gait speed, stride time, stride time variability, double support time, coronal trunk range of motion, heel strike angle, and distance traveled), and balance (coronal sway, coronal range, coronal velocity, coronal centroidal frequency, sagittal sway, sagittal range, sagittal velocity, and sagittal centroidal frequency). Patients completed the validated patient-reported questionnaires to assess symptoms common to chemotherapy: chemotherapy-induced peripheral neuropathy (Functional Assessment of Cancer Therapy/Gynecologic Oncology Group-Neurotoxicity subscale), nausea and pain (European Organization for Research and Treatment of Cancer Quality of Life Questionnaire), fatigue (Patient-Reported Outcomes Measurement Information System Fatigue Short Form 8a), vertigo (Vertigo Symptom Scale-short form), and depression (Center for Epidemiological Studies-Depression). Paired, 2-sided t tests were used to compare mobility between patients and controls. Stepwise multivariable linear regression models were used to evaluate associations between patient mobility and symptoms. Patients aged 60.3 (SD 10.3) years had significantly worse turning (turn duration; P<.001), gait (gait speed, stride time, stride time variability, double support time, heel strike angle, stride length, and distance traveled; all P<.001), and balance (coronal sway; P<.001, range; P<.001, velocity; P=.02, and frequency; P=.02; and sagittal range; P=.008) than controls. In patients, high nausea was associated with worse stride time variability (ß=.001; P=.005) and heel strike angle (ß=-.088; P=.02). Pain was associated with worse gait speed (ß=-.003; P=.003), stride time variability (ß=.012; P=.02), stride length (ß=-.002; P=.004), and distance traveled (ß=-.786; P=.005). Nausea and pain explained 17% to 33% and 14% to 36% of gait variance measured in patients, respectively. Patients scheduled to receive autoHSCT demonstrated worse mobility in multiple turning, gait, and balance domains compared with controls, potentially related in part to nausea and pain. Wearable inertial sensors used in the clinic setting could provide granular information about mobility before further treatment, which may in turn benefit from rehabilitation or symptom management. Future longitudinal studies are needed to better understand temporal changes in mobility and symptoms across the treatment trajectory to optimally time, design, and implement strategies, to preserve functioning in patients with hematologic cancer in the long term.

Living with a vestibular disorder during the Covid-19 pandemic: An online survey study.

People with vestibular disorders experience symptoms which put them at risk of reduced wellbeing during the Covid-19 pandemic. To assess the impact of the Covid-19 pandemic on vestibular symptoms, access to healthcare and daily activities amongst people living with a vestibular disorder. An online survey was completed by 124 people in the UK with a vestibular disorder. The survey incorporated the Vertigo Symptom Scale-Short Form and questions regarding health status, healthcare received, daily activities and employment during Covid-19. The Covid-19 pandemic affected perceptions of wellbeing. 54.1% rated their health as worse now than before the pandemic. Vertigo, unsteadiness, dizziness, tinnitus, loss of concentration/memory, and headaches were the most exacerbated symptoms. Respondents reported changes to their daily activities including reduced social contact (83%) and exercise (54.3%). Some experienced healthcare delays or received a remote appointment. Remote care was perceived as convenient, but barriers included difficulty communicating, trouble concentrating and perceived unsuitability for initial appointments. Unintended benefits of the pandemic included less social pressure, avoiding busy environments, and engaging in self-care. The effects of the Covid-19 pandemic are diverse. Clinical services should be mindful that Covid-19 can exacerbate vestibular and allied neuropsychiatric symptoms that require acute, multi-disciplinary intervention, but not lose sight of the potential benefit and cost saving associated with promoting self-management and delivering remote care, especially post-diagnosis.

Self-Reported Measures Have a Stronger Association With Dizziness-Related Handicap Compared With Physical Tests in Persons With Persistent Dizziness.

BackgroundAssociations between dizziness-related handicap and a variety of self-reported measures have been reported. However, research regarding associations between dizziness-related handicap and aspects of functioning that includes both physical tests and self-reported measures is scarce.ObjectiveThe purpose of the study was to describe the variations in signs and symptoms in people with persistent dizziness using physical tests and self-reported outcomes across three severity levels of the Dizziness Handicap Inventory (DHI) and investigate their associations with the DHI.MethodParticipants with persistent dizziness (n = 107) were included in this cross-sectional study. The participants underwent (1) physical tests (gait tests, grip strength, body flexibility, and movement-induced dizziness) and completed questionnaires regarding (2) psychological measures (Mobility Inventory of Agoraphobia, Body Sensation Questionnaire, Agoraphobic Cognitions Questionnaire, and Hospital Depression and Anxiety Questionnaire), and (3) fatigue, dizziness severity, and quality of life (Chalders Fatigue Scale, Vertigo Symptom Scale-Short Form, and EQ visual analog scale), in addition to the DHI. Data were presented by descriptive statistics for three DHI severity levels (mild, moderate, and severe). A multiple linear backward regression analysis was conducted for each group of measures in relation to the DHI total score, with additional analyses adjusting for age and sex. Based on these results, significant associations were tested in a final regression model.ResultsWith increasing severity levels of DHI, the participants demonstrated worse performance on most of the physical tests (preferred and fast gait velocity, dizziness intensity after head movements), presented with worse scores on the self-reported measures (avoidance behavior, fear of bodily sensation, fear of fear itself, psychological distress, fatigue, dizziness severity, quality of life). After adjusting for age and sex, significant associations were found between total DHI and avoidance behavior, psychological distress, dizziness severity, and quality of life, but not with any of the physical tests, explaining almost 56% of the variance of the DHI total score.ConclusionThere was a trend toward worse scores on physical tests and self-reported measurements with increasing DHI severity level. The DHI seems to be a valuable tool in relation to several self-reported outcomes; however, several signs and symptoms may not be detected by the DHI, and thus, a combination of outcomes should be utilized when examining patients with persistent dizziness.

Internet-based vestibular rehabilitation versus standard care after acute onset vertigo: a study protocol for a randomized controlled trial

BackgroundDizziness and vertigo affect around 15% of adults annually and represent common reasons for contacting health services, accounting for around 3% of all emergency department visits worldwide. Vertigo is also associated with excessive use of diagnostic imaging and emergency care and decreased productivity, primarily because of work absenteeism. Vestibular rehabilitation is an evidence-based treatment for chronic dizziness and supervised group exercise therapy has recently been shown to be effective after vestibular neuritis, a common cause of acute onset vertigo. However, such interventions are not readily available and there is a need for more easily accessible tools. The purpose of this study is to investigate the effects on vestibular symptoms of a 6-week online vestibular rehabilitation tool after acute onset vertigo, with the aim of aiding vestibular rehabilitation by presenting a more accessible tool that can help to reduce recovery time.MethodsThree hundred twenty individuals diagnosed with acute vestibular syndrome (AVS) will be recruited from multiple hospitals in Sweden and the effects of an online vestibular rehabilitation tool, YrselTräning, on vestibular symptoms after acute onset vertigo will be compared to standard care (written instructions leaflet) in a two-armed, evaluator-blinded, multicenter randomized controlled trial. The primary outcome will be the Vertigo Symptom Scale Short Form (VSS-SF) score at 6 weeks after symptom onset. Secondary outcomes include effects of the intervention on activities of daily living, mood and anxiety, vestibular function recovery, mobility measures, health economic effects, and the reliability of the Swedish VSS-SF translation.DiscussionParticipants using the online vestibular rehabilitation tool are expected to recover earlier and to a greater extent from their symptoms as compared to standard care. Since up to 50% of people with AVS without treatment develop persistent symptoms, effective treatment of AVS will likely lead to a higher quality of life and help reduce the societal costs associated with dizziness and vertigo.Trial registrationClinicaltrials.gov NCT05056324. Registered on September 24, 2021.

The Additional Effect of Vestibular Rehabilitation Therapy on Residual Dizziness After Successful Modified Epley Procedure for Posterior Canal Benign Paroxysmal Positional Vertigo.

Purpose The aim of the study was to evaluate the additional effect of vestibular rehabilitation therapy (VRT) compared with the modified Epley procedure alone on residual dizziness after a successful modified Epley procedure in patients with posterior canal benign paroxysmal positional vertigo (BPPV). Method In this cross-sectional analytical comparative study, 47 patients (35 women and 12 men) aged 18-80 years with posterior canal BPPV were randomly assigned to one of two following groups: the control group, who received the modified Epley procedure only, and the VRT group, who received the modified Epley procedure plus vestibular rehabilitation for 4 weeks. Outcome measures, including the Dizziness Handicap Inventory (DHI), the Vertigo Symptom Scale-Long Version (VSS-L), and the Vertigo Symptom Scale-Short Form (VSS-SF), were conducted on the same session before initial therapy (T1), at 48 hr later (T2), and at 4 weeks later (T3). Presence or absence of residual dizziness was evaluated at T2. Results Residual dizziness was found in 20 (42.6%) patients after a successful modified Epley procedure. There was no statistically significant difference between the mean DHI, VSS-L, and VSS-SF scores at T1, T2, and T3 in patients who manifested with residual dizziness and those without residual dizziness in both groups. The average DHI, VSS-L, and VSS-SF score reduced during the time in both groups. These results were demonstrated that the VRT group and the control group have similar reductions in symptoms after treatment with the VRT plus modified Epley procedure and the modified Epley procedure only, respectively. Conclusions Residual dizziness is a common condition after a successful modified Epley procedure for BPPV. The VRT plus modified Epley procedure is as effective as modified Epley procedure alone in the management of residual dizziness. Further studies with supervised and customized VRT and longer follow-up periods are needed. Supplemental Material https://doi.org/10.23641/asha.14825508.

Reliability and validity of the Turkish version of the vestibular rehabilitation benefit questionnaire

Background/aims Vestibular rehabilitation has an important role in the reduction of symptoms and in the recovery of patients in peripheral vestibular pathologies. Objective and subjective vestibular assessment tools are needed to assess vestibular rehabilitation effectiveness. The aims of the study were to develop the Turkish version of the internationally used Vestibular Rehabilitation Benefit Questionnaire (VRBQ) measure and to demonstrate the reliability and validity properties of the Turkish version in patients with peripheral vestibular hypofunction (PVH). Materials and methods110 patients with unilateral PVH were included. For the analysis of test-retest reliability, Turkish version of VRBQ developed by translation-back translation method was applied to patients on the day of admission and the day after admission. To assess validity, patients were also evaluated with the VRBQ, Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale-Short Form (VSS-SF), Vertigo Dizziness Imbalance (VDI) Questionnaire.ResultsThe VRBQ showed moderate to excellent internal consistency in total score and subscales scores (VRBQ-total Cronbach’s α = 0.91; dizziness α = 0.81; anxiety α = 0.68; motion-provoked dizziness α = 0.89; aypmtoms α = 0.88; health-related quality of life α = 0.87). In the test-retest reliability of VRBQ-total score was excellent (ICC = 0.94). The dizziness, the anxiety, the motion-provoked dizziness, symptoms and the health-related quality of life domains’ ICC were found respectively 0.90, 0.89, 0.84, 0.90, and 0.92. The construct validity of the VRBQ was determined. The VRBQ total was correlated with all parameters (r: 0.308 to –0.699, P < 0.05). The highest positive correlation was found between VRBQ total and DHI-functional (r: 0.680). The highest negative correlation was found between VRBQ total and VDI-total (r: –0.699).ConclusionThe results suggest that the Turkish version of the VRBQ is reliable and valid for evaluating the vestibular rehabilitation results.

A method for prediction functional dizziness after benign paroxysmal positional vertigo

To identify risk factors for functional vertigo (FV) in patients with benign paroxysmal positional vertigo (BPPV) based on the analysis of emotional and personality disorders at the time of the occurrence of BPPV and to develop a method for predicting its development. The study included 93 people, 81 women (87.1%), with benign paroxysmal positional vertigo (BPPV), aged 18 to 65 years, mean age 50 [41.5; 59]). After successful treatment with repositioning maneuvers, patients were re-examined 1 month later. Fifty-three patients underwent a semi-structured interview to identify a history of panic attacks (PA) using DSM-5 diagnostic criteria. After successful BPPV treatment, patients completed the following scales and questionnaires: Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale Short form (VSS-SF), Numeric analog scale of fear (from 0 to 10), Depersonalization-Derealization Inventory (DDI), PHQ-9, GAD-7, PHQ-15, Holmes-Rahe Stress Inventory, Anxiety Sensitivity Index (ASI). The cohort was divided into two groups according to the presence (group 1, n=17) or absence (group 2, n=76) of complaints for dizziness 1 month after BPPV. The frequency of PA history in group 1 was higher than in group 2 (80 vs 29.3%). Patients from group 1 had higher rates in all scales: DHI (57 vs 49, p=0.048), subscale DHI-E (18 vs 12, p=0.006), and subscale A VSS-SF (9 vs 5, p=0.03); DDI (18 vs 11, p=0.01), GAD-7 (13 vs 4), p=0.0002), Numeric analog scale of fear (10 vs 5, p<0.00005), ASI (55.5 vs 36.5, p<0.005). We developed a predictive method for diagnosis FD after BPPV, which sensitivity is 78.9% (95% CI 67.80-86.94) and specificity 94.12% (95% CI 71.31-99.85). The likelihood of developing FV after BPPV can be predicted using the proposed predictive method. Early screening for FV can be used to prevent persistent postural-perceptual dizziness.

Cost-effectiveness of internet-based vestibular rehabilitation with and without physiotherapy support for adults aged 50 and older with a chronic vestibular syndrome in general practice

ObjectivesTo evaluate the cost-effectiveness of stand-alone and blended internet-based vestibular rehabilitation (VR) in comparison with usual care (UC) for chronic vestibular syndromes in general practice.DesignEconomic evaluation alongside a three-armed, individually...

Treatment success of internet-based vestibular rehabilitation in general practice: development and internal validation of a prediction model

ObjectivesTo develop and internally validate prediction models to assess treatment success of both stand-alone and blended online vestibular rehabilitation (VR) in patients with chronic vestibular syndrome.DesignSecondary analysis of a randomised...

Successful treatment of orthostatic dysregulation with Japanese (Kampo) herbal medicine ryokeijutsukanto

ContextPharmacologic treatment of dizziness is still not well-established. Consequently, traditional Japanese (Kampo) herbal medicine is commonly used. Ryokeijutsukanto is used to treat dizziness caused by orthostatic dysregulation (OD). ObjectiveWe aimed to evaluate the effectiveness of ryokeijutsukanto, a traditional Japanese (Kampo) herbal medicine, in treating dizziness, including light-headedness and/or palpitations. We focused on dizziness caused by OD, a condition commonly treated with ryokeijutsukanto. DesignWe used a case series design. SettingThe study was centered in the department of internal medicine and department of otolaryngology at a general hospital. PatientsWe tested ryokeijutsukanto in four female patients who were experiencing dizziness and who were diagnosed with OD. Intervention(s)The patients received ryokeijutsukanto (1.5 g to 4.2 g of dried extract daily). Main Outcome Measure(s)Ryokeijutsukanto was prescribed to the four patients; clinical efficacy and improvement in dizziness were assessed using the Clinical Global Impression-Improvement scale and Vertigo Symptom Scale-Short Form. ResultsAll patients intended to continue Kampo treatment since high curative effects and no adverse effects were observed. ConclusionsTo the best of our knowledge, this is the first report elucidating the effectiveness of ryokeijutsukanto in treating dizziness as a result of OD. Ryokeijutsukanto may be an appropriate complementary therapy for OD.

Vestibular deficits and psychological factors correlating to dizziness handicap and symptom severity

ObjectiveTo determine the relative contribution of demographic variables, objective testing and psychological factors in explaining the variance in dizziness severity and handicap. MethodsOne-hundred and eighty-five consecutive patients on the waiting list to attend a diagnostic appointment in a tertiary neuro-otology clinic with a primary complaint of vertigo or dizziness completed a cross-sectional survey. Primary outcomes were the Dizziness Handicap Inventory and the vertigo subscale of the Vertigo Symptom Scale-Short Form. Psychological questionnaires assessed anxiety and depressive symptoms, illness perceptions, cognitive and behavioural responses to symptoms, beliefs about emotions and psychological vulnerability. Patients also underwent standardised audio-vestibular investigations and tests to reach a diagnosis at appointment. ResultsObjective disease characteristics were not associated with handicap and only the presence of vestibular dysfunction on one test (caloric) was associated with symptom severity. Almost all the psychological factors were correlated with dizziness outcomes. The total hierarchical regression model explained 63% of the variance in dizziness handicap, and 53% was explained by the psychological variables. The regression model for symptom severity explained 36% of the variance, and 30% was explained by the psychological factors. In adjusted models, factors associated with dizziness handicap included age, female gender, distress, symptom focusing, embarrassment, avoidance, and beliefs about negative consequences. Fear avoidance was the only independent correlate in the fully adjusted model of symptom severity. ConclusionSelf-reported dizziness severity and handicap are not correlated with clinical tests of vestibular deficits but are associated with psychological factors including anxiety, depression, illness perceptions, cognitive and behavioural responses.

Neck pain associated with clinical symptoms in dizzy patients-A cross-sectional study.

Many patients suffer from concurrent neck pain and dizziness. The aim of this study was to describe the clinical symptoms and physical findings in patients with concurrent neck pain and dizziness and to examine whether they differ from patients with dizziness alone. Consecutive patients with dizziness and neck pain were recruited from an ear-nose-throat department and a spine clinic. They were divided into three groups: patients with dizziness only (n = 100), patients with dizziness as their primary complaint and additional neck pain (n = 138) and finally, patients with neck pain as their primary complaint accompanied by additional dizziness (n = 55). The patients filled in questionnaires regarding their symptom quality, time-course, triggers of dizziness and the Vertigo Symptom Scale Short Form. The physical examination included Cervical Range of Motion, American College of Rheumatology (ACR) Tender Points, Cervical Pressure Pain Thresholds and Global Physiotherapy Examination 52-Flexibility. Both neck pain groups were more likely to have a gradual onset of dizziness symptoms, more light-headedness, visual disturbances, autonomic/anxiety symptoms, decreased cervical range of motion, decreased neck and shoulder flexibility and increased number of ACR tender points compared with patients with dizziness alone. The group having dizziness as their primary complaint and also reporting neck pain had the highest symptom severity and tended to report rocking vertigo and increased neck tenderness. The group with neck pain as their primary complaint was more likely to report headache. Neck pain is associated with certain dizziness characteristics, increased severity of dizziness and increased physical impairment when compared with dizzy patients without neck pain.

Internet based vestibular rehabilitation with and without physiotherapy support for adults aged 50 and older with a chronic vestibular syndrome in general practice: three armed randomised controlled trial

ObjectiveTo investigate the clinical effectiveness and safety of stand alone and blended internet based vestibular rehabilitation (VR) in the management of chronic vestibular syndromes in general practice.DesignPragmatic, three armed, parallel...

Carotico-vertebral Doppler Ultrasonography in Patients with Idiopathic Vertigo.

In the present study, we investigated the relationship between caroticovertebral Doppler USG measurement results and Vertigo Symptom Scale-Short Form (VSS-SF) in patients with idiopathic vertigo. Fifty patients with idiopathic vertigo and 30 healthy subjects were included into the study. Ear, Nose & Throat (ENT) examination, audiological examination, routine hemogram, biochemichal tests and temporal magnetic resonance imaging were performed to diagnose "idiopathic vertigo". By carotico-vertebral Doppler ultrasonography (USG), common carotid artery (CCA) area, intima media thickness; and vertebral artery dimension were measured on the right and left side of the study and control groups. CCA area values were not different between the study and control groups; and between the right and left sides of the each group. On the left side, intima media thickness and vertebral artery dimension values of the vertigo group were significantly higher than those of the control group. Correlation tests showed that CCA area and intima media thickness values on the right and left side were positively correlated with each other. Moreover, in patients with higher right; or left intima media thickness values, left vertebral artery dimensions decreased. Older age was associated with higher intima media thickness in right and left sides. When CCA values decreased on the right side, VSS-SF values increased; and patients' complaints for vertigo got higher. Linear regression analysis (Backward LR) results also showed that the significant compounding factor on VSS-SF was right CCA area. As right CCA area decreased, VSS-SF increased with more vertigo complaints. Whereas, vertigo complaints and VSS-SF decreased when right CCA increased. We concluded that a decrease in the right CCA were linked with higher VSS-SF scores and increasing vertigo symptoms. Whereas, a decrease in the left CCA area and left crabial blood supply are more important related to the left hemispheric dominance in right-handed people. Moreover, an increase in the intima media thickness was also detected in the vertigo patients and it probably causes a decrease in the central blood flow.