Patients with vertigo/dizziness of unknown origin during follow-ups by general otolaryngologists at outpatient town clinic.

OBJECTIVES: The purpose of this study was to access the contribution of vertigo/dizziness-related patients' interview and examinations during short-term hospitalization in determining the accurate final diagnosis of vertigo/dizziness of unknown origin. METHODS: We reviewed 1905 successive vertigo/dizziness patients at the Vertigo/Dizziness Center of Nara Medical University, who were introduced from general otolaryngologists at outpatient town clinic from May 2014 to April 2020. However, 244 patients were diagnosed with vertigo/dizziness of unknown origin (244/1905; 12.8%). Of these patients, 240 were hospitalized and underwent various examinations, including caloric test (C-test), video head impulse test (vHIT), vestibular evoked cervical myogenic potentials (cVEMP), subjective visual vertical (SVV), inner ear magnetic resonance imaging (ieMRI), Schellong test (S-test), and self-rating questionnaires of depression score (SDS). RESULTS: According to the examination data, together with interviewed vertigo/dizziness characteristics and daily changeable nystagmus findings, the final diagnoses were as follows: benign paroxysmal positional vertigo (BPPV: 107/240; 44.6%), orthostatic dysregulation (OD: 56/240; 23.3%), vestibular peripheral disease (VPD: 25/240; 10.4%), vestibular migraine (VM: 14/240; 5.8%), Meniere's disease (MD: 12/240; 5.0%), gravity perception disturbance (GPD: 10/240; 4.2%), psychogenic vertigo (Psycho: 10/240; 4.2%), and unknown (Unknown: 6/240; 2.5%). Supporting factors of final diagnosis was seen in gender, evoked dizziness, and positional nystagmus as BPPV; in evoked dizziness, S-test, and hypertension as OD; in evoked dizziness, head shaking after nystagmus, C-test, and vHIT as VPD; in gender, headache, and S-test as VM; in ear fullness and ieMRI as MD; in gender, evoked dizziness, and SVV as GPD; and in SDS as Psycho. To sum up, the ratios of Unknown were significantly reduced by this short-term hospitalization (244/1905→6/240). CONCLUSIONS: The answer lists for vertigo/dizziness of unknown origin obtained in the present study may be helpful for future general otolaryngologists at outpatient town clinic to better attain an accurate final diagnosis.

Treatment of Patients with Floating Sensation after the Great East Japan Earthquake / 日本東洋医学雑誌

We would like to report on the treatment of 15 patients with floating sensation after the Great East Japan Earthquake (2011 Tohoku Earthquake) in 2011.Twelve cases were effectively treated with hangekobokuto, while two cases were effectively treated with hangebyakujutsutemmato, but not with hangekobokuto.One case was effectively treated with ryokeijutsukanto. We discuss how to treat this floating sensation, focusing on the usage of hangekobokuto.<BR>Most patients who were successfully treated with hangekobokuto reported an uneasy feeling with a floating sensation. On the other hand, those who were successfully treated with hangebyakujutsutemmato or ryokeijutsukanto did not feel uneasy, but reported vertigo and upset stomach.Upon abdominal examination, epigastric resistance was frequently observed in the patients treated with hangekobokuto.This resistance decreased as the floating sensation was improved.<BR>Our results indicate that hangekobokuto could be efficacious for patients with floating sensation after an earthquake, who also felt uneasy and showed epigastric resistance upon abdominal examination.