Correlation between vitamin D deficiency and benign paroxysmal positional vertigo

Background: Benign Paroxysmal Positional Vertigo (BPPV) is the most common cause of peripheral vertigo. Vitamin D3 is an indispensable part of bone mineralization and calcium homeostasis. Vitamin D3 also plays a role in BPPV and therefore may offer a therapeutic option. Aim and Objective: This study aims to evaluate the relationship of BPPV with Vitamin D deficiency. Materials and Methods: This observational case–control study was done on 80 subjects out of which 40 were confirmed cases of BPPV patients and 40 were controls. Ear, throat, and nose were examined in all patients. Measurement of Vitamin D3 was done in all subjects. Assessment of quality of life was done using Dizziness Handicap Inventory score (DHI) and Visual Vertigo Analog Scale (VVAS). Results: In our study among cases, 14 patients (35%) had normal Vitamin D levels, Vitamin D deficiency was seen in 15 cases (37.5%) and 11 patients (27.5%) had Vitamin D insufficiency. In control group, 22 patients (55%) had normal Vitamin D levels and 9 patients (22.5%) each had Vitamin D insufficiency and deficiency. Mean of Vitamin D concentration in the case group was 23.78 ± 10.43 and in the control group had 35.99 ± 15.99. The relationship between the two groups was significant (P = 0.001). The mean of body mass index in case and control group was 22.46 ± 2.48 and 23.43 ± 2.38, respectively, with P-value of 0.032 indicating significant relationship statistically. Furthermore, VVAS and DHI scores were higher in cases with deficiency and insufficiency of Vitamin D. Conclusion: The present study shows a significant relationship of reduced concentration of Vitamin D with idiopathic BPPV.

A linguistic validation study on the Filipino dizziness handicap inventory

@#Objective: To determine the validity and reliability of the Filipino Dizziness Handicap Inventory (FDHI) questionnaire among geriatric patients with dizziness. Methods: Design: Linguistic Validation Setting: Tertiary Government Training Hospital Participants: Twenty-five (25) patients Results: The dizziness handicap inventory was translated into Filipino by a Filipino language specialist and an ENT specialist who are experts in their field. The translated version was easily understood by the 25 geriatric patients with Cronbach α scores of .957 overall [M = 2.16; SD = 1.93]. Sub-domain item-total correlation scores (physical M = 2.6, SD = 1.90, Cronbach α = .860; emotional M = 1.66, SD = 1.84, Cronbach α = .901; and functional M = 2.5, SD = 1.97, Cronbach α = .902) demonstrated validity of the respective subdomains. Conclusion: The Filipino Dizziness Handicap Inventory questionnaire is an internally valid tool for assessment of dizziness among geriatric patients. External validity and reliability can be evaluated in future studies employing corroborative measures and repeated testing.

Customized Vestibular Rehabilitation in the Patients with Bilateral Vestibulopathy: A Pilot Study in One Referred Center / 대한평형의학회지

OBJECTIVES: Bilateral vestibulopathy is characterized with unsteadiness and oscillopsia when walking or standing, worsening in darkness and/or on uneven ground. To establish the effect of customized vestibular rehabilitation in bilateral vestibulopathy, we analyzed the questionnaires and functional status before and after treatment. METHODS: Among 53 patients with customized vestibular rehabilitation from January 1st to November 30th in 2018, 6 patients (3 males; median age, 71 years; range, 54–75 years) who regularly exercised with good compliance were retrospectively enrolled. They were educated and trained the customized vestibular rehabilitation once a month or two by a supervisor during 40 minutes, and then exercised at home for 30 minutes over 5 days in a week. Dizziness handicap inventory (DHI), Korean vestibular disorders activities of daily living scale (vADL), Beck's depression index (BDI), test for dynamic visual acuity (DVA), and Timed Up and Go test (TUG) were performed before and after the customized vestibular rehabilitation. RESULTS: The patients exercised for median 5.5 months (range, 2–10 months) with the customized methods of vestibular rehabilitation, which included gaze and posture stabilization and gait control exercises. DHI score and TUG was improved after rehabilitation (DHI before vs. after rehabilitation=33 vs. 16, p=0.027, TUG before vs. after rehabilitation=12 vs. 10, p=0.026). BDI, DVA, and vADL scores did not differ between before and after treatment. CONCLUSIONS: Customized vestibular rehabilitation can improve dizziness and balance state in bilateral vestibulopathy. The steady exercises adapted individual peculiarities is the most important for vestibular rehabilitation.

Relationship between Video Head Impulse Gain and Severity of Dizziness in Patients with Vestibular Neuritis / 대한이비인후과학회지

BACKGROUND AND OBJECTIVES: We evaluated the correlation between video head impulse test (vHIT) and dizziness handicap inventory (DHI), which is commonly used to quantify severity of dizziness in vestibular neuritis (VN). SUBJECTS AND METHOD: Twenty VN patients undergoing vHIT either at the acute or follow-up stages of treatment were assessed by DHI questionnaire. Gain and gain asymmetry (GA) were correlated with DHI scores and abnormal vHIT rates were compared according to the severity of dizziness (mild ≤30; moderate-to-severe ≥32). RESULTS: vHIT gains significantly increased from the acute to follow-up stages (from 0.45±0.18 to 0.70±0.25), whereas GA and DHI scores decreased (GA, from 0.36±0.15 to 0.22±0.18; DHI scores, from 35±26 to 23±23). Although vHIT gains or GA showed no correlation with DHI scores at the acute stage, vHIT gains showed significant correlation with DHI scores at the follow-up (R-sq=0.32, p=0.01) stage. vHIT gains and GA did not differ according to the severity of dizziness during the acute stage; however, vHIT gains (0.78±0.25) of patients with mild dizziness were significantly higher than those (0.51±0.14) with moderate-to-severe dizziness at the follow-up stage. During the follow-up, all patients with moderate-to-severe dizziness showed abnormal vHIT gain, but 43% of patients with mild dizziness showed abnormal vHIT gain, showing a significant difference (p<0.05). CONCLUSION: Reduced vHIT gain was significantly correlated with high degrees of dizziness at the follow-up, but not at the acute stage, suggesting that high-frequency canal dysfunction is contributed in part by the subjective dizziness at the follow-up. Our findings suggest that vHIT might give an indirect evidence for implementing vestibular rehabilitation for enhancing impaired vestibular function and relieving subjective dizziness.

Clinical study on treatment of Bushen-Huoxue decoction for the patients with senile chronic cerebral circulation insufficiency / 国际中医中药杂志

Objective To observe the effect of Bushen-Huoxue decoction combined with conventional therapy on the clinical symptoms, vertigo degree and cognitive function of elderly patients with chronic cerebral cerebral circulation insufficiency (CCCI) and to explore its mechanism. Methods A total of 70 patients were randomly divided into observation group and control group according to random number table method. The two groups were given antihypertensive, hypoglycemic, lipid and other western medicine treatment. On this basic treatment, the control group added orally flunarizine hydrochloride capsules, 5 mg /day before sleeping, while the observation group with Bushen-Huoxue decoction per day. All the treatment last 30 days. dizziness handicap inventory (DHI) and montreal cognitive assessment (MoCA) were used for the symptoms evaluation, and the mean flow velocity of the following arteries basilar artery (BA), bilateral vertebral artery (VA) and middle cerebral artery (MCA) were assessed by the Ultrasound transcranial doppler blood flow analyzer. The acidity phosphatidic acid, AP were detected by chemical colorimetric method. And the clinical effect rates were compared after treatment. Results The total effective rate of observation group was 94.3％ (33/35), higher than 82.9％ (29/35) in the control group, and the difference in group 2 was statistically significant (χ2=9.728, P<0.05). After treatment, the TCM symptom scores (6.2 ± 3.3 vs. 9.8 ± 3.7, t=8.920), DHI score (4.4 ± 2.5 vs. 9.3 ± 3.6, t=12.081) and MoCA score (25.7 ± 2.6 vs. 23.2 ± 2.8, t=6.638) improvement of the observation group were significantly better than those of control group (P<0.05). The Vms of LVA (37.2 ± 8.5 cm/s vs. 34.9 ± 7.6 cm/s, t=9.103), LMCA (63.3 ± 9.8 cm/s vs. 60.1 ± 8.4 cm/s, t=7.839), RMCA (62.8 ± 10.5 cm/s vs. 60.9 ± 9.5 cm/s, t=6.583) and plasma AP (3.74 ± 1.08 μmol/L vs. 5.81 ± 1.35 μmol/L, t=9.627) improvement of the observation group were significantly better than those of control group (P<0.05). Conclusions The Bushen-Huoxue decoction can improve the clinical symptoms and vertigo of the elderly and improve the cognitive level of the patients. The mechanism may be related to the improvement of the cerebral blood flow velocity, the decrease of plasma AP, and the state of ischemia and hypoxia.

Rasch Analysis of the Clinimetric Properties of the Korean Dizziness Handicap Inventory in Patients with Parkinson Disease / 대한평형의학회지

OBJECTIVES: The Korean Dizziness Handicap Inventory (KDHI), which includes 25 patient-reported items, has been used to assess self-reported dizziness in Korean patients with Parkinson disease (PD). Nevertheless, few studies have examined the KDHI based on item-response theory within this population. The aim of our study was to address the feasibility and clinimetric properties of the KDHI instrument using polytomous Rasch measurement analysis. METHODS: The unidimensionality, scale targeting, separation reliability, item difficulty (severity), and response category utility of the KDHI were statistically assessed based on the Andrich rating scale model. The utilities of the orderedresponse categories of the 3-point Likert scale were analyzed with reference to the probability curves of the response categories. The separation reliability of the KDHI was assessed based on person separation reliability (PSR), which is used to measure the capacity to discriminate among groups of patients with different levels of balance deficits. RESULTS: Principal component analyses of residuals revealed that the KDHI had unidimensionality. The KHDI had satisfactory PSR and there were no disordered thresholds in the 3-point rating scale. However, the KDHI showed several issues for inappropriate scale targeting and misfit items (items 1 and 2) for Rasch model. CONCLUSIONS: The KDHI provide unidimensional measures of imbalance symptoms in patients with PD with adequate separation reliability. There was no statistical evidence of disorder in polytomous rating scales. The Rasch analysis results suggest that the KDHI is a reliable scale for measuring the imbalance symptoms in PD patients, and identified parts for possible amendments in order to further improve the linear metric scale.

Impacto de las Maniobras de Reposicionamiento en el grado de discapacidad de pacientes con Vértigo Posicional Paroxístico Benigno del conducto semicircular posterior

Introducción. El Vértigo Posicional Paroxístico Benigno (VPPB) del canal semicircular posterior es una enfermedad crónica que afecta severamente la calidad de vida de los pacientes que lo sufren. Para su manejo existen las Maniobras de Reposicionamiento, que son una serie de ejercicios secuenciales de la cabeza en 4 posiciones. El propósito de la maniobra es reposicionar los otolitos desde el conducto semicircular posterior dentro del vestíbulo a los sitios de donde migraron para dejar de producir vértigo. Permaneciendo en cada posición aproximadamente 30 segundos. Las maniobras han demostrado gran eficacia a corto plazo. Los resultados son medibles por medio de un cuestionario conocido como Dizziness Handicap Inventory (DHI). Objetivos: Medir el impacto de las maniobras de reposicionamiento en la discapacidad en los pacientes con Vértigo Posicional Paroxístico Benigno del conducto semicircular posterior, mediante el uso del DHI. Metodología. Es un estudio comparativo que utiliza la T de Student para muestras pareadas donde cada paciente es su propio control, se tomó una muestra de 20 pacientes diagnosticados con Vértigo Posicional Paroxístico Benigno del conducto semicircular posterior que serán tratados con maniobras de reposicionamiento, serán evaluados mediante la herramienta (DHI) que será completada por los pacientes al inicio del estudio, al día 7 y día 30, luego de realizadas las Maniobras de Reposicionamiento. Resultados: Las mujeres son las más afectadas por el (VPPB) del canal semicircular posterior en una relación de 2.1 aproximadamente. El grado de discapacidad fue medido por el resultado del DHI, el cual muestra para los días 1, 7, y 30 una media de 50.4, 30.4 y 24.2 respectivamente. La escala con mayor punteo durante los días 1, 7, y 30 fue la escala funcional mostrando una media de 20, 12.2, y 9.5 respectivamente. Las diferencias entre las medias fueron estadísticamente significativas. (p= 0.00006, 0.000002 y 0.03701). Conclusiones: El padecimiento de VPPB del conducto semicircular posterior afecta la calidad en el estilo de vida de las personas. Las maniobras de reposicionamiento son estadísticamente significativas para disminuir la incapacidad generada por el vértigo posicional paroxístico benigno del conducto semicircular posterior por lo que es importante acudir rápidamente al médico especialista cuando se manifiesten los primeros signos y evitar así aumentar la discapacidad total asociada al vértigo. Palabras Clave: Vértigo Posicional Paroxístico (VPPB), otolitos, Dizziness Handycap Inventory (DHI).

Introduction. Benign Paroxysmal Positional Vertigo (BPPV) of the posterior semicircular canal is a chronic disease severely affecting quality of life. Repositioning Maneuvers is a way of relieving it, consisting of a series of sequential exercises of the head into 4 positions. The purpose of the maneuver is to reposition the otoliths from the posterior semicircular canal inside the lobby to the sites where they migrated to stop producing vertigo. Each position has to remain for approximately 30 seconds. The maneuvers have proven to be highly effective in the short term. The results are measurable by means of a questionnaire known as Dizziness Handicap Inventory (DHI). Objectives: To measure the impact of repositioning maneuvers on disability in patients with BPPV of posterior semicircular canal, using the DHI. Methods: A comparative study using T-test for paired samples where each patient is his own control was used in a sample of 20 patients diagnosed with BPPV of posterior semicircular canal were studied and treated with repositioning maneuvers. Results were evaluated by DHI and ran in day 1, day 7 and 30 after Repositioning maneuvers performed. Results: Females are most affected by BPPV in a ratio of approximately 2.1. The degree of disability was measured by the result of DHI, which shows for days 1, 7, and 30 an average of 50.4, 30.4 and 24.2 respectively. The scale with a higher score were days 1 and 7 then showing a marked decreased on day 30. Mean results were the 20, 12.2 and 9.5 respectively. The differences between the means were statistically significant. (P = 0.000062, 0.000002 and 0.037010). Conclusions: BPPV affects the quality of life. Repositioning maneuvers are statistically significant to reduce the disability caused by BPPV of the posterior semicircular canal so, it is important to quickly see a specialist when first signs manifest and that way avoid increasing the total disability associated with vertigo. Keywords: Paroxysmal Positional Vertigo (BPPV), Otolith, Dizziness Handicap Inventory (DHI)

Application of the dizziness handicap inventory in the patients with benign paroxysmal positional vertigo / 临床耳鼻咽喉头颈外科杂志

Objective:This study was designed to observe the dizziness handicap inventory (DHI) scores in patients with BPPV (benign paroxysmal positional vertigo) before and after maneuver repositioning and aimed to discuss the values of DHI scores in the diagnosing and treatment of BPPV. Method:Charts of 72 patients with BPPV diagnosed by positioning test were reviewed. Four DHI scores were used including the total score (DHIT), the functional score (DHIF), the emotional score (DHIE), and the physical score (DHIP). We compared the pre-repositioning DHI scores and post-repositioning scores of patients, and also compared the DHI scores of patients with and without residual dizziness. Result:All of the 72 patients were underwent maneuver repositioning and recorded the DHI scores. The mean post-repositioning scores were dramatically decreased compared with pre-repositioning scores, and the difference was significant (P<0.01). The differences of the DHIP scores between the residual dizziness group and the non-residual dizziness group was not significant, while the DHIF scores, the DHIE scores and the DHIT scores between the two groups were statistically different. Conclusion:After maneuver repositioning the dizziness handicap of BPPV patients could be significantly improved. The next treatment program for residual dizziness patients after successful repositioning could be aimed at the functional and emotional dizziness.

Correlation between Rotating Chair Test and Dizziness Handicap Inventory in Patients with Acute Unilateral Vestibular Neuritis / 대한평형의학회지

OBJECTIVE: Vestibular neuritis (VN) is one of the most common causes of acute spontaneous vertigo. However, such dizziness symptoms in patients with VN vary among patients, and various methods are used to evaluate subjective vestibular symptoms following attack of VN. Studies on correlation between subjective vestibular symptom changes and result of rotation chair test after vestibular rehabilitation therapy (VRT) have not been reported. Therefore, we compared change of dizziness handicap inventory (DHI) and results of rotation chair test in patients with VN between attack and 3 month later following VRT. METHODS: Forty-seven patients were included in this study. In patients with VN, DHI and rotation chair test were performed at the time of VN attack and recovery time of 3 months after VN attack. RESULTS: In general, the DHI score and the percentage of directional preponderance (DP) in a rotation chair test performed on patients with VN have all decreased. However, the changes in these results were not statistically significant. DP% difference and DHI score were compared to each other among patients with VN and showed no relational significance to each other (r=0.326). CONCLUSION: The degree of improvement in a rotation chair test done on patients with VN did not reflect the severity of improvement for symptom like dizziness.

Clinical Significance of Spontaneous Nystagmus Frequency in Vestibular Neuronitis / 대한평형의학회지

OBJECTIVE: Spontaneous nystagmus is typical sign in vestibular neuronitis. However, the clinical significance of spontaneous nystagmus frequency remains unclear. The aim of this study is to analyze the spontaneous nystagmus frequency in patients with vestibular neuronitis. METHODS: Twenty-five patients with vestibular neuronitis were included. Patients were divided good (≥20%) and poor (<20%) group according to change of spontanous nystagmus frequency. Frequency and velocity of spontaneous nystagmus were analyzed by using video-nystagmography. Caloric test and slow harmonic acceleration test were also performed. RESULTS: There was a positive linear correlation between frequency and velocity in initial and follow test (R2=0.51, 0.43, p<0.01, p<0.01). Also, there was a strong positive linear correlation betweeng change of frequency and change of velocity (R2=0.64, p<0.01). The phase lead of slow harmonic acceleration test of good group was smaller compared with poor group, and this was statistically significant in 0.04 Hz. CONCLUSION: We suggested that frequency of spontaneous nystagmus may be a useful clinical factor in vestibular neuronitis.

Clinical obserbation on vertigo treatment of integrative traditional Chinese and Western medicine / 中草药

Objective: To evaluate the effect of clinical Western medicine and integrative traditional Chinese and Western medicine on vertigo. Methods: One hundred and twenty outpatients and inpatients suffered vertigo participated in the trial. Randomly, 60 cases were distributed into test group, and the other 60 cases were selected into control group. The patients in control group were given Alprostadil, Vinpocetine, Flunarizine, and Betahistine. The patients in test group, based on dialectical type, took Chinese herb decoction individually. Results: Visual analog scale (VAS) and dizziness handicap inventory (DHI) score results in the test group were significantly lower than those in the control group. The total effective rate of the test group was 93.33%. In the control group, the total effective rate of Western medicine was 81.67%. There was a significant statistical difference (P < 0.05) between the two groups. Conclusion: The therapy by integrative traditional Chinese and Western medicine could significantly improve the efficacy in vertigo treatment.

The Application of DHI Scale to Evaluation of Quality of Life in Patients with Benign Paroxysmal Positional Vertigo / 听力学及言语疾病杂志

Objective This paper attempts to explore the application of dizziness handicap inventory (DHI) in evaluation of health -related quality of life (QOL ) changes of patients with benign paroxysmal positional vertigo (BPPV) before and after the treatment with canalith repositioning procedure (CRP) .Methods The DHI was em-ployed to investigate and evaluate the dizziness handicap of 120 patients with BPPV before and after 3 months of CRP treatment (treatment group) and 60 healthy controls (control group) ,while the DHI scoring results were com-pared .Results As indicated by DHI evaluation ,the scoring of each DHI items of patients with BPPV before treatment was higher than that of control group ,treatment group before treatment :functional score 22 .60 ± 6 .54 ,emotional score 18 .50 ± 8 .28 ,physical score 17 .90 ± 5 .05 ,total composite score 59 .00 ± 14 .32 .For the control group:functional score 1 .35 ± 1 .74 ,emotional score 1 .00 ± 1 .01 ,physical score 1 .37 ± 1 .86 ,total composite score 3 .72 ± 3 .46 ,with the differ-ence statistically significant (P0 .05) .Conclusion CRP is effective to treat BPPV .The DHI is available for the evaluation of QOL of BPPV patients .

Homologación lingüística nacional del Dizziness Handicap Inventory (test de discapacidad vestibular) / National linguistic homologation of the Dizziness Handicap Inventory

La sintomatología de los síndromes vertiginosos es mayoritariamente subjetiva, de difícil evaluación para el médico. En tal sentido es útil contar con elementos que permitan estandarizar los síntomas que el paciente sufre y poder así medir el grado de discapacidad que la enfermedad le pueda provocar. Con este propósito, hace ya algunos años, Jacobson y Newman publicaron el llamado test del Dizziness Handicap Inventory (Test de discapacidad vestibular). Dicho test ha sido posteriormente validado por numerosos estudios, otorgándole alta veracidad y confiabilidad estadística. El presente estudio traduce al español cotidiano de los chilenos este test, para tener una herramienta confiable, que permita al otorrinolaringólogo poder con mayor seguridad, determinar el grado de discapacidad sea por desequilibrio o mareos que un síndrome vertiginoso le pueda provocar a un paciente.

The symptoms of dizziness syndromes are mainly subjective and difficult to evaluate by the physician. It is thus highly useful to count on elements that allow standardization of the patient's symptoms, and to have an available measurement of vestibular disability the disease may cause. In order to achieve this, Jacobson and Newman published some time ago the so called Dizziness Handicap Inventory. This test has been later validated by several studies, which gave it high veracity and statistical reliability. This paper translates the test into everyday chilean spanish in order to have a reliable tool that allows an ENT specialist to determine the patient's degree of discapacity.

Efeito da reabilitação vestibular em idosos: quanto ao equilíbrio, qualidade de vida e percepção / Effect of vestibular rehabilitation in elder people: regarding balance, quality of life and perception

As atuais preocupações com qualidade de vida (QV), envelhecimento da população, limitações impostas pelos distúrbios do equilíbrio na população idosa e a alternativa de tratamento por meio da reabilitação vestibular (RV) justificaram este estudo. Nele, objetivou-se analisar, perspectivamente, os resultados da aplicação do protocolo de Cawtome & Cooksey para RV, em idosos institucionalizados, com queixas de alterações de equilíbrio e probabilidade de queda (PQ), visando à melhoria da QV e à percepção desses idosos sobre as limitações impostas pelos distúrbios do equilíbrio. Utilizou-se uma metodologia híbrida, buscando a integração de dados quantitativos e qualitativos, associando-se o estudo experimental ao fenomenológico, em uma população de trinta idosos asilados com queixas de alterações do equilíbrio. Os instrumentos de avaliação foram a Escala de Berg, Dizziness Handicap Inventory (DHI) e análise de conteúdo. Como conclusão do estudo, constatou-se que, na população estudada, a RV foi efetiva quanto à melhora dos sintomas de alteração do equilíbrio em relação à QV, à PQ e aos sentimentos de segurança e independência dos idosos.

The current concerns with quality of life, population aging, limitations imposed by balance disturbance in the elder population and the alternative treatment through the vestibular rehabilitation had justified this study. The objective was to analyze in perspective the application of the Cawtome & Cooksey protocol for vestibular rehabilitation results in aged institutionalized people with complains of balance alterations and probability of fall, aiming the improvement of quality of life and that elders could perceive the limitations imposed by the balance disturbance. A hybrid methodology was used, searching an integration of quantitative and qualitative data associating the experimental to the phenomenological in a population of 30 elders with complains of balance alterations living in an asylum. The evaluation instruments had been the Berg Scale, Dizziness Handicap Inventory (DHI) and speech analysis. As conclusion, it was evidenced that, within the population studied, the vestibular rehabilitation was effective regarding the improvement of symptoms of balance alteration in relation to quality of life, probability of fall as well as the security and independence feelings of the elders.