-
The Journal of Laryngology and Otology Jun 2024Differential diagnosis of acute vertigo syndrome is challenging given the similarities between clinical presentations of posterior circulation stroke and peripheral...
BACKGROUND
Differential diagnosis of acute vertigo syndrome is challenging given the similarities between clinical presentations of posterior circulation stroke and peripheral vestibular dysfunction. The Head Impulse, Nystagmus, Test of Skew ('HINTS') assessment is a clinical bedside test used to aid diagnosis.
METHODS
Comprehensive training on use of the Head Impulse, Nystagmus, Test of Skew assessment was provided to one stroke consultant, and the effectiveness of the test in that setting was assessed. Further education was completed with more members of the stroke and emergency department multi-disciplinary team. Quality improvement measures including magnetic resonance imaging use and bed utilisation were explored.
RESULTS
Following training of one stroke consultant, the Head Impulse, Nystagmus, Test of Skew assessment was found to be a feasible, accurate bedside test within this acute stroke service. Further training for the multi-disciplinary team was completed, but outcome measures were not explored because of the coronavirus disease 2019 pandemic and maternity leave.
CONCLUSION
There is a role for trained members of the multi-disciplinary team to successfully use the Head Impulse, Nystagmus, Test of Skew assessment in hyperacute stroke settings, to aid diagnosis in acute vertigo syndrome.
Topics: Humans; Diagnosis, Differential; Stroke; Head Impulse Test; Vertigo; Nystagmus, Pathologic; COVID-19; Vestibular Function Tests; Syndrome; Vestibular Diseases
PubMed: 38779899
DOI: 10.1017/S0022215123002050 -
The Journal of Laryngology and Otology Jun 2024Driving capacity is affected by vestibular disorders and the medications used to treat them. Driving is not considered during medical consultations, with 92 per cent of...
BACKGROUND
Driving capacity is affected by vestibular disorders and the medications used to treat them. Driving is not considered during medical consultations, with 92 per cent of patients attending a centre for dizziness not discussing it with the doctor.
OBJECTIVE
To investigate if medical record prompts facilitate dizziness and driving conversations in ENT balance clinics.
METHODS
A questionnaire was designed to reflect the current standards of practice and advice given regarding driving and dizziness during balance clinic consultations.
RESULTS
Medical record prompts facilitated the improved frequency and recording of shared decision-making conversations about driving and dizziness in 98 per cent of consultations.
CONCLUSION
This study highlights the benefits of medical record prompts for documented and accurate shared decision-making conversations surrounding dizziness, vertigo, vestibular conditions and driving. This potentially improves safety for all road users, and protects the patient and clinician in the event of road traffic accidents and medico-legal investigations.
Topics: Humans; Dizziness; Automobile Driving; Surveys and Questionnaires; Medical Records; Male; Female; Otolaryngology; Middle Aged; Physician-Patient Relations; Aged; Decision Making; Adult; Documentation; Vertigo
PubMed: 38779898
DOI: 10.1017/S0022215123002104 -
The Journal of Laryngology and Otology Jun 2024Benign paroxysmal positional vertigo is the most common episodic vestibular disorder, although it is often quiescent by the time patients visit a specialist clinic,...
BACKGROUND
Benign paroxysmal positional vertigo is the most common episodic vestibular disorder, although it is often quiescent by the time patients visit a specialist clinic, making the diagnosis difficult to confirm. Patients fear the consequences of a relapse and it is not clear what follow up should be provided.
OBJECTIVE
This evaluation reviewed the results of an open access pathway that offered priority appointments to patients with a history of positional vertigo.
RESULTS AND CONCLUSION
In total, 664 patients were included in the analysis, 52 per cent of whom had unconfirmed benign paroxysmal positional vertigo. Open follow up improved diagnostic rates by approximately 40 per cent. The rate of benign paroxysmal positional vertigo recurrence was 34 per cent in patients with follow up of at least one year, 41 per cent with follow up of one to two years, and 53 per cent with follow up of two years or more. One in five recurrences occurred in a different semi-circular canal. These results suggest that specialist follow up is required for management of recurrent benign paroxysmal positional vertigo.
Topics: Humans; Benign Paroxysmal Positional Vertigo; Recurrence; Female; Male; Middle Aged; Aged; Adult; Aged, 80 and over
PubMed: 38779897
DOI: 10.1017/S0022215123002244 -
The Journal of Laryngology and Otology Jun 2024Balance dysfunction and vestibular conditions are major problems requiring significant resources. There is significant national and international variation in management...
BACKGROUND
Balance dysfunction and vestibular conditions are major problems requiring significant resources. There is significant national and international variation in management pathways for such patients.
METHODS
This paper outlines a collaborative project run by the ENT department and two vestibular rehabilitation trained physiotherapists to establish a clinic to manage patients referred to ENT with vestibular and/or balance complaints. As part of a six-month pilot, two physiotherapy-led balance clinics were provided per week.
RESULTS
A total of 159 new patients were seen, with only 15 needing ENT consultant input. This led to the successful creation of substantive posts; the clinic has seen 698 patients in its first two years.
CONCLUSION
Patient outcomes and experience have been positive, and accompanied by reduced waiting and in-service times. The authors discuss some of the pitfalls, challenges and opportunities of developing this type of clinic.
Topics: Humans; Postural Balance; Physical Therapy Modalities; Vestibular Diseases; Pilot Projects; Ambulatory Care Facilities; Male; Referral and Consultation; Female; Adult; Middle Aged
PubMed: 38779896
DOI: 10.1017/S0022215123002256 -
The Journal of Laryngology and Otology Jun 2024To examine the newly established role of a primary contact physiotherapist in an ENT clinic, in an Australian cohort and context, over two phases of development.
OBJECTIVE
To examine the newly established role of a primary contact physiotherapist in an ENT clinic, in an Australian cohort and context, over two phases of development.
METHODS
A retrospective cohort study was conducted with data collected from a medical record audit. Over the study duration, the primary contact physiotherapist completed initial appointments with patients; follow-up appointments were subsequently conducted by medical staff.
RESULTS
There was a 46 per cent reduction in patients with suggested vestibulopathy requiring an ENT medical review. This reduction could hypothetically increase to 71 per cent with follow-up primary contact physiotherapist appointments. Improvements in the service delivery model and a primary contact physiotherapist arranging diagnostic assessments could improve waitlist times and facilitate better utilisation of medical staff time.
CONCLUSION
The primary contact physiotherapist can help in the management of patients with suspected vestibulopathy on an ENT waitlist. This is achieved through: a reduction of patients requiring ENT review, improvements to waitlist time and improved utilisation of medical specialists' time.
Topics: Humans; Retrospective Studies; Physical Therapy Modalities; Australia; Female; Male; Middle Aged; Vestibular Diseases; Adult; Waiting Lists; Cohort Studies; Aged; Physical Therapists; Otolaryngology
PubMed: 38779895
DOI: 10.1017/S0022215123002074 -
The Journal of Laryngology and Otology Jun 2024Persistent postural-perceptual dizziness classifies patients with chronic dizziness, often triggered by an acute episode of vestibular dysfunction or threat to balance....
OBJECTIVE
Persistent postural-perceptual dizziness classifies patients with chronic dizziness, often triggered by an acute episode of vestibular dysfunction or threat to balance. Unsteadiness and spatial disorientation vary in intensity but persist for over three months, exacerbated by complex visual environments.
METHOD
Literature suggests diagnosis relies on a clinical history of persistent subjective dizziness and normal vestibular and neurological examination findings. Behavioural diagnostic biomarkers have been proposed, to facilitate diagnosis.
RESULTS
Research has focused on understanding the neural mechanisms that underpin this perceptual disorder, with imaging data supporting altered connectivity between neural brain networks that process vision, motion and emotion. Behavioural research identified the perceptual and motor responses to a heightened perception of imbalance.
CONCLUSION
Management utilises head and body motion detection, and downregulation of visual motion excitability, reducing postural hypervigilance and anxiety. Combinations of physical and cognitive therapies, with antidepressant medications, help if the condition is associated with mood disorder.
Topics: Humans; Chronic Disease; Dizziness; Postural Balance; Vestibular Diseases
PubMed: 38779894
DOI: 10.1017/S0022215123002153 -
The Journal of Laryngology and Otology Jun 2024Patients presenting to the emergency department with acute vertigo pose a diagnostic challenge. While 'benign' peripheral vestibulopathy is the most common cause, the... (Review)
Review
BACKGROUND
Patients presenting to the emergency department with acute vertigo pose a diagnostic challenge. While 'benign' peripheral vestibulopathy is the most common cause, the possibility of a posterior circulation stroke is paradoxically the most feared and missed diagnosis in the emergency department.
OBJECTIVES
This review will attempt to cover the significant advances in the ability to diagnose acute vertigo that have occurred in the last two decades. The review discusses the role of neurological examinations, imaging and specific oculomotor examinations. The review then discusses the relative attributes of the Head Impulse-Nystagmus-Test of Skew plus hearing ('HINTS+') examination, the timing, triggers and targeted bedside eye examinations ('TiTrATE'), the associated symptoms, timing and triggers, examination signs and testing ('ATTEST') algorithm, and the spontaneous nystagmus, direction, head impulse testing and standing ('STANDING') algorithm. The most recent technological advancements in video-oculography guided care are discussed, as well as other potential advances for clinicians to look out for.
Topics: Humans; Vertigo; Acute Disease; Head Impulse Test; Algorithms; Neurologic Examination; Vestibular Function Tests; Diagnosis, Differential; Emergency Service, Hospital; Nystagmus, Pathologic
PubMed: 38779893
DOI: 10.1017/S0022215123002232 -
The Journal of Laryngology and Otology Jun 2024
Topics: Humans; Dizziness; Postural Balance; Vestibular Diseases; Vertigo
PubMed: 38779892
DOI: 10.1017/S0022215123002335 -
Frontiers in Neuroscience 2024
PubMed: 38779511
DOI: 10.3389/fnins.2024.1399340 -
Diabetes Therapy : Research, Treatment... May 2024Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have attracted much attention because of their significant hypoglycemic and weight-loss effects. Previous...
INTRODUCTION
Glucagon-like peptide-1 receptor agonists (GLP-1RAs) have attracted much attention because of their significant hypoglycemic and weight-loss effects. Previous preparations can only be subcutaneously injected. Oral administration of GLP-1RAs semaglutide helps to broaden treatment options, but its safety in the real world still needs to be observed. This study is based on FDA adverse event reporting system (FAERS) database to mine adverse drug events (ADE) of oral semaglutide, and provide references for the clinical safe use of this drug.
METHODS
To analyze the signal quality of oral semaglutide, which is a drug used in the FAERS database from the third quarter of 2019 to the third quarter of 2023, we collected ADE data and performed data mining by using disproportionate analysis. Then, we standardized the data and used a variety of signal-quantification techniques, including reported odds ratio (ROR), proportional reporting ratio (PRR), Bayesian belief propagation neural network (BCPNN), and multiple empirical Bayesian gamma Poisson contractions (MGPS), for further analysis.
RESULTS
We screened 2398 reports on the use of semaglutide tablets, involving a total of 5653 ADE. These reports were mainly submitted by consumers, and the reporting country was mainly the United States. A total of 23 system organ classes (SOC) and 93 preferred terms (PT) were mined for the signals of semaglutide tablets. The three most common SOC were gastrointestinal disorders, general disorders and administration site conditions, and investigations. At the PT level, metabolism and nutrition disorders exhibit the highest number of signals, with the top three being thyroid cyst, acute cholecystitis, and ketosis. Gastrointestinal disorders rank second, primarily involving eructation, pancreatitis, impaired gastric emptying, and regurgitation. In addition, vith nerve paralysis occurs and the signal intensity is high.
CONCLUSIONS
Our study provides a deeper and broader understanding of the safety of oral semaglutide. The results of the ROR, PRR, BCPNN, and MGPS algorithms exhibit high consistency, with metabolism and nutrition-related disorders having the highest number of signals. The conclusions align with the technical specifications of the product. Notably, other unexpected effects are reported, including acute cholecystitis, paralysis of the abducens nerve, and positional vertigo.
PubMed: 38776037
DOI: 10.1007/s13300-024-01594-7