Single-Crystal P2-Na0.67Mn0.67Ni0.33O2 Cathode Material with Improved Cycling Stability for Sodium-Ion Batteries.

Layered oxides constitute one of the most promising cathode materials classes for large-scale sodium-ion batteries because of their high specific capacity, scalable synthesis, and low cost. However, their practical use is limited by their low energy density, physicochemical instability, and poor cycling stability. Aiming to mitigate these shortcomings, in this work, we synthesized polycrystalline (PC) and single-crystal (SC) P2-type Na0.67-δMn0.67Ni0.33O2 (NMNO) cathode materials through a solid-state route and evaluated their physicochemical and electrochemical performance. The SC-NMNO cathode with a large mean primary particle size (D50) of 12.7 µm was found to exhibit high cycling stability leading to 47% higher capacity retention than PC-NMNO after 175 cycles at 1C rate in the potential window 4.2-1.5 V. This could be attributed to the effective mitigation of parasitic side reactions at the electrode-electrolyte interface and suppressed intergranular cracking induced by anisotropic volume changes. This is confirmed by the lower volume variation of SC-NMNO (ΔV ∼ 1.0%) compared to PC-NMNO (ΔV ∼ 1.4%) upon charging to 4.2 V. Additionally, the SC-NMNO cathode displayed slightly higher thermal stability compared to PC-NMNO. Both cathodes exhibited good chemical stability against air and water exposure, thus enabling material storage/handling in the ambient atmosphere as well as making them suitable for aqueous processing. In this regard, PC-NMNO was investigated with two low-cost aqueous binders, carboxymethyl cellulose, and sodium trimetaphosphate, which exhibited higher binding strength and displayed excellent electrochemical performance compared to PVDF, which could potentially lead to significant cost reduction in electrode manufacturing.

Fast formation of anode-free Li-metal batteries by pulsed current.

Anode-free Li-metal batteries offer high energy density but are prone to dendrite formation during charging which can cause catastrophic failures. Ensuring dendrite-free smooth Li deposits during charging is therefore necessary. Suppressing dendrite growth can be achieved by pulsed current charging, especially during the formation cycle that largely determines the corrosion trajectory of a cell. As opposed to the constant-current technique, pulsed current techniques apply intermittently stopped current flows. This work investigates the electroplating of metallic Li onto a Cu foil current collector under constant-current and pulsed current formation protocols. In addition to smoother, less resistive electroplated metallic Li deposits and increased Coulombic efficiency, we show that by employing an optimized pulsed current formation protocol, the formation process is accelerated by a factor of 2 and the Coulombic efficiency was increased by 10% compared to a C/20 protocol. Finally, by employing a simple regression coupled to experimentation, we propose the pseudo-IR-drop to be used for live adjustment of pulsed current protocols i.e., individually approach each cell at all SOC during formation.

Exploring Reproducible Nonaqueous Scanning Droplet Cell Electrochemistry in Model Battery Chemistries.

The discovery and optimization of new materials for energy storage are essential for a sustainable future. High-throughput experimentation (HTE) using a scanning droplet cell (SDC) is suitable for the rapid screening of prospective material candidates and effective variation of investigated parameters over a millimeter-scale area. Herein, we explore the transition and challenges for SDC electrochemistry from aqueous toward aprotic electrolytes and address pitfalls related to reproducibility in such high-throughput systems. Specifically, we explore whether reproducibilities comparable to those for millimeter half-cells are achievable on the millimeter half-cell level than for full cells. To study reproducibility in half-cells as a first screening step, this study explores the selection of appropriate cell components, such as reference electrodes (REs) and the use of masking techniques for working electrodes (WEs) to achieve consistent electrochemically active areas. Experimental results on a Li-Au model anode system show that SDC, coupled with a masking approach and subsequent optical microscopy, can mitigate issues related to electrolyte leakage and yield good reproducibility. The proposed methodologies and insights contribute to the advancement of high-throughput battery research, enabling the discovery and optimization of future battery materials with improved efficiency and efficacy.

Psychometric Properties and Concurrent Validity of a 10-Item Questionnaire for Patients With Vestibular Disorders.

OBJECTIVE: This study aimed to investigate the psychometric properties and concurrent validity of the Haukeland Dizziness Questionnaire (HDQ-10), a 10-item questionnaire designed for simplified assessment of symptom severity and emotional effects in patients with vestibular disorders. STUDY DESIGN: Cross-sectional study. SETTING: Secondary referral hospital. METHODS: Out of 238 consecutive patients examined for suspected vestibular disease at an otolaryngology clinic, 201 completed the questionnaire. The psychometric properties of the HDQ-10 were examined by exploratory factor analysis and analysis of internal consistency. Concurrent validity was determined in comparison with the Dizziness Handicap Inventory (DHI), Vertigo Symptom Scale-Short Form (VSS-SF), and the Hospital Anxiety and Depression Scale. RESULTS: The factor analysis revealed 3 subscales of the questionnaire covering "function," "unsteadiness," and "emotion." The examination of the total scale (α = .866) and its subscales indicated satisfactory psychometric properties. The HDQ-10 correlated highly with both DHI (r = .732. P < .001) and VSS-SF (r = .720. P < .001) indicating good concurrent validity. CONCLUSION: The HDQ-10 is a 10-item questionnaire designed for simplified assessment of symptom severity and emotional effects in patients with vestibular disorders. It has satisfactory psychometric properties and good concurrent validity compared to existing dizziness questionnaires.

Greener, Safer and Better Performing Aqueous Binder for Positive Electrode Manufacturing of Sodium Ion Batteries.

P2-type cobalt-free MnNi-based layered oxides are promising cathode materials for sodium-ion batteries (SIBs) due to their high reversible capacity and well chemical stability. However, the phase transformations during repeated (dis)charge steps lead to rapid capacity decay and deteriorated Na+ diffusion kinetics. Moreover, the electrode manufacturing based on polyvinylidene difluoride (PVDF) binder system has been reported with severely defluorination issue as well as the energy intensive and expensive process due to the use of toxic and volatile N-methyl-2-pyrrolidone (NMP) solvent. It calls for designing a sustainable, better performing, and cost-effective binder for positive electrode manufacturing. In this work, we investigated inorganic sodium metasilicate (SMS) as a viable binder in conjunction with P2-Na0.67Mn0.55Ni0.25Fe0.1Ti0.1O2 (NMNFT) cathode material for SIBs. The NMNFT-SMS electrode delivered a superior electrochemical performance compared to carboxy methylcellulose (CMC) and PVDF based electrodes with a reversible capacity of ~161 mAh/g and retaining ~83 % after 200 cycles. Lower cell impedance and faster Na+ diffusion was also observed in this binder system. Meanwhile, with the assistance of TEM technique, SMS is suggested to form a uniform and stable nanoscale layer over the cathode particle surface, protecting the particle from exfoliation/cracking due to electrolyte attack. It effectively maintained the electrode connectivity and suppressed early phase transitions during cycling as confirmed by operando XRD study. With these findings, SMS binder can be proposed as a powerful multifunctional binder to enable positive electrode manufacturing of SIBs and to overall reduce battery manufacturing costs.

Modification of Al Surface via Acidic Treatment and its Impact on Plating and Stripping.

Amorphous Al2 O3 film that naturally exists on any Al substrate is a critical bottleneck for the cyclic performance of metallic Al in rechargeable Al batteries. The so-called electron/ion insulator Al oxide slows down the anode's activation and hinders Al plating/stripping. The Al2 O3 film induces different surface properties (roughness and microstructure) on the metal. Al foils present two optically different sides (shiny and non-shiny), but their surface properties and influence on plating and stripping have not been studied so far. Compared to the shiny side, the non-shiny one has a higher (~28 %) surface roughness, and its greater concentration of active sites (for Al plating and stripping) yields higher current densities. Immersion pretreatments in Ionic-Liquid/AlCl3 -based electrolyte with various durations modify the surface properties of each side, forming an electrode-electrolyte interphase layer rich in Al, Cl, and N. The created interphase layer provides more tunneling paths for better Al diffusion upon plating and stripping. After 500 cycles, dendritic Al deposition, generated active sites, and the continuous removal of the Al metal and oxide cause accelerated local corrosion and electrode pulverization. We highlight the mechanical surface properties of cycled Al foil, considering the role of immersion pretreatment and the differences between the two sides.

Fluorine-Substituted Halide Solid Electrolytes with Enhanced Stability toward the Lithium Metal.

The high ionic conductivity and good oxidation stability of halide-based solid electrolytes evoke strong interest in this class of materials. Nonetheless, the superior oxidative stability compared to sulfides comes at the expense of limited stability toward reduction and instability against metallic lithium anodes, which hinders their practical use. In this context, the gradual fluorination of Li2ZrCl6-xFx (0 ≤ x ≤ 1.2) is proposed to enhance the stability toward lithium-metal anodes. The mechanochemically synthesized fluorine-substituted compounds show the expected distorted local structure (M2-M3 site disorder) and significant change in the overall Li-ion migration barrier. Theoretical calculations reveal an approximate minimum energy path for Li2ZrCl6-xFx (x = 0 and 0.5) with an increase in the Li+ migration energy barrier for Li2ZrCl5.5F0.5 in comparison to Li2ZrCl6. However, it is found that the fluorine-substituted compound exhibits substantially lower polarization after 800 h of lithium stripping and plating owing to enhanced interfacial stability against the lithium metal, as revealed by density functional theory and ex situ X-ray photoelectron spectroscopy, thanks to the formation of a fluorine-rich passivating interphase.

Vestibular Tests Related to Tumor Volume in 137 Patients With Small to Medium-Sized Vestibular Schwannoma.

OBJECTIVE: The video head impulse test (vHIT) and cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP) are new methods for measuring peripheral vestibular function. The objectives of this study were to compare these tests and the traditionally used caloric test in patients with small and medium-sized untreated vestibular schwannoma (VS) and to measure the correlation between the tests' results and tumor volume. STUDY DESIGN: National cross-sectional study. SETTING: Tertiary university clinic. METHODS: Prevalence of abnormal cVEMP, oVEMP, caloric test, and 6-canal vHIT results on the tumor side and the nontumor side were compared and related to tumor volume with regression analyses in 137 consecutive VS patients assigned to a wait-and-scan protocol in the period 2017 to 2019. RESULTS: The sensitivity of 6-canal vHIT, caloric test, cVEMP, and oVEMP to detect vestibulopathy in VS patients was 51%, 47%, 39%, and 25%, respectively. Normal tests were found in 21% of the patients. The results of vHIT and caloric test were related to tumor volume, but this was not found for cVEMP and oVEMP. CONCLUSION: The caloric test and 6-canal vHIT showed the highest sensitivity in detecting vestibulopathy in untreated VS patients. vHIT, and particularly the posterior canal, was limited with a high prevalence of abnormal results on the nontumor side. A combination of cVEMP and caloric test was favorable in terms of a relatively high sensitivity and low prevalence of abnormal results on the nontumor side. Larger tumors had a higher rate of pathology on caloric testing and vHIT.

Musculoskeletal pain patterns and association between dizziness symptoms and pain in patients with long term dizziness - a cross-sectional study.

BACKGROUND: The impact of long-term dizziness is considerable both on the personal level and in society and may lead to self-imposed restrictions in daily activities and social relations due to fear of triggering the symptoms. Musculoskeletal complaints seem to be common in persons with dizziness, but studies addressing these complaints as a widespread occurrence, are scarce. This study aimed to examine the occurrence of widespread pain in patients with long-term dizziness and investigate the associations between pain and dizziness symptoms. Further, to explore whether diagnostic belonging is related to the occurrence of pain. METHODS: This cross-sectional study was conducted in an otorhinolaryngology clinic and included 150 patients with persistent dizziness. The patients were categorized into three groups: episodic vestibular syndromes, chronic vestibular syndromes, and non-vestibular group. The patients completed questionnaires on dizziness symptoms, catastrophic thinking, and musculoskeletal pain when entering the study. Descriptive statistics were used to describe the population, and associations between pain and dizziness were investigated by linear regression. RESULTS: Pain was reported by 94.5% of the patients. A significantly higher prevalence of pain was reported in all the ten pain sites examined compared to the general population. Number of pain sites and pain intensity were associated with the dizziness severity. Number of pain sites was also associated with dizziness-related handicap, but not with catastrophic thinking. There was no association between pain intensity and dizziness-related handicap or catastrophic thinking. Pain was equally distributed in the diagnostic groups. CONCLUSION: Patients with long-term dizziness have a considerably higher prevalence of pain and number of pain sites than the general population. Pain co-exists with dizziness and is associated with dizziness severity. These findings may indicate that pain should be systematically assessed and treated in patients with persisting dizziness.

Conductivity experiments for electrolyte formulations and their automated analysis.

Electrolytes are considered crucial for the performance of batteries, and therefore indispensable for future energy storage research. This paper presents data that describes the effect of the electrolyte composition on the ionic conductivity. In particular, the data focuses on electrolytes composed of ethylene carbonate (EC), propylene carbonate (PC), ethyl methyl carbonate (EMC), and lithium hexafluorophosphate (LiPF6). The mass ratio of EC to PC was varied, while keeping the mass ratio of (EC + PC) and EMC at fixed values of 3:7 and 1:1. The conducting salt concentration was also varied during the study. Conductivity data was obtained from electrochemical impedance spectroscopy (EIS) measurements at various temperatures. Based on the thus obtained temperature series, the activation energy for ionic conduction was determined during the analysis. The data is presented here in a machine-readable format and includes a Python package for analyzing temperature series of electrolyte conductivity according to the Arrhenius equation and EIS data. The data may be useful e.g. for the training of machine learning models or for reference prior to experiments.

Prevalence and consequences of concurrent dizziness on disability and quality of life in patients with long-lasting neck pain.

PURPOSE: The purpose of this study was to examine the prevalence of concurrent dizziness in patients seeking treatment for neck pain at a secondary care clinic and examine how dizziness associates with physical function, disability, quality of life, and duration of neck pain. METHODS: This was a cross-sectional study where patients referred for neck pain (n = 133) were recruited from an outpatient spine clinic and divided into: patients with and without dizziness. All patients were examined with posturography, global body examination-flexibility and cervical range of motion, and completed the Neck Disability Index (NDI) and RAND-12 health survey. Patients with concurrent dizziness completed the Vertigo Symptom Scale short form (VSSsf). RESULTS: Forty-three percent of the patients reported dizziness. Concurrent dizziness was associated with increased postural sway with eyes open (p < .001), eyes closed (p = .024), eyes open on foam (p = .010), eyes closed on foam (p = .003), higher disability on the NDI (ß: 2.9, p = .009), RAND-12 physical (ß: -4.3, p = .014) and mental subscales (ß: -4.0, p = .014). A higher score on NDI was associated with higher score on the VSSsf (total score: r = 0.51, p < .001, anxiety: r = 0.52, p < .001, vertigo: r = 0.43, p = .02.). CONCLUSION: Dizziness is common among patients with long-lasting neck pain. It is associated with higher disability due to neck symptoms and general health-related quality of life. The findings highlight the importance of evaluating and addressing dizziness in patients with neck disorders.

Hearing threshold and physical performance in older people: a cross-sectional study from the HUNT4 cohort.

PURPOSE: To evaluate the association between increased hearing loss and reduced physical performance in older people. METHODS: Cross-sectional population-based study using data from the fourth wave of the Trøndelag Health Survey (HUNT4) in Norway. Data were obtained from the subproject HUNT4 Hearing which collected audiometric data of people > 70 years (N = 13,197). Analyses were performed on all participants who had completed audiometry and measured balance using the Short Physical Performance Battery (SPPB), which was scored from 0 (worst score) to 12. The hearing threshold was expressed as a pure tone average (PTA). Associations between the hearing threshold for the best and worst ear and physical performance were analyzed by linear regression models adjusted for age, sex, education, diabetes, and cardiovascular disease. Hearing threshold was indicated with steps of 10 dB. RESULTS: Of 13,197 eligible participants, 4101 who completed audiometry and SPPB (52.3% women. mean age 76.3 years) were included. The analyses revealed an association between reduced SPPB and increased hearing threshold in the best ear (b = - 0.296; 95% CI - 0.343 to - 0. 249; P < 0.001) and the worst ear (b = - 0.229; 95% CI - 0.270 to - 0.189; P < 0.001). CONCLUSIONS: In this population study, we found that the increased hearing threshold was associated to reduced physical performance as measured by SPPB. The association seemed to be strongest for the best ear. The association between hearing threshold and physical performance illustrates the importance of assessing physical performance in people with hearing loss to prevent the risk of falls and disability. The underlying causes of the associations between hearing loss and poorer physical performance are not fully understood and should be further investigated. LEVEL OF EVIDENCE: Level 3.

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 REHABILITATIONApproximately 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.

Self-Reported Measures Have a Stronger Association With Dizziness-Related Handicap Compared With Physical Tests in Persons With Persistent Dizziness.

Background: Associations between dizziness-related handicap and a variety of self-reported measures have been reported. However, research regarding associations between dizziness-related handicap and aspects of functioning that includes both physical tests and self-reported measures is scarce. Objective: The purpose of the study was to describe the variations in signs and symptoms in people with persistent dizziness using physical tests and self-reported outcomes across three severity levels of the Dizziness Handicap Inventory (DHI) and investigate their associations with the DHI. Method: Participants with persistent dizziness (n = 107) were included in this cross-sectional study. The participants underwent (1) physical tests (gait tests, grip strength, body flexibility, and movement-induced dizziness) and completed questionnaires regarding (2) psychological measures (Mobility Inventory of Agoraphobia, Body Sensation Questionnaire, Agoraphobic Cognitions Questionnaire, and Hospital Depression and Anxiety Questionnaire), and (3) fatigue, dizziness severity, and quality of life (Chalders Fatigue Scale, Vertigo Symptom Scale-Short Form, and EQ visual analog scale), in addition to the DHI. Data were presented by descriptive statistics for three DHI severity levels (mild, moderate, and severe). A multiple linear backward regression analysis was conducted for each group of measures in relation to the DHI total score, with additional analyses adjusting for age and sex. Based on these results, significant associations were tested in a final regression model. Results: With increasing severity levels of DHI, the participants demonstrated worse performance on most of the physical tests (preferred and fast gait velocity, dizziness intensity after head movements), presented with worse scores on the self-reported measures (avoidance behavior, fear of bodily sensation, fear of fear itself, psychological distress, fatigue, dizziness severity, quality of life). After adjusting for age and sex, significant associations were found between total DHI and avoidance behavior, psychological distress, dizziness severity, and quality of life, but not with any of the physical tests, explaining almost 56% of the variance of the DHI total score. Conclusion: There was a trend toward worse scores on physical tests and self-reported measurements with increasing DHI severity level. The DHI seems to be a valuable tool in relation to several self-reported outcomes; however, several signs and symptoms may not be detected by the DHI, and thus, a combination of outcomes should be utilized when examining patients with persistent dizziness.

The Romberg sign, unilateral vestibulopathy, cerebrovascular risk factors, and long-term mortality in dizzy patients.

Objectives: Describe the relationship between unsteadiness, canal paresis, cerebrovascular risk factors, and long-term mortality in patients examined for dizziness of suspected vestibular origin. Study design: Observational cohort with prospective collection of survival data. Setting: University clinic neurotological unit. Patients: Consecutive patients aged 18-75 years examined in the period 1992-2004 for dizziness of suspected vestibular origin. Outcome measures: Overall survival. Standardized mortality ratio (SMR). Factors: Unsteadiness, canal paresis, age, sex, patient-reported diabetes, hypertension, heart disease, stroke, or TIA/minor stroke. Patients were classified as steady or unsteady based on static posturography at baseline compared to normative values. Results: The study included 1,561 patients with mean age 48 years and 60 % females. Mean follow-up was 22 years. Unsteadiness was associated with higher age, heart disease, diabetes, hypertension, and cerebrovascular dizziness. There were 336 deaths over 31,335 person-years (SMR 0.96; 95 % confidence interval: 0.86-1.07). Canal paresis was not related to unsteadiness (chi square: p = 0.46) or to mortality (unadjusted Cox hazard ratio: 1.04, 95% CI: 0.80-1.34). Unsteadiness was an independent predictor of mortality (adjusted Cox hazard ratio: 1.44, 95% CI: 1.14-1.82). Conclusions: Unsteadiness measured by static posturography is associated with higher age, known cerebrovascular risk factors, and with increased long-term mortality, but not with canal paresis in patients evaluated for dizziness. The study highlights the importance of evaluating patients with conspicuous postural instability for non-vestibular causes.

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

BACKGROUND AND PURPOSE: Musculoskeletal 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. METHODS: A 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. RESULTS: Out 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. DISCUSSION: In 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 Risk of Benign Paroxysmal Positional Vertigo After Head Trauma.

OBJECTIVES: Head trauma may cause dislodgement of otoconia and development of benign paroxysmal positional vertigo (BPPV). The risk of developing BPPV is expected to be highest shortly after the trauma, then decrease and approach the risk seen in the general population. The aim of this study was to estimate the risk-time curve of BPPV development after head trauma. STUDY DESIGN: Prospective observational study. METHODS: Patients with minimal, mild, or moderate head trauma treated at the Department of Neurosurgery or the Department of Orthopedic Emergency at Oslo University Hospital, were interviewed and examined for BPPV using the Dix-Hallpike and supine roll maneuvers. BPPV was diagnosed according to the International diagnostic criteria of the Bárány Society. Telephone interviews were conducted at 2, 6, and 12 weeks after the first examination. RESULTS: Out of 117 patients, 21% developed traumatic BPPV within 3 months after the trauma. The corresponding numbers were 12% with minimal trauma, 24% with mild, and 40% with moderate trauma. The difference in prevalence between the groups was significant (P = .018). During the first 4 weeks after the trauma, it was observed 20, 3, 0, and 1 BPPV onsets, respectively. No BPPV cases were seen for the remainder of the 3-month follow-up. CONCLUSION: The risk of developing BPPV after minimal-to-moderate head trauma is considerable and related to trauma severity. Most cases occur within few days after the trauma, but any BPPV occurring within the first 2 weeks after head trauma are likely due to the traumatic event. LEVEL OF EVIDENCE: 3 Laryngoscope, 132:443-448, 2022.

Dizziness and physical health are associated with pain in dizzy patients-A cross-sectional study.

BACKGROUND AND PURPOSE: Associations between dizziness, health-related quality of life, and musculoskeletal pain have not been systematically explored in patients with vestibular disorders. Such knowledge may be important for choice of treatments. The study objectives were to examine the extent and localization of musculoskeletal pain and explore whether pain was associated with dizziness and health-related quality of life. METHODS: The cross-sectional study investigated anonymized data from an earlier survey on patients with long-lasting dizziness (>3 months) examined in an oto-rhino-laryngological department. The sample includes patient between 18 and 70 years with Ménière's disease, vestibular schwannoma, benign positional paroxysmal vertigo, vestibular neuritis, non-otogenic dizziness, and cervicogenic dizziness. General musculoskeletal, that is, pain in muscles, tendons, and joints was registered by a yes/no question. A pain drawing registered localization of pain. Multiple binary logistic regression models were used to determine the association between pain and vertigo-balance and autonomic-anxiety related dizziness by the short Vertigo Symptom Scale (VSS) and sub-scales (VSS-V, VSS-A), and between pain and health-related quality of life by the SF-36, mental and physical component summary scale (SF-36 MCS, SF-36 PCS). RESULTS: The sample consisted of 503 patients, 60.2% were women, the median age was 50 years. General musculoskeletal pain was reported by 72.8% of patients, neck pain by 59.2% and widespread pain by 21.9%. Multiple binary logistic regression models demonstrated that all the pain measures were significantly associated with VSS-V and VSS-A and SF-36 PCS, but not SF-36 MCS. DISCUSSIONS: Musculoskeletal pain is prevalent in patients with long-lasting dizziness. The strong associations between pain, VSS, and SF-36 PCS could result in a self-sustaining complex condition. The findings imply that in addition to assessing and treating the vestibular symptoms, musculoskeletal symptoms and physical health should be addressed.

Long-Term Survival in 1,931 Patients With Dizziness: Disease- and Symptom-Specific Mortality.

OBJECTIVE: To evaluate mortality among patients referred for suspected vestibular disorder and to examine whether specific symptoms or disorders predict long-term survival among patients with dizziness or vertigo. STUDY DESIGN: Retrospective cohort study. METHODS: This retrospective cohort study analyzed long-term survival data. Consecutive patients examined for suspected vestibular disease at an otolaryngology clinic completed a detailed questionnaire regarding symptoms and comorbidities. RESULTS: The study included 1,931 patients. Their mean age (standard deviation) was 50.5 (16.5) years, and 60% were women. The mean follow-up period was 20.6 years (range, 15.3-27.5 years). The standardized mortality ratio for the entire cohort compared with the Norwegian age- and sex-matched population was 1.03 (95% confidence interval [CI]: 0.94-1.12), illustrating no difference in overall survival. Patients with a cerebrovascular cause of dizziness had higher mortality in adjusted Cox regression analyses (hazard ratio [HR] 1.56, 95% CI: 1.11-2.19), whereas patients reporting periodic or short attacks of dizziness had lower mortality (HR 0.62 [0.50-0.77] and 0.76 [0.63-0.93], respectively). Reported unsteadiness between dizziness attacks was associated with higher mortality with an HR of 1.30 (95% CI: 1.08-1.57). CONCLUSION: This long-term study found comparable mortality rates between patients evaluated for suspected vestibular disorder and that of the general population. However, subgroup analyses showed reduced mortality in patients with periodic or short attacks of dizziness and increased mortality in patients with unsteadiness between attacks or cerebrovascular causes of dizziness. The time course of vestibular symptoms should be determined, and thorough evaluation including fall risk and comorbidities must be considered in patients with nonepisodic symptoms. LEVEL OF EVIDENCE: 3 Laryngoscope, 131:E2031-E2037, 2021.

Treatment of horizontal canal BPPV-a randomized sham-controlled trial comparing two therapeutic maneuvers of different speeds.

OBJECTIVES: To compare the effect of a high-speed barbecue maneuver with the modified Lempert maneuver and sham in patients with benign paroxysmal positional vertigo (BPPV) of the horizontal canal. METHODS: Randomized sham-controlled, single blinded multicenter clinical trial in two university hospitals investigating consecutive patients with horizontal canal BPPV.Patients were randomly assigned to high-speed barbecue (HSB), modified Lempert maneuver (ML), or sham maneuver (SM). All treatments were performed in a biaxial rotational chair with weekly follow-up to a maximum of three treatment sessions. The final follow-up was 3 months after the last treatment. RESULTS: Primary outcome: 2-week recovery rate per protocol. Secondary outcome: Cumulative recovery rate and Dizziness Handicap Inventory (DHI) scores after 3 months per protocol (HSB and ML) and intention to treat (all groups).Fifty-four patients were analyzed after 2 weeks (HSB = 17; ML = 20; SM = 17). Two-week recovery rate was 14/17 after HSB, 11/20 after ML, and 4/17 after SM, with significantly better recovery in HSB [OR 15.17, 95% CI (1.85, 124.63), P = .001] using sham as base level. Recovery rate after 3 months was 15/17 after HSB and 15/19 after ML. Cumulative recovery rate showed no significant differences between the two treatment groups [95% CI (0.30, 13.14), P = .46] in cure rate DHI [95% CI (-16.56, 15.02), P = .92]. No unexpected adverse events were observed. CONCLUSION: Velocity change in horizontal canal BPPV treatment gives a faster initial recovery. Rapid recovery could reduce the disease burden. TRIAL REGISTRATION: Clinicaltrials.gov. Identifier: NCT01905800. LEVEL OF EVIDENCE: 1b.