Journal of Vestibular Research-Equilibrium & Orientation最新文献

BackgroundPersistent postural-perceptual dizziness (PPPD) is a common yet challenging functional vestibular disorder. The Niigata PPPD Questionnaire (NPQ) is a simple diagnostic tool developed to assess the severity and presence of PPPD.ObjectiveTo validate the Korean version of the NPQ and to evaluate its reliability and diagnostic performance in differentiating PPPD from other vestibular disorders in comparison to Dizziness Handicap Inventory (DHI).MethodsWe recruited 255 patients, 150 with PPPD, 64 with peripheral vestibular disorders, and 41 with central vestibulopathy at a tertiary dizziness center in South Korea from January to December 2024. The NPQ was translated into Korean with a forward-backward translation procedure. In addition, all participants completed DHI, the Beck Depression Inventory-II (BDI-II), the State-Trait Anxiety Inventory (STAI), and the Perceived Stress Scale (PSS) to assess dizziness-related disability and psychological symptoms. Internal consistency was assessed using Cronbach's alpha. Discriminative ability was evaluated through between-group comparisons, correlation analyses, and receiver operating characteristic (ROC) curve analyses.ResultsThe Korean NPQ demonstrated excellent internal consistency (Cronbach's α = 0.93). The total and subscale scores of the NPQ were significantly higher in PPPD than in other vestibular disorder groups. ROC analysis yielded an area under the curve of 0.670 with a cut-off score at 15.5 (sensitivity 59.3%, specificity 71.4%). The visual stimulation subscale showed the highest AUC (0.703). A logistic regression combined model using NPQ visual stimulation and dizziness handicap inventory (DHI) emotional subscales achieved the best diagnostic accuracy (AUC = 0.756). The NPQ total score was moderately correlated with the DHI (ρ = 0.65) and modestly correlated with psychological symptoms.ConclusionThe Korean NPQ is reliable and provides acceptable diagnostic utility for distinguishing PPPD. Combining NPQ and DHI subscales enhances diagnostic accuracy, supporting its use as a screening tool in diverse clinical settings, including telemedicine.

BackgroundPatients with dizziness and unsteadiness are commonly prescribed gaze stability exercises at varying target distances to manage vestibular impairments but lack objective tools to monitor progress. Maintaining gaze stability during head motion at near distances demands greater eye velocity relative to head velocity due to vergence and increased translational eye rotation demands.ObjectivesThis study compared dynamic visual acuity (DVA) during yaw and pitch at both near and far distances in patients and healthy controls.MethodsThis study includes individuals with unilateral vestibular deafferentation (UVD), veterans with dizziness yet healthy vestibular function, and healthy controls. The computerized DVA at near (50 cm) and far (200 cm) distances were collected. Data analysis included comparisons of near and far DVA in yaw and pitch planes.ResultsA total of 94 participants (34 UVD, 24 veterans with dizziness, 36 controls) were included. Near-distance DVA was significantly worse than far-distance DVA for the entire sample and within each group (p < 0.001).ConclusionsNear-distance DVA is more challenging than far-distance DVA across populations and planes of head rotation. Near-distance DVA may serve as a robust measure of vestibulo-ocular reflex function and offers a practical means for patients to self-monitor the effects of gaze stability training.

BackgroundBenign paroxysmal positional vertigo (BPPV) is the most common peripheral vestibular disorder, and its prevalence is substantial. While primary BPPV has been well studied, the understanding of secondary BPPV is still limited.ObjectiveTo investigate the prevalence and clinical characteristics of secondary BPPV in a national multicenter retrospective analysis.MethodsThe study involved a retrospective analysis of medical records from 17 institutions across South Korea, between January and June 2022. We evaluated clinical features, presumed etiologies, involvement of semicircular canals, response to canalith repositioning procedures (CRPs), presence of residual dizziness, recurrence, and results of auditory and vestibular function tests for both primary and secondary BPPV cases.ResultsOf the total 1363 BPPV cases, 14.5% (198 patients) were categorized as secondary BPPV. The most prevalent etiology for secondary BPPV was head trauma. Secondary BPPV was associated with a higher prevalence of comorbidities including diabetes and inner ear diseases. Patients with secondary BPPV demonstrated more frequent involvement of multiple semicircular canals, necessitated a greater number of CRPs for resolution, and experienced a higher incidence of residual dizziness compared to primary BPPV cases. Furthermore, secondary BPPV patients exhibited more frequent abnormalities in auditory and vestibular function tests.ConclusionsSecondary BPPV accounts for a significant proportion of BPPV cases, with distinct clinical characteristics compared to primary BPPV.

BackgroundIn Ménière's disease (MD), impaired sleep worsens the quality of life and triggers episodes, perpetuating a vicious cycle. The intricate connection between vestibular function and sleep regulation is poorly understood.ObjectiveWe aimed to investigate this link by studying sleep in confirmed MD patients.MethodsIn a single-center observational study, 26 consecutive patients with MD were enrolled. Sleep characterization included thorough symptom inquiry, questionnaires (PSQI, ESS, PFS, STOP-Bang, and AAO-HNS), and respiratory polygraphy (RP) or polysomnography (PSG).ResultsDespite 42% of patients reporting overall sleep satisfaction, further inquiry revealed 76% experiencing sleep disturbances per PSQI. STOP-Bang indicated 56% with a moderate-to-severe risk of OSAS. OSAS defined by apnea hypopnea index (AHI) ≥ 5/h was present in 75%. OSAS severity was categorized as mild (5/h ≤ AHI < 15/h, 33%), moderate (15/h ≤ AHI < 30/h, 21%), and severe (AHI ≥ 30/h, 21%). In patients with AAO-HNS score >3, migraines and insomnia were more prevalent. Patients with moderate-to-severe OSAS had poorer hearing. All recently diagnosed patients with moderate-to-severe OSAS had undergone more than one medical treatment compared to others (32%).ConclusionsThe high prevalence of sleep disorders in MD patients underscores the need for thorough screening, even without spontaneous complaints. Instrumental sleep exploration via RP or PSG is essential, as OSAS treatment could aid vestibular function.

BackgroundThe vestibular implant is an experimental device that may provide treatment to patients suffering from bilateral vestibulopathy who do not benefit from standard vestibular rehabilitation.ObjectiveThe objective is to identify the various methodology regarding device designs and surgical approaches in addition to assessing subjective and objective vestibular and clinical outcomes in order to evaluate the future and possible limitations of the vestibular implant.MethodsA systematic search of Medline and Embase was conducted according to the PRISMA guidelines using pre-defined inclusion and exclusion criteria. 350 hits were found, which after 2 rounds of screening by 2 independent reviewers resulted in 21 studies eligible for full-text review.ResultsA total of 36 recipients of a vestibular implant across four centres world-wide were identified. Both surgical approach and devices as well as vestibular and functional outcomes varied greatly across centres and from patient to patient, evaluated using a variety of objective and subjective tests.ConclusionSeveral promising results in vestibular implantation were found using both subjective and objective measurements. However, some questions with regards to hearing preservation and long-term, continuous use of the vestibular implant remain to be answered, and more studies are needed to assess the efficacy and cost-utility of the implant.

BackgroundPersistent postural-perceptual dizziness (PPPD) represents a relatively new vestibular diagnosis that has garnered attention within the medical community. Consequently, there is a pressing demand for efficacious management strategies.ObjectiveTo assess the comparative effectiveness of virtual reality (VR) versus vestibular rehabilitation therapy (VRT) in improving PPPD symptoms.MethodsWe randomly assigned a cohort of 42 individuals conclusively diagnosed with PPPD to two distinct groups. The experimental group included 21 participants who received a combination of VR and optokinetic stimulation in addition to VRT, while the control group, also made up of 21 individuals, only received optokinetic stimulation in conjunction with VRT. We administered the intervention sessions twice weekly over a span of 6 weeks, resulting in a total of 10-intervention sessions. Additionally, baseline, post-intervention, and follow-up assessments were conducted.ResultsOur analysis revealed that participants in both groups significantly improved with no significant differences between the groups. Individuals undergoing VR interventions demonstrated marked improvements across all of the assessed parameters including the primary outcome measure that were reduced from 41.55 (11.87) to 23.40 (14.17) (p<0.001). Moreover, participants in the control group also displayed notable enhancements in select outcome measures post-intervention including the primary outcome measure that were reduced from 43.60 (12.75) to 26.10 (16.25) (p = 0.001). All participants in both groups maintained significant improvement in the severity of PPPD after 1 year of the. However, the study cannot determine if this change was definitely from the treatment because there was no non-treatment control group.ConclusionsThe study found that the addition of VR to a well-structured VRT did not significantly improve clinical outcomes, indicating a need for further investigation into more effective approaches to yield meaningful clinical benefits. Moreover, adding a control group with no intervention would help revealing a real effect of the intervention.

BackgroundTranscranial magnetic stimulation (TMS) is extensively studied as a neuromodulation tool in neurological disorders. However, its use with the central vestibular disorders is limited.ObjectiveTo evaluate the utility of TMS as an assessment and treatment of chronic vestibular disorders and propose recommendations for future work.MethodsA comprehensive search of four electronic databases (PubMed, CINAHL, PsycINFO, and Rehabilitation and Sports Medicine Source) identified 206 records of which 16 studies were included.ResultsOne study used TMS as a neurophysiological assessment tool and 15 used repetitive TMS (rTMS) as a neuromodulatory intervention. Mal de Debarquement syndrome was the most frequently explored diagnosis. Dorsolateral prefrontal cortex and the cerebellum were the most frequent sites for rTMS application. Statistically significant improvements were noted on the Dizziness Handicap Inventory (3/7 studies) but clinically significant improvements were not observed. Postural control (7/7 studies) showed improvements along with VOR gain (1/1 studies).ConclusionsTMS shows promise as both a neurophysiological assessment tool and a neuromodulatory intervention for chronic vestibular disorders. Methodological limitations of the studies warrant caution while interpreting the results. Larger sample sizes, control groups, optimal neuroanatomical targeting, and dosing along with active rehabilitation are required to determine effectiveness in chronic vestibular disorders.

BackgroundRamsay Hunt syndrome with dizziness (RHSD), vestibular neuritis (VN), and idiopathic sudden sensorineural hearing loss with vertigo (SHLV) all present with acute vestibular symptoms, and no study has compared the semicircular canal (SCC) deficits among them.ObjectiveThis study aimed to use video head impulse test (vHIT) to compare the SCC injury patterns in RHSD, VN, and SHLV.MethodsTwenty-three RHSD patients, 44 VN patients, and 70 SHLV patients were enrolled. The vestibulo-ocular reflex gain and incidence of corrective saccades of anterior, horizontal, and posterior SCC (ASCC, HSCC, and PSCC) were examined using vHIT. Pathological vHIT results referred to decreased VOR gain and presence of corrective saccades.Results(1) The pathological rate of each SCC in RHSD group was the highest. (2) Impairment pattern of SCCs can be divided into 7 types based on vHIT results. The pattern of ASCC + HSCC + PSCC disability was the most common in RHSD patients (12/23, 52.2%). In the VN group, the HSCC deficit alone was the most common (16/44, 36.4%), followed by HSCC + ASCC impairment (13/44, 29.5%). In SHLV patients, the most common type was the PSCC deficit alone (26/70, 37.1%). (3) The system cluster analysis revealed that the injury of all SCCs in RHSD patients, the deficit of HSCC alone in VN patients, and the impairment of PSCC alone in SHLV patients showed the farthest distance from other injury patterns.ConclusionSCCs deficit showed more severe and extensive vestibular impairment in RHSD compared with VN and SHLV, suggesting these three peripheral acute vestibular disorders may have different pathophysiologic mechanisms.

BackgroundThe International Classification of Vestibular Disorders defines probable vestibular migraine (PVM) as an episodic vestibular disorder with either a history of migraine (criterion B) or migraine features during vestibular episodes (criterion C).ObjectiveThe purpose of this study is to investigate the clinical characteristics of PVM, focusing on items in the diagnostic criteria.MethodsWe retrospectively reviewed the medical records of 30 consecutive PVM patients diagnosed according to the Barany classification. The PVM patients were divided into two groups: those who fulfilled the criterion B (pre-existing migraine group) and those who fulfilled the criterion C (migraine features group).ResultsTwenty-four patients (80%) were in the pre-existing migraine group and the remaining 6 patients (20%) were in the migraine features group. All patients in the migraine features group had headache episodes. There were no significant differences between the two groups with regard to prevalence of migraine features listed in the criterion C and abnormal testing results.ConclusionsThe diagnosis of PVM was based on a history of migraine in most patients and on migraine features during vestibular episodes only in a few. All patients with migraine features during vestibular episodes had also headache episodes.

BackgroundIndividuals with dizziness often face balance issues and anxiety, which can result in reduced physical activity levels and decreased participation in their daily activities. Few studies have evaluated physical activity levels in individuals with chronic dizziness, and none have specifically focused on the two most prevalent types: vestibular migraine (VM) and persistent postural perceptual dizziness (PPPD).ObjectiveEvaluate self-reported physical activity levels in individuals diagnosed with PPPD and VM who are awaiting vestibular rehabilitation.MethodsIn a retrospective cross-sectional study, we extracted data from the electronic healthcare records involving 121 individuals presenting either VM or PPPD, referred for vestibular rehabilitation at National Hospital for Neurology and Neurosurgery, University College London. Data on IPAQ (International Physical Activity Questionnaire) and DHI (dizziness handicap inventory) questionnaires were analysed across groups.ResultsThe total sample consisted of 94 (77.7%) women and 27 (22.3%) men with a median age of 56 years old, ranging from 17 to 81 years (P25 = 41 and P75 = 64). Regarding the total sample, a minority (9.1%) of the individuals scored a high activity level on the IPAQ. We observed a significant difference between VM and PPPD in IPAQ score distribution (p = 0.039, Mann-Whitney). Within the category of high physical activity, a larger proportion of individuals had VM compared to PPPD. An inverse correlation was found between DHI and IPAQ (the lower IPAQ, the higher DHI) in the PPPD group (p<0.003).ConclusionsIn a sample of individuals with PPPD and VM referred for vestibular rehabilitation, only a minority demonstrated high physical activity levels on the IPAQ, with PPPD exhibiting lower activity levels compared to those with VM.