Epidemiología de los trastornos vestibulares en la consulta de otoneurología / Epidemiology of vestibular disorders in the otoneurology unit

Introducción y objetivos: El conjunto de síntomas relacionados con los trastornos del sistema de equilibrio son comunes en la población general. Sin embargo, hay pocos estudios que cuantifiquen la frecuencia de inicio de los diversos trastornos vestibulares que se presentan en unidades especializadas de otoneurología. El objetivo de este estudio es establecer la epidemiología de los trastornos vestibulares, La forma de presentación y la carga de atención esperada en una clínica especialista en otoneurología. Material y métodos: Estudio descriptivo observacional retrospectivo sobre los pacientes remitidos a la consulta de Otoneurología de un centro hospitalario de tercer nivel entre el 1/1/2015 y el 31/12/2015. Resultados: Fueron valorados 174 pacientes (121 mujeres y 53 hombres) con una media de edad de 5 3± 17 años. Durante el periodo de estudio se valoraron 43 individuos por cada 100.000 habitantes. Los pacientes fueron remitidos en su mayoría desde consultas externas de Otorrinolaringología (36,8%) y desde Atención Primaria (28,7%). El motivo de consulta más frecuente fue inestabilidad (40,2%), seguido de vértigo (31%). Los diagnósticos más frecuentes fueron vértigo posicional paroxístico benigno (28,2%) y migraña vestibular (28,2%) -definida (59%) o probable (41%)-, seguidos de enfermedad de Ménière (13.8%), trastornos de origen vascular (5.7%), mareo subjetivo crónico (4,6%) y neuritis vestibular (4%). Conclusiones: Disponer de información precisa acerca de la prevalencia e impacto de los trastornos vestibulares es importante para la correcta planificación de los servicios sanitarios con el objetivo de responder satisfactoriamente a la demanda asistencial esperada en la comunidad. El trastorno más frecuentemente diagnosticado en una consulta de Otoneurología es el vértigo posicional paroxístico benigno y la migraña vestibular. Para la comparación de resultados es indispensable la utilización de terminología sistemática (AU)

Introduction and objectives: The set of symptoms relating to disorders of the balance system are common in the general population. However, there are few studies quantifying the frequency of onset of the various vestibular disorders that present in specialist otoneurology units in the Spanish population. The aim of this study is to establish the epidemiology of vestibular disorders, their form of presentation, and the expected care burden in a specialist otoneurology clinic. Material and methods: A retrospective, descriptive, observational study of patients referred to the otoneurology unit of a third level hospital between 1/1/2015 and 31/12/2015. Results: One hundred and seventy-four patients were assessed (121 women and 53 men) with a mean age of 53 ± 17 years. Forty-three individuals per 100,000 inhabitants were assessed over the study period. The patients were referred in the majority from external ENT (36.8%) and primary care (28.7%) clinics. The most frequent reason for consultation was dizziness (40.2%) followed by vertigo (31%). The most frequent diagnoses were benign paroxysmal positional vertigo (28.2%) and vestibular migraine (28.2%) -defined (59%) or probable (41%)-, followed by Ménière's disease (13.8%), vascular disorders (5.7%), chronic subjective dizziness (4.6%) and vestibular neuritis (4%). Conclusions: The availability of precise information on the prevalence and impact of vestibular disorders is important to enable the health services to plan an appropriate response to the expected care demand in the community. Benign paroxysmal positional vertigo and vestibular migraine are the most commonly diagnosed disorders in otoneurology clinics. Systematic terminology is essential for the comparison of results (AU)

Bilateral vestibulopathy: Diagnostic criteria Consensus document of the Classification Committee of the Bárány Society.

This paper describes the diagnostic criteria for bilateral vestibulopathy (BVP) by the Classification Committee of the Bárány Society. The diagnosis of BVP is based on the patient history, bedside examination and laboratory evaluation. Bilateral vestibulopathy is a chronic vestibular syndrome which is characterized by unsteadiness when walking or standing, which worsen in darkness and/or on uneven ground, or during head motion. Additionally, patients may describe head or body movement-induced blurred vision or oscillopsia. There are typically no symptoms while sitting or lying down under static conditions.The diagnosis of BVP requires bilaterally significantly impaired or absent function of the vestibulo-ocular reflex (VOR). This can be diagnosed for the high frequency range of the angular VOR by the head impulse test (HIT), the video-HIT (vHIT) and the scleral coil technique and for the low frequency range by caloric testing. The moderate range can be examined by the sinusoidal or step profile rotational chair test.For the diagnosis of BVP, the horizontal angular VOR gain on both sides should be <0.6 (angular velocity 150-300°/s) and/or the sum of the maximal peak velocities of the slow phase caloric-induced nystagmus for stimulation with warm and cold water on each side <6°/s and/or the horizontal angular VOR gain <0.1 upon sinusoidal stimulation on a rotatory chair (0.1 Hz, Vmax = 50°/sec) and/or a phase lead >68 degrees (time constant of <5 seconds). For the diagnosis of probable BVP the above mentioned symptoms and a bilaterally pathological bedside HIT are required.Complementary tests that may be used but are currently not included in the definition are: a) dynamic visual acuity (a decrease of ≥0.2 logMAR is considered pathological); b) Romberg (indicating a sensory deficit of the vestibular or somatosensory system and therefore not specific); and c) abnormal cervical and ocular vestibular-evoked myogenic potentials for otolith function.At present the scientific basis for further subdivisions into subtypes of BVP is not sufficient to put forward reliable or clinically meaningful definitions. Depending on the affected anatomical structure and frequency range, different subtypes may be better identified in the future: impaired canal function in the low- or high-frequency VOR range only and/or impaired otolith function only; the latter is evidently very rare.Bilateral vestibulopathy is a clinical syndrome and, if known, the etiology (e.g., due to ototoxicity, bilateral Menière's disease, bilateral vestibular schwannoma) should be added to the diagnosis. Synonyms include bilateral vestibular failure, deficiency, areflexia, hypofunction and loss.

Clinical and neurophysiological risk factors for falls in patients with bilateral vestibulopathy.

Patients with bilateral vestibular failure (BVF) exhibit imbalance when standing and walking that is linked to a higher fall risk. The purpose of this study was to identify risk factors for falls in BVF. We therefore systematically investigated the interrelationship of clinical and demographic characteristics, gait impairments, and the fall frequency of these patients. Clinical and demographic characteristics as well as quantitative measures of gait performance on a pressure-sensitive gait carpet were collected from 55 patients with different etiologies of BVF. Clinical and demographic data as well as spatiotemporal gait characteristics were used for ANOVA testing and a logistic regression model with categorized fall events as dependent variables. The impairment of peripheral vestibular function, duration of disease, and the overall gait status were not associated with the history of falls in patients with BVF. In contrast, the most predictive factors for falls in BVF were an increase in temporal gait variability, especially at slow walking speeds (p < 0.001; OR = 1.3), and the presence of a concomitant peripheral neuropathy (p < 0.045; OR = 3.6). BVF patients with a high risk of falling exhibit specific gait alterations in a speed-dependent manner. In particular, increased gait fluctuations during slow walking are most predictive for an increased fall risk. The presence of a concomitant peripheral neuropathy further critically impairs postural stability in these patients. Clinical assessment of both these aspects is therefore important to identify those patients at a particularly high fall risk and to initiate preventive procedures early.