Vértigo en gestantes: presentación clínica, impacto en la calidad de vida y factores asociados / Vertigo in pregnancy: clinical presentation, impact on quality of life and associated factors

OBJETIVO: Evaluar las características clínicas, el impacto en la calidad de vida y los factores asociados con vértigo en gestantes hospitalizadas en una institución de alta complejidad. MÉTODO: Estudio transversal. Se realizó una encuesta dirigida a la presencia de vértigo y sus características clínicas en 2020-2021. La calidad de vida se evaluó con el cuestionario Dizziness Handicap Inventory (DHI). El análisis estadístico incluyó un modelo lineal generalizado. RESULTADOS: De 103 mujeres, el 19,4% indicaron vértigo principalmente en el segundo trimestre de gestación (60%), con una mediana de 3,5 (rango intercuartil: 1,5-7,5) episodios. Fueron referidos vértigos episódicos asociados con cambios posicionales (40%), acompañados de inestabilidad (60%), cefalea (60%), fotopsias (55%) y tinnitus (45%). Las mujeres con vértigo presentaron mayor frecuencia de discapacidad moderada a grave en las dimensiones del DHI emocional (30 vs. 2,4%; p = 0,001), funcional (40 vs. 2,4%; p < 0,001) y física (55 vs. 2,4%; p < 0,001) en comparación con las mujeres sin la patología. La hospitalización durante el embarazo Razón de proporción (RP): 4,02; intervalo de confianza del 95% [IC95%]: 1,64-9,85; p = 0,002) y la presencia de vértigo pregestacional (RP: 2,37; IC95%: 1,15-4,88; p = 0,019) se identificaron como factores asociados. CONCLUSIONES: La alta frecuencia de vértigo en las gestantes sugiere la importancia de estudiar esta condición durante el embarazo, para lograr un manejo integral y generar acciones de prevención y control efectivas.

OBJECTIVE: To evaluate clinical characteristics, impact on quality of life and factors associated with vertigo in pregnant women hospitalized in a highly complex institution. METHOD: A cross-sectional study was conducted in 2021-2022. One focused survey including Dizziness Handicap Inventory (DHI) was performed. The statistical analysis was performed using a generalized lineal regression. RESULTS: 103 patients were included, 19.4% indicated vertigo mostly during the second semester (60%). A median of 3.5 episodes was obtained (RIC: 1.5-7.5). Positional and episodic vertigos (40%) associated with unsteadiness (60%), headache (60%), photopsia (55%) and tinnitus (45%) were described. DHI in pregnant females with vertigo compared to those without vertigo, presented higher rates of moderate to severe disability in the emotional (30 vs. 2.4%: p = 0.001), functional (40 vs. 2.4%; p < 0.001) and physical (55 vs. 2.4%; p < 0.001) dimensions. Hospitalizations during the pregnancy (RP: 4.02; 95%CI: 1.64-9.85; p = 0.002) and previous episodes before pregnancy (RP: 2.37; 95%CI: 1.15-4.88; p = 0.019) were identified as associated factors with current vertigo episodes. CONCLUSIONS: The high frequency of vertigo in pregnant women suggests the importance of studying this condition during pregnancy, to achieve comprehensive management and generate effective prevention and control actions.

Research progress on the questionnaire related to persistent postural-perceptual dizziness / 临床耳鼻咽喉头颈外科杂志

Persistent postural-perceptual dizziness（PPPD） is the most common chronic vestibular disease, the clinical manifestation is dizziness, unstable and non-rotational dizziness for three months or more. And the symptom is exacerbated by upright posture, active or passive movement, and complex visual stimuli. In addition, PPPD is a functional disease, so routine vestibular function tests and imaging tests are often negative. According to the diagnostic criteria established by the Barany Association, the diagnosis of PPPD often relies on history. This article provides a review of PPPD-related questionnaires.

Dizziness in Traumatic Brain Injury: Visual-Vestibular Dysfunction, Neurotological Approach / 대한평형의학회지

Traumatic brain injury (TBI) could give rise to variable clinical manifestations based on the involved structures of our bodies. Although there are no structural abnormalities proven, the patients with mild TBI suffer from chronic dizziness and imbalance. Herein, I will discuss the visuo-vestibular interaction and neurotological finding in TBI, which could demonstrate the clue to the diagnosis and management in dizzy patients with TBI.

Vestibular Rehabilitation for Patient with Bilateral Peripheral Vestibular Deficit / 대한평형의학회지

Bilateral vestibular deficit affects far fewer patients than unilateral deficit, and thus has been understudied. When bilateral vestibular organs are injured, loss of input of vestibulo-ocular and vestibulo-spinal reflex that normally stabilize the eyes and body, affected patients suffer blurred vision during head movement, postural instability, and disequilibrium. Vestibular rehabilitation therapy is an exercise-based treatment program designed to promote vestibular adaptation and substitution. The rationale for the exercises, which originated from the observation that patients who were active recovered faster, was based on the supposition that the head movements that provoke the patient's dizziness play an important role in hastening the recovery process. Here the author reviews the clinical manifestation and treatment of bilateral vestibular deficit that include vestibular rehabilitation therapy and vestibular device that studied today.

Vestibular Rehabilitation for Patients with Unilateral Peripheral Vestibular Deficit / 대한평형의학회지

Unilateral peripheral vestibular deficit can occur from a different etiology including viral infection, trauma, ear surgery or idiopathic. Patients with sudden unilateral vestibular deficit usually complain of whirling vertigo, postural imbalance and ipsilesional lateropulsion, which gradually recover over a few weeks by vestibular compensation mechanism. Vestibular rehabilitation therapy has been accepted as helpful exercise based training program with strong evidence for acceleration of vestibular compensation in unilateral vestibular deficit. Here the authors described the current issue regarding vestibular rehabilitation in unilateral vestibular hypofunction from the informative literature review.

Doença vestibular em cães: 81 casos (2006-2013) / Vestibular disease in dogs: 81 cases (2006-2013)

Eighty-one cases of vestibular disease in dogs were diagnosed by the neurology service in a veterinary teaching hospital in southern Brazil from 2006 to 2013. Approximately 2/3 of these cases were interpreted as central vestibular disease (CVD) with the remaining cases being considered as peripheral vestibular disease (PVD). Pure breed dogs, especially Dachshunds (PVD) and Boxers (CVD) were more affected than mixed breed dogs. The main clinical signs observed in cases of CVD and PVD included head tilt, vestibular ataxia, and ventral or ventrolateral strabismus. Proprioceptive deficits, cranial nerve V-XII dysfunction, and changes in the levels of conscience were observed only in cases of CVD, whereas absence of palpebral reflex occurred only in cases of PVD. Inflammatory or infectious diseases, especially canine distemper and bacterial otitis were the most commonly observed conditions associated with CVD and PVD, respectively. This article establishes the epidemiology (sex, age, and breed) and prevalence of clinical signs related to canine vestibular disease in the Central Rio Grande do Sul State; discusses the use of the clinical findings in the correct diagnosis and differentiation between CVD and PVD; and defines the main specific diseases responsible for the occurrence of CVD and PVD in dogs.

De 2006 a 2013 foram diagnosticados 81 casos de doença vestibular canina no serviço de rotina em neurologia de um hospital veterinário universitário do sul do Brasil. Desses, aproximadamente dois terços foram diagnosticados com doença vestibular central (DVC) e cerca de um terço como doença vestibular periférica (DVP). Cães com raça definida foram mais acometidos que aqueles sem raça definida, principalmente Dachshund (DVP) e Boxer (DVC). Os principais sinais clínicos observados, tanto na DVP quanto na DVC, incluíram: inclinação de cabeça, ataxia vestibular e estrabismo ventral ou ventrolateral. Deficiência proprioceptiva, disfunção dos nervos cranianos V-XII e alteração de nível de consciência foram vistos apenas em casos de DVC, já a ausência de reflexo palpebral ocorreu apenas em casos de DVP. Doenças inflamatórias/infecciosas, principalmente cinomose e otite bacteriana, foram as condições mais comumente associadas à DVC e à DVP, respectivamente. Esse artigo estabelece os aspectos epidemiológicos (sexo, idade e raça) e a prevalência dos sinais clínicos observados em cães com doença vestibular na Região Central do Rio Grande do Sul, discute a utilização dos achados clínicos no diagnóstico correto e na diferenciação entre DVC e DVP, e define quais as principais doenças responsáveis pela ocorrência dessas duas síndromes clínicas.

Factors relating to depressive symptoms among elderly people with chronic vestibular dysfunction / Fatores relacionados aos sintomas depressivos de idosos com disfunção vestibular crônica

OBJECTIVE: To identify factors relating to depressive symptoms among elderly people with chronic vestibular dysfunction. METHOD: This was a cross-sectional study in which 120 elderly people with chronic vestibular dysfunction answered the Geriatric Depression Scale questionnaire. Multivariate linear regression analysis was performed (p<0.05 and 95 percent CI). RESULTS: The patients presented a mean score of 12.86 ± 6.39 points on the Geriatric Depression Scale, and 67 of them (55.8 percent) scored above the cutoff of 11 points. The predictive model for worsening of depressive symptoms was composed of female gender, memory and concentration disorders, insomnia, hearing disorders, poor sight, nonuse of walking aids and greater emotional impact of dizziness. CONCLUSION: Greater numbers of depressive symptoms among elderly people with chronic vestibular disease were related to the presence of memory and concentration disorders, insomnia, hearing disorders, very poor sight, greater emotional impact of dizziness, female gender and nonuse of walking aids.

OBJETIVO: Identificar os fatores relacionados aos sintomas depressivos de idosos com disfunção vestibular crônica. MÉTODO: Estudo transversal, em que 120 idosos com disfunção vestibular crônica submeteram-se ao questionário Geriatric Depression Scale. Realizou-se análise de regressão linear multivariada (p<0,05 e IC de 95 por cento). RESULTADOS: Os pacientes apresentaram média de 12,86 ± 6,39 pontos no GDS, sendo que 67 idosos (55,8 por cento) pontuaram acima da nota de corte 11. O modelo preditivo para piora dos sintomas depressivos foi composto por gênero feminino, distúrbios de memória e da concentração, insônia, hipoacusia, visão péssima, não utilização de dispositivo de auxílio à marcha e maior impacto da tontura no aspecto emocional. CONCLUSÃO: O maior número de sintomas depressivos de idosos vestibulopatas crônicos está relacionado à presença de distúrbios de memória e da concentração, insônia, hipoacusia, visão péssima, maior impacto da tontura no aspecto emocional, gênero feminino e não utilização de dispositivo de auxílio à marcha.

Possibility of Misdiagnosing the Lesion Side in Unilateral Vestibular Weakness / 대한평형의학회지

Sudden sensorineural Hearing Loss with Vertigo (SHLV) is characteristic of sudden onset vertigo and unilateral hearing loss, due to acute and profound deterioration in a vestibular and cochlear system. It is relatively easy to determine the lesion side in SHLV, because the patient will complain of unilateral hearing loss. But, it might not beapplicable to vestibular neuritis case, and several vestibular function tests may be helpful in deciding the lesion side. We have recently encountered a patient with SHLV whose caloric and SHA did not match with the lesion side. We speculated that the uncompensated dynamic defect and imbalance of the cerebellar clamping has been implicated in this lab finding. Although the exact mechanism of this curious finding cannot be explained by this single case report, we should consider that one could make a mistake to determine the involved site just only by lab finding in vestibular neuritis.

Benign Paroxysmal Positional Vertigo in Bilateral Vestibular Loss

Usual presentations of bilateral vestibular loss are ataxia and oscillopsia. However, fluctuating dizziness is also observed in bilateral vestibulopathy patient. Fluctuating vestibular function in bilateral vestibular loss patients may suggest asymmetric progression of functional loss after compensation is partially accomplished. Because labyrinthine lesion causing vestibular loss is a predisposing factor of benign paroxysmal positional vertigo (BPPV), secondary BPPV can also be developed in bilateral vestibular loss patients. However, BPPV has been hardly noticed in bilateral vestibulopathy patients as a cause of fluctuating dizziness. Authors experienced two cases of BPPV developed in bilateral vestibular loss, one of which showed complete dead labyrinth on ice water caloric test and no significant vestibule-ocular reflex on rotation test. These cases show recurrent BPPV can be the cause of recurrent vertigo in bilateral vestibular loss patients.

Clinical Manifestations of Patients with Migraine-associated Vertigo / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: The clinical association between migraine and vestibular symptoms has been indicated in many studies and it is believed that migraine-associated vertigo is one of the most common causes of spontaneous recurrent vertigo. SUBJECTS AND METHOD: We investigated the nature of vestibular and migrainous symptoms of 26 patients suffering vertigo associated with migraine and their responses to antimigrainous medications. Neurotologic tests such as oculomotor tests, calorictest, and audiometry were performed between attacks. RESULTS: A marked female predominance was found. The duration of rotational (77%) and/or to-and-fro vertigo (23%) lasted from a few seconds to several hours or, less frequently, even days. We found that patients showed vestibular abnormalities in central and peripheral types. In the symptom-free interval, 31% of the patients showed central oculomotor signs such as delayed saccadic latency and horizontal saccadic pursuit. On the other hand, 15% showed unilateral weakness in the caloric test and 15% showed positive results in the head thrust tests. Overall, 85% of patients experienced resolution or significant reduction of their attacks of vertigo with medication. CONCLUSION: Most patients with migraine-associated vertigo showed normal results on the vestibular tests and responded well to preventive medication. Migraine-associated vertigo caused various clinical manifestations and there should be relevant differential diagnosis for epiodic vertigo.

Fatores associados ao equilíbrio funcional em idosos com disfunção vestibular crônica / Functional balance associated factors in the elderly with chronic vestibular disorder

Tarefas do dia-a-dia podem ser muito desafiadoras para o equilíbrio do idoso. OBJETIVO: Verificar a associação entre equilíbrio funcional, avaliado pela Berg Balance Scale (BBS) e os dados sociodemográficos, clínicos e de mobilidade (Timed up and go test - TUGT, Dynamic Gait Index - DGI) em idosos vestibulopatas crônicos. MATERIAL E MÉTODO: Estudo de casos com 120 idosos com diagnóstico de disfunção vestibular crônica. Foram utilizados os testes de Mann-Whitney, Kruskal-Wallis seguido do teste de Dunn e Coeficiente de Correlação de Spearman. RESULTADOS: Ocorreram associações =-0,354; e correlações significantes entre a pontuação total da BBS e idade (p<0,001), faixa etária (p<0,001), número de doenças (p=0,030), número de =-0,287; p=0,001), número de medicamentos (p=0,014), número de doenças (=-0,274; p=0,002), quedas recorrentes (p=0,010), tendência a medicamentos (quedas (p=0,002), diagnóstico topográfico de vestibulopatia central (p<0,001) =-0,709; periodicidade da tontura (p=0,039), TUGT (<0,001) e DGI =-0,748; p(<0,001). CONCLUSÕES: O equilíbrio funcional de idosos vestibulopatas crônicos avaliados à BBS é mais comprometido quando associado ao avançar da idade, faixa etária mais idosa (80 anos ou mais), aumento do número de doenças, presença de cinco ou mais doenças, polifarmacoterapia, quedas recorrentes, tendência a quedas, vestibulopatia central, tontura diária, comprometimento da mobilidade e marcha.

Daily activities can be challenging for the elderly. AIM: To study the association between functional balance, evaluated by the Berg Balance Scale (BBS), sociodemographics, clinical and mobilility (Timed up and go test - TUGT, Dynamic Gait Index - DGI) variables in the elderly with chronic vestibular disorder. MATERIALS AND METHODS: A series study with one hundred and twenty elderly with chronic vestibular disorder. We performed the Mann-Whitney test, the Kruskal-Wallis test followed by Dunn test and the Spearman Coefficient (). RESULTS: Statistically significant associations and correlations were observed between total BBS score and age (=-0.354; p<0.001), age group (p<0.001), number off illnesses (p=0.030), number of illnesses (=-0.287; p=0.001), number of medications (p=0.014), number of medications (=-0.274; p=0.002), recurrent falls (p=0.010), tendency to fall (p=0.002), topographic diagnosis of central vestibular disorder (p<0.001) and periodicity of dizziness (p=0.039), TUGT (=-0.709; p<0.001) and DGI (=-0.748; p<0.001). CONCLUSIONS: Functional balance in the elderly with chronic vestibular disorders evaluated by the BBS is worse when associated with aging, with a more advanced age group (80 years or more), increasing number of illnesses, presence of five or more illnesses, use of multiple medications, recurrent falls, tendency to fall, central vestibular syndromes, daily dizziness, mobility and gait impairments.

Clinical Significance of Vibration-Induced Nystagmus in Unilateral Peripheral Vestibular Loss / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: Vibration-induced nystagmus(VIN) may be a useful bedside sign for detecting vestibular imbalance. However, the clinical significance of VIN remains unclear. The aim of this study is to analyze the lateralizing value of VIN in patients with unilateral vestibular deficit after acute vestibular functional loss. SUBJECTS AND METHOD: Forty patients with peripheral vestibular loss of acute etiology were included. Patients assuming fluctuating or slowly aggravating vestibular dysfunction were excluded. VIN was induced by applying 100 Hz vibratory stimuli to both mastoids side by side. Direction and intensity of horizontal nystagmus were analyzed by using video-oculography. Post-head shaking nystagmus(HSN), caloric test and vestibular evoked myogenic potential(VEMP) were also performed. Age matched 25 healthy volunteers were included for control. RESULTS: Of the 40 patients, 37(92.5%) showed contralesional VIN whereas only one exhibited ipsilesional nystagmus. Two patients(2.5%) did not develop VIN. Immediate HSN was present in 31(77.5%) patients. VIN and HSN were present in the same direction in 24 patients and in the opposite direction in 5. The intensity of VIN showed significant correlations with the intensity of HSN and the degree of canal paresis on bithermal caloric test, whereas it did not depend on the presence of VEMP. CONCLUSION: VIN is mostly contralesional in peripheral vestibulopathies. VIN may be a simple and useful clinical sign for indicating lateralization in fixed vestibular loss.

Discapacidad por enfermedad auditiva y vestibular en un centro de atención especializada / Disability due to auditory and vestibular dysfunction in a specialized care center

Objetivo: identificar la limitación que en su vida diaria padecen los pacientes evaluados por hipoacusia o enfermedad vestibular en un Centro de Atención Especializada del IMSS. Método: participaron 530 pacientes evaluados por primera vez con hipoacusia (n=252) o enfermedad vestibular (n=278), de los cuales eran económicamente activos 54 y 50% respectivamente. Después de la evaluación especializada y de la administración un cuestionario de síntomas co cleovestibulares, se identificó la frecuencia y número de días de discapacidad relacionados con la hipoacusia o enfermedad vestibular y la frecuencia de consultas médicas durante el último año. Resultados: los pacientes con hipoacusia solicitaron consulta médica 1-6 veces/año y 15.8% informaron discapacidad. Mientras que aquéllos con enfermedad vestibular solicitaron 1-8 consultas e informaron discapacidad con más frecuencia (60.8%) (p < 0.01); de los pacientes económicamente activos 5% con hipoacusia y 51% con enfermedad vestibular había tenido discapacidad laboral, de 115 días acumulados para el primer grupo y de 1 365 días para el segundo grupo. La correlación entre el tiempo de evolución de la enfermedad y los días de discapacidad por hipoacusia fue de r de Spearman -0.14 (p < 0.01) y -0.27 (p < 0.01) por enfermedad vestibular. Conclusión. La enfermedad vestibular produce discapacidad, que puede ser prolongada, con implicaciones económicas tanto para el paciente como para la institución que le otorga la atención médica.

Objective: To assess the frequency and characteristics of the disability associated with hearing loss and vestibular disease in a Specialized Medical Center of the Mexican Social Security Institute. Methods: 530 patients agreed to participate. They were assessed due to hearing loss (n=252) and vestibular disease (n=278), 54% and 50% of them worked. After a clinical evaluation and administration of a symptom questionnaire, they were asked about the frequency and days of disability to perform daily life activities related to their audiological or vestibular disease and how often they visited the physician during the last year because of their symptoms. Results: Hearing loss patients visited the physician 1-6 times/ year and 15.8% reported disability. Vestibular patients visited the physician 1-8 times/ year and reported disability more frequently (60.8%) (p < 0.01). Among those who worked, 5% of patients with hearing loss and 51% of patients with vestibular disease stopped working during 115 cumulative days for the first group and 1 365 cumulative days for the second group. Spearman's correlation coefficient between the evolution of the disease and disability days was -0.14 (p < 0.01) for hearing loss patients and -0.27 (p < 0.01 ) for vestibular disease. Conclusion. Vestibular disease is a cause of disability, which can have financial impact on both the patient and the health care system.

Treatment outcome of two different methods of canalith repositioning maneuver

BACKGROUND AND OBJECTIVES: Canalith repositioning procedure described by Epley is an effective treatment of benign paroxysmal positional vertigo (BPPV) based on the theory of canalithiasis. Although there are many modifications of Epley's maneuver, they have much similarity and are usually composed of 4 steps. However there is considerable variation of pause at each position from 6 seconds to 4 minutes. The purpose of this study is to determine treatment outcome of short and long pause at each position. MATERIALS AND METHODS: This is a randomized prospective study of patients with posterior canal type BPPV. One hundred patients were randomized to one of two groups at their first clinic visit between March 1999 and September 2000. The diagnosis was based on typical findings of vertigo and nystagmus by Dix-Hallpike maneuver and head turning in supine position. The authors treated patients with two different methods of the canalith repositioning procedure. One group maintained each position until the nystagmus stopped. If no nystagmus was observed, the position was maintained for 5 to 10 seconds. The other group maintained each position for 3 minutes. We assessed treatment outcomes of two methods. RESULTS: We can not find the difference of a success rate between two groups. CONCLUSION: It takes less than one minute with rapid head position changing method, so this method is more feasible in out-patients clinics.