Journal of Vestibular Research - Volume 29, issue 4

Authors: Agrawal, Yuri | Van de Berg, Raymond | Wuyts, Floris | Walther, Leif | Magnusson, Mans | Oh, Esther | Sharpe, Margaret | Strupp, Michael

Article Type: Research Article

Abstract: This paper describes the diagnostic criteria for presbyvestibulopathy (PVP) by the Classification Committee of the Bárány Society. PVP is defined as a chronic vestibular syndrome characterized by unsteadiness, gait disturbance, and/or recurrent falls in the presence of mild bilateral vestibular deficits, with findings on laboratory tests that are between normal values and thresholds established for bilateral vestibulopathy. The diagnosis of PVP is based on the patient history, bedside examination and laboratory evaluation. The diagnosis of PVP requires bilaterally reduced function of the vestibulo-ocular reflex (VOR). This can be diagnosed for the high frequency range of the VOR with the …video-HIT (vHIT); for the middle frequency range with rotary chair testing; and for the low frequency range with caloric testing. For the diagnosis of PVP, the horizontal angular VOR gain on both sides should be < 0.8 and > 0.6, and/or the sum of the maximal peak velocities of the slow phase caloric-induced nystagmus for stimulation with warm and cold water on each side should be < 25°/s and > 6°/s, and/or the horizontal angular VOR gain should be > 0.1 and < 0.3 upon sinusoidal stimulation on a rotatory chair. PVP typically occurs along with other age-related deficits of vision, proprioception, and/or cortical, cerebellar and extrapyramidal function which also contribute and might even be required for the manifestation of the symptoms of unsteadiness, gait disturbance, and falls. These criteria simply consider the presence of these symptoms, along with documented impairment of vestibular function, in older adults. Show more

DOI: 10.3233/VES-190672

Citation: Journal of Vestibular Research, vol. 29, no. 4, pp. 161-170, 2019

Authors: Wu, Peixia | Yang, Mei | Hu, Yan | Li, Huawei

Article Type: Research Article

Abstract: BACKGROUND: The activities and participation component of the International Classification of Functioning, Disability and Health (ICF) has gained increasing recognition in rehabilitation field. The vestibular activities and participation measure (VAP) was the first instrument using the ICF to evaluate activities and participation outcomes for vestibular research and clinical practice. OBJECTIVES: This study aimed to cross-culturally adapt the VAP into Chinese language and to examine the psychometric properties of the Chinese version of VAP (VAP-C). METHODS: A standard “forward-backward” translation procedure was followed and the results were presented to the panel of experts and consensus was …sought. Internal consistency was assessed using Cronbach’s alpha and test-retest reliability examined by intraclass correlation coefficient (ICC). Convergent validity was determined by calculating the Pearson’s correlation coefficient between the VAP-C and the Visual Analog Scale (VAS) and the Dizziness Handicap Inventory (DHI). Discriminative validity for test subjects versus control subjects was evaluated by Receiver Operating Characteristic curve (ROC) analysis. RESULTS: Minor revisions were made during translation to ensure semantic equivalence and to suit Chinese culture. A total of 121 patients complaining of dizziness or vertigo due to peripheral vestibular disorders (test subjects) and 41 control subjects were enrolled. Cronbach’s alpha was 0.94 for the VAP-C total scale and greater than 0.80 for the two subscales. ICC for the VAP-C total scale was 0.78, and for subscale one was 0.77 and subscale two 0.76. The VAP-C had strong correlations (r  = 0.85–0.88) with the VAS and fair to moderate correlations (r  = 0.23–0.53) with DHI. Through ROC analysis, we found the VAP-C discriminated significantly between patients and control subjects. Based on the estimate of Youden J, the optimal cut-off values for VAP-C total and the two subscales were established. CONCLUSIONS: The VAP-C shows evidence of reliability and validity, which can be applied for evaluating the impact of the vestibular disorder on patients’ activities and participation in Chinese language populations. Show more

Keywords: Vestibular, activities and participation, reliability, validity, ICF

DOI: 10.3233/VES-190675

Citation: Journal of Vestibular Research, vol. 29, no. 4, pp. 171-179, 2019

Authors: Seidel, David Ulrich | Park, Jonas Jae-Hyun | Sesterhenn, Andreas M. | Kostev, Karel

Article Type: Research Article

Abstract: AIM: The aim of this study was to analyze the demographic data pertaining to and seasonal variation in specific vestibular disorders in ear, nose, and throat (ENT) practices in Germany based on data from a representative nationwide practice database. METHOD: The study sample included patients from 116 ENT practices in Germany who received an initial diagnosis (ICD-10 code) of Meniere’s disease (MD, H81.0), benign paroxysmal positioning vertigo (BPPV, H81.1), or vestibular neuronitis (VN, H81.2) between January 2014 and December 2016. Collected parameters included age, sex, and month of diagnosis. Seasonal variation was analyzed for younger vs. older patients …(≤50 vs. >50 years of age). Two univariate Poisson regression models were fitted to estimate the association between the month of diagnosis and the number of diagnosed patients per practice. RESULTS: A total of 20,720 patients were available for analysis. The average case numbers for MD, BPPV, and VN were 0.8 patients, 2.7 patients, and 1.5 patients per practice per month, respectively. The mean ages of female vs. male patients were 55 and 56 years (MD), 59 and 60 years (BPPV), and 58 and 57 years (VN), respectively. The proportions of female patients with these diagnoses were 62%, 70%, and 61%, respectively. All diagnoses were evenly distributed throughout the years in all age groups. No seasonal variation was observed. CONCLUSIONS: The demographic data of MD and BPPV patients are comparable to those found by previous large-scale epidemiologic studies. However, no seasonal variation was demonstrated for any vestibular disorder in this large sample. Show more

Keywords: Vestibular disorders, seasonal variation, demographic data, ENT practices, Germany, Meniere’s disease, BPPV, benign paroxysmal positioning vertigo, vestibular neuritis, vestibular neuronitis

DOI: 10.3233/VES-190668

Citation: Journal of Vestibular Research, vol. 29, no. 4, pp. 181-190, 2019

Authors: Dao-Ming, Tong | Ye-Ting, Zhou

Article Type: Research Article

Abstract: BACKGROUND: Whether the acute dizziness would be associated with potentially life-threatening event, which was previously unknown. METHODS: Between Jan 2014 and Dec 2016, We performed a retrospective survey to investigate the clinical data of patients with acute dizziness from an intensive care unit (ICU) in China. Inclusion criteria for all cases were presented with acute dizziness at onset, and then with a potentially life-threatening event. Baseline data and 30-days outcomes were collected. RESULTS: Approximately 1.0% of ICU patients had an acute dizziness with potentially life-threatening events. The median age of patients was 60 years (range 23 …to 81 years), male: female ratio was 1.8:1. The causes of acute dizziness included focal cerebral hemorrhage in 15 cases (60%), shock in 7cases (28%), and cerebral infarction in 3 cases (12%). The most frequent potentially life-threatening event was acute brain failure (24/25), and the most common cause leading to brain failure was the lesion enlarged (54.2%, including hematoma enlargement in 8 cases, large area infarction or new infarction in 3 cases, and intraventricular hemorrhage in 2 cases). The second potentially life-threatening event was septic shock/secondary sepsis (45.8%). The fatality rate for all life- threatening events was in 64%. Compared with the survival group, the patients with lesion enlarged (56.3% vs. 11.1%, p  < 0.05), acute respiratory failure (93.8% vs. 55.6% p  < 0.05), lactate level (5.3 mmol/l vs. 1.3 mmol/l, p  < 0.05), and Sequential Organ Failure Assessment (SOFA) score (6.9 vs. 3.4, p  < 0.0001) in the non-survival group were significantly higher, while late mean arterial blood pressure (84.6 mmHg vs.124 mmHg, p  < 0.0001), GCS score (5.0 score vs. 15 score, p  < 0.0001) in the non-survival group were significantly lower. CONCLUSION: Acute dizziness with potentially life-threatening events accounts for about 1% of adult ICU patients. Acute dizziness in ICU patients is associated with a high risk of death within 30 days of onset. Show more

Keywords: Acute dizziness or vertigo; life-threatening event, organ dysfunction, prognosis

DOI: 10.3233/VES-190677

Citation: Journal of Vestibular Research, vol. 29, no. 4, pp. 191-196, 2019

Authors: Jeon, Eun-Ju | Lee, Dong-Hee | Park, Jung Mee | Oh, Jeong-Hoon | Seo, Jae-Hyun

Article Type: Research Article

Abstract: BACKGROUND: Dix-Hallpike (DH) test is sometimes done in a modified or reduced manner in a clinical setting. However, there has been no study that evaluated the reliability of this modified test. OBJECTIVES: The purposes of this study were to determine whether the efficacy of a modified DH test, named the ‘pillow under shoulders’ test, was equivalent to the standard DH test and to assess the difference in patient discomfort between the two methods. METHODS: Randomized controlled study at three academic referral hospitals, conducted in compliance with the CONSORT statement. Patients suspected for BPPV based on symptoms …were randomly assigned to Group A or Group B. Patients in Group A received a standard DH test initially, followed by a modified DH test with a pillow under shoulders. Patients in Group B also received the two tests, but in the reverse order. The diagnostic results of both tests and patients’ subjective scoring for uneasiness (discomfort, pain, anxiety) were statistically analyzed. RESULTS: McNemar’s test and Kappa statistics showed a statistically equivalent diagnostic value between standard and modified DH tests (Cohen’s kappa = 0.823 and McNemar P  = 0.18). The modified DH test had high sensitivity (95.5%) and fairly good specificity (87.9%). There was no statistical significance in the patients’ subjective scoring for uneasiness between the two methods, although most patients reported less inconvenience after the modified DH test compared to the standard DH test. CONCLUSIONS: The modified version of the standard DH test, the ‘pillow under shoulders’ method, may be a reliable, comfortable option to diagnose vertical canal BPPV. We suggest that this method can be used when head hanging is not feasible or sufficient for the standard DH test. Show more

Keywords: Benign paroxysmal positional vertigo, modified test, Dix-Hallpike test, vertigo

DOI: 10.3233/VES-190666

Citation: Journal of Vestibular Research, vol. 29, no. 4, pp. 197-203, 2019

Authors: Meehan, Anna | Hebert, Donald | Deru, Kayla | Weaver, Lindell K.

Article Type: Research Article

Abstract: BACKGROUND: Dizziness and imbalance are common after mild traumatic brain injury (mTBI). Hyperbaric oxygen (HBO2 ) has been proposed for persistent post-concussive symptoms after mTBI, but its effect on vestibular function is unknown. OBJECTIVE: To describe balance function in military service-members before and after intervention, and to explore the influence of post-traumatic stress disorder (PTSD), anxiety, and depression on vestibular outcomes. METHODS: Seventy-one participants with mTBI and seventy-five healthy adults without brain injury were enrolled (NCT01611194 and NCT01925963). mTBI participants were randomized to 40 HBO2 sessions or 40 sham chamber sessions over 12 weeks. Normative …controls received no intervention. Balance and neuropsychological function were measured at baseline, 13 weeks, and 6 months. RESULTS: The mTBI cohort performed worse than healthy controls on balance and gait measures and reported more affective symptoms. Some within-group improvements were noted at 13 weeks and 6 months. Significant between-intervention differences on balance measures were minimal but effects on postural control generally favored HBO2 . Those with affective symptoms, particularly PTSD, had the most improvement in postural control and otolith function following 13 weeks of HBO2 . CONCLUSION: HBO2 may influence balance function after mTBI, particularly in those with affective symptoms. Show more

Keywords: Mild traumatic brain injury, persistent post-concussive symptoms, hyperbaric oxygen, computerized dynamic posturography, vestibular evoked myogenic potentials, anxiety, post-traumatic stress, depression

DOI: 10.3233/VES-180671

Citation: Journal of Vestibular Research, vol. 29, no. 4, pp. 205-219, 2019