Vértigo posicional paroxístico benigno primario y secundario a neuritis vestibular. Estudio de casos y controles / Primary and Secondary Benign Paroxysmal Positional Vertigo due to Peripheral Acute Vestibular Syndrome: A Case-Control Study

Introducción y objetivo: El objetivo de nuestro estudio fue demostrar las diferencias clínicas entre el vértigo posicional paroxístico benigno (VPPB) idiopático y secundario a síndrome vestibular agudo periférico (SVA). Método: Estudio de casos y controles, retrospectivo. La recolección de datos fue tomada de historias clínicas de nuestro hospital. Datos demográficos y clínicos de pacientes con diagnóstico de VPPB idiopático y secundario a SVA, fueron recogidos para el análisis. Además, en el grupo de los casos, se realizó una correlación entre el déficit vestibular periférico, medido a través del video head impulse test (vHIT), y el número de maniobras y tiempo hasta la resolución del VPPB. Resultados: Se incluyeron 72 pacientes, 64% mujeres. En el grupo control se incluyeron 50 pacientes con VPPB idiopático y 22 con VPPB secundario a SVA en el grupo de los casos. En el VPPB secundario, el canal semicircular posterior estuvo afectado en el 100% (OR: 1.2; IC 95% [1,088 - 1,436]). Ambos grupos mostraron una resolución del vértigo del 90% y 89%, respectivamente. El grupo de VPPB secundario tuvo 4 veces más riesgo de recurrencia (OR: 4.18; IC 95% [1.410 - 12.406]); necesitaron más maniobras (3.32 ± 2.2 vs. 1.7 ± 1.3, p = 0.004) y tiempo (61.9 días ± 73.1 vs. 12.9 días ± 9.6, p = 0.007) para la resolución del VPPB. Se encontraron correlaciones significativas entre la diferencia de ganancia media del reflejo vestíbulo-ocular (RVO) y el número de maniobras (r = 0.462, p = 0.030) y el tiempo hasta la resolución (r = 0.577, p = 0.008). Discusión: Existen diferencias clínicas entre el VPPB idiopático y secundario a SVA, principalmente en términos de canal semicircular afecto, mayor número de maniobras y tiempo en días hasta la resolución del VPPB. Además, de determinar que a mayor déficit vestibular en un paciente con VPPB secundario a SVA, necesitará un mayor número de maniobras y un tiempo prolongado hasta la resolución del VPPB. Conclusiones: ... (AU)

Introduction and Objective: The aim of our study was to demonstrate the clinical differences between idiopathic benign paroxysmal positional vertigo (BPPV) and BPPV secondary to acute peripheral vestibular syndrome (APVS). Method: Retrospective case-control study. Data collection was obtained from medical records at our hospital. Demographic and clinical data of patients diagnosed with idiopathic BPPV and BPPV secondary to APVS were collected for analysis. Additionally, in the case group, a correlation was performed between peripheral vestibular deficit, measured through the video head impulse test (vHIT), and the number of maneuvers and time until resolution of BPPV. Results: Seventy-two patients were included, with 64% being women. The control group included 50 patients with idiopathic BPPV and 22 with BPPV secondary to APVS in the case group. In secondary BPPV, the posterior semicircular canal was affected in 100% of cases (OR: 1.2; 95% CI [1.088 - 1.436]). Both groups showed a vertigo resolution rate of 90% and 89%, respectively. The secondary BPPV group had a 4-fold higher recurrence risk (OR: 4.18; 95% CI [1.410 - 12.406]); they required more maneuvers (3.32 ± 2.2 vs. 1.7 ± 1.3, p = 0.004) and more time (61.9 days ± 73.1 vs. 12.9 days ± 9.6, p = 0.007) for BPPV resolution. Significant correlations were found between the difference in mean gain of the vestibulo-ocular reflex (VOR) and the number of maneuvers (r = 0.462, p = 0.030) and the time until resolution (r = 0.577, p = 0.008). Discussion: Clinical differences exist between idiopathic BPPV and BPPV secondary to APVS, primarily in terms of the affected semicircular canal, a higher number of maneuvers, and a longer time in days until BPPV resolution. Furthermore, it was determined that a greater vestibular deficit in a patient with secondary BPPV to APVS requires a higher number of maneuvers and an extended time until BPPV resolution. Conclusions: ... (AU)

Neurological update: neuro-otology 2023.

Much has changed since our last review of recent advances in neuro-otology 7 years ago. Unfortunately there are still not many practising neuro-otologists, so that most patients with vestibular problems need, in the first instance, to be evaluated and treated by neurologists whose special expertise is not neuro-otology. The areas we consider here are mostly those that almost any neurologist should be able to start managing: acute spontaneous vertigo in the Emergency Room-is it vestibular neuritis or posterior circulation stroke; recurrent spontaneous vertigo in the office-is it vestibular migraine or Meniere's disease and the most common vestibular problem of all-benign positional vertigo. Finally we consider the future: long-term vestibular monitoring and the impact of machine learning on vestibular diagnosis.

[The value of high intensity stimulation training of semicircular canal of SRM-â £ vertigo diagnosis and treatment system in the rehabilitation of vestibular neuritis].

Objective:To evaluate the value of high intensity stimulation training of semicircular canal of SRM-Ⅳ vertigo diagnosis and treatment system in the rehabilitation of vestibular neuritis. Methods:To analyze 68 patients with vestibular neuritis treated in Department of Otorhinolaryngology Head and Neck Surgery, Shijiazhuang People's Hospital from January 2020 to January 2021, conduct spontaneous nystagmus and head toss test, and perform spontaneous nystagmus and rotation test of SRM-Ⅳvertigo system, compare the positive rate of the side of disease was between the two. To randomly divide 68 patients into treatment group 1, 2 and control group, the control group with drugs, treatment group 1 with drugs and vestibular rehabilitation training exercise, treatment group 2 with additional high intensity stimulation training of semicircular canal at one week after onset, on the basis of drug therapy and vestibular rehabilitation training exercise. At 2 weeks and 1 month, through swivel chair test negative rate, DHI score, compare the efficacy of the three groups. Results:Spontaneous nystagmus combined with head toss test confirmed 80.9% of the side of the disease, spontaneous nystagmus and rotation test of SRM-Ⅳ vertigo system confirmed 100%, the difference is statistically significant（P<0.05）. Compared with the control group and the treatment group 1, the negative conversion rate of the rotation test in the treatment group 2 at the second week and the first month of treatment, the difference is statistically significant（P<0.05, the second week χ²=6.474, the first month χ²=6.245）; the DHI score of treatment group 2 was statistically significant compared with that of control group and treatment group 1 at the second week and first month of treatment（P<0.05, the second week F=13.578, the first month F=28.599）. Conclusion:SRM-Ⅳ vertigo diagnosis and treatment system semicircular canal high intensity stimulation training has a certain role in the rehabilitation treatment of vestibular neuritis. It is simple to operate, patient tolerance and compliance are good, and it is worth promoting.

Acute vestibular neuritis: A rare complication after the adenoviral vector-based COVID-19 vaccine.

Vestibular neuritis was first reported in 1952 by Dix and Hallpike, and 30% of patients reporting a flu-like symptom before acquiring the disorder. The most common causes are viral infections, often resulting from systemic viral infections or bacterial labyrinthitis. Here we presented a rare case of acute vestibular neuritis after the adenoviral vector-based COVID-19 vaccination. A 51-year-old male pilot awoke early in the morning with severe vertigo, nausea, and vomiting after receiving the first dose of the ChAdOx1 nCoV-19 vaccine 11 days ago. Nasopharyngeal SARS-CoV-2 RT-PCR test and chest CT scan were inconclusive for COVID-19 pneumonia. Significant findings were a severe spontaneous and constant true-whirling vertigo which worsened with head movement, horizontal-torsional spontaneous nystagmus, abnormal caloric test, positive bedside head impulse tests, and inability to tolerate head-thrust test. PTA, MRI of the brain and internal auditory canal, and cerebral CT arteriography were normal. According to the clinical, imaging, and laboratory findings, he was admitted to the neurology ward and received treatment for vestibular neuritis. His vertigo increased gradually over 6-8 h, peaking on the first day, and gradually subsided over 7 days. Ten days later, the symptoms became tolerable; the patient was discharged with advice for home-based vestibular rehabilitation exercises. Despite the proper treatment and rehabilitation, signs of dynamic vestibular imbalances persisted after 1 year. Based on the Federal Aviation Administration (FAA) regulations, the Air Medical Council (AMC) suspended him from flight duties until receiving full recovery. Several cases of vestibular neuritis have been reported in the COVID-19 patients and after the COVID-19 vaccination. This is the first case report of acute vestibular neuritis after the ChAdOx1 nCoV-19 vaccination in a healthy pilot without past medical history. However, the authors believe that this is a primary clinical suspicion that must be considered and confirmed after complete investigations.

The feasibility of SHIMP for judging subjective vertigo and recovery in patients with vestibular neuritis.

PURPOSE: We aimed to study the results of the head impulse paradigm (HIMP) and the suppression head impulse paradigm (SHIMP) in patients with acute vestibular neuritis (AVN) to compare dizziness handicap inventory (DHI) scores before and after treatment. We also wanted to investigate the correlation between the HIMP, SHIMP and DHI score and to analyze the factors that affect the recovery with AVN in the short term. METHODS: The HIMP, SHIMP, and DHI score were assessed in 20 patients with AVN before (T0) and after treatment (T1). We collected the following indicators: T0, T1-HIMP VOR gain; T0, T1-SHIMP VOR gain; the percentage of the anti-compensatory saccades of T0-SHIMP and T1-SHIMP on the affected side; T0-DHI score, T1-DHI score; and efficacy index (EI). The correlation between HIMP and SHIMP parameters with the DHI score and EI was analyzed, and the factors that affect the recovery of patients with AVN were assessed. RESULTS: T0-SHIMP anti-compensatory saccades (%),T1-SHIMP VOR gain, and T1-SHIMP anti-compensatory saccades (%) were significantly correlated with the corresponding DHI score and EI (P < 0.05). T0, T1-HIMP VOR gain and T0-SHIMP VOR gain had no correlation with the corresponding DHI score and EI (P > 0.05). T0-SHIMP anti-compensatory saccades (%) significantly affect EI (P < 0.05). CONCLUSION: Both HIMP and SHIMP can assess the current vestibular function and recovery of AVN patients, but SHIMP can more accurately reflect the degree of subjective vertigo. At the same time, T0-SHIMP anti-compensatory saccades (%) can be used as a good index to evaluate the short-term recovery of AVN patients.

The Impact of the COVID-19 Pandemic on Follow-Ups for Vertigo/Dizziness Outpatients.

OBJECTIVES: In the present report, we aimed to investigate the impact of the coronavirus disease (COVID-19) pandemic on vertigo/dizziness outpatient cancellations in Japan. METHODS: We examined 265 vertigo/dizziness outpatients at the ear, nose, and throat department of the Nara Medical University between March 01, 2020, and May 31, 2020, during the COVID-19 pandemic in Japan. We also focused on 478 vertigo/dizziness outpatients between March 01, 2019, and May 31, 2019, before the COVID-19 pandemic, to compare the number of cancellations between these 2 periods. The reasons for cancellation and noncancellation were investigated using telephone multiple-choice questionnaires (telMCQs), particularly for patients with benign paroxysmal positional vertigo (BPPV) and Meniere's disease (MD). RESULTS: There were many cancellations for medical examinations during the 2020 study period. The total number of vertigo/dizziness outpatients decreased by 44.6% in the 2020 period compared to the same period in 2019. The percent reduction in clinic attendance from 2019 to 2020 (ie, [2019-2020]/2019) for patients with BPPV was higher than that for patients with MD. Compared to the other vertigo-associated conditions, patients with MD exhibited a lower percent reduction in clinic attendance. According to the results of the telMCQs, 75.0% of BPPV cases and 88.2% of MD cases cancelled their appointment and gave up visiting hospitals due to fear of COVID-19 infection, even if they had moderate to severe symptoms. On the contrary, 25.0% and 80.0% patients with BPPV and MD, respectively, did not cancel their appointment; they should not have visited the hospital but stayed at home because they had slight symptoms. CONCLUSIONS: These findings suggest that advanced forms should be prepared for medical care, such as remote medicine. These forms should not only be for the disease itself but also for the mental distress caused by persistent symptoms.

Vestibular failure managed with osteopathic manipulative treatment: A report of two cases.

INTRODUCTION: Vestibular failure or hypofunction can be generated by pathologies such as vestibular neuritis (VN), causing the onset of rotatory vertigo and the vestibulo-ocular reflex (VOR) hyporeaction. VN is a post-viral inflammation-producing vestibular nerve-axon impairment, which reaches compensation in 70% of cases. Here, we present two cases of vestibular failure that did not respond to pharmacological therapy, but did show modulated vestibular response after an osteopathic manipulative treatment. Dizziness handicap inventory (DHI) was used to assess disability, while VOR was examined by means of video head impulse test (v-HIT). Case 1 showed bilateral VOR areflexia with severe related disability due to chronic vertigo, while case 2 showed sub-acute VN complicated by intense vomiting. After treatment, both cases had a complete remission of symptoms, with a reduction in DHI score of 60 and 70 points respectively, as well as a normalization of the v-HIT exam. CONCLUSION: OMT might work to modulate VOR, through osteopathic manipulation of the fascial-system and interaction with proprioceptive inputs. Further clinical trials should be performed to investigate the OMT clinical efficacy in uncompensated vestibular neuritis.

Vestibular Neuritis: Recent Advances in Etiology, Diagnostic Evaluation, and Treatment.

Purpose of Chapter: This chapter highlights the recent advances in etiology, diagnostic evaluation, and management of vestibular neuritis (VN). Recent Findings: The viral hypothesis has been strengthened with new evidence as the main etiology of VN. Recent evidence indicates that bedside oculomotor findings play a critical role in differentiating VN from stroke. The implementation of cervical and ocular vestibular evoked myogenic potential, and video head impulse test in vestibular function testing has made it possible to diagnose selective damage of the vestibular nerves. The management of the acute phase of VN is primarily medical, while long-term treatment is designed to improve vestibular compensation. Summary: VN is clearly defined as an important viral inner ear disorder.

[Approach to patients with vertigo]. / Enfoque del paciente con vértigo.

Vertigo is defined as an abnormal sensation of body motion or of its surrounding objects. It is a common chief complaint in emergency departments comprising 2 to 3% of these consultations worldwide. Vertigo is classified as peripheral or central, according to its origin, and can also be occasionally mixed, the most common cause of peripheral involvement being benign paroxysmal positional vertigo. The initial findings on clinical evaluation of patients are the clues for making a correct diagnosis. The differentiation between central and peripheral vertigo can be optimized by analysing nystagmus, by using the skew test and the head impulse test (HINTS), as also by performing the appropriate tests to evaluate the integrity of the vestibular-cerebellar pathway. In addition, tonal threshold audiometry could raise the diagnostic sensibility from 71 to 89% on initial approach. Appropriate diagnosis is the principal key for managing this clinical condition.

Enfoque del paciente con vértigo / Approach to patients with vertigo

El vértigo es definido como la sensación de movimiento ilusorio del cuerpo o de los objetos que le rodean. Es una de las causas más comunes de consulta en los departamentos de emergencia, y 2 a 3% de la población mundial consulta anualmente por este síntoma. De acuerdo al compromiso vestibular en el oído interno o en el sistema nervioso central o ambos, puede clasificarse en vértigo periférico, central o de origen mixto, siendo la principal causa del periférico el vértigo posicional paroxístico benigno. La valoración semiológica y anamnesis es fundamental para el diagnóstico. En el examen físico inicial, la diferenciación de un vértigo de origen central de otro de origen periférico, puede realizarse mediante el análisis del nistagmo, la valoración del impulso cefálico y la desviación ocular, que se integran en un sistema denominado HINTS, por sus siglas en inglés (Head Impulse, Nystamus type, Test of Skew), y por la realización de pruebas que evalúen también la vía vestíbulo-cerebelosa. Además, la realización de una audiometría tonal, aumentaría la sensibilidad diagnóstica de 71 a 89% en la evaluación inicial. El diagnóstico apropiado es la base para el tratamiento y control de esta condición clínica en el mediano y largo plazo.

Vertigo is defined as an abnormal sensation of body motion or of its surrounding objects. It is a common chief complaint in emergency departments comprising 2 to 3% of these consultations worldwide. Vertigo is classified as peripheral or central, according to its origin, and can also be occasionally mixed, the most common cause of peripheral involvement being benign paroxysmal positional vertigo. The initial findings on clinical evaluation of patients are the clues for making a correct diagnosis. The differentiation between central and peripheral vertigo can be optimized by analysing nystagmus, by using the skew test and the head impulse test (HINTS), as also by performing the appropriate tests to evaluate the integrity of the vestibular-cerebellar pathway. In addition, tonal threshold audiometry could raise the diagnostic sensibility from 71 to 89% on initial approach. Appropriate diagnosis is the principal key for managing this clinical condition.

[Non-drug therapy of vertigo]. / Nelekarstvennye metody lecheniia golovokruzheniia.

AIM: To study the efficacy of various methods of non-drug therapy of diseases manifested by vertigo and dizziness in neurological practice. MATERIAL AND METHODS: Referral and final diagnoses were compared after neurovestibular examination of 599 patients (177 men and 422 women), aged 25 to 79 years (mean age 55 years), with various causes of vertigo. Patients underwent vestibular rehabilitation, trainings on the stabiloplatform with biological feedback (biofeedback), repositioning maneuvers in patients with benign paroxysmal positional vertigo (BPPV). Severity of dizziness on a Visual analogue scale of dizziness (VAS-d) and balance on stabilography before and after a course of vestibular rehabilitation was analyzed. RESULTS: Before neurovestibular examination, the diagnoses of vertebrobasilar insufficiency (44%), hypertensive or atherosclerotic encephalopathy (35%), cervical spondyloarthrosis (8%), autonomic dystonia (11%)) are often considered mistakenly as the causes of vertigo and dizziness. After neurovestibular examination, the diagnoses were as follows: BPPV (39%), phobic postural vertigo (29%), Ménière's disease (14%), vestibular neuritis (11%), multisensory dizziness in elderly (5%). The effectiveness of repositioning maneuvers in BPPV was 90,2% after the first session and 100% after the second session. After a course of vestibular exercises and trainings on the stabiloplatform with biofeedback, there was the marked improvement in indicators of stabilography and VAS-d in patients with vestibular neuritis, Meniere's disease, phobic postural vertigo (p<0.05). Vestibular rehabilitation was most effective if started within the first month after vestibular neuritis. There was the high efficacy of complex rehabilitation, including vestibular exercises and trainings on stabilographic platform with biofeedback, in patients with Meniere's disease. In the rehabilitation of patients with phobic postural vertigo, better results were achieved when vestibular exercises were combined with trainings on stabilographic platform with biofeedback and psychotherapy. CONCLUSION: The results demonstrated the low accuracy of diagnosis of diseases manifested by vertigo and dizziness and high efficacy of non-drug therapy in most cases, especially BPPV, vestibular neuritis, Meniere's disease, postural phobic vertigo.

[Classification of acute vestibular syndrome].

Objective:To explore the epidemiological characteristics and to help accomplish accurate diagnosis and treatment strategies by analyzing the composition and clinical features of various diseases with acute constant vertigo.Method:We retrospectively analyzed medical records (including name, sex, age, diabetes, hypertension, history of vertigo, family history, etc.),otoneurological examination, vestibular function tests and radiological examination of patients with acute vestibular syndrome.We classified various diseases according to diagnostic criteria, and then analyze the clinical data.Result:A total of 77 patients with acute vestibular syndrome were enrolled in this study. It included 34 patients with vestibular neuritis, 18 patients with sudden sensorineural deafness with vertigo, 1 with vestibular schwannoma, 6 with acute vestibular syndrome with migraine, 3 with Hunter syndrome with vertigo, 1 with vertigo after trauma,1 with acute bilateral vestibulopathy, 9 with acute vertigo syndrome with other etiology, 3 with acute labyrinthitis, and 1 with posterior circulation infarction. There were no significant differences in the age and course of disease between different etiologies (P>0.05). There were statistical differences between vestibular neuritis and sudden sensorineural deafness with vertigo among head impulse test and hearing loss (P<0.05). There was significant difference in hearing between sudden sensorineural deafness with vertigo and acute vertigo syndrome (P<0.05).Conclusion:Most of the acute vestibular syndrome patients attending the otorhinolaryngology head and neck surgery clinic were peripheral acute vestibular syndrome, vestibular neuritis, and sudden sensorineural deafness with vertigo.Patients with acute vestibular syndrome with migraine are not rare, and central vertigo can also be seen.

Corticosteroids versus vestibular rehabilitation in long-term outcomes in vestibular neuritis.

BACKGROUND: The management strategy for functional recovery after vestibular neuritis (VN) has not yet been established. Therapeutic choices involve corticosteroids, vestibular rehabilitation therapy (VRT) and the combination of corticosteroids with VRT. OBJECTIVE: The present study aimed to compare the efficacy of corticosteroids, vestibular rehabilitation, and combination of them in terms of subjective and objective improvement in patients with VN. METHODS: A prospective randomized study was conducted on 60 patients with acute vestibular neuritis within 3 days after symptom onset. The patients were divided into three groups; steroid group treated with corticosteroids (n = 20), VRT group (n = 20) managed with vestibular rehabilitation exercises and combination group (n = 20) received combined (corticosteroids and vestibular exercises). Groups were compared by caloric lateralization, vestibular myogenic potential amplitude asymmetry and Dizziness Handicap Inventory scores, both at presentation and up to 12 months. RESULTS: The study found no statistically significant difference between the three groups of the study at the end of the follow up period. CONCLUSION: Corticosteroids and VRT seem to be equivalently effective in patients with VN. The study proposes that corticosteroids may accelerate the recovery of VN, with no more beneficial role in the long-term prognosis of the disease.

Health-related quality of life and disability in patients with acute unilateral peripheral vestibular disorders / Qualidade de vida relacionada à saúde e incapacidade em pacientes com distúrbios vestibulares periféricos unilaterais agudos

Abstract Introduction: Health-related quality of life is used to denote that portion of the quality of life that is influenced by the person's health. Objectives: To compare the health-related quality of life of individuals with vestibular disorders of peripheral origin by analyzing functional, emotional and physical disabilities before and after vestibular treatment. Methods: A prospective, non randomized case-controlled study was conduced in the ENT Department, between January 2015 and December 2015. All patients were submitted to customize a 36 item of health survey on quality of life, short form 36 health survey questionnaire (SF-36) and the Dizziness Handicap Inventory for assessing the disability. Individuals were diagnosed with acute unilateral vestibular peripheral disorders classified in 5 groups: vestibular neuritis, Ménière Disease, Benign Paroxysmal Positional Vertigo, cochlear-vestibular dysfunction (other than Ménière Disease), or other type of acute peripheral vertigo (as vestibular migraine). Results: There was a statistical significant difference for each parameter of Dizziness Handicap Inventory score (the emotional, functional and physical) between the baseline and one month both in men and women, but with any statistical significant difference between 7 days and 14 days. It was found a statistical significant difference for all eight parameters of SF-36 score between the baseline and one month later both in men and women; the exception was the men mental health perception. The correlation between the Dizziness Handicap Inventory and the SF-36 scores according to diagnostics type pointed out that the Spearman's correlation coefficient was moderate correlated with the total scores of these instruments. Conclusion: The Dizziness Handicap Inventory and the SF-36 are useful, proved practical and valid instruments for assessing the impact of dizziness on the quality of life of patients with unilateral peripheral vestibular disorders.

Resumo Introdução: Qualidade de vida relacionada à saúde é usada para designar a parte da qualidade de vida que é influenciada pela saúde do indivíduo. Objetivos: Comparar a qualidade de vida relacionada à saúde de indivíduos com distúrbios vestibulares de origem periférica, analisar incapacidades funcionais, emocionais e físicas antes e após o tratamento vestibular. Método: Um estudo de caso-controle prospectivo, não randomizado, foi conduzido no Departamento de Otorrinolaringologia, entre janeiro de 2015 e dezembro de 2015. Todos os pacientes foram submetidos a uma pesquisa de saúde personalizada de 36 itens sobre qualidade de vida, ao formulário abreviado de avaliação de saúde 36 (SF-36) e ao Dizziness Handicap Inventory para avaliar a incapacidade. Os indivíduos foram diagnosticados com distúrbios vestibulares periféricos unilaterais agudos, classificados em cinco grupos: neurite vestibular, doença de Ménière, vertigem posicional paroxística benigna, disfunção cócleo-vestibular (exceto Doença de Ménière) ou outro tipo de vertigem periférica aguda (como enxaqueca vestibular). Resultados: Houve uma diferença estatisticamente significante para cada parâmetro de escore no Dizziness Handicap Inventory (emocional, funcional e físico) entre a avaliação basal e depois de um mês, tanto em homens quanto em mulheres, mas sem diferença estatística significativa entre sete dias e 14 dias. Foi encontrada uma diferença estatisticamente significante para todos os oito parâmetros do escore no SF-36 entre a avaliação basal e um mês mais tarde, tanto em homens quanto em mulheres; a exceção foi a percepção de saúde mental nos homens. A correlação entre Dizziness Handicap Inventory e o SF-36 de acordo com o tipo de diagnóstico mostrou que o coeficiente de correlação de Spearman foi moderado quando correlacionado com o escore total desses instrumentos. Conclusão: O Dizziness Handicap Inventory e o SF-36 demonstraram ser instrumentos úteis, práticos e válidos para avaliar o impacto da tontura na qualidade de vida de pacientes com distúrbios vestibulares periféricos unilaterais.

[Idiopathic cranial nerve failure]. / Idiopathische Hirnnervenausfälle.

Cranial nerve lesions require a thorough diagnostic work-up and known etiologies have to be excluded before the term idiopathic can be considered. The focus of the present review is on idiopathic peripheral facial nerve paralysis (Bell's palsy) for which this terminology has been established. For all other cranial nerve lesions the typical clinical signs, established etiologies and possible diagnostic pitfalls are discussed.

Inpatient Treatment of Patients Admitted for Dizziness: A Population-Based Healthcare Research Study on Epidemiology, Diagnosis, Treatment, and Outcome.

OBJECTIVE: To determine inpatient treatment rates of patients with dizziness with focus on diagnostics, treatment and outcome. STUDY DESIGN: Retrospective population-based study. SETTING: Inpatients in the federal state Thuringia in 2014. PATIENTS: All 1,262 inpatients (62% females, median age: 61 yr) treated for inpatient dizziness were included. MAIN OUTCOME MEASURES: The association between analyzed parameters and probability of improvement and recovery was tested using univariable and multivariable statistics. RESULTS: Final diagnosis at demission was peripheral vestibular disorder (PVD), central vestibular disorder (CVD), cardiovascular syndrome, somatoform syndrome, and unclassified disease in 75, 9, 3, 0.6, and 13%, respectively. The most frequent diseases were acute vestibular neuritis (28%) and benign paroxysmal positional vertigo (22%). The follow-up time was 38 ±â€Š98 days. 88.5% of patients showed at least an improvement of complaints and 31.4% a complete recovery. The probability for no improvement from inpatient dizziness was higher if the patient had a history of ear/vestibular disease (hazard ratio [HR] = 1.506; 95% confidence interval [CI] = 1.301-1.742), and was taking more than two drugs for comorbidity (HR = 1.163; CI = 1.032-1.310). Compared with final diagnosis of cardiovascular syndrome, patients with PVD (HR = 1.715; CI = 1.219-2.415) and CVD (HR = 1.587; CI = 1.076-2.341) had a worse outcome. CONCLUSIONS: Inpatient treatment of dizziness was highly variable in daily practice. The population-based recovery rate was worse than reported in clinical trials. We need better ways to implement clinical trial findings for inpatients with dizziness.