Prevalence and consequences of concurrent dizziness on disability and quality of life in patients with long-lasting neck pain.

PURPOSE: The purpose of this study was to examine the prevalence of concurrent dizziness in patients seeking treatment for neck pain at a secondary care clinic and examine how dizziness associates with physical function, disability, quality of life, and duration of neck pain. METHODS: This was a cross-sectional study where patients referred for neck pain (n = 133) were recruited from an outpatient spine clinic and divided into: patients with and without dizziness. All patients were examined with posturography, global body examination-flexibility and cervical range of motion, and completed the Neck Disability Index (NDI) and RAND-12 health survey. Patients with concurrent dizziness completed the Vertigo Symptom Scale short form (VSSsf). RESULTS: Forty-three percent of the patients reported dizziness. Concurrent dizziness was associated with increased postural sway with eyes open (p < .001), eyes closed (p = .024), eyes open on foam (p = .010), eyes closed on foam (p = .003), higher disability on the NDI (ß: 2.9, p = .009), RAND-12 physical (ß: -4.3, p = .014) and mental subscales (ß: -4.0, p = .014). A higher score on NDI was associated with higher score on the VSSsf (total score: r = 0.51, p < .001, anxiety: r = 0.52, p < .001, vertigo: r = 0.43, p = .02.). CONCLUSION: Dizziness is common among patients with long-lasting neck pain. It is associated with higher disability due to neck symptoms and general health-related quality of life. The findings highlight the importance of evaluating and addressing dizziness in patients with neck disorders.

Self-Reported Measures Have a Stronger Association With Dizziness-Related Handicap Compared With Physical Tests in Persons With Persistent Dizziness.

Background: Associations between dizziness-related handicap and a variety of self-reported measures have been reported. However, research regarding associations between dizziness-related handicap and aspects of functioning that includes both physical tests and self-reported measures is scarce. Objective: The purpose of the study was to describe the variations in signs and symptoms in people with persistent dizziness using physical tests and self-reported outcomes across three severity levels of the Dizziness Handicap Inventory (DHI) and investigate their associations with the DHI. Method: Participants with persistent dizziness (n = 107) were included in this cross-sectional study. The participants underwent (1) physical tests (gait tests, grip strength, body flexibility, and movement-induced dizziness) and completed questionnaires regarding (2) psychological measures (Mobility Inventory of Agoraphobia, Body Sensation Questionnaire, Agoraphobic Cognitions Questionnaire, and Hospital Depression and Anxiety Questionnaire), and (3) fatigue, dizziness severity, and quality of life (Chalders Fatigue Scale, Vertigo Symptom Scale-Short Form, and EQ visual analog scale), in addition to the DHI. Data were presented by descriptive statistics for three DHI severity levels (mild, moderate, and severe). A multiple linear backward regression analysis was conducted for each group of measures in relation to the DHI total score, with additional analyses adjusting for age and sex. Based on these results, significant associations were tested in a final regression model. Results: With increasing severity levels of DHI, the participants demonstrated worse performance on most of the physical tests (preferred and fast gait velocity, dizziness intensity after head movements), presented with worse scores on the self-reported measures (avoidance behavior, fear of bodily sensation, fear of fear itself, psychological distress, fatigue, dizziness severity, quality of life). After adjusting for age and sex, significant associations were found between total DHI and avoidance behavior, psychological distress, dizziness severity, and quality of life, but not with any of the physical tests, explaining almost 56% of the variance of the DHI total score. Conclusion: There was a trend toward worse scores on physical tests and self-reported measurements with increasing DHI severity level. The DHI seems to be a valuable tool in relation to several self-reported outcomes; however, several signs and symptoms may not be detected by the DHI, and thus, a combination of outcomes should be utilized when examining patients with persistent dizziness.

Associations between pressure pain threshold in the neck and postural control in patients with dizziness or neck pain - a cross-sectional study.

BACKGROUND: It is theorized that neck pain may cause reduced postural control due to the known physiological connection between the receptors in the cervical spine and the vestibular system. The purpose of this study was to examine whether the pressure pain threshold in the neck is associated with postural sway in patients with dizziness or neck pain. METHODS: Consecutive patients with dizziness (n = 243) and neck pain (n = 129) were recruited from an otorhinolaryngological department and an outpatient spine clinic, respectively. All subjects underwent static posturography. Pressure pain thresholds were measured at four standardized points in the neck, and generalized pain was assessed using the American College of Rheumatology tender points. The relationship between postural sway and pressure pain threshold was analyzed by linear regression, and the covariates included age, sex, and generalized pain. RESULTS: In the dizzy group, there was a small, inverse relationship between pressure pain thresholds and sway area with eyes closed, after adjusting for age, sex, and generalized pain (bare platform; lower neck, p = 0.002, R2 = 0.068; upper neck, p = 0.038, R2 = 0.047; foam rubber mat; lower neck, p = 0.014, R2 = 0.085). The same inverse relationship was found between pressure pain thresholds in the neck and the Romberg ratio on a bare platform after adjusting for age, sex and generalized pain (upper neck, p = 0.15, R2 = 0.053; lower neck, p = 0.002, R2 = 0.069). Neither of these relationships were present in the neck pain group. CONCLUSION: Our findings indicate that the pressure pain threshold in the neck is associated with postural sway in patients suffering from dizziness after adjusting for age, sex, and generalized pain, but only with closed eyes. The association was small and should be interpreted with caution. TRIAL REGISTRATION: Trial registration: Clinicaltrial.gov NCT03531619. Retrospectively registered 22 May 2018.

Hearing loss in divers: a 6-year prospective study.

Occupational diving is associated with hearing loss, but the cause is disputed. Our aim was to follow a cohort of divers through the first 6 years of their career in order to look for evidence of permanent threshold shift associated with diving activity, occupational noise exposure or acute injuries. Hearing was measured by pure tone audiometry in 67 participants at a basic course for working divers. Hearing thresholds were adjusted for age (ISO 7029). The subjects were examined and interviewed by an otologist. Additional medical and exposure data were recorded in questionnaires and personal logbooks. The procedure was repeated after 3 and 6 years. None of the subjects suffered inner ear barotrauma or inner ear decompression sickness during follow-up. Middle ear barotrauma was common. The prevalence of subjective hearing difficulties increased during follow-up, and there was a significant threshold shift at 4 kHz (mean 2.6 dB, 95% confidence interval 0.9-4.3 dB). Both subjective and objective hearing loss was associated with occupational noise exposure, but not with diving frequency or with a history of middle ear barotrauma. In the absence of manifest inner ear barotrauma or inner ear decompression sickness, noise seems to be the most important cause of long-term hearing loss in occupational divers. This study did not find evidence of long-term hearing loss caused by uneventful diving per se.

Long-term symptoms in dizzy patients examined in a university clinic.

BACKGROUND: The long-term course of dizziness was investigated combining medical chart and survey data. The survey was undertaken median (interquartile range (IQR)) 4.6 (4.3) years after the initial medical examination. METHODS: Chart data comprised sex, age, diagnosis, symptom duration, postural sway and neck pain. Survey data comprised symptom severity assessed by the Vertigo Symptom Scale - Short Form (VSS-SF), and data regarding current state of dizziness, medication, neck pain and other chronic conditions. RESULTS: The sample consisted of 503 patients, the mean (standard deviation (SD)) age was 50.0 (11.6) years, women being slightly overrepresented (60%). Severe problems with dizziness (VSS-SF mean (SD) 13.9, (10.8)) were indicated in the total group and in 5 of 6 diagnostic sub-groups. Vertigo/balance- and autonomic/anxiety-related symptoms were present in all groups. Current dizziness was confirmed by 73% who had significantly more severe problems than the non-dizzy (VSS-SF mean (SD): 17.2 (10.1) versus 5.0 (7.3)). Symptoms were related to vertigo/balance more than to autonomic/anxiety (test of interaction p < 0.001).Based on simple logistic regression analysis, sex, symptom duration, neck pain, sway and diagnoses predicted dizziness. Symptom duration and neck pain remained predictors in the adjusted analysis. Age, symptom duration, neck pain, sway and diagnoses predicted vertigo/balance-related dizziness in both regression analyses. Sex, neck pain and sway predicted development of autonomic/anxiety-related dizziness according to simple regression analysis, while only neck pain remained a significant predictor in the adjusted analysis. With respect to diagnosis, simple regression analysis showed significant reduced likelihood for development of dizziness in all vestibular sub-groups when compared to the non-otogenic dizziness group. With respect to vertigo/balance- and autonomic/anxiety-related symptoms, the implication of diagnostic belonging varied. No effect of diagnoses was seen in adjusted analyses. CONCLUSION: The majority of patients had persistent and severe problems with dizziness. The wait-and-see attitude before referral to specialist institutions may be questioned. Early, active movements seem necessary, and attention should be paid to the presence of neck pain. Diagnoses had limited prognostic value. Questionnaire-based evaluations could assist in classification and identification of type of dizziness and thereby provide a better basis for specific rehabilitation.

Psychometric properties of the Vertigo symptom scale - Short form.

BACKGROUND: The aim of the study was to examine the psychometric properties of the Vertigo symptom scale - short form (VSS-SF), a condition-specific measure of dizziness, following translation of the scale into Norwegian. METHODS: A cross-sectional survey design was used to examine the factor structure, internal consistency and discriminative ability (sample I, n = 503). A cross-sectional pre-intervention design was used to examine the construct validity (sample II, n = 36) of the measure and a test-retest design was used to examine reliability (sub-sample of sample II, n = 28). RESULTS: The scree plot indicated a two factor structure accounting respectively for 41% and 12% of the variance prior to rotation. The factors were related to vertigo-balance (VSS-V) and autonomic-anxiety (VSS-A). Twelve of the items loaded clearly on either of the two dimensions, while three items cross-loaded. Internal consistency of the VSS-SF was high (alpha = 0.90). Construct validity was indicated by correlation between path length registered by platform posturography and the VSS-V (r = 0.52), but not with the VSS-A. The ability to discriminate between dizzy and not dizzy patients was excellent for the VSS-SF and sub-dimension VSS-V (area under the curve 0.87 and 0.91, respectively), and acceptable for the sub-dimension VSS-A (area under the curve 0.77). High test-retest reliability was demonstrated (ICC VSS-SF: 0.88, VSS-V: 0.90, VSS-A: 0.90) and no systematic change was observed in the scores from test to retest after 2 days. CONCLUSION: Using a Norwegian translated version of the VSS-SF, this is the first study to provide evidence of the construct validity of this instrument demonstrating a stable two factor structure of the scale, and the identified sub-dimensions of dizziness were related to vertigo-balance and autonomic-anxiety, respectively. Evidence regarding a physical construct underlying the vertigo-balance sub-scale was provided. Satisfactory internal consistency was indicated, and the discriminative ability of the instruments was demonstrated. The instrument showed satisfactory test-retest reliability.