An Uncommon Culprit: Dural Arteriovenous Fistula Presenting as Otodynia and Dizziness.

Dural arteriovenous fistulas (DAVFs) are rare vascular abnormalities that can present with diverse neurological symptoms. We report a case of a woman in her early 60s who presented with pain in the left ear and dizziness. Neurological evaluation and imaging studies revealed a DAVF in the left cerebellopontine angle. This case underscores the importance of considering DAVF as a potential etiology in patients presenting with atypical otological symptoms.

Migrainous vertigo impairs adaptive learning as a function of uncertainty.

Objective: In this study, we examined whether vestibular migraine, as a source of increased perceptual uncertainty due to the associated dizziness, interferes with adaptive learning. Methods: The IOWA gambling task (IGT) was used to assess adaptive learning in both healthy controls and patients with migraine-related dizziness. Participants were presented with four decks of cards (A, B, C, and D) and requested to select a card over 100 trials. Participants received a monetary reward or a penalty with equal probability when they selected a card. Card decks A and B (high-risk decks) involved high rewards (win £100) and high penalties (lose £250), whereas C and D (low-risk decks; favorable reward-to-punishment ratio) involved lower rewards (win £50) and penalties (lose £50). Task success required participants to decide (i.e., adaptively learn) through the feedback they received that C and D were the advantageous decks. Results: The study revealed that patients with vestibular migraine selected more high-risk cards than the control group. Chronic vestibular migraine patients showed delayed improvement in task performance than those with acute presentation. Only in acute vestibular migraine patients, we observed that impaired learning positively correlated with measures of dizzy symptoms. Conclusion: The findings of this study have clinical implications for how vestibular migraine can affect behavioural adaption in patients, either directly through altered perception or indirectly by impacting cognitive processes that can result in maladaptive behavior.

Brazilian Version of the Vestibular Activities and Participation Measure: Cross-Cultural Adaptation, Validity, and Reliability.

BACKGROUND: Vestibular Activities and Participation Measure (VAP) subscales assess the effect of vestibular disorders on activity and participation. This study aimed to perform the cross-cultural adaptation and assess the validity, internal consistency, reliability, and measurement error of the Brazilian version of VAP subscales. METHODS: The cross-cultural adaptation followed the translation, synthesis, back-translation, review by a committee of experts, and pretesting phases. Structural validity was assessed using exploratory factor analysis (EFA) and confirmatory factor analysis (CFA), while Spearman's correlation between VAP subscales and the Dizziness Handicap Inventory (DHI) was used to assess construct validity. Cronbach's alpha measured internal consistency. Intraclass correlation coefficient (ICC) assessed intra- and inter-rater reliability, and measurement error was calculated by using the standard error of measurement (SEM) and minimal detectable change (MDC). RESULTS: Additional information was included in the Brazilian version of the Vestibular Activities and Participation measure (VAP-BR) after approval by one of the developers of the instrument to improve the understanding among individuals. One factor was found in the EFA for each subscale with 50% explained variance. Regarding CFA, the subscales 1 (S1) and 2 (S2) presented, respectively, adequate model fit indices (ie, comparative fit index of 0.99 and 0.97, and standardized root mean square residual of 0.04 for both subscales), but a very low factor load in item 6 of S1 (0.08). Chronbach's alpha was 0.80 (S1) and 0.82 (S2). For intra-rater assessment, the S1 and S2 presented an ICC of 0.87 and 0.90, SEM of 0.01 and 1.16, and MDC of 0.39 and 0.46, respectively. When assessed by 2 different raters, SEM values were 1.03 and 1.53, and MDC values were 2.85 and 4.23 for S1 and S2, respectively; both subscales showed an ICC of 0.92. Correlations between DHI and VAP subscales presented coefficients above 0.57. CONCLUSION: The Brazilian version of VAP subscales presents good measurement properties and may assist health professionals in identifying activity limitations and participation restrictions in individuals with vestibular disorders.

Feasibility of gamified visual desensitisation for visually-induced dizziness.

Visually-induced dizziness (visual vertigo) is a core symptom of Persistent Perceptual Postural Dizziness (PPPD) and occurs in other conditions and general populations. It is difficult to treat and lacks new treatments and research. We incorporated the existing rehabilitation approach of visual desensitisation into an online game environment to enhance control over visual motion and complexity. We report a mixed-methods feasibility trial assessing: Usage and adherence; rehabilitation potential; system usability and enjoyment; relationship with daily dizziness. Participants played online with (intervention, N = 37) or without (control, N = 39) the visual desensitisation component for up to 5-10 min, twice daily for 6 weeks. Dropout was 45%. In the intervention group, N = 17 played for the recommended time while N = 20 played less. Decreases in visual vertigo symptoms, anxiety and depression correlated with playtime for the intervention but not control. System usability was high. Daily symptoms predicted playtime. Qualitative responses broadly supported the gamified approach. The data suggest gamified visual desensitisation is accessible, acceptable and, if adherence challenges can be overcome, could become a useful addition to rehabilitation schedules for visually-induced dizziness and associated anxiety. Further trials are needed.

Impact of Epley's Manoeuvre on Quality of Life in Patients with Posterior Semicircular Canal Benign Paroxysmal Positional Vertigo: A Pre- and Post-Treatment Analysis.

Benign paroxysmal positional vertigo (BPPV) is a common vestibular disorder, predominantly affecting the posterior semicircular canal (PSC), and significantly impacts the quality of life (QoL) of patients. This study assesses the effectiveness of Epley's manoeuvre in improving QoL in patients with PSC-BPPV. This prospective analytical study, conducted at a tertiary care centre from January 2021 to December 2022, included 93 adult patients diagnosed with PSC-BPPV via the Dix-Hallpike test. Participants were evaluated using the dizziness handicap inventory (DHI) and visual vertigo analogue score (VAS) at baseline and on days 3, 10, and 30 post-treatments with Epley's manoeuvre. Data analysis focused on changes in DHI and VAS scores to assess the impact of treatment. The cohort comprised 58.1% males and 41.9% females, with a significant majority over 50 years of age. Notably, 90% of patients reported improvement by the first follow-up. Both DHI and VAS scores showed a statistically significant decrease over the follow-up period (p < 0.05), indicating a reduction in perceived dizziness and visual vertigo symptoms post-treatment. Epley's manoeuvre effectively improves the QoL in patients with PSC-BPPV, as evidenced by significant reductions in DHI and VAS scores. This study contributes to the evidence supporting Epley's manoeuvre as a key intervention in PSC-BPPV treatment, emphasizing its role in enhancing patient outcomes in clinical practice.

Diagnosis of Benign Paroxysmal Positional Vertigo Using a Questionnaire in a Hospital Based Rural Setting in India.

To develop and validate a simple questionnaire for the diagnosis of Benign Paroxysmal Positional Vertigo (BPPV) and also to accurately predict the involved side in BPPV. Patients (N = 148) who presented with dizziness to the ENT department were asked to fill out a questionnaire which was formulated to diagnose BPPV and the affected side. Five questions were part of the questionnaire. The fifth question was set to ascertain the affected side in BPPV. All the patients underwent a detailed neuro-otological examination and the findings were noted. The findings of the examination were correlated with the questionnaire findings. The mean age of the patient group was 54.72 years of age. The sensitivity of the questionnaire in detecting BPPV was 94.5%, though in 12.79% (n = 11) the side was not predicted correctly. The specificity of the questionnaire was 91.22%. The positive predictive value of the questionnaire in detecting BPPV was assessed at 94.5%.The questionnaire can be effectively used in predicting BPPV amongst patients presenting with dizziness and thus helps in avoiding unnecessary imaging and referrals to higher centres in view of suspicion of central causes of dizziness.

A Study of Quality of Life Improvement in Videonystagmography Guided Epley's Manoeuvre in Posterior Canal Benign Paroxysmal Positional Vertigo.

To assess Quality of life improvement in Videonystagmography guided Epley's Manoeuvre in posterior canal benign paroxysmal positional vertigo. The design of present study is cross-sectional analytical study. The study is conducted in the Department of Otorhinolaryngology, Sri Aurobindo Medical College and Post Graduate Institute, Indore in association with Sri Aurobindo Institute of speech and hearing, Indore. Current study done to assess the effectiveness of canalolith repositioning procedures (Epley's maneuver) with and without drug therapy in posterior canal benign paroxsymal positional vertigo and to assess the patients based on Dizziness Handicap Inventory. All Patients who come to ENT OPD at Sri Aurobindo Medical College and Post Graduate Institute, Indore in the specified duration and according to the inclusion criteria were chosen in the study. Majority of the patients were in the age group of 18-58 years with the median age of 32 and subjective symptomatic relief on Epley's manoeuvre and DHI on day 15, 46 out of 60 subjects reported symptomatic relief with a percentage of 76.6%. This group of 46 subjects with symptomatic relief was labeled as resolved group. The age range in resolved group was between 18 and 58 years. Remaining 14 subjects, labelled as relapsed group were prescribed beta-histine and repeat Epley's maneuver was performed to assess the effectiveness of adjunct therapy. We conclude that a single Videonystagmography guided Epley's maneuver is an excellent tool for effective rehabilitation of majority of posterior canal BPPV alone and combined with adjunct betahistine therapy can even cure refractory cases providing them with better quality of life.

Corrigendum: Residual dizziness after BPPV management: exploring pathophysiology and treatment beyond canalith repositioning maneuvers.

[This corrects the article DOI: 10.3389/fneur.2024.1382196.].

The First 100 Children Treated in a Newly Established Pediatric Vertigo Center.

BACKGROUND: Correctly diagnosing dizziness in children is essential for appropriate management; nevertheless, healthcare professionals face challenges due to children's limited ability to describe their symptoms and their cooperation during physical examination. The objective of this study is to describe the first 100 patients seen at a newly established pediatric vertigo center. METHODS: This is a retrospective review of a consecutive series of 100 patients seen at our pediatric vertigo clinic in a tertiary referral center from August 2019 until June 2022. Comprehensive clinical data were collected. The diagnoses were established by 2 pediatric otolaryngologists based on validated diagnostic criteria. Trends in diagnosis, investigation, and treatment of these patients were analyzed. RESULTS: A total of 100 children were included in the study. Vestibular migraine was the most common diagnosis (20%) followed by benign paroxysmal vertigo of childhood (14%). Eleven patients had combined pathologies. Fifteen out of 70 children (21%) had abnormal audiograms, 30 out of 48 children (62.5%) had abnormal vestibular testing, and 6 out of 31 (19%) patients had abnormal imaging. Fifty-one children received medical treatment, 23 received vestibular physiotherapy, and 9 patients had particle repositioning maneuvers; moreover, 17 of these patients received multimodal treatment. CONCLUSIONS: Our analysis suggests that imaging and audiology testing have relatively low yield in the assessment of pediatric vertigo. On the other hand, vestibular testing detected a high proportion of abnormalities, such as saccadic pursuit, vertical nystagmus, central positional nystagmus, and abnormal directional preponderance, particularly associated with vestibular migraine. Given the complexity of diagnosing vertigo in children, it is critical to establish multidisciplinary specialized centers capable of providing accurate diagnosis and treatment for these children.

Labor market effects of rehabilitation for patients diagnosed with dizziness - a Danish nationwide register-based cohort study.

PURPOSE: Both vestibular neuronitis (VN) and Meniere's disease (MD) have great impact on quality of life and are associated with a significant number of sick leave days absent from work. The aim was to assess labor market participation rate one year after hospital diagnosis of VN and MD and the use of rehabilitation measures. STUDY DESIGN: Nationwide register-based cohort study including patients with VN (n = 1,341) and MD (n = 843) and control persons matched in 1:5 with a VN cohort control (n = 6,683) and MD cohort control (n = 4,209). RESULTS: Compared to control persons, VN patients were more likely to be single, have higher income, and a higher Charlson comorbidity index score. MD patients had a higher level of education and a higher Charlson index compared to control persons. One year after patients were diagnosed with VN, no significant difference in labor market participation was observed (p = 0.88). However, MD patients had a 10.4% reduced probability of possessing a full-time job one year after diagnosis compared to matched control persons (58.1 ± 0.5% vs. 68.5 ± 0.5%, p < 0.001). Both VN and MD patients consulted otorhinolaryngologists, general practitioners, and physiotherapists more than control persons both before and after the initial diagnosis (p < 0.01). In addition, MD patients also consulted psychologists more frequently before and after diagnosis of the disease (p < 0.01). CONCLUSION: Intrahospital diagnosed MD increases the risk of leaving the labor market in opposition to VN. Both MD and VN are associated with significant expenses to the Danish health care system from the use of public rehabilitation measures and medical consultations.

French adaptation and validation of the Niigata PPPD Questionnaire: measure of severity of Persistent Postural-Perceptual Dizziness and its association with psychiatric comorbidities and perceived handicap.

Persistent Postural-Perceptual Dizziness (PPPD) is a functional vestibular condition. Despite being the most common chronic neuro-otologic disorder, it remains undertreated. The Niigata PPPD Questionnaire (NPQ), developed by Yagi et al. in 2019 to assess the severity of PPPD, could be a useful tool to help in the screening and diagnosis of this condition. This study aimed to validate a French version of the NPQ and make it an available assessment tool. Moreover, we aimed to understand the characteristics of PPPD patients better. The NPQ was translated and adapted into French. 50 PPPD patients, 50 patients with vestibular disorders without PPPD, and 50 healthy controls were included. They answered the adapted NPQ and additional questionnaires assessing trait (STAI) and state anxiety (HADS-A), depression (HADS-D) and handicap related to dizziness (DHI). The NPQ's reliability was assessed by Cronbach's alpha. Intergroup comparisons and multiple linear regressions were conducted to examine the characteristics of PPPD patients compared to vestibular patients and healthy controls, to validate NPQ's reliability, and to explore the effect of clinical parameters and treatment with selective serotonin reuptake inhibitors. Receiver operating characteristic (ROC) curves were carried out to determine the diagnostic values of the NPQ total score and sub-scores. Relations between NPQ and reported handicap, depression and anxiety were evaluated by correlations between questionnaire scores. The internal consistency was high (>0.8) for all NPQ subscales and the total score. Intergroup comparisons showed a significantly higher NPQ total score and sub-scores in the PPPD group compared to the two others. The ROC curve analysis showed a significant, but poor, discrimination of NPQ (AUC = 0.664) and its subscales. DHI scores, depressive symptoms and trait anxiety were significantly higher in PPPD patients than in vestibular patients and healthy controls. State anxiety did not differ between patients with PPPD and vestibular patients without PPPD. Finally, there was a significant correlation between the NPQ and the DHI. Our study provides a better understanding of PPPD symptomatology and its assessment. It showed that the NPQ is a reliable tool that can assist in symptom assessment for a French-speaking population.

Clinical features of persistent postural-perceptual dizziness coexisting with Meniere's disease in comparison with Meniere's disease alone.

Background: Persistent postural-perceptual dizziness (PPPD) is a chronic vestibular syndrome often triggered by acute or episodic vestibular syndromes, such as Meniere's disease (MD). According to the diagnostic criteria, PPPD may coexist with other structural diseases, and the evidence of another active illness does not necessarily exclude PPPD diagnosis. However, persistent symptoms, even those meeting the PPPD criteria even long after Meniere's attack, are often overlooked as potential PPPD precipitated by MD. Some clinicians overlook PPPD in such patients, treating them solely for MD once diagnosed. Since a treatment strategy for PPPD is completely different from that for MD, this may result in the deprivation of adequate treatments. Objectives: To emphasize the importance of diagnosing PPPD coexisting with MD including not treating such patients solely for MD, and to compare the clinical features of PPPD and MD. Methods: Vestibular function tests, including canal paresis (CP)%, c- and o-vestibular myogenic potentials, vestibulo-ocular reflex-direction preponderance, and posturography and clinical symptom scales, including the Dizziness Handicap Inventory, Niigata PPPD Questionnaire, and Hospital Anxiety and Depression Scale, were compared between 105 PPPD patients with MD or other precipitants and 130 patients with MD alone. The clinical symptom scales were further compared between 23 patients with PPPD coexisting with MD and those with MD alone. Results: The CP% was significantly higher in patients with MD than in those with PPPD. However, the total and subscores of all three clinical symptom scales were higher in patients with PPPD than in those with MD. The total score on all clinical symptom scales was higher in patients with PPPD coexisting with MD than in those with MD alone. Conclusion: Persistent postural-perceptual dizziness development from a precipitating MD may be associated with more severe clinical symptoms. Thus, clinical symptom scales may be useful for detecting PPPD in patients with Meniere's disease.

Mal De Debarquement Syndrome: An Often Unrecognized and Unreported Condition.

Mal de debarquement syndrome (MdDS), also known as "the sickness of disembarkment," is characterized by a persistent bobbing, rocking, or swaying sensation reported by patients long after they have completed travel on a boat or other forms of extended transportation. A detailed patient history, focusing on specific inquiries about recent boat or ship travel, is crucial for a timely diagnosis. The syndrome is unique in that reintroducing similar movements, such as driving, swinging, or returning to the boat, alleviates symptoms temporarily. We describe the case history of a 28-year-old male who experienced a persistent illusion of ground movement for six months following a fishing expedition. The patient reported alleviated symptoms when re-exposed to movements such as driving or swinging. The patient had undergone extensive medical workups and imaging tests under multiple physicians before being diagnosed with MdDS. MdDS is a commonly misdiagnosed, underdiagnosed, unreported, and unrecognized condition. Diagnosing MdDS requires a detailed medical and travel history, accompanying an understanding that the symptoms improve upon re-exposure to the same or similar motion.

Ear Complaints in Fibromyalgia: A Narrative Review.

INTRODUCTION: Patients with fibromyalgia (FM) have innumerable complaints due to the central amplification of somatic stimuli. The aim of this paper was to review the ear complaints in patients with FM. METHODS: A review of articles published in PubMed/MEDLINE, Embase, Web of Science, and Scopus from 1966 to June 2023 was performed. RESULTS: Seventeen papers were included in the review. They showed that patients with FM have a higher hearing loss rate, mostly at high frequencies, and hyperacusis. The prevalence of vestibular symptoms (tinnitus, dizziness) and hyperacusis was higher than in the general population, reaching 87.0% of the sample. Subjective findings did not always correspond to objective results. In some studies, the degree of FM severity was associated with ear symptoms; in others, it was not. CONCLUSIONS: Ear complaints in patients with FM are linked to subjacent disease and may be related to stimuli central amplification.

Jordanian Arabic Version of the Dizziness Handicap Inventory.

Objective: This study aimed to establish and validate a Jordanian Arabic version of the Dizziness Handicap Inventory (DHI-JA) equivalent to the original DHI in English (DHI-E). Methods: The THI-E questionnaires were translated into formal Jordanian Arabic by two bilingual volunteer audiologists. The final version, curated by the author, was administered to 20 participants with normal balance and 64 patients experiencing dizziness at the Middle East Hearing and Balance Centre. Results: The results demonstrated excellent internal consistency and reliability of DHI-JA. A highly significant correlation was observed between the total scores and sub-scores of DHI-JA and DHI-E. Conclusion: This study concludes that the DHI-JA is a valid and reliable tool for assessing the severity of dizziness and balance disorders in the Jordanian Arabic-speaking population.

Wearable sensor and smartphone assisted vestibular physical therapy for multiple sclerosis: usability and outcomes.

Introduction: Vertigo, dizziness, gaze instability and disequilibrium are highly prevalent in people with MS (PwMS) and head movement induced dizziness is commonly reported. Vestibular physical therapy (VPT) is a specialised, non-invasive and effective therapy for these problems but usually involves travel for the person to a specialist center with both personal and carbon costs. The use of wearable sensors to track head movement and smartphone applications to deliver and track programs has potential to improve VPT in MS. Methods: This study investigated the usability and effects of a commercially available digital VPT system (wearable head sensor, smartphone app and clinician software) to deliver VPT to PwMS. A pre/post treatment design was employed and the primary outcome was the System Usability Scale (SUS). Other patient reported outcomes were the Service User Acceptability Questionnaire (SUTAQ), the Patient Enablement Instrument (PEI) and the Dizziness Handicap Inventory (DHI). Physical outcomes measurements included Mini-BESTest (MB), Modified Dynamic Gait Index (mDGI), Gait Speed (GS), Dynamic Visual Acuity (DVA) and head kinematics and symptoms during exercise. Results: Sixteen PwMS (14 female), mean age 44(±14) years were recruited to the study and twelve completed VPT. Mean adherence to exercise, measured digitally was 60% (±18.4). SUS scores were high at 81 (±14) and SUTAQ scores also demonstrated high levels of satisfaction and acceptability of the system. Statistically significant improvements in MB (mean change 2.25; p = 0.004), mDGI (median change 1.00; p = 0.008), DVA (median change -1.00; p = 0.004) were found. Head frequencies significantly improved with concurrent decreased intensity of dizziness during head movements (mean change across 4 gaze stabilization exercises was 23 beats per minute; p < 0.05). Non-significant improvements were seen in DHI (p = 0.07) and GS (p = 0.15). 64.5% of follow up visits were conducted remotely (video or phone), facilitated by the system. Discussion: This study had two main outcomes and benefits for PwMS. Firstly, we showed that the system used was both acceptable and could be used by PwMS. Secondly, we demonstrated an improvement in a range of dizziness, balance and gait metrics with remotely delivered care. This system has the potential to positively impact on MS physiotherapy service provision with the potential to deliver effective remote care.

Comparative effectiveness of non- pharmacological treatments in patients with persistent postural-perceptual dizziness: a systematic review and effect sizes analyses.

Introduction: The patho-psychological mechanisms of persistent postural-perceptual dizziness (PPPD) appear to be very complex, and a multimodal, multidisciplinary approach is suggested for treating patients with PPPD. The aim of this review was to provide a comprehensive overview of non-pharmacological treatments and their comparative effectiveness in patients with PPPD. Methods: Scopus, Web of Science, PsycINFO, Medline, Embase, CINAHL, Cochrane Library and ClinicalTrials.gov were searched in April 2022 with a search update in August 2023. Only randomized controlled trials (RCTs) were included. There was no restrictions regarding publication date. Two reviewers independently identified eligible trials, extracted data, double-checked all extracted information from the included articles and assessed the risk of bias using the Cochrane risk of bias tool. A qualitative synthesis was performed, considering methodological heterogeneity between trials. Finally, an effect size analysis was performed for each treatment comparison. The standardized mean differences (SMD) and their corresponding 95% confidence intervals (95%CI) were calculated for each trial using Review Manager 5.4. Results: Thirteen RCTs (618 patients with moderate or mild dizziness) out of 1,362 references describing seven different non-pharmacological comparisons were selected. Nine trials included patients with PPPD, and four trials included patients with functional dizziness. The trials used different interventions that were classified as: (1) psychotherapeutic interventions (cognitive behavioral therapy, patient education), (2) physiotherapeutic interventions/training (vestibular rehabilitation, optokinetic stimulation), (3) stimulation procedures (vagus nerve stimulation, transcranial direct current stimulation) and (4) device application (visual desensitization using personalized glasses). However, most of the trials investigated the effects of single interventions, rather than multimodal interdisciplinary treatment of patients with PPPD. The SMD for dizziness handicap and severity was between 0.04 and 0.52 in most trials. In one trial using visual desensitization, the SMD was 1.09 (strong effect on the severity of dizziness) and 1.05 (strong effect on dizziness handicap). Discussion: Several individual interventions have shown benefits in the treatment of patients with PPPD with small to moderate effects. However, the multimodal treatment or a combination of vestibular rehabilitation with visual desensitization, cognitive behavioral therapy including patient education, and medication support should be further investigated. Future trials should include a large sample size with severe dizziness, and provide a longer follow-up period. Clinical trial registration: PROSPERO CRD42022320344.

Association of Peripheral Vestibular Disorder with Diabetes: A Population-Based Study.

BACKGROUND: This study aimed to investigate the association of peripheral vestibular disorders with type 1 and type 2 diabetes using a population-based dataset. METHODS: The data for this study were obtained from Taiwan's Longitudinal Health Insurance Database 2010. The sample consisted of 150,916 patients who were newly diagnosed with peripheral vestibular disorders as cases and 452,748 propensity-score-matching controls without peripheral vestibular disorders. We utilized multivariate logistic regression models to quantitatively evaluate the association between peripheral vestibular disorders and diabetes while considering factors such as sex, age, geographic location, monthly income, urbanization level of the patient's residence, coronary heart disease, hypertension, and hyperlipidemia. RESULTS: The chi-squared test indicates that diabetes was more common in the peripheral vestibular disorder group compared to controls (20.6% vs. 15.1%, p < 0.001). Of all sampled patients, the adjusted odds ratio for diabetes was 1.597 (95% CI = 1.570~1.623) for those with peripheral vestibular disorders when compared to controls, while patients with Ménière's disease, benign paroxysmal positional vertigo, unilateral vestibulopathy, and other peripheral vestibular disorders had respective adjusted odds ratios of diabetes at 1.566 (95% CI = 1.498~1.638), 1.677 (95% CI = 1.603~1.755), 1.592 (95% CI = 1.504~1.685), and 1.588 (95% CI = l.555~1.621) in comparison to controls. CONCLUSIONS: Our research has revealed an association between diabetes and an increased susceptibility to peripheral vestibular disorders.

Cervical spine proprioception and vestibular/oculomotor function: An observational study comparing young adults with and without a concussion history.

OBJECTIVE: To investigate dizziness, vestibular/oculomotor symptoms, and cervical spine proprioception among adults with/without a concussion history. METHODS: Adults ages 18-40 years with/without a concussion history completed: dizziness handicap inventory (DHI), visio-vestibular exam (VVE), and head repositioning accuracy (HRA, assesses cervical spine proprioception). Linear regression models were used to assess relationships between (1) concussion/no concussion history group and VVE, HRA, and DHI, and (2) DHI with HRA and VVE for the concussion history group. RESULTS: We enrolled 42 participants with concussion history (age = 26.5 ± 4.5 years, 79% female, mean = 1.4± 0.8 years post-concussion) and 46 without (age = 27.0± 3.8 years, 74% female). Concussion history was associated with worse HRA (ß = 1.23, 95% confidence interval [CI]: 0.77, 1.68; p < 0.001), more positive VVE subtests (ß = 3.01, 95%CI: 2.32, 3.70; p < 0.001), and higher DHI scores (ß = 9.79, 95%CI: 6.27, 13.32; p < 0.001) after covariate adjustment. For the concussion history group, number of positive VVE subtests was significantly associated with DHI score (ß = 3.78, 95%CI: 2.30, 5.26; p < 0.001) after covariate adjustment, while HRA error was not (ß = 1.10, 95%CI: -2.32, 4.51; p = 0.52). CONCLUSIONS: Vestibular/oculomotor symptom provocation and cervical spine proprioception impairments may persist chronically (i.e., 3 years) after concussion. Assessing dizziness, vestibular/oculomotor and cervical spine function after concussion may inform patient-specific treatments to address ongoing dysfunction.

Consensus paper on the management of acute isolated vertigo in the emergency department.

Acute vertigo is defined as the perception of movement of oneself or the surroundings in the absence of actual motion and it is a frequent cause for emergency department admissions. The utilization of medical resources and the duration of hospital stay for this kind of symptom is high. Furthermore, the efficiency of brain imaging in the acute phase is low, considering the limited sensitivity of both CT and MRI for diagnosing diseases that are the causes of central type of vertigo. Relying on imaging tests can provide false reassurance in the event of negative results or prolong the in-hospital work-up improperly. On the other hand, clinical examinations, notably the assessment of nystagmus' features, have proven to be highly accurate and efficient when performed by experts. Literature data point out that emergency physicians often do not employ these skills or use them incorrectly. Several clinical algorithms have been introduced in recent years with the aim of enhancing the diagnostic accuracy of emergency physicians when evaluating this specific pathology. Both the 'HINTS and 'STANDING' algorithms have undergone external validation in emergency physician hands, showing good diagnostic accuracy. The objective of this consensus document is to provide scientific evidence supporting the clinical decisions made by physicians assessing adult patients with acute vertigo in the emergency department, particularly in cases without clear associated neurological signs. The document aims to offer a straightforward and multidisciplinary approach. At the same time, it tries to delineate benchmarks for the formulation of local diagnostic and therapeutic pathways, as well as provide a base for the development of training and research initiatives.