dizziness

Cervicogenic dizziness is non-specific sensation of disequilibrium in space. Abnormal proprioceptive input from cervical spine and neck muscles may induce Cervicogenic dizziness. Trigger point activation of suboccipital muscles may be related to Cervicogenic dizziness.

Present case report describe a 38-year-old patient was refereed to physiotherapy to restore motion of right shoulder after surgery of humerus fracture. Patient reported dizziness after shoulder surgery. Patient had no medical problems induced dizziness. Physical examination revealed trigger point activation of suboccipital muscles. Myofascial release and chin tuck exercise were done and patient reported improvement for dizziness. Trigger point activation of suboccipital muscles in this patient may be related to abnormal head posture during shoulder surgery and/or impaired scapulohumeral rhythm and overactivity of cervical muscles to participate in shoulder elevation.

It is suggested to consider possibility of existence of Cervicogenic dizziness in patients seeking physiotherapy after shoulder surgery.

Vestibular vertigo and decreased sleep quality are prevalent issues that significantly affect the life expectancy, quality of life, and mental health of the elderly. Evidence from human and animal studies suggests a link between sleep disorders and vertigo. However, this association has not been sufficiently explored in the elderly population. The present study investigates the associations between vertigo-induced handicap and sleep quality in older people. This cross-sectional study included individuals aged 60–70 with vestibular vertigo. The participants completed two questionnaires—the Dizziness Handicap Inventory (DHI) and the Pittsburgh Sleep Quality Index (PSQI)—in the presence of one of the authors. In this study, 96% of participants exhibited some degree of poor sleep quality. Correlation analysis revealed positive relationships between PSQI subcategory scores and specific domains of the DHI. Subjective sleep quality was significantly associated with DHI-Total (DHI-T), DHI-Emotional (DHI-E), and DHI-Functional (DHI-F) scores. Sleep disturbance showed significant links with the DHI-E and DHI-F domains. The use of sleeping medication was significantly correlated with DHI-T, DHI-E, and DHI-F scores, while daytime dysfunction was associated with DHI-T and DHI-F scores (P<0.05). However, the PSQI-Total (PSQI-T) score did not show significant correlations with DHI-T, DHI-P (Physical), DHI-E, or DHI-F scores (P>0.05). This study demonstrated that, in elderly individuals with vestibular vertigo, there is a correlation between the degree of vertigo-induced handicap and various dimensions of sleep quality. Specifically, as the handicap worsens, sleep quality deteriorates. These findings underscore the importance of assessing sleep quality when evaluating elderly patients with vestibular vertigo.

Experiencing dizziness/vertigo is often an indication of dysfunction in the vestibular system. Recent findings show a connection between peripheral vestibular dysfunction and cognitive impairments. The Neuropsychological Vertigo Inventory (NVI) can assess physical, emotional, and cognitive issues in individuals with dizziness/vertigo. The aim of this research was to translate, cultural adaptation and evaluation of the reliability and validity of NVI to Persian.

In this descriptive-analytical study, the NVI scale was translated and adapted to the Iranian cultural context following the international quality of life assessment protocol for translation and equivalence. After obtaining face validity, the scale was administered to 140 patients with peripheral vestibular system dysfunction and 70 control group (age between 25 and 80 years). After one week, 50 participants were asked to complete the questionnaire again. Eventually, reliability was evaluated with both methods of internal consistency and test-retest reproducibility.

Out of the 28 items in the NVI scale, 3 items were modified to better align with the cultural conditions of Iranians. The impact scores for most items in this scale were found to be higher than 1.5. The Cronbach’s alpha coefficient values for the overall scale (0.90) and test-retest reliability with intra-class correlation coefficient for the overall scale (0.91) were confirmed.

The Persian version of NVI scale demonstrates excellent validity and reliability, and it exhibits a high level of content alignment with the original version. Therefore, it can be a useful tool to better understand the physical, emotional and cognitive disturbances in patients with vertigo/dizziness.

Dizziness and nausea are among the symptoms of multiple sclerosis (MS). The present manuscript reports a case suspected of MS who experienced severe dizziness and nausea while recording pattern reversal checkerboard (PRC) visual evoked potential (VEP), whereas she felt comfortable during the flash type of VEP (FVEP). Therefore, we suggest recording FVEP in patients with any problem produced due to PRC VEP.

Dizziness may be associated with negative health outcomes. This study aimed to determine the associations between dizziness and mental and physical health outcomes in middle-aged and older community-dwelling adults in India.

Cross-sectional data from 72,262 individuals (≥ 45 years) of the Longitudinal Ageing Study in India (LASI) Wave 1 in 2017-2018 were analyzed. Dizziness was assessed with the question of having persistent or troublesome dizziness or light headedness in the past two years.

More than one in seven participants (13.7%) reported past 2-years dizziness. In adjusted logistic, linear and Poisson regression analyses, dizziness was associated with worse self-rated health status, lower life satisfaction, major depressive disorder, insomnia symptoms and severe fatigue. Regarding physical health, dizziness increased the odds of pain conditions, cardiovascular conditions, chronic lung disease, functional limitations, fall history, hearing loss, impaired vision and higher number of medications currently used. In addition, in the unadjusted analysis, dizziness was negatively associated with cognitive functioning.

Dizziness was associated with six poor mental health and eight poor physical health outcomes. Findings support multidimensional management of dizziness in the general population.

The purpose of this study was to investigate regional cerebral blood flow (rCBF) reduction in patients with dizziness and perfusion-related clinical impairment using brain perfusion single photon emission tomography (SPECT). Thirty-four patients with subjective dizziness and 13 age- and sex-matched healthy controls were studied. Dizziness-related impairments were assessed using the Dizziness Handicap Inventory (DHI) and Short Physical Performance Battery (SPPB). Brain perfusion SPECT scan was acquired from all participants. The carotid intima-media thickness (CIMT) was also measured. Brain perfusion data were qualitatively interpreted in all cases. Voxel-wise analysis was also conducted in 11 patients compared to healthy controls. Thirty-four patients (mean age=53.8±13.4 years, m/f: 19/15) and 13 age- and sex-matched controls (mean age=51.5±13.1, m/f: 7/6) were included. The dizziness severity was mild in 58.8% (n=20), moderate in 26.5% (n=9), and severe in 14.7% (n=5). Qualitative interpretation of SPECT images showed normal scans in 4 (11.2%) patients and abnormal scans in 30 (88.2%) patients. Patients with dizziness showed a significantly decreased brain perfusion in the precuneus, cuneus, occipital lobe (superior and inferior parts), frontal lobe (inferior and middle parts), temporal lobe, parietal lobe (inferior and superior parts), cerebellum, insula, and putamen nucleus. Based on both qualitative SPECT interpretation and voxel-wise analysis, perfusion defect had a significant association with the total SPPB score and the scores of two sub-domains (p<0.05), but not with the DHI (p>0.05) score . The perfusion- and atherosclerosis-related impairments of gait and balance were largely independent of subjective dizziness and dizziness severity. Moreover, this study provided support for contribution of perfusion impairment to the disturbance of gait and balance in older populations along with other pathologic processes.

To identify the type of referrals received by vestibular physiotherapists for vertigo and assess whether medical review for these patients would be appropriate.

We performed a retrospective review of referral forms, vestibular assessment forms, and vertigo clinic letters of patients referred for vertigo or vestibular physiotherapy input between July 1, 2013, to December 31, 2013.

We studied 29 patients with a median age of 63 years. A diagnosis was provided in 65.5% of the referrals. Of 14 patients with possible benign paroxysmal positional vertigo (BPPV), Dix-Hallpike had been performed only for 4 patients. Almost half were seen for the medical review in the Vertigo Clinic due to the concerns of possible alternative non-vestibular diagnosis, medication issues, or syncope. Alternative diagnoses identified medically included orthostatic hypotension, stroke, vestibular migraine, medication-induced bradycardia, and phobic postural vertigo. Medication changes in vertigo clinic included treatment for heart failure, migraine, and medication optimization.

Medical review is appropriate for some patients referred for vestibular physiotherapy. A medical opinion should be sought by vestibular physiotherapists if there is uncertainty or concerns that the referred patients did not have straightforward vestibular problems, or there were possible alternative diagnoses, concerns with medications, or syncope.

The present study was designed to investigate the psychometric properties of the Persian version of the Dizziness Handicap Inventory (P-DHI). In addition, this research was targeted toward assessing the association of P-DHI withMedical Outcome Study 36-Item Short Form Health Survey (SF-36) and Hospital Anxiety and Depression Scale (HADS). The current study also involved a comparison of the scores of patients and healthy participantsand implementation of a factor analysis.  

This cross-sectional study was conducted on 113 patients with dizziness and 30 healthy individuals referring to tertiary centers for otolaryngology and neurology, affiliated to Guilan University of Medical Sciences, Rasht, Iran. The mean age of the patients was 44.5±13.6 years. All patients re-completed the P-DHI after 2 weeks. Internal consistency and reproducibility of the inventory were evaluated using the Cronbach’s alpha coefficient, Bland-Altman limits of agreement, and intraclass correlation coefficients. In addition, the relationships of the P-DHI with SF-36 and HADS were evaluated using the Spearman correlation coefficient. An exploratory factor analysis was also run to determine the factor structure of the questionnaire.  

The Cronbach’s alpha coefficient of P-DHI scale was obtained as 0.86. In addition, the functional, physical, and emotional subscales of this instrument had the Cronbach’s alpha coefficients of 0.76, 0.52, and 0.80, respectively. The limits of agreement were 16 points for the total scale, and the range of intraclass correlation coefficients was 0.90-0.96. The P-DHI showed a fair correlation with vertigo severity which assesses functional disability subscale. This scale also demonstrated a moderate correlation with SF-36 and HADS. Factor analysis revealed a 2-factor solution which was different from the factor structure of the original DHI.  

As the findings indicated, the P-DHI had good psychometric properties; therefore, it could serve as a useful tool for measuring disability in patients with dizziness and unsteadiness.

Dizziness is one the most common complaints of patients in the emergency rooms. It has various etiologies and can lead to falling and other life-threatening injuries, especially in the elderly. Dizziness affects the quality of life and results in negative emotional reactions. This research studied the etiology of dizziness in a three-year study. This study was conducted on 650 patients with the complaint of dizziness, whose specialists suspected them of having possible vestibular involvement, referred to a tertiary audiology clinic from 2015 to 2018. Videonystagmography, electrocochleography and cervical vestibular evoked myogenic potentials were administered. Other medical tests including neu rologic examinations, blood analysis, and brain imaging were performed based on patients’ complaints. This was a descriptive study of dizziness prevalence with different etiologies. Patients’ age range was 18-85 years with mean (SD) age: 42.34 (13.12), including 377 (58%) females and 273 (42%) males. Patients’ chief complaints included vertigo in 64.8%, dizziness in 20.2% and imbalance in 15.1%. Vestibular disorders were identified in 49.2% of the referred patients. The patients’ final diagnosis in order of prevalence were as follows: systemic involvement (292 cases), benign paroxysmal positional vertigo (187 cases), unilateral vestibular weakness (63 cases), endolymphatic hydrops (51 cases), bilateral vestibular weakness (37 cases), central involvement (20 cases), cervical (10 cases) and migraine-associated vertigo (8 cases). About 49.2% of the patients referred to the ENT clinic had actual vestibular involvement. Careful history taking, teamwork, and comprehensive evaluations are necessary to differentiate underlying cause and selecting appropriate treatment

To improve our understanding of dizziness, its assessment, as well as its management to identify the appropriate treatment in order to reduce the costs and to increase the patients’ quality of life. A single blind parallel group randomized controlled trial was conducted on 164 participants with dizziness. One group received 25mg/ml promethazine and another received 5mg/ml diazepam. To assess the severity of dizziness, Visual Analog Scale was used prior to and two hours after treatment. Both promethazine and diazepam had significant effects on decreasing the severity of dizziness, i.e. the severity score decreased from 9.31 to 1.81 in promethazine versus 9.33 to 4.50 in diazepam (P<0.001). A single IV dose of promethazine is more effective in reducing vertigo as compared with diazepam.

Assessment of vestibular rehabilitation outcomes is a necessary step in this process. Assessment by clinical devices can reveal and measure some aspects of intervention but cannot show its effects on the patient quality of life. Vestibular rehabilitation benefit questionnaire is a scale for evaluating the effects of vestibular deficits on the quality of life and psychological aspects more efficiently than similar questionnaires. This research studied preparation and assessment of validity and reliability of Persian version of this questionnaire.
The translation process was based on International Quality Of Life Assessment protocol with considering cultural adaptation. Face validity and content validity, including content validity ratio and content validity index (CVI) were evaluated and test-retest reliability and Cronbach alpha was measured for reliability assessment of 108 vestibular deficit patients who received vestibular rehabilitation interventions. Furthermore, dizziness handicap inventory was used to evaluate correlation between vestibular rehabilitation benefit questionnaire and dizziness handicap inventory results.
Questions with imperfections were modified. CVI in Lawshe method was equal to 1 indicating the necessity of inserting some questions in the questionnaire. Intraclass correlation was 0.94 for the test-retest reliability and the Cronbach alpha was 0.68, i.e. Persian vestibular rehabilitation benefit questionnaire has good reliability. In addition, the Spearman correlation coefficient was 0.74, indicating a good correlation between two questionnaire scores.
Persian version of vestibular rehabilitation benefit questionnaire is as reliable and valid as its original version and can be used for patients with vestibular deficits under vestibular rehabilitation treatment.

Non-motor symptoms of Parkinson disease have significant effects on the quality of life in this group of patients. Among these symptoms, dizziness is associated with the changes in Orthostatic Hypotension (OH). About 30% of people over 65 years have dizziness; However, the exact mechanism of dizziness in these patients was not clear. Dizziness has symptoms such as fainting, light headache, vertigo and imbalance. The present study is based on the given fact that one of the reasons for dizziness in Parkinson patients is the disturbance of balance systems. In addition, the vestibular system is one of the main elements involved in normal balance. As, the role of vestibular system in Parkinson disease has been suggested in previous studies. The main aim of current study is to investigate the effects of vestibular exercises on the dizziness of Parkinson patients. Twenty-four patients participated in this study based on the inclusion criteria and were randomly assigned into intervention and control groups. Dizziness Handicap Inventory-Persian (DHI-P) was used for dizziness measurement. In addition, Berg Balance Scale (BBS), Functional Reach (FR) and 2 Minutes Walking Test (2MWT) were used for measuring the postural control before and after interventions. The intervention group performed the vestibular exercises and the control group performed the conventional exercises (3 days a week for 60 minutes and a total of 24 sessions). The total score of DHI-P showed a significant improvement in the intervention group compared to the control group (P<0.001). Also, the BBS tests (P<0.001), FR (P<0.001), 2MWT (P=0.001) showed a significant improvement in the intervention group. Based on the results of this study, it could be suggested that vestibular exercises, as none sophisticated, feasible, and low cost rehabilitation–protocol has beneficial effects for patients with Parkinson disease. This protocol does not need any particular equipment and can be used in all environments while it can reduce dizziness and improve motor skills and postural control in this group of patients.
References

The aim of this case report was to investigate the relationship between sleep disorders and audio vestibular symptoms.
Case Report: A case of undiagnosed sleep disorder, presenting as a temporary auditory processing difficulty, is presented. The disorder was initially treated as sudden deafness with dizziness. A 23-year-old male patient complained of acute hearing disturbance despite normal results on pure tone audiometry. The patient was initially administered a steroid injection in the hospital. After treatment, his hearing symptoms improved only slightly and he reported balance difficulty with rightward spontaneous nystagmus. Vestibular rehabilitation was performed. We also suspected that his hearing symptom was due to an auditory processing difficulty. Despite steroid treatment and vestibular rehabilitation, neither of his symptoms improved. We subsequently identified the presence of insomnia. He was prescribed zolpidem 5 mg, which slightly improved his symptoms, and referred to a sleep specialist for further examination. Polysomnography was performed, which identified restless leg syndrome and sleep disturbance with delayed sleep phase syndrome. After pharmacological treatment, his sleep disturbance, hearing difficulty, and balance disorder completely resolved.
Sleep disorders may provoke reversible auditory processing difficulties. We should carefully evaluate patients for a potentially undiagnosed sleep disorder, even in patients chiefly complaining of intractable sensory dysfunction such as hearing or balance disturbance.

Chronic vestibular dysfunction is a frustrating problem in the elderly and can have a tremendous impact on their life, but only a few studies are available. Vestibular rehabilitation therapy (VRT) is an important therapeutic option for the neuro-otologist in treating patients with significant balance deficits. The purpose of this study was to assess the effect of vestibular rehabilitation on dizziness in elderly patients with chronic vestibular dysfunction.. A total of 33 patients older than 60 years with chronic vestibular dysfunction were studied. Clinical and objective vestibular tests including videonystagmography (VNG) and dizziness handicap inventory (DHI) were carried out at their first visit, 2 weeks, and 8 weeks post-VRT. The VRT exercises were performed according to Cawthorne and Cooksey protocols.. Oculomotor assessments were within normal limits in all patients. Nineteen patients (57.57%) showed abnormal canal paralysis on caloric testing which at follow-up sessions; CP values were decreased remarkably after VRT exercises. We found a significant improvement between pre-VRT and post-VRT total DHI scores (P < 0.001). This improvement was most prominent in functional subscore. Our study demonstrated that VRT is an effective therapeutic method for elderly patients with chronic vestibular dysfunction.