Chronic Unilateral Vestibular Hypofunction: Insights into Etiologies, Clinical Subtypes, Diagnostics and Quality of Life
Abstract
:1. Introduction
2. Materials and Methods
2.1. Ethical Approval
2.2. Participants
2.3. Etiology and Clinical Subtypes
- Recurrent vertigo with UVH—This subtype involved recurrent, brief vertigo attacks. Patients may have experienced vertigo, imbalance and/or oscillopsia (an illusion of an unstable vision). Conditions linked to this subtype included MD, VM, BPPV, benign recurrent vertigo, auto-immune inner ear disease, and overlap MD/VM;
- Rapidly progressive UVH—Patients in this subtype experienced a sudden onset of UVH symptoms, which rapidly progressed. Conditions could include infection/inflammation (like acute unilateral vestibulopathy/vestibular neuritis, labyrinthitis), trauma (labyrinthine concussion), vascular (inner ear ischemia), and iatrogenic factors such as stapedotomy or intratympanic/systemic gentamicin administration;
- Slowly progressive UVH—Clinical symptoms of UVH developed gradually in this subtype, typically without episodes of vertigo. Conditions associated with this subtype included vestibular schwannoma, cholesteatoma, retrofenestral otosclerosis, labyrinthitis ossificans, and iatrogenic factors such as radiation therapy;
- Idiopathic/unknown UVH—In this subtype, the dizziness complaints or vertigo attacks could not be attributed to any specific vestibular disorder or trauma. However, patients exhibited symptoms of vestibular hypofunction (e.g., imbalance, dizziness with fast head movements) despite never experiencing any specific episodes.
- Congenital UVH—This subtype refers to UVH caused by genetic factors, such as inner ear malformations.
2.4. Symptoms and Co-Morbidities
2.5. Objective Vestibular Testing
2.6. Ancillary Testing
2.7. Quality of Life and Symptoms (QoL)
2.8. Statistical Analysis
3. Results
3.1. Etiology
3.2. Clinical Subtypes of UVH
3.3. Co-Morbidities and Vestibular Symptoms
3.4. Imaging
3.5. Hearing
3.6. Vestibular Testing
3.7. Quality of Life (QoL) and Psychological Symptoms
3.8. Vestibular Testing and QoL
3.9. Factors Influencing Quality of Life and Symptoms
4. Discussion
4.1. Etiologies
4.2. Secondary Diagnoses
4.3. Clinical Subtypes
4.4. Co-Morbidities
4.5. Symptoms
4.6. Imaging
4.7. Vestibular Testing
4.7.1. Caloric Test
4.7.2. (Video) Head Impulse Test
4.8. QoL and Psychological Symptoms
4.9. Vestibular Testing and QoL
4.10. Factors Related to QoL
4.11. Management of Chronic UVH
4.12. Limitations
5. Conclusions
Supplementary Materials
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
- Brandt, T.; Strupp, M. General vestibular testing. Clin. Neurophysiol. 2005, 116, 406–426. [Google Scholar] [CrossRef] [PubMed]
- Fetter, M. Acute unilateral loss of vestibular function. Handb. Clin. Neurol. 2016, 137, 219–229. [Google Scholar] [CrossRef] [PubMed]
- Karabulut, M.; Van Laer, L.; Hallemans, A.; Vereeck, L.; Van Rompaey, V.; Viechtbauer, W.; Melliti, A.; van Stiphout, L.; Mohamad, A.; Fornos, A.P.; et al. Chronic symptoms in patients with unilateral vestibular hypofunction: Systematic review and meta-analysis. Front. Neurol. 2023, 14, 1177314. [Google Scholar] [CrossRef] [PubMed]
- Strupp, M.; Brandt, T. Vestibular Neuritis. Semin. Neurol. 2009, 29, 509–519. [Google Scholar] [CrossRef]
- Deveze, A.; Bernard-Demanze, L.; Xavier, F.; Lavieille, J.-P.; Elziere, M. Vestibular compensation and vestibular rehabilitation. Current concepts and new trends. Neurophysiol. Clin./Clin. Neurophysiol. 2014, 44, 49–57. [Google Scholar] [CrossRef]
- Lacour, M.; Helmchen, C.; Vidal, P.-P. Vestibular compensation: The neuro-otologist’s best friend. J. Neurol. 2016, 263, 54–64. [Google Scholar] [CrossRef]
- Čada, Z.; Balatková, Z.; Čakrt, O.; Hrubá, S.; Komarc, M.; Plzak, J.; Černý, R. Predictors of central vestibular compensation after surgery for vestibular schwannomas. Acta Otorhinolaryngol. Ital. 2019, 39, 46–52. [Google Scholar] [CrossRef]
- Cohen, H.S.; Kimball, K.T.; Jenkins, H.A. Factors affecting recovery after acoustic neuroma resection. Acta Oto-Laryngol. 2002, 122, 841–850. [Google Scholar] [CrossRef]
- Saman, Y.; Bamiou, D.E.; Gleeson, M.; Dutia, M.B. Interactions between stress and vestibular compensation—A review. Front. Neurol. 2012, 3, 116. [Google Scholar] [CrossRef]
- Shiozaki, T.; Ito, T.; Wada, Y.; Yamanaka, T.; Kitahara, T. Effects of vestibular rehabilitation on physical activity and subjective dizziness in patients with chronic peripheral vestibular disorders: A six-month randomized trial. Front. Neurol. 2021, 12, 656157. [Google Scholar] [CrossRef]
- Paredis, S.; van Stiphout, L.; Remmen, E.; Strupp, M.; Gerards, M.-C.; Kingma, H.; Van Rompaey, V.; Fornos, A.-P.; Guinand, N.; van de Berg, R. DISCOHAT: An acronym to describe the spectrum of symptoms related to bilateral vestibulopathy. Front. Neurol. 2021, 12, 771650. [Google Scholar] [CrossRef] [PubMed]
- Neuhauser, H.K.; Radtke, A.; von Brevern, M.; Lezius, F.; Feldmann, M.; Lempert, T. Burden of dizziness and vertigo in the community. Arch. Intern. Med. 2008, 168, 2118–2124. [Google Scholar] [CrossRef]
- Kerber, K. Chronic unilateral vestibular loss. Handb. Clin. Neurol. 2016, 137, 231–234. [Google Scholar] [CrossRef] [PubMed]
- Strupp, M.; Bisdorff, A.; Furman, J.; Hornibrook, J.; Jahn, K.; Maire, R.; Newman-Toker, D.; Magnusson, M. Acute unilateral vestibulopathy/vestibular neuritis: Diagnostic criteria. J. Vestib. Res. 2022, 32, 389–406. [Google Scholar] [CrossRef]
- Yacovino, D.A.; Martin, L.A.; Akly, M.P.; Hain, T.C. Characteristics of vestibular corrective saccades in patients with slow visual saccades, vestibular disorders and controls: A descriptive analysis. PLoS ONE 2018, 13, e0197079. [Google Scholar] [CrossRef] [PubMed]
- Kerber, K.A.; Newman-Toker, D.E. Misdiagnosing dizzy patients: Common pitfalls in clinical practice. Neurol. Clin. 2015, 33, 565–575. [Google Scholar] [CrossRef]
- Vlastarakos, P.V.; Michailidou, E.; Nikolopoulos, T.P. Unilateral vestibular weakness: An often under-recognized entity. Is symptom improvement feasible? Hear. Balance Commun. 2023, 21, 16–29. [Google Scholar] [CrossRef]
- Starkov, D.; Strupp, M.; Pleshkov, M.; Kingma, H.; van de Berg, R. Diagnosing vestibular hypofunction: An update. J. Neurol. 2021, 268, 377–385. [Google Scholar] [CrossRef]
- Strupp, M.; Dlugaiczyk, J.; Ertl-Wagner, B.B.; Rujescu, D.; Westhofen, M.; Dieterich, M. Vestibular disorders: Diagnosis, new classification and treatment. Deutsches Ärzteblatt Int. 2020, 117, 300. [Google Scholar] [CrossRef]
- Lucieer, F.; Vonk, P.; Guinand, N.; Stokroos, R.; Kingma, H.; van de Berg, R. Bilateral vestibular hypofunction: Insights in etiologies, clinical subtypes, and diagnostics. Front. Neurol. 2016, 7, 26. [Google Scholar] [CrossRef]
- Fuentealba-Bassaletti, C.; Neve, O.M.; van Esch, B.F.; Jansen, J.C.; Koot, R.W.; van Benthem, P.P.G.; Hensen, E.F. Vestibular complaints impact on the long-term quality of life of vestibular schwannoma patients. Otol. Neurotol. 2023, 44, 161. [Google Scholar] [CrossRef] [PubMed]
- Mbongo, F.; Huy, P.T.; Vidal, P.-P.; de Waele, C. Relationship between dynamic balance and self-reported handicap in patients who have unilateral peripheral vestibular loss. Otol. Neurotol. 2007, 28, 905–910. [Google Scholar] [CrossRef]
- Petri, M.; Chirilă, M.; Bolboacă, S.D.; Cosgarea, M. Health-related quality of life and disability in patients with acute unilateral peripheral vestibular disorders. Braz. J. Otorhinolaryngol. 2017, 83, 611–618. [Google Scholar] [CrossRef] [PubMed]
- Yip, C.W.; Strupp, M. The Dizziness Handicap Inventory does not correlate with vestibular function tests: A prospective study. J. Neurol. 2018, 265, 1210–1218. [Google Scholar] [CrossRef]
- Best, C.; Tschan, R.; Eckhardt-Henn, A.; Dieterich, M. Who is at risk for ongoing dizziness and psychological strain after a vestibular disorder? Neuroscience 2009, 164, 1579–1587. [Google Scholar] [CrossRef]
- Herdman, D.; Norton, S.; Pavlou, M.; Murdin, L.; Moss-Morris, R. Vestibular deficits and psychological factors correlating to dizziness handicap and symptom severity. J. Psychosom. Res. 2020, 132, 109969. [Google Scholar] [CrossRef]
- Herdman, S.J.; Hall, C.D.; Delaune, W. Variables associated with outcome in patients with unilateral vestibular hypofunction. Neurorehabilit. Neural Repair 2012, 26, 151–162. [Google Scholar] [CrossRef] [PubMed]
- Meli, A.; Zimatore, G.; Badaracco, C.; De Angelis, E.; Tufarelli, D. Effects of vestibular rehabilitation therapy on emotional aspects in chronic vestibular patients. J. Psychosom. Res. 2007, 63, 185–190. [Google Scholar] [CrossRef]
- Perez, N.; Garmendia, I.; García-Granero, M.; Martin, E.; García-Tapia, R. Factor analysis and correlation between Dizziness Handicap Inventory and Dizziness Characteristics and Impact on Quality of Life scales. Acta Oto-Laryngol. 2001, 121, 145–154. [Google Scholar] [CrossRef]
- Fong, E.; Li, C.; Aslakson, R.; Agrawal, Y. Systematic review of patient-reported outcome measures in clinical vestibular research. Arch. Phys. Med. Rehabil. 2015, 96, 357–365. [Google Scholar] [CrossRef]
- Möhwald, K.; Hadzhikolev, H.; Bardins, S.; Becker-Bense, S.; Brandt, T.; Grill, E.; Jahn, K.; Dieterich, M.; Zwergal, A. Health-related quality of life and functional impairment in acute vestibular disorders. Eur. J. Neurol. 2020, 27, 2089–2098. [Google Scholar] [CrossRef] [PubMed]
- Molnár, A.; Maihoub, S.; Mavrogeni, P.; Tamás, L.; Szirmai, Á. Depression scores and quality of life of vertiginous patients, suffering from different vestibular disorders. Eur. Arch. Oto-Rhino-Laryngol. 2022, 279, 5173–5179. [Google Scholar] [CrossRef] [PubMed]
- Mezzalira, R.; Bittar, R.S.M.; do Carmo Bilécki-Stipsky, M.M.; Brugnera, C.; Grasel, S.S. Sensitivity of caloric test and video head impulse as screening test for chronic vestibular complaints. Clinics 2017, 72, 469–473. [Google Scholar] [CrossRef] [PubMed]
- Lopez-Escamez, J.A.; Carey, J.; Chung, W.-H.; Goebel, J.A.; Magnusson, M.; Mandalà, M.; Newman-Toker, D.E.; Strupp, M.; Suzuki, M.; Trabalzini, F.; et al. Diagnostic criteria for Menière’s disease. J. Vestib. Res. 2015, 25, 1–7. [Google Scholar] [CrossRef]
- Lempert, T.; Olesen, J.; Furman, J.; Waterston, J.; Seemungal, B.; Carey, J.; Bisdorff, A.; Versino, M.; Evers, S.; Kheradmand, A.; et al. Vestibular migraine: Diagnostic criteria (update). J. Vestib. Res. 2022, 32, 1–6. [Google Scholar] [CrossRef]
- Ling, X.; Zhao, D.-H.; Shen, B.; Si, L.-H.; Li, K.-Z.; Hong, Y.; Li, Z.-Y.; Yang, X. Clinical characteristics of patients with benign paroxysmal positional vertigo diagnosed based on the diagnostic criteria of the Bárány Society. Front. Neurol. 2020, 11, 602. [Google Scholar] [CrossRef]
- Staab, J.P.; Eckhardt-Henn, A.; Horii, A.; Jacob, R.; Strupp, M.; Brandt, T.; Bronstein, A. Diagnostic criteria for persistent postural-perceptual dizziness (PPPD): Consensus document of the committee for the Classification of Vestibular Disorders of the Bárány Society. J. Vestib. Res. 2017, 27, 191–208. [Google Scholar] [CrossRef]
- van de Berg, R.; Kingma, H. History Taking in Non-Acute Vestibular Symptoms: A 4-Step Approach. J. Clin. Med. 2021, 10, 5726. [Google Scholar] [CrossRef]
- van Stiphout, L.; Lucieer, F.; Pleshkov, M.; Van Rompaey, V.; Widdershoven, J.; Guinand, N.; Fornos, A.P.; Kingma, H.; van de Berg, R. Bilateral vestibulopathy decreases self-motion perception. J. Neurol. 2021, 269, 5216–5228. [Google Scholar] [CrossRef]
- ASHA. Degree of Hearing Loss. 2009. Available online: https://www.asha.org/public/hearing/Degree-of-Hearing-Loss/ (accessed on 14 June 2024).
- Vanspauwen, R.; Knoop, A.; Camp, S.; van Dinther, J.; Offeciers, F.E.; Somers, T.; Zarowski, A.; Blaivie, C. Outcome evaluation of the dizziness handicap inventory in an outpatient vestibular clinic. J. Vestib. Res. 2016, 26, 479–486. [Google Scholar] [CrossRef]
- Whitney, S.L.; Wrisley, D.M.; Brown, K.E.; Furman, J.M. Is perception of handicap related to functional performance in persons with vestibular dysfunction? Otol. Neurotol. 2004, 25, 139–143. [Google Scholar] [CrossRef]
- Snaith, R.P.; Zigmond, A.S. The Hospital Anxiety and Depression Scale with the Irritability-Depression-Anxiety Scale and the Leeds Situational Anxiety Scale: Manual; Nfer-Nelson: Heslington, UK, 1994. [Google Scholar]
- Versteegh, M.M.; Vermeulen, K.M.; Evers, S.M.; De Wit, G.A.; Prenger, R.; Stolk, E.A. Dutch tariff for the five-level version of EQ-5D. Value Health 2016, 19, 343–352. [Google Scholar] [CrossRef] [PubMed]
- Welie, A.G.; Gebretekle, G.B.; Stolk, E.; Mukuria, C.; Krahn, M.D.; Enquoselassie, F.; Fenta, T.G. Valuing health state: An EQ-5D-5L value set for Ethiopians. Value Health Reg. Issues 2020, 22, 7–14. [Google Scholar] [CrossRef] [PubMed]
- Tarnutzer, A.A.; Bockisch, C.J.; Buffone, E.; Weber, K.P. Vestibular mapping in patients with unilateral peripheral-vestibular deficits. Neurology 2020, 95, e2988–e3001. [Google Scholar] [CrossRef]
- Blödow, A.; Heinze, M.; Bloching, M.B.; von Brevern, M.; Radtke, A.; Lempert, T. Caloric stimulation and video-head impulse testing in Ménière’s disease and vestibular migraine. Acta Oto-Laryngol. 2014, 134, 1239–1244. [Google Scholar] [CrossRef]
- Limviriyakul, S.; Luangsawang, C.; Suvansit, K.; Prakairungthong, S.; Thongyai, K.; Atipas, S. Video head impulse test and caloric test in definite Ménière’s disease. Eur. Arch. Oto-Rhino-Laryngol. 2020, 277, 679–686. [Google Scholar] [CrossRef]
- McGarvie, L.A.; Curthoys, I.S.; MacDougall, H.G.; Halmagyi, G.M. What does the dissociation between the results of video head impulse versus caloric testing reveal about the vestibular dysfunction in Ménière’s disease? Acta Oto-Laryngol. 2015, 135, 859–865. [Google Scholar] [CrossRef]
- Yetiser, S. Review of the pathology underlying benign paroxysmal positional vertigo. J. Int. Med. Res. 2020, 48, 0300060519892370. [Google Scholar] [CrossRef]
- von Brevern, M.; Radtke, A.; Lezius, F.; Feldmann, M.; Ziese, T.; Lempert, T.; Neuhauser, H. Epidemiology of benign paroxysmal positional vertigo: A population based study. J. Neurol. Neurosurg. Psychiatry 2007, 78, 710–715. [Google Scholar] [CrossRef] [PubMed]
- Balatsouras, D.G.; Koukoutsis, G.; Ganelis, P.; Economou, N.C.; Moukos, A.; Aspris, A.; Katotomichelakis, M. Benign paroxysmal positional vertigo secondary to vestibular neuritis. Eur. Arch. Oto-Rhino-Laryngol. 2014, 271, 919–924. [Google Scholar] [CrossRef]
- Bin Lee, J.; Choi, S.J. Canal Paresis in Benign Paroxysmal Positional Vertigo Secondary to Sudden Sensorineural Hearing Loss. Otol. Neurotol. 2015, 36, 1708–1713. [Google Scholar] [CrossRef]
- Turk, B.; Akpinar, M.; Kaya, K.S.; Korkut, A.Y.; Turgut, S. Benign Paroxysmal Positional Vertigo: Comparison of Idiopathic BPPV and BPPV Secondary to Vestibular Neuritis. Ent-Ear Nose Throat J. 2021, 100, 532–535. [Google Scholar] [CrossRef] [PubMed]
- Waissbluth, S.; Becker, J.; Sepúlveda, V.; Iribarren, J.; García-Huidobro, F. Benign Paroxysmal Positional Vertigo Secondary to Acute Unilateral Peripheral Vestibulopathy: Evaluation of Cardiovascular Risk Factors. J. Int. Adv. Otol. 2023, 19, 28–32. [Google Scholar] [CrossRef] [PubMed]
- Balatsouras, D.G.; Ganelis, P.; Aspris, A.; Economou, N.C.; Moukos, A.; Koukoutsis, G. Benign Paroxysmal Positional Vertigo Associated with Meniere’s Disease: Epidemiological, Pathophysiologic, Clinical, and Therapeutic Aspects. Ann. Otol. Rhinol. Laryngol. 2012, 121, 682–688. [Google Scholar] [CrossRef] [PubMed]
- Ganança, C.F.; Caovilla, H.H.; Gazzola, J.M.; Ganança, M.M.; Ganança, F.F. Epley’s maneuver in benign paroxysmal positional vertigo associated with Meniere’s disease. Braz. J. Otorhinolaryngol. 2007, 73, 506–512. [Google Scholar] [CrossRef]
- Perez, N.; Martin, E.; Zubieta, J.L.; Romero, M.D.; Garcia-Tapia, R. Benign paroxysmal positional vertigo in patients with Meniere’s disease treated with intratympanic gentamycin. Laryngoscope 2002, 112, 1104–1109. [Google Scholar] [CrossRef]
- Zhu, R.T.; Van Rompaey, V.; Ward, B.K.; Van de Berg, R.; Van de Heyning, P.; Sharon, J.D. The interrelations between different causes of dizziness: A conceptual framework for understanding vestibular disorders. Ann.Otol. Rhinol. Laryngol. 2019, 128, 869–878. [Google Scholar] [CrossRef]
- Maarsingh, O.R.; Dros, J.; Schellevis, F.G.; van Weert, H.C.; Bindels, P.J.; van der Horst, H.E. Dizziness reported by elderly patients in family practice: Prevalence, incidence, and clinical characteristics. BMC Fam. Pract. 2010, 11, 2. [Google Scholar] [CrossRef]
- van Leeuwen, R.B.; Colijn, C.; van Wensen, E.; Bruintjes, T.D. The dizzy patient: Consider a second diagnosis. Neurologist 2017, 22, 69–71. [Google Scholar] [CrossRef]
- Argaet, E.; Bradshaw, A.; Welgampola, M. Benign positional vertigo, its diagnosis, treatment and mimics. Clin. Neurophysiol. Pract. 2019, 4, 97–111. [Google Scholar] [CrossRef]
- Adamec, I.; Meaški, S.J.; Skorić, M.K.; Jažić, K.; Crnošija, L.; Milivojević, I.; Habek, M. Persistent postural-perceptual dizziness: Clinical and neurophysiological study. J. Clin. Neurosci. 2020, 72, 26–30. [Google Scholar] [CrossRef] [PubMed]
- Kim, H.-J.; Lee, J.-O.; Choi, J.-Y.; Kim, J.-S. Etiologic distribution of dizziness and vertigo in a referral-based dizziness clinic in South Korea. J. Neurol. 2020, 267, 2252–2259. [Google Scholar] [CrossRef] [PubMed]
- Xue, H.; Chong, Y.; Jiang, Z.; Liu, Z.; Ding, L.; Yang, S.; Wang, L.; Xiang, W. Etiological analysis on patients with vertigo or dizziness. Zhonghua Yi Xue Za Zhi 2018, 98, 1227–1230. [Google Scholar] [CrossRef] [PubMed]
- Kabaya, K.; Tamai, H.; Okajima, A.; Minakata, T.; Kondo, M.; Nakayama, M.; Iwasaki, S. Presence of exacerbating factors of persistent perceptual-postural dizziness in patients with vestibular symptoms at initial presentation. Laryngoscope Investig. Otolaryngol. 2022, 7, 499–505. [Google Scholar] [CrossRef]
- Gambacorta, V.; D’orazio, A.; Pugliese, V.; Di Giovanni, A.; Ricci, G.; Faralli, M. Persistent Postural Perceptual Dizziness in Episodic Vestibular Disorders. Audiol. Res. 2022, 12, 589–595. [Google Scholar] [CrossRef]
- Trinidade, A.; Cabreira, V.; Kaski, D.; Goebel, J.; Staab, J.; Popkirov, S.; Stone, J. Treatment of Persistent Postural-Perceptual Dizziness (PPPD). Curr. Treat. Options Neurol. 2023, 25, 281–306. [Google Scholar] [CrossRef]
- Lee, S.-H.; Kim, J.-H.; Kwon, Y.-S.; Lee, J.-J.; Sohn, J.-H. Risk of vestibulocochlear disorders in patients with migraine or non-migraine headache. J. Pers. Med. 2021, 11, 1331. [Google Scholar] [CrossRef]
- Moreira, M.D.; Trelha, C.S.; Marchiori, L.L.d.M.; Lopes, A.R. Association between complaints of dizziness and hypertension in non-institutionalized elders. Int. Arch. Otorhinolaryngol. 2013, 17, 157–162. [Google Scholar] [CrossRef]
- Newman-Toker, D.E.; Hsieh, Y.-H.; Camargo, C.A.; Pelletier, A.J.; Butchy, G.T.; Edlow, J.A. Spectrum of dizziness visits to US emergency departments: Cross-sectional analysis from a nationally representative sample. Mayo Clin. Proc. 2008, 83, 765–775. [Google Scholar] [CrossRef]
- Sitsen, A. Auto-Immuunziekten; AccreDidact: Houten, The Netherlands, 2014. [Google Scholar]
- Russo, F.Y.; Ralli, M.; De Seta, D.; Mancini, P.; Lambiase, A.; Artico, M.; de Vincentiis, M.; Greco, A. Autoimmune vertigo: An update on vestibular disorders associated with autoimmune mechanisms. Immunol. Res. 2018, 66, 675–685. [Google Scholar] [CrossRef]
- Adams, M.E.; Karaca-Mandic, P.; Marmor, S. Use of neuroimaging for patients with dizziness who present to outpatient clinics vs emergency departments in the US. JAMA Otolaryngol. Head Neck Surg. 2022, 148, 465–473. [Google Scholar] [CrossRef] [PubMed]
- Comolli, L.; Korda, A.; Zamaro, E.; Wagner, F.; Sauter, T.C.; Caversaccio, M.D.; Nikles, F.; Jung, S.; Mantokoudis, G. Vestibular syndromes, diagnosis and diagnostic errors in patients with dizziness presenting to the emergency department: A cross-sectional study. BMJ Open 2023, 13, e064057. [Google Scholar] [CrossRef] [PubMed]
- Müller, M.; Goeldlin, M.B.; Gaschen, J.; Sauter, T.C.; Stock, S.; Wagner, F.; Exadaktylos, A.K.; Fischer, U.; Kalla, R.; Mantokoudis, G. Characteristics and resource needs in patients with vestibular symptoms: A comparison of patients with symptoms of unknown versus determined origin. BMC Emerg. Med. 2020, 20, 70. [Google Scholar] [CrossRef]
- Alessandrini, M.; Viziano, A.; Pistillo, R.; Granito, I.; Basso, L.; Preziosi, N.; Micarelli, A. Changes in daily energy expenditure and movement behavior in unilateral vestibular hypofunction: Relationships with neuro-otological parameters. J. Clin. Neurosci. 2021, 91, 200–208. [Google Scholar] [CrossRef]
- Asai, H.; Murakami, S.; Morimoto, H.; Asai, Y.; Johnson, E.G.; Yamashita, Y.; Horiba, M.; Mizutani, Y.; Kabaya, K.; Ueki, Y. Effects of a walking program in patients with chronic unilateral vestibular hypofunction. J. Phys. Ther. Sci. 2022, 34, 85–91. [Google Scholar] [CrossRef]
- van de Berg, R.; van Tilburg, M.; Kingma, H. Bilateral vestibular hypofunction: Challenges in establishing the diagnosis in adults. Orl 2015, 77, 197–218. [Google Scholar] [CrossRef] [PubMed]
- Burston, A.; Mossman, S.; Mossman, B.; Weatherall, M. Comparison of the video head impulse test with the caloric test in patients with sub-acute and chronic vestibular disorders. J. Clin. Neurosci. 2018, 47, 294–298. [Google Scholar] [CrossRef]
- Bartolomeo, M.; Biboulet, R.; Pierre, G.; Mondain, M.; Uziel, A.; Venail, F. Value of the video head impulse test in assessing vestibular deficits following vestibular neuritis. Eur. Arch. Oto-Rhino-Laryngol. 2014, 271, 681–688. [Google Scholar] [CrossRef]
- Liu, J.; Hu, Y.; Wang, Q.; Ding, Y.; Li, J.; Tang, H. Correlation and difference analysis in parameters between video head impulse test and caloric test in vestibular disease. J. Clin. Otorhinolaryngol. Head Neck Surg. 2021, 35, 802–806. [Google Scholar] [CrossRef]
- Mahringer, A.; Rambold, H.A. Caloric test and video-head-impulse: A study of vertigo/dizziness patients in a community hospital. Eur. Arch. Oto-Rhino-Laryngol. 2014, 271, 463–472. [Google Scholar] [CrossRef]
- McCaslin, D.L.; Jacobson, G.P.; Bennett, M.L.; Gruenwald, J.M.; Green, A.P. Predictive properties of the video head impulse test: Measures of caloric symmetry and self-report dizziness handicap. Ear Hear. 2014, 35, e185–e191. [Google Scholar] [CrossRef]
- van Esch, B.F.; Nobel-Hoff, G.; van Benthem, P.P.G.; Van Der Zaag-Loonen, H.; Bruintjes, T.D. Determining vestibular hypofunction: Start with the video-head impulse test. Eur. Arch. Oto-Rhino-Laryngol. 2016, 273, 3733–3739. [Google Scholar] [CrossRef]
- Azami, M.; Fushiki, H.; Tsunoda, R.; Kamo, T.; Ogihara, H.; Tanaka, R.; Kato, T. Clinical features of persistent postural-perceptual dizziness with isolated otolith dysfunction as revealed by VEMP and vHIT findings. Front. Neurol. 2023, 14, 1129569. [Google Scholar] [CrossRef]
- Murofushi, T.; Nishimura, K.; Tsubota, M. Isolated otolith dysfunction in persistent postural-perceptual dizziness. Front. Neurol. 2022, 13, 872892. [Google Scholar] [CrossRef]
- Bayat, A.; Hoseinabadi, R.; Saki, N.; Sanayi, R. Disability and anxiety in vestibular diseases: A cross-sectional study. Cureus 2020, 12, e11813. [Google Scholar] [CrossRef]
- Eckhardt-Henn, A.; Dieterich, M. Psychiatric disorders in otoneurology patients. Neurol. Clin. 2005, 23, 731–749. [Google Scholar] [CrossRef]
- Redondo-Martínez, J.; Bécares-Martínez, C.; Orts-Alborch, M.; García-Callejo, F.J.; Pérez-Carbonell, T.; Marco-Algarra, J. Relationship between video head impulse test (vHIT) and caloric test in patients with vestibular neuritis. Acta Otorrinolaringol. 2016, 67, 156–161. [Google Scholar] [CrossRef]
- Zellhuber, S.; Mahringer, A.; Rambold, H.A. Relation of video-head-impulse test and caloric irrigation: A study on the recovery in unilateral vestibular neuritis. Eur. Arch. Oto-Rhino-Laryngol. 2014, 271, 2375–2383. [Google Scholar] [CrossRef]
- Graham, M.K.; Staab, J.P.; Lohse, C.M.; McCaslin, D.L. A comparison of dizziness handicap inventory scores by categories of vestibular diagnoses. Otol. Neurotol. 2021, 42, 129–136. [Google Scholar] [CrossRef]
- Steensnaes, M.H.; Knapstad, M.K.; Goplen, F.K.; Berge, J.E. Persistent Postural-Perceptual Dizziness (PPPD) and quality of life: A cross-sectional study. Eur. Arch. Oto-Rhino-Laryngol. 2023, 280, 5285–5292. [Google Scholar] [CrossRef]
- Kuritzky, A.; Ziegler, D.K.; Hassanein, R. Vertigo, motion sickness and migraine. Headache J. Head Face Pain 1981, 21, 227–231. [Google Scholar] [CrossRef] [PubMed]
- Vetvik, K.G.; MacGregor, E.A. Sex differences in the epidemiology, clinical features, and pathophysiology of migraine. Lancet Neurol. 2017, 16, 76–87. [Google Scholar] [CrossRef] [PubMed]
- A Schenck, A.; Kruyt, J.M.; van Benthem, P.P.; Cannegieter, S.C.; Hout, W.B.v.D.; Böhringer, S.; Hammer, S.; Hombergen, S.P.M.; Blom, H.M. Effectiveness of endolymphatic duct blockage versus endolymphatic sac decompression in patients with intractable Ménière’s disease: Study protocol for a double-blinded, randomised controlled trial. BMJ Open 2021, 11, e054514. [Google Scholar] [CrossRef]
- Frosolini, A.; Lovato, A. Monoclonal Antibodies Targeting CGRP to Treat Vestibular Migraine: A Rapid Systematic Review and Meta-Analysis. Indian J. Otolaryngol. Head Neck Surg. 2024, 76, 3737–3744. [Google Scholar] [CrossRef] [PubMed]
- Herdman, D.; Norton, S.; Murdin, L.; Frost, K.; Pavlou, M.; Moss-Morris, R. The INVEST trial: A randomised feasibility trial of psychologically informed vestibular rehabilitation versus current gold standard physiotherapy for people with persistent postural perceptual dizziness. J. Neurol. 2022, 269, 4753–4763. [Google Scholar] [CrossRef]
- Hall, C.D.; Herdman, S.J.P.; Whitney, S.L.D.; Anson, E.R.; Carender, W.J.P.; Hoppes, C.W.P.; Cass, S.P.; Christy, J.B.; Cohen, H.S.O.; Fife, T.D.M.; et al. Vestibular rehabilitation for peripheral vestibular hypofunction: An updated clinical practice guideline from the academy of neurologic physical therapy of the American Physical Therapy Association. J. Neurol. Phys. Ther. 2022, 46, 118–177. [Google Scholar] [CrossRef]
- Stultiens, J.J.A.; Lewis, R.F.; Phillips, J.O.; Boutabla, A.; Della Santina, C.C.; Glueckert, R.; van de Berg, R. The next challenges of vestibular implantation in humans. J. Assoc. Res. Otolaryngol. 2023, 24, 401–412. [Google Scholar] [CrossRef] [PubMed]
- van de Berg, R.; Guinand, N.; Nguyen, T.A.K.; Ranieri, M.; Cavuscens, S.; Guyot, J.-P.; Stokroos, R.; Kingma, H.; Perez-Fornos, A. The vestibular implant: Frequency-dependency of the electrically evoked vestibulo-ocular reflex in humans. Front. Syst. Neurosci. 2015, 8, 255. [Google Scholar] [CrossRef]
- Bell, A. What Barany’s caloric test might have overlooked: The primary factor may be the middle ear muscles. J. Hear. Sci. 2019, 9, 9–22. [Google Scholar] [CrossRef]
- O’Neill, G.; Calhoun, E.N.; Francis, K.R.; Chui, P.; Hayward, C. The influence of temporal bone anatomical variation upon the caloric stimulus. Clin. Otolaryngol. 1987, 12, 277–282. [Google Scholar] [CrossRef]
Variables (n = 251) | Mean ± SD; (Range) |
---|---|
Age | 58.96 ± 13.42; (18–84) |
Gender | n (%) |
Female | 145 (58) |
Male | 106 (42) |
Profession | |
Employed | 137 (55) |
Unemployed | 33 (13) |
Retired | 38 (15) |
Missing | 43 (17) |
Duration of symptoms | |
≥3–11 months | 62 (25) |
>12–23 months | 50 (20) |
≥24 months | 139 (55) |
The presence of attacks | |
No attack | 71 (28) |
One attack | 63 (25) |
Previous attacks | 44 (18) |
Current attacks | 73 (29) |
Side of lesion | |
Right | 138 (55) |
Left | 113 (45) |
Type | n (%) | ||
---|---|---|---|
MRI | Normal | 127 (50.6) | |
n = 168 | Abnormal | Vestibular schwannoma | 17 (6.8) |
Vascular lesion | 13 (5.2) | ||
Inner ear ossification/fibrosis | 3 (1.2) | ||
Inner ear dysplasia | 2 (0.8) | ||
Cerebral atrophy | 2 (0.8) | ||
Other | 4 (1.6) | ||
CT | Normal | 26 (10.4) | |
n = 37 | Abnormal | SCDS | 3 (1.2) |
Trauma/Skull base fracture | 3 (1.2) | ||
Post-operative changes | 2 (0.8) | ||
Other | 3 (1.2) | ||
Not tested | 46 (18.3) | ||
Total | 251 (100) |
Handicap Level | Mild n (%) | Moderate n (%) | Severe n (%) | Mean ± SD | |
---|---|---|---|---|---|
Quality of Life (n = 251) | |||||
DHI Total | 43 (17%) | 118 (47%) | 90 (36%) | 51.63 ± 21.61 | |
Median (IQR) | |||||
HADS Depression | 44 (18%) | 40 (16%) | 10 (4%) | 6 (7.5) | |
HADS Anxiety | 41 (16%) | 42 (17%) | 21 (8%) | 6 (6.5) | |
EQ-5D-5L | VAS: 65 (30) |
Predictors | Baseline/Reference | Outcome Variable | ||||||
---|---|---|---|---|---|---|---|---|
n = 193 | DHI Total Score | DHI Physical Score | DHI Functional Score | DHI Emotional Score | HADS Depression Score | HADS Anxiety Score | EQ-5D-5L VAS Score | |
(Intercept) | 47.04 *** | 16.08 *** | 16.53 *** | 14.44 *** | 6.68 *** | 7.76 *** | 66.29 *** | |
(5.08) | (1.69) | (2.19) | (2.07) | (1.16) | (1.12) | (5.21) | ||
PPPD | Yes | 16.79 *** | 5.40 *** | 6.69 *** | 4.70 ** | 2.07 * | 2.41 ** | −12.59 *** |
No | (3.51) | (1.17) | (1.51) | (1.43) | (0.80) | (0.78) | (3.59) | |
Migraine | Yes | 4.68 | 0.56 | 2.24 | 1.88 | 1.02 | 0.30 | −4.70 |
No | (3.48) | (1.16) | (1.50) | (1.41) | (0.80) | (0.77) | (3.59) | |
Hearing | Continuous variable | −1.03 | 0.56 * | −0.27 | −0.21 | −0.11 | −0.19 | 0.85 |
(0.84) | (0.28) | (0.36) | (0.34) | (0.19) | (0.19) | (0.86) | ||
The presence of attacks | † | F (3177) = 2.890, p = 0.136 | F (3177) = 3.136, p = 0.026 | F (3177) = 2.060, p = 0.107 | F (3177) = 2.920, p = 0.135 | F (3177) = 0.727, p = 0.536 | F (3177) = 2.185, p = 0.041 | F (3177) = 1.148, p = 0.331 |
One attack | 2.76 | 0.94 | 2.04 | −0.22 | −0.98 | −1.66 | −4.31 | |
No attack | (4.22) | (1.41) | (1.81) | (1.72) | (0.97) | (0.93) | (4.31) | |
Previous attacks | −7.05 | −3.40 * | −1.29 | −2.36 | −1.38 | −1.93 * | 3.62 | |
No attack | (4.30) | (1.44) | (1.85) | (1.75) | (0.99) | (0.95) | (4.42) | |
Current attacks | 4.23 | −0.62 | 2.51 | 2.34 | −0.90 | −0.34 | −2.08 | |
No attack | (3.85) | (1.28) | (1.66) | (1.57) | (0.88) | (0.85) | (3.97) | |
Duration of symptoms | † | F (2177) = 1.741, p = 0.178 | F (2177) = 1.334, p = 0.024 | F (2177) = 1.580, p = 0.208 | F (2177) = 2.325, p = 0.100 | F (2177) = 0.256, p = 0.774 | F (2177) = 1.181, p = 0.329 | F (2177) = 0.095, p = 0.908 |
12–24 months | −2.25 | 0.79 | −0.01 | −3.03 | −0.62 | −0.45 | 0.17 | |
3–12 months | (4.25) | (1.42) | (1.83) | (1.73) | (0.98) | (0.94) | (4.34) | |
≥24 months | 4.34 | 1.80 | 2.23 | 0.31 | −0.46 | 0.76 | −1.23 | |
3–12 months | (3.36) | (1.12) | (1.44) | (1.37) | (0.77) | (0.74) | (3.43) | |
Vestibular test result | † | F (2177) = 3.780, p = 0.024 | F (2177) = 5.853, p = 0.003 | F (2177) = 4.045, p = 0.019 | F (2177) = 0.490, p = 0.612 | F (2177) = 2.224, p = 0.111 | F (2177) = 1.059, p = 0.348 | F (2177) = 1.449, p = 0.237 |
Caloric ≥ 6°/s and <25°/s | −1.23 | −1.07 | −0.17 | 0.01 | 0.27 | −0.28 | 0.78 | |
Caloric ≥25°/s | (3.60) | (1.20) | (1.55) | (1.46) | (0.83) | (0.80) | (3.72) | |
Caloric < 6°/s Caloric ≥ 25°/s | 10.85 * | 3.90 * | 5.18 * | 1.76 | 2.30 | 1.12 | −6.84 | |
(5.29) | (1.77) | (2.28) | (2.15) | (1.21) | (1.17) | (5.44) | ||
R2 | 0.23 | 0.25 | 0.22 | 0.14 | 0.09 | 0.10 | 0.15 | |
Adj. R2 | 0.19 | 0.21 | 0.17 | 0.09 | 0.04 | 0.04 | 0.10 |
Disclaimer/Publisher’s Note: The statements, opinions and data contained in all publications are solely those of the individual author(s) and contributor(s) and not of MDPI and/or the editor(s). MDPI and/or the editor(s) disclaim responsibility for any injury to people or property resulting from any ideas, methods, instructions or products referred to in the content. |
© 2024 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Karabulut, M.; Viechtbauer, W.; Van Laer, L.; Mohamad, A.; Van Rompaey, V.; Guinand, N.; Perez Fornos, A.; Gerards, M.-C.; van de Berg, R. Chronic Unilateral Vestibular Hypofunction: Insights into Etiologies, Clinical Subtypes, Diagnostics and Quality of Life. J. Clin. Med. 2024, 13, 5381. https://doi.org/10.3390/jcm13185381
Karabulut M, Viechtbauer W, Van Laer L, Mohamad A, Van Rompaey V, Guinand N, Perez Fornos A, Gerards M-C, van de Berg R. Chronic Unilateral Vestibular Hypofunction: Insights into Etiologies, Clinical Subtypes, Diagnostics and Quality of Life. Journal of Clinical Medicine. 2024; 13(18):5381. https://doi.org/10.3390/jcm13185381
Chicago/Turabian StyleKarabulut, Mustafa, Wolfgang Viechtbauer, Lien Van Laer, Alfarghal Mohamad, Vincent Van Rompaey, Nils Guinand, Angélica Perez Fornos, Marie-Cecile Gerards, and Raymond van de Berg. 2024. "Chronic Unilateral Vestibular Hypofunction: Insights into Etiologies, Clinical Subtypes, Diagnostics and Quality of Life" Journal of Clinical Medicine 13, no. 18: 5381. https://doi.org/10.3390/jcm13185381