Dizziness, Falls, and Hearing Loss in Adults Living With Sickle Cell Disease.

OBJECTIVE: The aim of this study was to assess the prevalence of reported dizziness/imbalance, frequency of falls, and hearing loss in adults with sickle cell disease (SCD) and determine the relationship of these self-reported problems both during and in the absence of an SCD crisis. Also, the impact of educational level and health insurance on seeking treatment services, as well as the relationship of falls to stroke, legal blindness, and other orthopedic problems, was assessed. Interrupted blood flow to shared vestibular and auditory arteries supports the notion of increased likelihood of balance deficits and increased falls in this population. DESIGN: A cross-sectional survey study design was used. Adults living with SCD responded to a questionnaire that was distributed online and through traditional mail. STUDY SAMPLE: Adults living with SCD (N = 135) participated in the study. RESULTS: Responses revealed 70% of participants with SCD experienced dizziness/imbalance and 23% reported hearing loss. Furthermore, 33% of participants reported falling one or more times in the last year. The prevalence of dizziness/imbalance, falling, and hearing loss in the respondents with SCD was much higher than that of the general population of the United States. Additionally, for dizziness and falling, the prevalence was higher not only than the national average but also for persons over 65 years of age. A significant association was demonstrated between dizziness/imbalance and hearing loss as well as dizziness/imbalance and falls for adults living with SCD. In fact, participants with self-reported hearing loss were 5.2 times more likely to also report dizziness/imbalance. They were 4.9 times more likely to fall if they also reported dizziness/imbalance. Numbness of the feet was revealed to significantly impact the likelihood of falling in this disease population and should be further studied. Regarding SCD crisis status, dizziness/imbalance and falls were more likely to occur outside of SCD crisis than during a crisis. Furthermore, pain levels were significantly associated with dizziness/imbalance only when respondents were in crisis and not in the absence of a crisis. In crisis, higher pain levels were reported from respondents who also reported dizziness/imbalance than from those who did not report dizziness. No significant relationship was revealed between hearing loss and falls. DISCUSSION: These results provide justification for patient and health care provider education regarding appropriate referrals for vestibular/balance assessments and provision of fall prevention strategies. Future studies on balance and SCD are encouraged.

Static Positional Nystagmus in the Healthy Vestibular System.

BACKGROUND: A repeat of the seminal 1973 study on static positional nystagmus (PN) using more accurate recording techniques. PURPOSE: The purpose was to further characterize PN and, using current data, introduce new clinical criteria for its identification. RESEARCH DESIGN: Static PN was recorded in ten positions with vision denied. Each position was analyzed using age, gender, presence, direction, and persistence of nystagmus while taking into account the number of beats and mean slow-phase velocity (SPV). STUDY SAMPLE: One hundred healthy patients who were asymptomatic with no known neurological disorders were tested. INTERVENTION: No intervention was used. DATA COLLECTION: Analysis of variance, descriptive statistics, and confidence intervals were used to describe results. RESULTS: Results showed 74% of normal participants had horizontal nystagmus in at least one position. Only 7% of the observed nystagmus was persistent. The average SPV was 2°/sec. The mean number of positions in which nystagmus was observed was three. Neither age nor gender influenced the occurrence of nystagmus. Forty-three percent of the participants had vertical nystagmus in at least one position; however, the SPV was 2°/sec or less. CONCLUSIONS: The present study demonstrated that intermittent or persistent PN in four or fewer positions should not be considered pathological when the SPV is 4°/sec or less (n = 100). Observance of vertical nystagmus in one position should not be considered pathological if the SPV is 2°/sec or less. Suggested positions for positional testing should include seated-upright, supine, head right, head left, head-hanging, and the precaloric (30° supine) positions. Fixation when PN is observed is indicated.

Vestibular Assessment and Rehabilitation: Ten-Year Survey Trends of Audiologists' Opinions and Practice.

BACKGROUND: The past decade has yielded changes in the education and training of audiologists and technological advancements that have become widely available for clinical balance function testing. It is unclear if recent advancements in vestibular instrumentation or the transition to an AuD degree have affected audiologists' vestibular clinical practice or opinions. PURPOSE: The purpose of this study was to examine predominant opinions and practices for vestibular assessment (VA) and vestibular rehabilitation (VR) over the past decade and between master's- and AuD-level audiologists. METHOD: A 31-question survey was administered to audiologists via U.S. mail in 2003 (N = 7,500) and electronically in 2014 (N = 9,984) with a response rate of 12% and 10%, respectively. RESULTS: There was an increase in the number of audiologists providing vestibular services in the past decade. Most respondents agreed that audiologists were the most qualified professionals to conduct VA. Less than half of the surveyed audiologists felt that graduate training was adequate for VA. AuD-level audiologists were more satisfied with graduate training and felt more comfortable performing VA compared to master's-level audiologists. Few respondents agreed that audiologists were the most qualified professionals to conduct VR or that graduate training prepared them to conduct VR. The basic vestibular test battery was unchanged across surveys and included: calorics, smooth pursuit, saccades, search for spontaneous, positional, gaze and optokinetic nystagmus, Dix-Hallpike, case history, and hearing evaluation. There was a trend toward greater use of air (versus water) calorics, videonystagmography (versus electronystagmography), and additional tests of vestibular and balance function. CONCLUSIONS: VA is a growing specialty area in the field of audiology. Better training opportunities are needed to increase audiologists' knowledge and skills for providing vestibular services. The basic tests performed during VA have remained relatively unchanged over the past 10 yr.

Performance of musicians and nonmusicians on dichotic chords, dichotic CVs, and dichotic digits.

Perception of dichotic chords (free recall and directed recall), nonsense syllables (CVs), and three-pair digits was assessed on 24 musicians and 24 nonmusicians. On the dichotic-CV and dichotic-digit free-recall tasks, there was a significant right-ear advantage, but there were no group differences. With the dichotic-chords, free-recall condition, a significant left-ear advantage was observed but no group difference. For the dichotic-chords, directed-recall conditions, the musicians performed significantly better by 10 percent than the nonmusicians. Unexpectedly, for the dichotic chords, the 62-72 percent correct performances were better on the free-recall condition than the 42-55 percent performances on the directed-recall conditions. These differences between the two response modes were attributed to the difficulty of the dichotic-chord listening tasks and the probabilities associated with the closed-set response paradigms. The findings suggest that the dichotic-chord paradigm used in this study should not be included in clinical protocols used to assess auditory perceptual abilities.