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Ugeskrift For Laeger Jun 2017Benign paroxysmal positional vertigo (BPPV) remains the most frequent cause of vertigo. The TRV chair is a mechanical device suited for optimization of managing complex... (Review)
Review
Benign paroxysmal positional vertigo (BPPV) remains the most frequent cause of vertigo. The TRV chair is a mechanical device suited for optimization of managing complex cases of BPPV. Although the use of repositioning devices in the management of BPPV is increasing, no applicable guide for the TRV management of the different BPPV subtypes exists. This article presents the techniques for addressing canalolithiasis and cupulolithiasis in the TRV chair for each affected semicircular canal. In a tertiary referral centre like our unit the TRV chair is an asset in the management of BPPV.
Topics: Benign Paroxysmal Positional Vertigo; Humans; Patient Positioning; Physical Therapy Modalities
PubMed: 28606300
DOI: No ID Found -
European Archives of... Aug 2022Intratympanic (IT) drug delivery receives attention due to its effectivity in treatment for Menière's disease (MD). Due to the release of the consensuses and new... (Review)
Review
PURPOSE
Intratympanic (IT) drug delivery receives attention due to its effectivity in treatment for Menière's disease (MD). Due to the release of the consensuses and new evidence on IT drug delivery for MD have been published, the review with a view to supplementing the details of IT treatment of MD is indispensable.
METHODS
The literatures on IT injection for MD treatment over the last two decades are retrieved, International consensus (ICON) on treatment of Menière's disease (2018), Clinical Practice Guideline (2020) and European Position statement on Diagnosis and Treatment of Meniere's Disease (2018) are taken into account for reference, and follow advice from experts from Europe, USA and China.
RESULTS
Experts agree on the following: (1) The effectiveness of IT methylprednisolone (ITM) on vertigo control seems to be somewhat better than that of IT dexamethasone (ITD), and ITM can restore hearing in some cases. (2) Due to the ototoxicity of aminoglycosides, the application of intratympanic gentamicin (ITG) in MD patients with good hearing is conservative. However, some studies suggest that ITG with low doses has no significant effect on hearing, which needs to be further proved by clinical studies with high levels of evidence. (3) Currently, generally accepted treatment endpoint of ITG is no vertigo attack in a 12-month period or a vestibular loss in objective tests in the affected ear.
CONCLUSION
More studies with high level of evidence are needed to evaluate the drug type, efficacy, and therapeutic endpoint of IT therapy for MD.
Topics: Anti-Bacterial Agents; Consensus; Gentamicins; Humans; Injection, Intratympanic; Meniere Disease; Treatment Outcome; Vertigo
PubMed: 35469039
DOI: 10.1007/s00405-022-07374-y -
Nigerian Journal of Clinical Practice Jul 2022Tinnitus is a common auditory complaint among individuals characterized by ringing, buzzing, hissing, chirping, whistling, or other sounds in the ear. Following a...
BACKGROUND
Tinnitus is a common auditory complaint among individuals characterized by ringing, buzzing, hissing, chirping, whistling, or other sounds in the ear. Following a low-fat/low-cholesterol diet can help reduce the blood cholesterol and triglyceride levels, which aids improvement in tinnitus symptoms. High cholesterol and triglyceride levels in the bloodstream play a significant role in the development of tinnitus, hearing loss, and vertigo.
AIM
This paper aims to test the association between hyperlipidemia and tinnitus among outpatients in King Khalid University (KKU) ENT clinic.
PATIENTS AND METHODS
A retrospective review of the medical records of patients who attended the ENT clinic at KKU was performed. An otological examination including pure tone audiometry, personal habits, and lipid profile was conducted. Patients were contacted by phone if there were any missing data.
RESULTS
The study included 300 patients who were treated in the outpatient clinic during the study period. About 80% of the patients were of age >45 years and 60.3% were males. Half of the cases (150 cases) had tinnitus and 13% had hyperlipidemia. Patients with high lipid profile recorded doubled risk for tinnitus (P < 0.05). Other risk factors found to be significantly associated with tinnitus include vertigo, young age, and wearing an earpiece.
CONCLUSIONS
In conclusion, there was a significant association between hyperlipidemia and the incidence of tinnitus even after adjusting for all other risk factors. More large-scale researches are needed to assess in detail the association between different lipid components such as low-density lipoprotein, high-density lipoprotein, triglycerides, and tinnitus epidemiology.
Topics: Cholesterol; Female; Humans; Hyperlipidemias; Male; Middle Aged; Tinnitus; Triglycerides; Vertigo
PubMed: 35859463
DOI: 10.4103/njcp.njcp_1465_21 -
Orphanet Journal of Rare Diseases Aug 2019Idiopathic bilateral vestibulopathy (IBV) is an acquired bilateral peripheral vestibular dysfunction of unknown etiology, with persistent unsteadiness but without... (Review)
Review
BACKGROUND
Idiopathic bilateral vestibulopathy (IBV) is an acquired bilateral peripheral vestibular dysfunction of unknown etiology, with persistent unsteadiness but without sensorineural hearing loss (SNHL) other than age-related hearing loss (ARHL).
MAIN TEXT
The prevalence of IBV is unknown. The most common symptom is persistent unsteadiness, particularly in darkness and/or on uneven ground. The other main symptom is oscillopsia during head and body movements. IBV is neither associated with SNHL, except for ARHL, nor any other neurological dysfunction that causes balance disorders. The clinical time course of IBV can generally be divided into two main types: progressive type and sequential type. The progressive type involves gradually progressive persistent unsteadiness without episodes of vertigo. The sequential type involves recurrent vertigo attacks accompanied by persistent unsteadiness. Originally, IBV was found to exhibit bilateral dysfunction in the lateral semicircular canals (LSCCs) and the superior vestibular nerve (SVN) system. However, recently, with the development of more sophisticated vestibular function tests of the otolith organs and vertical semicircular canals, it has been revealed that IBV involves peripheral vestibular lesions other than those already identified in the LSCC and the SVN system. Furthermore, novel subtypes of IBV that do not involve bilateral dysfunction of the LSCC and/or the SVN system have been proposed. Therapeutically, exercise-based vestibular rehabilitation in adult bilateral vestibulopathy (BVP) patients has resulted in improved gaze and postural stability moderately. There are several technical approaches for the treatment of BVP such as vestibular implants, sensory substitution devices and noisy galvanic vestibular stimulation.
CONCLUSIONS
Combined use of various vestibular function tests, including recently developed tests, revealed the diversity of lesion sites in IBV. Further studies are required to determine the therapeutic effects of the technical approaches on IBV.
Topics: Bilateral Vestibulopathy; Hearing Loss, Sensorineural; Humans; Motion Perception; Vertigo
PubMed: 31426838
DOI: 10.1186/s13023-019-1180-8 -
Endokrynologia Polska 2020Vertigo and balance disorders are common symptoms reported by approximately 15-20% of the adult population worldwide. For many years thyroid diseases have been suspected... (Review)
Review
Vertigo and balance disorders are common symptoms reported by approximately 15-20% of the adult population worldwide. For many years thyroid diseases have been suspected as the cause of vertigo by ENT physicians. Almost every patient hospitalised due to severe vertigo is investigated for thyroid disease as a suspected cause of acute vestibulopathy. The issue presented in this paper is related to a difficult and poorly understood relationship between autoimmune thyroid disease and peripheral vertigo.
Topics: Hashimoto Disease; Humans; Meniere Disease; Vertigo; Vestibular Neuronitis
PubMed: 32129465
DOI: 10.5603/EP.a2019.0069 -
Journal of Neurophysiology Jun 2019For many years, people working near strong static magnetic fields of magnetic resonance imaging (MRI) machines have reported dizziness and sensations of vertigo. The... (Review)
Review
For many years, people working near strong static magnetic fields of magnetic resonance imaging (MRI) machines have reported dizziness and sensations of vertigo. The discovery a decade ago that a sustained nystagmus can be observed in all humans with an intact labyrinth inside MRI machines led to a possible mechanism: a Lorentz force occurring in the labyrinth from the interactions of normal inner ear ionic currents and the strong static magnetic fields of the MRI machine. Inside an MRI, the Lorentz force acts to induce a constant deflection of the semicircular canal cupula of the superior and lateral semicircular canals. This inner ear stimulation creates a sensation of rotation, and a constant horizontal/torsional nystagmus that can only be observed when visual fixation is removed. Over time, the brain adapts to both the perception of rotation and the nystagmus, with the perception usually diminishing over a few minutes, and the nystagmus persisting at a reduced level for hours. This observation has led to discoveries about how the central vestibular mechanisms adapt to a constant vestibular asymmetry and is a useful model of set-point adaptation or how homeostasis is maintained in response to changes in the internal milieu or the external environment. We review what is known about the effects of stimulation of the vestibular system with high-strength magnetic fields and how the understanding of the mechanism has been refined since it was first proposed. We suggest future ways that magnetic vestibular stimulation might be used to understand vestibular disease and how it might be treated.
Topics: Adaptation, Physiological; Humans; Magnetic Fields; Nystagmus, Physiologic; Vertigo; Vestibule, Labyrinth
PubMed: 30969883
DOI: 10.1152/jn.00873.2018 -
Nutrients Oct 2021Vestibular disorders may generate complex signs and symptoms, which may alter patients' balance and the quality of life. Dizziness and vertigo can strongly affect daily... (Review)
Review
Vestibular disorders may generate complex signs and symptoms, which may alter patients' balance and the quality of life. Dizziness and vertigo can strongly affect daily activities and relations. Despite the presence of conventional drugs, maneuvers, and surgery, another interesting therapeutic opportunity is offered by nutraceuticals. These molecules are often used in the treatment of dizziness and vertigo, but the rationale of their application is not always solidly demonstrated by the scientific evidence. Several substances have shown a variable level of efficacy/usefulness in this field, but there is lack of important evidence for most of them. From a medico-legal point of view, specific information must be provided to the patient regarding the efficacy and possibilities that the use of these preparations can allow. Administering the right nutraceutical to the proper patient is a fundamental clinical skill. Integrating conventional drug treatment with nutraceutical administration seems to be easy, but it may be difficult considering the (in part unexplored) pharmacodynamics and pharmacokinetics of nutraceuticals. The aim of the scientific community should be to elevate nutraceuticals to the same law and technical dignity of conventional drugs.
Topics: Dietary Supplements; Dizziness; Humans; Legislation as Topic; Vertigo; Vestibule, Labyrinth
PubMed: 34684646
DOI: 10.3390/nu13103646 -
Journal of Neurology Apr 2016The leading symptoms of vestibular paroxysmia (VP) are recurrent, spontaneous, short attacks of spinning or non-spinning vertigo that generally last less than one minute... (Review)
Review
The leading symptoms of vestibular paroxysmia (VP) are recurrent, spontaneous, short attacks of spinning or non-spinning vertigo that generally last less than one minute and occur in a series of up to 30 or more per day. VP may manifest when arteries in the cerebellar pontine angle cause a segmental, pressure-induced dysfunction of the eighth nerve. The symptoms are usually triggered by direct pulsatile compression with ephaptic discharges, less often by conduction blocks. MR imaging reveals the neurovascular compression of the eighth nerve (3D constructive interference in steady state and 3D time-of-flight sequences) in more than 95% of cases. A loop of the anterior inferior cerebellar artery seems to be most often involved, less so the posterior inferior cerebellar artery, the vertebral artery, or a vein. The frequent attacks of vertigo respond to carbamazepine or oxcarbazepine, even in low dosages (200-600 mg/d or 300-900 mg/d, respectively), which have been shown to also be effective in children. Alternative drugs to try are lamotrigine, phenytoin, gabapentin, topiramate or baclofen or other non-antiepileptic drugs used in trigeminal neuralgia. The results of ongoing randomized placebo-controlled treatment studies, however, are not yet available. Surgical microvascular decompression of the eighth nerve is the "ultima ratio" for medically intractable cases or in exceptional cases of non-vascular compression of the eighth nerve by a tumor or cyst. The International Barany Society for Neuro-Otology is currently working on a consensus document on the clinical criteria for establishing a diagnosis of VP as a clinical entity.
Topics: Abnormalities, Multiple; Craniofacial Abnormalities; Diagnosis, Differential; Disease Management; Humans; Nerve Compression Syndromes; Pigmentation Disorders; Treatment Outcome; Vertigo
PubMed: 27083889
DOI: 10.1007/s00415-015-7973-3 -
European Annals of Otorhinolaryngology,... Nov 2016Pneumolabyrinth is defined as the presence of air within the inner ear causing cochleovestibular signs and symptoms. Twenty-seven cases of pneumolabyrinth are published...
INTRODUCTION
Pneumolabyrinth is defined as the presence of air within the inner ear causing cochleovestibular signs and symptoms. Twenty-seven cases of pneumolabyrinth are published in the literature of which only two were described as delayed pneumolabyrinth as a complication of stapes surgery.
CASE REPORT
A 45-year-old male patient presented with vertigo after Valsalva maneuver 12 years after stapedectomy. He was diagnosed with delayed pneumolabyrinth on high resolution computed tomography and underwent an exploratory tympanotomy with surgical repair.
DISCUSSION
Delayed pneumolabyrinth is a rare complication of stapes surgery and should be considered in patients presenting with vestibulocochlear symptoms even many years later. An exploratory tympanotomy is recommended for patients diagnosed with pneumolabyrinth and having a sensorineural hearing loss and/or persistent vertigo.
Topics: Emphysema; Humans; Labyrinth Diseases; Male; Middle Aged; Stapes Surgery; Vertigo
PubMed: 27318888
DOI: 10.1016/j.anorl.2015.10.005 -
Brazilian Journal of Otorhinolaryngology 2022Visual vertigo occurs after a vestibular disorder compromising daily living. It can be assessed by "the Visual Vertigo Analogue Scale" (VVAS), a self-administered...
OBJECTIVES
Visual vertigo occurs after a vestibular disorder compromising daily living. It can be assessed by "the Visual Vertigo Analogue Scale" (VVAS), a self-administered questionnaire without Portuguese version. To perform the translation, cross cultural adaptation, and validation of VVAS from English to Portuguese.
METHODS
Prospective study involving the translation and cross-cultural adaptation of the VVAS into the Portuguese language, according to recognized guidelines. It was completed by 63 healthy controls and 198 participants with vestibulopathy who also completed the Dizziness Handicap Inventory (DHI) to further explore the link between DHI and VVAS. Groups were compared for severity of visual vertigo and VVAS reliability and internal consistency were tested.
RESULTS
The VVAS score was significantly higher in vestibular group (p < 0.001). A Cronbach's α of 0.9 confirmed the valid internally consistent of the applied version. The severity score of VVAS showed a positive strong correlation with DHI (p < 0.0001).
CONCLUSION
The present Portuguese translation of the scale showed satisfactory properties for the assessment of self-perceived and severity of visual vertigo in a significant group of vestibular Portuguese patients.
Topics: Humans; Language; Reproducibility of Results; Prospective Studies; Portugal; Vertigo; Dizziness; Surveys and Questionnaires
PubMed: 36328929
DOI: 10.1016/j.bjorl.2022.09.004