vertigo

The present study aimed to evaluate the impact of vitamin D supplementation as an adjuvant therapy on tinnitus and vertigo in individuals diagnosed with Meniere’s disease.

The study was conducted from November 2021 to October 2022 at Tehran University Hospital, Tehran, Iran. This clinical trial involved 60 individuals diagnosed with Meniere’s disease and vitamin D deficiency. Participants were randomly allocated to receive either vitamin D (50,000 IU weekly) or a placebo for eight weeks. The study assessed the frequency, intensity, and duration of vertigo attacks, as well as several measures of dizziness and tinnitus, both before and after the intervention.

No significant change was observed in the number of vertigo attacks (P = 0.85), the duration (P = 0.52), or the severity of vertigo (P = 0.33) in the vitamin D group compared to the placebo group at the end of the trial. Additionally, vitamin D supplementation did not significantly affect the results of various dizziness and tinnitus indices at the study’s conclusion (P > 0.05). As expected, serum levels of vitamin D were significantly higher in the intervention group compared to the placebo group at the trial's endpoint (P < 0.001).

Vitamin D supplementation did not significantly affect vertigo and tinnitus in patients with Meniere’s disease. Further clinical trials with larger sample sizes and longer durations are recommended to confirm these findings.

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.

Meniere's disease is characterized by recurrent episodes of vertigo, sensorineural hearing loss, tinnitus, and aural fullness, with endolymphatic hydrops being the most significant histopathological change associated with the condition. The etiology of Meniere's disease and the connection between its symptoms and endolymphatic hydrops remain unclear and controversial. Approximately 3% of patients with Meniere's disease are pediatric, leading to a scarcity of studies focused on this demographic. This report presents a rare case of Meniere's disease in a child. The patient was a 14-year-old girl who visited the Echo Hearing-Balance Clinic in Mashhad, reporting hearing loss and tinnitus. Evaluations revealed low-frequency hearing loss, and MRI results were completely normal. A comprehensive assessment, including medical history, audiological findings, electrophysiological tests, and vestibular evaluations, indicated a diagnosis of Meniere's disease.

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.

Questionnaires are useful tools for clinicians. This study aimed to translate the Dizziness Handicap Inventory for Patient Caregivers (DHI-PC) into Persian (DHI-PC-P) and assess its psychometric properties for children aged 5–12 years.

This is a descriptive-analytical psychometrics study. After obtaining permission from the developers of the DHI-PC, translation into Persian and cross-cultural adaptation were done according to the international guidelines for self-assessment tools recommended by the American Association of Orthopedic Surgeons. Participants were 21 parents (mean age: 38.05 years, SD=6.1 years, 18 female) and their children with dizziness (mean age 8.69 years, SD=2.41 years, 9 female) between the ages of 5–12 years old. Face validity, content validity, and test-retest reliability at an interval of 14–21 days were evaluated for the DHI-PC-P.

The face validity was confirmed qualitatively by the experts’ opinions and quantitatively by calculating the item impact score. Content validity was confirmed by calculating the content validity index and the content validity ratio (0.97 and 0.86, respectively). The internal consistency was good (Cronbach’s alpha=0.90). For the testretest reliability, the intraclass correlation coefficient was obtained 0.94, indicating an excellent reliability.

The DHI-PC-P can be used clinically as a valid and reliable tool for children with dizziness aged 5–12 years.

Idiopathic Sudden Sensorineural Hearing Loss as a subset of sensorineural hearing loss will be confirmed by a progressive hearing loss of at least 30 dB at three contiguous frequencies over 72 hours or less. A sudden or abrupt hearing loss correlates with the time course, and a vascular event is presumptive aetiology. There is an inverse association between Omega-3 consumption and hearing loss. This study aimed to evaluate the efficacy of Omega-3 adjunctive therapy in Idiopathic Sudden Sensorineural Hearing Loss by audiometric assessments.In this randomised, triple-blind, placebo-controlled trial, all participants aged 18-70 with a history of sudden deafness (within 12 hours and ≤ 30 days) were eligible for enrollment. They were included if audiology diagnostic tests confirmed the SSNHL. Ultimately, they were randomised to the Omega-3 group and the placebo group.Thirty-three patients were randomly allocated to the Omega-3 group and thirty-two to the placebo group. Vertigo (32.3% of all patients) and underlying conditions had significant relationships with complete response (C.R.)-final hearing level ≤of 25 dB in pure-tone average (P < 0.05). There was no significant difference between both groups before and after treatment. Although it was not statistically significant, patients in the Omega-3 group had faster recovery than placebo.Omega-3 adjunctive therapy did not have a therapeutic effect on SSNHL patients. Moreover, C.R. happened in half the patients. Vertigo and underlying conditions considerably worsen the recovery from SSNHL.

Dizziness is a common scenario in the Emergency Departments (EDs). Among dizziness un-derlying causes, the posterior circulation stroke is especially relevant due to its mobimortality and concerningmisdiagnosis rates. Therefore, we conducted this study to assess dizziness evaluation and baseline characteris-tics of patients with PS in the ED.

We conducted a 3-year retrospective observational study on PS casesconfirmed by magnetic resonance imaging (MRI). Concretely, we analysed the demographic profile of these pa-tients, the initial PS clinical presentation, and diagnostic workup (with emphasis on dizziness evaluation) per-formed at the ED.

During the study period, 85 cases were registered. Risk factors for cardiovasculardisease were present in 85.5% and previous visits to the ED due to dizziness were recorded in 16.5%. The mainclinical presentation was dizziness, concretely as an acute vestibular syndrome (38.8%) with additional neuro-logical signs or symptoms (80%). Evaluation by the otolaryngologist on call was requested in less than 10% ofthe cases and included the HINTS protocol use with a sensitivity of 100% for central nervous system underlyingcausality. A brain CT study was always performed with a sensitivity of 27%. However, 96.47% of patients wereprimarily admitted to the Neurology hospitalization ward and MRI was always performed in a mean time of3.21 days confirming the diagnosis.

Dizziness is the most frequent symptom of PS. Patients usuallypresent an AVS (associated with additional N-SS or not) and HINTS bedside examination is the most adequateprotocol to differentiate a PS from other AVS causes until the diagnostic confirmation via MRI. Interestingly,mainly otolaryngologists seem to use HINTS. However, the use of CT is widespread despite its poor value.

This study aimed to investigate the relationship between sudden sensorineural hearing loss, vestibular neuritis, and infection with COVID-19.

In this study, a total of 56 Iranians (32 females and 24 males) with a Mean±SD age of 45.12±14 years were studied in Tehran City, Iran. Individuals diagnosed with Sudden Sensorineural Hearing Loss (SSNHL) or vestibular neuritis based on definitive diagnostic criteria were included in the study. The methodology comprised four sections of underlying Sudden Hearing Loss,, auditory and vestibular inspection, SARS-CoV-2 Reverse Transcription-Polymerase Chain Reaction (RT-PCR) test, and statistical analysis. Also, the videonystagmography test was used in participants with vertigo to diagnose vestibular neuritis. Pure tone audiometry confirmed SSNHL in some patients with a complaint of hearing loss. Furthermore, tuning fork, Rinne and Weber tests were also performed.

The results of SARS-CoV-2 RT-PCR in 56 subjects showed that eight subjects (22.2%) with vestibular neuritis and two with SSNHL (10%) had a positive RT-PCR test. The Chi-square and Fisher exact-tests with a 95% confidence interval revealed no statistically significant (P>0.05) relationship between COVID-19 infection and vestibular neuritis or SSNHL.

The present study showed no statistically significant relationship between audiovestibular disorders and positive SARS-CoV-2 RT-PCR test. However, the possibility of this relationship cannot be ruled out, and there is a need for studies with larger sample sizes.

Differentiating central vertigo from peripheral ones poses a challenge to specialists. The present study aimed to examine the potential screening value of S100B and neuron-specific enolase (NSE) in this regard.

This prospective cross-sectional study recruited adult acute vertigo patients with suspected central causes visiting the emergency department (ED) in the first six hours since the onset of symptoms. The screening performance characteristics of S100B and NSE biomarkers in differentiating central vertigo cases were measured considering brain magnetic resonance imaging (MRI) as the reference test.

85 cases who met the cri- teria were enrolled to the study (82.3% female). The MRI of 21 (24.7%) cases had abnormal findings. The two groups were the same in terms of age, sex, and vital signs. Patients with abnormal brain MRI had significantly higher levels of S100B (p < 0.001) and NSE (p < 0.001). S100B and NSE had area under the receiver operating characteristic (ROC) curve of 90.3 (95% CI: 80.7 – 99.8) and 96.9 (95% CI: 93.7 – 100.0) in differentiating the cen- tral causes of acute vertigo, respectively. At the cut-off point of above 119.68 pg/l, S100b had sensitivity of 90.00% (95% CI: 78.83 – 95.86) and specificity of 92.00% (95% CI: 72.49 – 98.60). The sensitivity and specificity of NSE at the cut-off point of above 18.12 ng/ml were 100.00% (95% CI: 93.14 – 100.00) and 89.47% (95% CI: 65.46 – 98.15), respectively.

The serum levels of S100B and NSE were significantly higher in patients with central vertigo, and could therefore be considered as accurate tools in screening acute vertigo cases with central causes in ED.

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.

Although vertigo is a common complaint in patients presenting to the emergency department (ED), its ideal treatment is still under debate. This study was conducted to compare oral betahistine and oral piracetam in management of outpatients with peripheral vertigo. This was a randomized clinical trial performed on patients who were presented to the EDs of 4 teaching hospitals, with complaint of true vertigo. Patients were randomly allocated to either betahistine or piracetam group and their 7-day outcomes were compared. 100 cases with the mean age of 54.72 ± 14.09 years were randomly allocated to either group (62.0% female). The two groups were similar regarding age, sex, and intensity of symptom at the time of presenting to the ED. Twelve (24%) patients in piracetam group and 6 (12%) patients in betahistine group experienced adverse events (odds ratio: 2.32, CI 95%: 0.79-6.76; p = 0.125). There were 3 (6%) patients in each group that experienced a recurrence of their symptoms and 2 (4%) patients in each group saw another physician for vertigo. Oral piracetam is a potentially proper treatment for management of peripheral vertigo and there are few adverse effects associated with it.

Auditory-verbal memory and reading problems are frequently observed in patients with vestibular disorders, but rarely considered as a cognitive consequence of vestibular disease. Many clinicians do not recognize or ignore the psychological symptoms of vestibular disease. This approach could underestimate the cognitive problems of the patients, or even led to misdiagnosis of a combined vestibular-cognitive condition. The current study aimed to assess the cognitive impact of acute vestibular disorders. A total of 71 patients with unilateral vestibular neuritis, Meniere’s disease, and benign paroxysmal positional vertigo underwent a through audiologic evaluation, including otoscopy, pure tone audiometry, tympanometry, vestibular evoked myogenic potentials, videonystagmography plus caloric testing, and video head impulse testing in the plane of horizontal semicircular canals. After determination of the disease, the Persian version of the dizziness handicap inventory, the Persian reading test, and Rey auditory-verbal learning test were administered. There were no significant difference between the patient groups with regard to their inabilities like reading and learning problems according to their auditory verbal memory score induced by acute vertigo. However, acute vertigo can reduce the reading ability and capacity of auditory-verbal memory of the patients compared with normal subjects. Unilateral vestibular disorders in which patients suffer from acute rotatory vertigo could lead to reading difficulties and learning because of auditory-verbal memory impairment. The exact mechanism of vestibular impairment is not a determinant factor for these cognitive problems.

Labyrinthine fistulae (LF) are the common complications of chronic otitis media (COM) of squamosal variety. The final therapeutic outcome of this condition is to preserve the cochlear and vestibular functions. Herein, we present the data of the cases managed at our institute with respect to their presenting complaints, adopted therapeutic approaches and outcomes.   A retrospective chart review was conducted on all cases with COM squamosal type in adult patients. A total of 275 patients were reviewed, out of whom 30 cases had LF. The results were mainly studied with respect to the postoperative improvement of hearing and vertigo.   The incidence rate of LF in the present study was obtained at 10.9%. Only 50% of the cases had the symptoms of vertigo. Furthermore, positive fistula test was elicited in 3.3% of the cases. All cases undergoing preoperative imaging were diagnosed successfully. In addition, 42.85% of the cases had profound hearing loss preoperatively, which sustained after the operation. However, 47.61% of the cases showed an improvement of at least ≥ 10 dB in the air-bone gap. Out of the 15 LF cases with vertigo as the main complaint, only 11 cases referred for follow-up. In this regard, 63.63% of the cases had no postoperative vertigo symptoms.   Patients with LF may not have complaints of vertigo and a positive fistula sign upon admission. Pre-operative imaging facilitates the diagnosis of this condition. The removal of the matrix under constant irrigation, followed by repair with bone wax and/or autologous tissue, is sufficient to preserve the cochlear and vestibular symptoms postoperatively.

Bilateral Meniere’s disease presents with attacks of vertigo leading to severe imbalance and oscillopsia. Sometimes, treatment of bilateral Meniere’s disease is challenging. The following case report presents an appropriate and successful management for a complicated Bilateral Meniere’s disease. Patient was a 42 years male referred with severe attacks of vertigo, severe to profound bilateral hearing loss and severe tinnitus as well as imbalance. Vestibular assessment was done with electronystagmography, head impulse test, cervical and ocular vestibular evoked myogenic potential that showed bilateral and widespread vestibular abnormality in the semicircular canals and otolith systems. Patient had different medical treatments before referring to us and we started some medical and rehabilitation treatments based on his unstable conditions and followed him up for over three years. Vestibular rehabilitation is an approach for the management of many vestibular abnormalities such as Meniere’s disease. It could help to resolve vertigo and imbalance in acute and chronic stage of Meniere’s disease. Vestibular rehabilitation may be helpful in controlling the acute symptoms and helps to improve imbalance and oscillopsia.