Vestibular Diagnosis Research Articles

Epidemiology and Comorbidities of Vestibular Disorders: Preliminary Findings of the AVOCADO Study.

Studies on incidence and prevalence of vestibular disorders tend to focus on small pockets of patients recruited from specialized clinics and often exclude measures of vestibular function. The objectives of the study were to characterize patients with common vestibular disorders, estimate the prevalence of common vestibular disorders, and ascertain whether patients with vestibular disorders experience increased risks of falls and morbidity. This retrospective cohort study includes both inpatient and outpatient routine clinical care data culled from a nationally representative, population-based sample. Patients were included if their record in the TriNetX Diamond Cohort comprised at least one vestibular function test or vestibular diagnosis. The main outcome measures were diagnosis with a vestibular disorder, a fall, or a common medical comorbidity (e.g., diabetes, cerebrovascular disease). The cohort includes n = 4,575,724 patients, of which 55% (n = 2,497,136) had a minimum of one vestibular diagnosis. Patients with vestibular diagnoses were 61.3 ± 16.6 years old (mean ± standard deviation), 67% women, 28% White race (69% unknown race), and 30% of non-Hispanic or Latino ethnicity (66% unknown ethnicity). The prevalence of vestibular disorders was estimated at 2.98% (95% confidence interval [CI]: 2.98-2.98%). Patients with vestibular diagnoses experienced a significantly greater odds of falls (odds ratio [OR] = 1.04; 95% CI: 1.02-1.05), cerebrovascular disease (OR = 1.42; 95% CI: 1.40-1.43), ischemic heart disease (OR = 1.17; 95% CI: 1.16-1.19), and diabetes (OR = 1.14; 95% CI: 1.13-1.15), among others. Vestibular disorders affect an estimated 3% of the U.S. population, after weighting. Patients with these disorders are at greater risk for many common, consequential medical conditions.

Discussion and analysis the value of supine median³ nystagmus in the diagnosis and treatment of HC-BPPV

Objective:To explore the clinical value of supine median³ nystagmus in the accurate diagnosis of horizontal semicircular canal benign paroxysmal positional vertigo（HC-BPPV）. Methods:A total of 187 patients with HC-BPPV admitted to the First Affiliated Hospital of Xi'an Jiaotong University from June 2020 to March 2021 were selected. Among them 42 cases of Cupulolithiasis and 145 cases of Canalithiasis. The nystagmus parameters of patients left and right supine position and supine median³ position were recorded in detail by RART. According to the direction of supine median³ nystagmus, patients were divided into three groups: group A（nystagmus to weak side）, group B（nystagmus to strong side）, group C（negative nystagmus）. The canalith repositioning manoeuvres（CRM） was carried out by utility of an automatic vestibular function diagnosis and therapy system（SRM-IV）. The cure rate of CRM in three groups of HC-BPPV patients was compared, Multivariate logistic regression analysis was performed to analyze the influencing factors of CRM for HC-BPPV. Results:The cure rates of group A, group B and group C were 81.58%, 16.13% and 56.25%, respectively. The difference among the three groups was statistically significant. Then a pairwise comparison of group A, B and C, the difference was statistically significant（χ²A-B=40.294,P<0.001,χ²B-C=14.528, P<0.001,χ²A-C=11.606, P=0.001）; the results of multivariate logistic regression analysis showed that the direction of supine median³ nystagmus and BMI were the influencing factors of CRM for HC-BPPV. Conclusion:The direction, intensity and duration of supine median³ nystagmus play an important role in determining the responsibility semicircular canal of HC-BPPV.

Vestibular Hypofunction Screening in Older Cochlear Implant Candidates.

Vestibular loss is associated with increasing age and hearing loss. Cochlear implantation (CI) may be performed in these patients; however, CI can induce vestibular hypofunction (VH) postoperatively. If CI is performed in the "better balancing ear," patients may experience vestibulopathy from new bilateral VH. The objective of this study was to evaluate the rates of VH in older CI candidates, thereby helping to identify patients at increased risk for bilateral VH after CI. Retrospective cohort study from 2019 to 2022 of patients age 60 to 80 years old who underwent videonystagmography (VNG). Tertiary care neurotology practice. VNG, including spontaneous nystagmus, cervical vestibular evoked myogenic potential (cVEMP), caloric stimulation, and rotary chair, was reviewed and stratified by CI candidacy. Patients with prior CI or known vestibular diagnosis were excluded. Thirty-three patients were CI candidates and 184 patients were controls. cVEMP demonstrated a significantly greater rate of unilateral VH in CI candidates (P = .018). Caloric stimulation demonstrated an elevated rate of bilateral VH and presbyvestibulopathy in CI candidates (P = .057 and P = .036, respectively). Rotary chair demonstrated a significantly higher rate of bilateral VH and incomplete vestibular compensation based on reduced gain and gain asymmetry, respectively, in CI candidates (P < .001 and P = .043, respectively). Mean bithermal slow phase velocity sum and rotary chair gain were significantly lower in the CI candidate group (P = .002 and P < .001, respectively). Preoperative identification of VH determined the side of implantation in 4 patients (15%). VH and incomplete vestibular compensation are common and more frequently seen in CI candidates compared to age-matched controls. Vestibular screening can play a role in surgical counseling and planning, and should be considered in older patients undergoing CI.

Efficacy of Altered Frequency Dynamics of Ocular-Vestibular Evoked Myogenic Potentials in Type 2 Diabetes Mellitus

Purpose: The study aims to address the gap in understanding the relationship between type 2 diabetes mellitus (T2DM) and vestibular dysfunction, particularly focusing on how T2DM may affect the tuning of the vestibular system. Specifically, the investigation aims to explore the impact of stimulus parameters, particularly stimulus frequency, on ocular vestibular evoked myogenic potentials (oVEMP) in individuals with T2DM.Methods: A case-control study design was used, utilizing non-probability sampling. All participants underwent routine audiological and vestibular evaluations before inclusion in the study. oVEMP’s were compared across 40 healthy individuals (group A) and 40 individuals with T2DM (group B) at 500 Hz, 1 KHz, and 2 KHz.Results: In group A, all 80 participants exhibited oVEMP responses across all frequencies in both ears, while in group B, consisting of individuals with T2DM, response rates were slightly lower, ranging from 70% to 77.5% across frequencies. Statistical analysis revealed significant amplitude differences at all frequencies tested in type 2 diabetic ears compared to healthy ears, although amplitude remained consistent within type 2 diabetic ears. Latencies (first negative [N1] and first positive [P1]) were consistent across groups, with delays observed in P1 latency, particularly noticeable at higher frequencies, both in healthy and type 2 diabetic ears. Gender didn't affect oVEMP frequency dynamics in any of the groups.Conclusion: Diabetes may create an impact in the functioning of otolith organs, the vestibular branch of eighth cranial nerve, and their innervations. VEMP evaluates both the sacculo-collic and utriculo-ocular pathways to detect changes in the functions of vestibular organs. Therefore, it's crucial to consider diabetes when conducting vestibular diagnosis or treatment.

A diagnostic framework to identify vestibular involvement in multi-sensory neurological disease.

Identifying vestibular causes of dizziness and unsteadiness in multi-sensory neurological disease can be challenging, with problems typically attributed to central or peripheral nerve involvement. Acknowledging vestibular dysfunction as part of the presentation provides an opportunity to access targeted vestibular rehabilitation, for which extensive evidence exists. A diagnostic framework was developed and validated to detect vestibular dysfunction, benign paroxysmal positional vertigo or vestibular migraine. The specificity and sensitivity of the diagnostic framework was tested in patients with primary mitochondrial disease. Adults with a confirmed diagnosis of primary mitochondrial disease were consented, between September 2020 and February 2022. Participants with and without dizziness or unsteadiness underwent remote physiotherapy assessment and had in-person detailed neuro-otological assessment. The six framework question responses were compared against objective neuro-otological assessment or medical notes. The output was binary, with sensitivity and specificity calculated. Seventy-four adults completed the study: age range 20-81 years (mean 48 years, ±SD 15.05 years); ratio 2:1 female to male. The framework identified a vestibular diagnosis in 35 participants, with seven having two diagnoses. The framework was able to identify vestibular diagnoses in adults with primary mitochondrial disease, with a moderate (40-59) to very high (90-100) sensitivity and positive predictive value, and moderate to high (60-74) to very high (90-100) specificity and negative predictive value. Overall, the clinical framework identified common vestibular diagnoses with a moderate to very high specificity and sensitivity. This presents an opportunity for patients to access effective treatment in a timely manner, to reduce falls and improve quality of life.

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.

Delayed Diagnoses in Patients With Dizziness in the US Commonwealth of Virginia and the Tidewater Region.

In a region of approximately 1.7 million people (Tidewater, coastal Virginia), identify secondary diagnoses in persons with dizziness. This cross-sectional study utilizing TriNetX included individuals in the region of interest diagnosed with dizziness between 2010 and 2020. Subsequent diagnoses of vestibular disease or medical conditions possibly associated with dizziness in the same subjects were catalogued. During the study period, 31,670 subjects were identified with diagnoses of dizziness as a symptom; 18,390 subjects were subsequently given a dizziness-related nonvestibular diagnosis, and 930 were given a subsequent vestibular disease diagnosis. The proportion of subjects diagnosed with vestibular disease (3%) after the dizziness diagnosis is far below expected norms (25%-34%) in the general population. There were greater proportions of delayed diagnoses of labyrinth dysfunction (odds ratio [OR], 4.8; P < 0.0001), superior semicircular canal dehiscence (OR, 3.1; P = 0.0023), otolith disease (OR, 3.1; P = 0.0023), among others, and a decreased proportion of delayed diagnosis of benign paroxysmal positional vertigo (OR, 0.56; P < 0.0001). The discrepancy between expected and observed prevalence in our region indicates that vestibular disease is likely underdiagnosed.

Socioeconomic determinants impact quality of life at vestibular schwannoma diagnosis

BackgroundSocioeconomic variables including race, education, and income have been shown to affect vestibular schwannoma incidence, treatment, and outcomes. We sought to determine the impact of socioeconomic factors on quality of life at the time of vestibular schwannoma diagnosis. MethodsRetrospective cohort study conducted at a tertiary academic center. All patients evaluated for vestibular schwannoma from March 1, 2010 to December 31, 2021 who completed at least one Penn Acoustic Neuroma Quality of Life (PANQOL) questionnaire at presentation or prior to any intervention were included. PANQOL scores were compared across income quintiles, racial groups, and health insurance categories. ResultsTwo-hundred and ninety-six patients who had non-missing information on variables of interest were included. Compared to White/Caucasian patients (84.5 %), Black/African American patients (4.7 %) had significantly lower PANQOL total scores (b = -12.8[-21.7, −4.0], p = 0.005). Compared to patients with Commercial insurance (53 %), patients who were Uninsured/ Self-pay (1.7 %) had significantly lower PANQOL total scores (b = -16.7[-31.4, −1.9], p = 0.027). Patients in higher income quintiles had significantly higher PANQOL total scores (b = 11.7[3.9, 19.5], p = 0.004 comparing highest income quintile to lowest). After controlling for potential confounders, income quintile (b = 9.6[1.3, 17.9], p = 0.023 comparing highest quintile to lowest) and insurance (b = -17.0[-31.9, −21], p = 0.025 comparing Uninsured/Self-pay to Commercial insurance) remained predictors of total PANQOL score. ConclusionsSocioeconomic factors including race, health insurance, and income appear to contribute to quality of life at the time of vestibular schwannoma diagnosis. These variables are interrelated and the effects of race may be mediated in part by differences in income and health insurance coverage.

Neurological update: neuro-otology 2023

Much has changed since our last review of recent advances in neuro-otology 7 years ago. Unfortunately there are still not many practising neuro-otologists, so that most patients with vestibular problems need, in the first instance, to be evaluated and treated by neurologists whose special expertise is not neuro-otology. The areas we consider here are mostly those that almost any neurologist should be able to start managing: acute spontaneous vertigo in the Emergency Room—is it vestibular neuritis or posterior circulation stroke; recurrent spontaneous vertigo in the office—is it vestibular migraine or Meniere's disease and the most common vestibular problem of all—benign positional vertigo. Finally we consider the future: long-term vestibular monitoring and the impact of machine learning on vestibular diagnosis.

Balance disorders and migraine

BackgroundMigraine is associated with motion sensitivity symptoms such as kinetosis, vestibular symptoms and balance alterations. While focus is given to headache management, addressing these symptoms is often neglected, although they are related to additional migraine burden and increased disability. PurposeOur aim is to disseminate the current understanding of the motion sensitivity symptoms among patients with migraine, with focus on balance impairments. We discuss the susceptibility of migraine to motion sensitivity, its suggested mechanisms, the balance alterations during quiet standing, mobility tasks and reactions to external perturbations. The role of migraine subdiagnosis, implications for clinical practice and future perspectives are also acknowledged. ImplicationsBalance disorders are one of the signs reflecting a broader and complex spectrum of motion sensitivity, which are present even between attacks. Migraineurs are especially inherent to these symptoms probably due to brain hyperexcitability and to shared pathophysiological mechanisms.Patients, especially with aura and chronic migraine, exhibit balance instability during quiet standing under different surface and visual input conditions. Migraineurs demonstrated reduced limits of stability and lower performance on walk, transposing obstacles and sit to stand tasks. Only patients with aura present impairment of motor control reactions following external perturbations. Balance alterations are associated with falls and are influenced by aura, migraine frequency and psychosocial aspects, but not by vestibular symptoms or vestibular migraine diagnosis. There is a high demand for high quality of evidence regarding the assessment and care of motion sensitivity symptoms in migraineurs, considering approaches to manage not just the pain, but its associated symptoms.

Team Approach to Delayed Pediatric Vestibular Diagnosis: A Case Study.

This report highlights the challenges of diagnosing pediatric vestibular neuritis following dental treatment and addressing fear avoidance behaviors. An 11-year-old boy came to physical therapy with vestibular dysfunction following dental treatment that was unable to be diagnosed by emergency department staff. The participant received multispecialty treatment for 6 weeks. Computerized Dynamic Posturography, Limits of Stability, Dizziness Handicap Inventory, Functional Gait Assessment, Dynamic Visual Acuity, and Modified Clinical Test of Sensory Interaction on Balance. Most notable improvements were seen in Limits of Stability and Computerized Dynamic Posturography. The participant made a full return to school and sport. The difficulty of pediatric vestibular neuritis diagnosis led to fear avoidance behaviors that were addressed by a collaborative specialty approach. This is the first documented case of pediatric vestibular neuritis as a complication of a dental procedure with intervention focused on fear avoidance behaviors.

Vestibular syndromes, diagnosis and diagnostic errors in patients with dizziness presenting to the emergency department: a cross-sectional study

ObjectivesWe aimed to determine the frequency of vestibular syndromes, diagnoses, diagnostic errors and resources used in patients with dizziness in the emergency department (ED).DesignRetrospective cross-sectional study.SettingTertiary referral hospital.ParticipantsAdult patients presenting...

Vergence and Accommodation Deficits in Children and Adolescents with Vestibular Disorders.

The high frequency of vergence and accommodation deficits coexisting in patients with a vestibular diagnosis merits a detailed visual function examination. Deficits in vergence and saccades have been reported in patients with vestibular symptomatology. We retrospectively evaluated visual function deficits in adolescents with vestibular diagnoses and concussion. The following inclusion criteria were used: vestibular and optometric evaluations between 2014 and 2020, 6 to 22 years old, and 20/25 best-corrected vision or better. Clinical criteria assigned vestibular diagnoses and concussion diagnoses. Vestibular diagnoses included vestibular migraine, benign paroxysmal positional vertigo, and persistent postural perceptual dizziness. Visual function deficits were compared with a pediatric control group (30). Nonparametric statistics assessed differences in group distribution. A total of 153 patients were included: 18 had vestibular diagnoses only, 62 had vestibular diagnoses related to concussion, and 73 had concussion only. Vergence deficits were more frequent in patients with vestibular diagnoses and concussion (42%) and concussion only (34%) compared with controls (3%; all P = .02). Accommodation deficits were more frequent in patients with vestibular diagnoses only (67%), vestibular diagnoses and concussion (71%), and concussion (58%) compared with controls (13%; all P = .002). Patients with vestibular migraine and concussion (21) had more vergence deficits (62%) and accommodation insufficiency (52%) than concussion-only patients (47%, P = .02; 29%, P = .04). Patients with benign paroxysmal positional vertigo and concussion (20) had lower positive fusional vergence and failed near vergence facility (35%) more than concussion-only patients (16%; P = .03). Visual function deficits were observed at a high frequency in patients with a vestibular diagnosis with or without a concussion and particularly in vestibular migraine or benign paroxysmal positional vertigo. Visual function assessments may be important for patients with vestibular diagnoses.

153 AN EVALUATION OF OLDER PERSONS WITH VESTIBULAR DYSFUNCTION AS IDENTIFIED DURING COMPREHENSIVE GERIATRIC ASSESSMENT

Abstract Background Vestibular dysfunction accounts for 25% of dizziness complaints. In 30-50% of these cases, dizziness is attributed to Benign Paroxysmal Positional Vertigo (BPPV). Thirty percent of people will experience vestibular dysfunction in their lifetime, with likelihood increasing with age. Individuals with vestibular dysfunction are eight times more likely to experience a fall. Vestibular assessment and rehabilitation services can be difficult to access. Methods A Plan, Do, Study, Act (PDSA) cycle was undertaken. All referrals to the Older Persons’ Services Clinics from November 2021 to May 2022 were triaged by an Integrated Care Team for the Older Person and scheduled for Comprehensive Geriatric Assessment (CGA). In the course of CGA, patients who reported symptoms suggestive of vestibular dysfunction received assessment by a Physiotherapist with vestibular expertise. Results were entered on an Excel spreadsheet and analysed using descriptive statistics. Results Six patients (4 female, 2 male) received vestibular assessment and treatment. Mean age was 75 years (SD: 11) with median Clinical Frailty Score of 4 (vulnerable). Reported symptoms were dizziness (n=3) and spinning (n=3). Sixteen percent (n=1) reported a fall and 66% (n=4) reported fear of falling. All patients had symptom duration of &amp;gt;2 years. Following vestibular assessment, the following diagnoses were made; right posterior canal BPPV, (n=2), vestibular migraine (n=2), right horizontal canal canalithiasis BPPV, with secondary diagnosis of persistent postural-perceptual dizziness (n=1) and left peripheral vestibular hypofunction due to vestibular neuronitis (n=1). The mean number of Physiotherapy visits per person was 4. Three patients reported full resolution of symptoms. The remaining 3 reported an improvement in symptoms and confidence to self-manage. Conclusion This small cohort of older persons with chronic vestibular dysfunction benefited from vestibular diagnosis and intervention. The next step of the process is to include specific vestibular screening questions into CGA. This will enable Integrated Care Team members to screen more specifically for vestibular dysfunction.

Seasonal variation of hip fractures in patients with Benign Paroxysmal Positional Vertigo

Introduction: Seasonal variation of benign paroxysmal positional vertigo (BPPV) presentation has been reported, with higher rates of presentation in months associated with times of lower serum vitamin D levels. The purpose of this study was to examine the association between the timing of hip fracture in patients with BPPV. Methods: A retrospective review (2013 to 2019) of adult patients was performed at a tertiary care academic center to identify patients with hip fracture due to ground level fall (ICD-10 code S72) and a previously established diagnosis of vestibular disorder (ICD-10 codes H81-83, A88.1, and R42). Included patients were matched by age and sex to control for patients who had hip fracture without a vestibular diagnosis. Patient charts were reviewed, and demographic and clinical data were extracted related to hip fracture and prior vestibular diagnosis. Groups were subdivided based on whether patients had a hip fracture from January to June versus July to December. Fisher’s exact test was used to evaluate for a difference in seasonal variation between groups. Results: There were 201 patients with vestibular disorders of whom 27 patients carried the diagnosis of BPPV, with a mean age of 80.4 years. The rates of hip fracture among patients with BPPV was higher in the period extending from January to June (63.0%) versus July to December (37.0%), [odds ratio 1.59, 95% CI 0.66-4.00]. The rate of hip fracture was not significantly different between these time periods for the control group (51.7% versus 48.3%) or the vestibular group (53.2% versus 46.8%). Conclusion: These results offer preliminary evidence that, in addition to an increased presentation for BPPV during months associated with decreased serum vitamin D, injuries due to BPPV may be increased as well. The present study is limited by the statistical power afforded by the small number of patients with BPPV and hip fracture that were identified.

Using magnetic resonance imaging to improve diagnosis of peripheral vestibular disorders

Peripheral vestibular disorders are caused by pathology of the inner ear. The majority of these disorders are diagnosed with a detailed history and vestibular physical exam. Imaging is rarely a part of diagnostic work up as the pathologies of these disorders are “invisible,” or undetectable on imaging. However, these “invisible” diagnoses are becoming increasingly visible with advancements in imaging technology. Developments in magnetic resonance imaging are allowing for increased spatial resolution and better image contrast, improving our ability to see soft tissue structures including the membranous labyrinth, sensory epithelia and nerves. With these improvements in imaging, clinicians will be able to understand better atypical presentations of peripheral vestibular disorders, disease intractable to traditional therapy, disorders with unclear pathoetiology and disease only seen on histopathological studies. This review assesses the current state of imaging in the neurotology clinic with a special focus on magnetic resonance imaging and then gathers diseases identified by vestibular testing and histopathological studies that could be better understood with developments in imaging. In doing so, we hope to guide advancement in neurotologic imaging and apprise clinicians of the utility of imaging in peripheral vestibular disease diagnosis.

Migraine and balance impairment: Influence of subdiagnosis, otoneurological function, falls, and psychosocial factors.

To assess the balance sensory organization among patients with migraine, considering the influence of migraine subdiagnosis, otoneurological function, falls, and psychosocial factors. Migraine has been associated with vestibular symptoms and balance dysfunction; however, neither comprehensive balance assessment nor associated factors for greater impairment have been addressed thus far. Patients from a tertiary headache clinic with a diagnosis of episodic migraine with aura (MWA), without aura (MWoA), and chronic migraine (CM) were included for this cross-sectional study (30 patients per group). Thirty headache-free controls (CG) were recruited. Participants underwent a comprehensive evaluation protocol, including the Sensory Organization Test (SOT) and otoneurological examination. Questionnaires about fear of falls, dizziness disability, and kinesiophobia were administered. All migraine groups presented lower composite SOT scores than controls (CG: 82.4 [95% confidence interval (CI): 79.5-85.3], MWoA: 76.5 [95% CI: 73.6-79.3], MWA: 66.5 [95% CI: 63.6-69.3], CM: 69.1 [95% CI: 66.3-72.0]; p<0.0001). Compared to controls and to MWoA, MWA and CM groups exhibited greater vestibular (CG: 75.9 [95% CI: 71.3-80.4], MWoA: 67.3 [95% CI: 62.7-71.8], MWA: 55.7 [95% CI: 51.2-60.3], CM: 58.4 [95% CI: 53.8-63.0]; p<0.0001) and visual functional impairment (CG: 89.6 [95% CI: 84.2-94.9], MWoA: 83.2 [95% CI: 77.9-88.6], MWA: 68.6 [95% CI: 63.3-74.0], CM: 71.9 [95% CI: 66.5-77.2], p<0.0001). Fall events during the assessment were documented more often among patients with migraine (CG: 0.0, interquartile range [IQR], 0.0, 0.0); MWoA: 1.0 [IQR: 1.0, 1.0], MWA: 2.0 [IQR: 1.8, 4.3], CM: 1.0 [IQR: 1.0, 2.0]; p=0.001). The SOT scores correlated with fear of falls (r = -0.44), dizziness disability (r = -0.37), kinesiophobia (r = -0.38), and migraine frequency (r = -0.38). There was no significant influence of the vestibular migraine diagnosis in the study outcomes when used as a covariate in the analysis (composite score [F=3.33, p=0.070], visual score [F=2.11, p=0.149], vestibular score [F=1.88, p=0.172], somatosensory score [F=0.00, p=0.993]). Aura and greater migraine frequency were related to falls and balance impairment with sensory input manipulation, although no otoneurological alterations were detected. The diagnosis of vestibular migraine does not influence the balance performance. The vestibular/visual systems should be considered in the clinical examination and treatment of patients with migraine.

Vestibular and cochlear dysfunction in aging: Two sides of the same coin?

Nonspecific complaints of hearing loss, vertigo, imbalance, and instability, without a defined etiology, are very prevalent in the elderly population, with a great impact on morbidity and mortality in this age group. The objectives of this study were to verify whether there is age-related vestibular dysfunction and to test the association of vestibular dysfunction with presbycusis in the elderly population. Original retrospective analytical cross-sectional study, carried out with 80 patients who underwent a videonystagmography and complete audiometric evaluation due to nonspecific vestibular complaints, without a specific vestibular disorder diagnosis. Patients were selected and divided into two distinct age groups (group A: >60 years; group B: 18-50 years) and, in both groups, we analyzed the caloric tests and the pure-tone audiometry. In the vestibular evaluation, we found that there was a statistically significant difference (P < 0.05) between groups in the prevalence of bilateral vestibular weakness (group A: 22.5%; group B: 5%), and that the increase in age, above 60 years, is negatively correlated with the mean total caloric response. Additionally, we obtained a reasonable negative and statistically significant correlation (r = -0.320, P < 0.05) between the mean bone conduction thresholds at high frequencies and total caloric responses in group A. In patients with hearing loss, it is essential to perform a complete vestibular study to diagnose vestibular disorders and, consequently, prevent adverse outcomes that may result from these alterations.

Prevalence and distribution of musculoskeletal pain in patients with dizziness-A systematic review.

Background and purposeMusculoskeletal disorders are among the leading causes of disability globally, but their role in patients with dizziness and imbalance is not well understood or explored. Such knowledge may be important as musculoskeletal pain and dizziness can mutually influence each other, leading to a complex condition requiring more comprehensive approaches to promote successful recovery. We conducted a systematic review to examine the extent and characteristic of reported musculoskeletal pain in patients with dizziness.MethodsA comprehensive literature search in Medline, Embase, Cochrane, Scopus, Amed, Google Scholar, SveMed+, and Web of Science was conducted in March 2021. Inclusion criteria were studies examining patients with a vestibular diagnosis, patients with cervicogenic dizziness and patients included based on having dizziness as a symptom; and reported musculoskeletal pain. Data regarding age, sex, sample size, diagnosis and musculoskeletal pain was extracted. The Crowe Critical Appraisal Tool was used for assessing methodical quality of the included studies.ResultsOut of 1507 screened studies, 16 studies met the inclusion criteria. The total sample consisted of 1144 individuals with dizziness. The frequency of patients reporting pain ranged between 43% and 100% in the included studies. Pain intensity were scored between 5 and 7 on a 0–10 scale. Pain in the neck and shoulder girdle was most often reported, but musculoskeletal pain in other parts of the body was also evident.DiscussionIn the included studies, musculoskeletal pain was highly prevalent in patients with dizziness, with pain intensity that may have a moderate to severe interference with daily functioning. Pain in the neck and shoulder is well documented, but there are few studies addressing musculoskeletal pain in additional parts of the body. More research is needed to understand the relations between dizziness and musculoskeletal pain.

The Dizziness Handicap Inventory and sickness absence: a cross-sectional study

Purpose The aim of this study was to examine the association between the Dizziness Handicap Inventory (DHI) and sickness absence from work in patients with dizziness. Material and methods This was a cross-sectional study conducted at an otolaryngology clinic with 238 patients referred for a suspected vestibular disorder during a 1-year period. The association between sickness absence over the last 30 days and DHI was examined with binary and ordinal logistic regression. The Hospital Anxiety and Depression scale (HADS), health-related quality of life (RAND-12), duration of dizziness, diagnosis, age and gender were used as adjustments variables. Results The adjusted analysis showed that a 10-point increase on DHI was associated with an increased risk of sickness absence (yes/no) (OR: 1.50, 95% CI: 1.25–1.90, p < 0.001). In addition, a 10-point increase in DHI-score was associated with a higher degree of sickness absence (OR: 1.50, 95% CI: 1.25–1.80, p < 0.001). Conclusion A higher DHI-score was associated with sickness absence in addition to the duration of absence the previous month. These results indicate the relevance and clinical usefulness of the DHI as a possible indicator of sickness absence from work in patients with dizziness regardless of diagnosis. IMPLICATIONS FOR REHABILITATION Approximately half of patients referred to a dizziness clinic have sickness absence. A higher score on The Dizziness Handicap Inventory is associated with longer duration of sickness absence. A vestibular diagnosis was not associated with sickness absence. The results indicate that the Dizziness Handicap Inventory may be a clinically useful tool for identifying patients with a high risk of sickness absence.