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At least 109 records · Page 6Linked to original sources
PubMed2005

What accounts for vertigo one year after neuritis vestibularis - anxiety or a dysfunctional vestibular organ?

One year after neuritis vestibularis, 29% from a sample of 75 patients still complained of vertigo. The objective of this investigation was to study why patients suffer from persisting vertigo. The alternative hypotheses were that the vertigo experienced could be explained either by a persisting vestibular dysfunction or by psychopathological changes. To elucidate this question, patients were examined with dynamic posturography, the symptom check list (SCL 90 R), the state-trait anxiety inventory (STAI), the agoraphobic cognitions questionnaire (ALQ) and the body sensations questionnaire (BSQ). After one year, only two patients had overall pathological results in the posturography. Following the assumption that sub-clinical dysfunction of the organs of balance can also lead to an altered body perception in combination with anxiety, the pathological results of posturographic sub-tests were related to experiences of vertigo. Here also there were no significant associations. However, vertigo correlated highly significantly with body-related anxiety and anxiety-related apprehension. In conclusion, chronic vertigo after an acute vestibular disorder could be regarded as a somatopsychic process. Persisting experience of vertigo is not explained by sub-clinical organic changes. Anxiety seems to be the crucial factor in persisting vertigo.

Anxiety↗
PubMed2006

The genetics of vertigo.

Vertigo is a common principal complaint among patients seen by primary care physicians, neurologists, and otolaryngologists. The most common causes of recurrent episodes of vertigo are benign inner ear disorders, but central nervous system disorders must be excluded. Several common vertigo syndromes are now known to be familial, a feature distinguishing them from other common causes of vertigo. Familial vertigo has been recognized in patients with isolated recurrent attacks of vertigo, genetic deafness syndromes, and in patients with neurological disorders. Although susceptibility loci and mutations have been identified, genetic heterogeneity is common in all familial vertigo syndromes. Research in these disorders has advanced the understanding of vertigo pathophysiology but much remains to be known. This article provides an overview of the clinical features, genetic analyses, and treatment strategies for these disorders.

Family Health↗
PubMed1980

[Peripheral vestibular vertigo (author's transl)].

In 88 patients with benign paroxysmal postural vertigo and repeated attacks of vestibular vertigo the clinical and electronystagmographic findings were evaluated in a retrospective study. After an interval of at least two years 16 patients with paroxysmal postural vertigo were symptom-free 39 had rare or (and) tolerable vertigo, 30 frequent and (or) disturbing recurrent postural vertigo. Five patients showed transition into spontaneous recurrent attacks of vertigo. Out of 37 patients with single vestibular vertigo after an interval of at least 4 weeks 9 had unilateral caloric unresponsiveness, 11 hyporesponsiveness, 11 spontaneous nystagmus and 6 normal findings. 58 patients with recurrent vestibular vertigo could be differentiated into two groups: 29 with signs of labyrinthine damage and 29 with persistent normal findings in the interval even after many years of the disease. The two groups were significantly different in their age of manifestation. It is thus justified to separate functional from organic vestibulopathies. Not even in the group of organic vestibulopathy was there any clear-cut evidence of general vascular disease as the underlying cause.

Adult↗
PubMed2002

Intratympanic gentamicin therapy for persistent vertigo after endolymphatic sac surgery.

OBJECTIVES: To evaluate the role of intratympanic gentamycin therapy (ITGM) in controlling vertigo in patients with refractory Meniere's who have recurrent or persistent vertigo after endolymphatic sac surgery. STUDY DESIGN AND SETTING: A retrospective review of 491 patients seen in a university balance clinic between July 1999 and July 2000. Of these, 68 patients had Meniere's disease; 4 patients had recurrent vertigo after endolymphatic sac surgery and were followed for at least 1 year. These 4 patients received a series of ITGM injections. Outcome measures included control of vertigo and audiometric results. RESULTS: Three of 4 (75%) patients had control of their vertigo with ITGM therapy. The 1 patient who failed ITGM therapy underwent a successful vestibular neurectomy with ultimate control of his vertigo. No patients had progression of their sensorineural hearing loss. CONCLUSION: ITGM therapy can be used to control vertigo in selected patients with Meniere's disease who have persistent vertigo after unsuccessful endolymphatic sac surgery. SIGNIFICANCE: ITGM therapy may reduce the need for vestibular neurectomy in patients with refractory Meniere's disease after endolymphatic sac surgery.

Administration, Topical↗
PubMed1995

Dizziness and vertigo in a department of emergency medicine.

Dizziness is a common and vexing diagnostic problem in emergency departments. The term is rather undefinite and often misused, but can in practice be classified into four categories: fainting, disequilibrium, vertigo and miscellaneous syndromes. Vertigo is the most common category of dizziness. Classification of vertigo can be based either on chronological criteria (acute, recurrent or chronic vertigo) or on topographical criteria (peripheral or central vertigo). Physicians working in emergency departments must be able to rapidly identify patients with potentially serious forms of vertigo, which could cause death or disability, and patients with mild conditions, that can be effectively treated. Previous studies and the experience of the authors have shown that reliable diagnostic hypotheses can be generated by taking a proper clinical history (focused on the onset and duration of the disease, the circumstances causing the vertigo and associated otological or neurological symptoms) and performing an accurate physical examination (evaluation of neurological defects and spontaneous or provoked nystagmus), supplemented by few laboratory tests and diagnostic procedures. Therapy of vertigo in emergency settings is mainly symptomatic and based on sedation and use of vestibulosuppressant drugs (antihistamines, phenothiazines).

Algorithms↗
PubMed2001

Effect of smoking on the treatment of vertigo.

OBJECTIVE: To study the effect of smoking on patients with vertigo. SETTING: University hospital. PATIENTS: Thirty patients with vertigo who smoke and 30 patients with vertigo who don't smoke were age-, sex-, and diagnosis-matched and given the same medication consecutively for 3 months. Then treatment efficacy was compared between two groups to investigate the relationship between smoking and vertigo. RESULTS: The efficacy of treatment of vertigo in the smoking group (30%) was lower than the nonsmoking group (74%). Intractable vertigo is related to smoking behavior but unrelated to either smoking year or tobacco year (exposure to smoking). CONCLUSIONS: For patients with vertigo who smoke during the course of treatment, the treatment may be ineffective. Therefore, neurotologists should inquire about the smoking history in vertigo patients and advise them to abstain from smoking.

Adult↗
PubMed2006

Factors relating to the vertigo control and hearing changes following intratympanic gentamicin for intractable Ménière's disease.

OBJECTIVE: To look for factors relating to the vertigo control and hearing changes after intratympanic injections of gentamicin (GM). STUDY DESIGN: Prospective. SETTING: Tertiary referral medical center. PATIENTS: Twenty-eight patients with intractable Ménière's disease. INTERVENTIONS: Three intratympanic injections of GM (once per day for three consecutive days). MAIN OUTCOME MEASURES: Although five patients needed further GM injections or vestibular neurectomy because of poor control (Group I), 23 patients had their vertigo controlled for more than two years without further treatment (Group II). The number of vertigo spells per month, pure-tone audiometry, electrocochleography, caloric response, post-head shake nystagmus, and plasma vasopressin as a stress marker were examined. RESULTS: Before GM injections, there was no difference in the number of vertigo spells per month between Groups I and II. However, the hearing thresholds were higher in Group I. Hearing improvement, increase in percentage of canal paresis and induction of post-head shake nystagmus were observed after GM injections only in Group II. Even in the 11 patients who showed an improvement in hearing of more than 10 dB (hearing improvement group), percentage of canal paresis was increased after GM. More, premedication plasma vasopressin levels were lower in the hearing improvement group as compared with the hearing loss/no changes group. Four of eight patients became negative for dominant negative summating potential in electrocochleography after GM injections in the hearing improvement group. CONCLUSION: Our data indicate that the frequency of vertigo is not a key factor in the vertigo control after GM injections, that induction of vestibular damage in the injected ear is essential for the control of vertigo and this effect is mostly pronounced in patients with milder hearing loss, and that hearing improvement is not only a consequence of good vertigo control but also affected by the stress level before treatment.

Adult↗
PubMed1989

Dynamic posturography and caloric test results in patients with and without vertigo.

Patients with dizziness were evaluated with caloric stimulation and with dynamic platform posturography (Neurocom Equitest). The ability of these tests to detect abnormalities in patients with and without vertigo was assessed. In 159 patients, roughly a third had abnormal calorics while half experienced one or more "falls" during posturography. Calorics revealed proportionately more abnormalities in patients with vertigo, whereas posturography alone did not distinguish between patients with or without vertigo. Posturography did, however, identify abnormalities in a third of patients with normal calorics, regardless of their history of vertigo. Overall, more patients with vertigo had at least one abnormal test result (70%) compared with patients without vertigo (47%). We conclude that caloric abnormalities correlate with a history of vertigo, whereas posturographic deficits can be identified regardless of the presence of vertigo.

Adolescent↗
PubMed2006

Migrainous vertigo: prevalence and impact on quality of life.

OBJECTIVE: To investigate the epidemiology of migrainous vertigo (MV) in the general population by assessing prevalence, clinical features, comorbid conditions, quality of life, and health care utilization. METHODS: We screened a representative sample of the adult population in Germany (n = 4,869) for moderate or severe dizziness/vertigo and followed up with validated neurotologic telephone interviews (n = 1,003). Diagnostic criteria for MV were as follows: 1) recurrent vestibular vertigo; 2) migraine according to the International Headache Society; 3) migrainous symptoms during at least two vertiginous attacks (migrainous headache, photophobia, phonophobia, or aura symptoms); and 4) vertigo not attributed to another disorder. In a concurrent validation study (n = 61) the interviews had a sensitivity of 84% and a specificity of 94% for vestibular vertigo and 81% and 100% for migraine. RESULTS: The lifetime prevalence of MV was 0.98% (95% CI 0.70 to 1.37), the 12-month prevalence 0.89% (95% CI 0.62 to 1.27). Spontaneous rotational vertigo was reported by 67% of participants with MV while 24% had positional vertigo. Twenty-four percent always experienced headaches with their vertigo. Logistic regression analysis comparing participants with MV with dizziness-free migraineurs showed an independent association with coronary heart disease but not with sex, age, migrainous aura, education, stroke, hypertension, hyperlipidemia, body mass index, or depression. Age-adjusted health-related quality of life scores (SF-8 Health Survey) were consistently lower in participants with MV compared to dizziness-free controls. Two thirds of participants with MV had consulted a doctor but only 20% of these were diagnosed with MV. CONCLUSIONS: Migrainous vertigo is relatively common but underdiagnosed in the general population and has considerable personal and healthcare impact.

Adult↗
PubMed2003

Migraine patients with or without vertigo: comparison of clinical and electronystagmographic findings.

OBJECTIVE: To find the differences between patients with migraine with and without vertigo. STUDY DESIGN: A prospective study. SETTING: Ambulatory dizziness centre of a tertiary referral hospital. METHODS: Eighty-four patients with migraine (31 with headache, 53 with headache and vertigo) according to the diagnostic criteria of migraine published by the International Headache Society in 1988 were included in the study. Patient history, vestibular tests, electronystagmography (ENG), and imaging studies were performed for differential diagnosis. MAIN OUTCOME MEASURES: Clinical findings and ENG parameters. RESULTS: Fifty-three of 84 patients (63%) had episodic vertigo attacks. Vertigo was independent from headache in 24 patients (45%). Vertigo symptoms always appeared later in the history of migraine headache. Headache started at age 27 +/- 8.3 years and vertigo symptoms began 7.7 +/- 8.7 years later. The beginning age of the migraine and female-to-male ratio were significantly greater in the vertigo group. Fifty-eight of the 84 patients had ENG testing. Fifty-eight percent of the patients with migraine and 55% of the patients with migraine + vertigo had abnormal ENG findings. None of the tests except the Dix-Hallpike manoeuvre had a statistically significant difference between the two groups. CONCLUSION: The presence of the same ENG abnormalities in patients with pure headache shows that the vestibular pathways are also affected in these patients, even when there are no vestibular symptoms.

Adult↗
PubMed2003

Quantitative measurement of vertigo frequency: preliminary results.

Persons who experience vertigo often describe their symptoms as a sensation of oscillations. Based on such a description, a pilot study was performed to determine if the frequency of the vertigo sensation could be quantified in a manner analogous to tone matching in tinnitus treatment. Fifteen subjects were tested using a virtual image system that consisted of a head mounted display showing a scene that oscillated horizontally or vertically at an adjustable frequency. Subjects were asked to adjust the direction and frequency to match their typical vertigo sensation. Results show that most persons with chronic vertigo had symptoms that could be realistically simulated by vection induced by the oscillating scene and that matched to a consistent specific frequency. They reported an average frequency of 1.09 Hz (range 0.27 to 3.3 Hz, SD 0.25). The large majority (13 out of 15) matched to a horizontal stimulus. Subjects that gave particularly high subjective ratings of the similarity of the motion sensation (7-8 out of 10) from the vection to their vertigo had lower frequency matches (average 0.61 +/- 0.25). Repeated measurements in 4 subjects 8 to 27 days later showed consistent results. This vertigo measurement technique may be used in the future to assess the ability of vestibular rehabilitation to reduce chronic vertigo. Identification of a specific frequency of chronic vertigo may be important in the specification of rehabilitation exercises.

Adult↗
PubMed2005

[Differential diagnosis and treatment of vertigo in hypertensive patients].

AIM: To study causes of vertigo in hypertensive patients and specify approaches to its treatment. Material and methods. Prevalence and causes of vertigo were analysed in 285 patients with arterial hypertension (AH). The examination included 24-h monitoring of arterial pressure (APM) and MR-tomography of the head. RESULTS: The majority of patients (78%) hospitalized with the diagnosis "hypertensive crisis" were diagnosed to have other diseases (headaches of tension, stroke, Meniere's syndrome and disease, etc.) the development of which was accompanied with hypertension and simulated a hypertensive crisis. Vertigo occurs in 20% hypertensive patients and is unrelated to elevated blood pressure. It is rather due to associated neurological, peripheral vestibular and other diseases. APM shows that vertigo occurs in hypotension after intake of hypotensive drugs. In hypertensive patients treatment of vertigo should not be directed only to management of elevated pressure but demands treatment of underlying disease. Vertigo plus mnestic disorders are effectively corrected with tanakan in a dose 120-160 mg/day. CONCLUSION: Vertigo in hypertensive patients is not caused by elevated pressure but related with concomitant neurological or peripheral vestibular diseases as well as hypotension. Hypertensive patients with vertigo need correction of the condition causing it.

Administration, Oral↗
PubMed2005

[Clinical study on canalith repositioning procedure for benign paroxysmal positional vertigo of semicircular canal].

OBJECTIVE: To determine the effectiveness of canalith repositioning procedure for the treatment of benign paroxysmal positional vertigo (BPPV). METHOD: Medical records from two hundred and thirty cases with benign paroxysmal positional vertigo treated between January 2002 to June 2004 were analyzed retrospectively. Patients were divided into two groups,treatment group (122 cases) and control group (108 cases). Treatment group received a single treatment of canalith repositioning procedure based on the hypothesis that the vertigo and nystagmus of BPPV were due to debris floating in the long arm of the semicircular canal. Treatment outcome was analyzed after two weeks classified as cure, improvement or no change. RESULT: After a single treatment of canalith repositioning procedure, the vertigo and nystagmus in 88 cases of treatment group immediately or gradually disappeared in 1-2 weeks, 18 cases improved, 16 cases got no effect. Complete remission of vertigo and nystagmus was found in 72.1%, the total improvement rate was 86.9%. The vertigo and nystagmus in 51 cases of control group immediately disappeared in 1-2 weeks, 23 cases improved, 34 cases got no effect. Complete remission of vertigo and nystagmus was found in 47.2%, the total improvement rate was 68.5%, and the difference between groups was very significant (P < 0.001, P < 0.01). CONCLUSION: The canalith repositioning procedure was effective for most patients with benign paroxysmal positional vertigo and can be recommended as the first-line treatment modality.

Adult↗
PubMed1990

Vertigo and object relationship.

Vertigo appeared to me in analysis to be an expression of separation anxiety; we can observe the vicissitudes of the object relationship by way of the development of this symptom in the treatment. I identify different forms of vertigo according to the particular stage reached by the patient, from fusion-related vertigo via vertigo about being dropped, vertigo associated with aspiration, vertigo connected with the alternation of prison and escape and vertigo related to the attraction of the void, to competition-related vertigo which appears in an oedipal context. They correspond to different moments in the constitution of relational space: first, the two-dimensional world in which even the void is inconceivable; then, the sensation of the void manifesting a disavowal of the absence of relationship; next, the constitution of a three-dimensional space in which the patient initially feels carried by the object but then discovers that he can carry himself; and, finally, the constitution of the internal space which allows internalization of the feeling of 'buoyancy'.

Adult↗
PubMed1996

Characteristics of six otologic diseases involving vertigo.

To characterize otologic causes for vertigo, data on 564 patients with the six most common diseases involving vertigo were retrieved from the database of a computer-aided diagnostic system for neurotologic diseases. The diseases were Meniere's disease, vestibular schwannoma, benign paroxysmal positional vertigo, vestibular neuritis, sudden deafness, and traumatic vertigo. The prevalence of tinnitus in the study population was 76%. The most severe forms of vertigo and nausea were found in vestibular neuritis, whereas the most severe case of tinnitus appeared in Meniere's disease. Of the patients with vestibular schwannoma, 49% had had vertigo. A linear discrimination analysis using case history classified 90% of the patients into correct groups. The key questions discriminating between the diseases concerned the frequency and duration of vertigo attacks, the duration of hearing loss and vertigo, and the occurrence of head injury. Making a correct diagnosis during the first office visit can be difficult, especially for sudden deafness, vestibular schwannoma, and Meniere's disease. Neurotologic and audiometric information was of minor value in distinguishing between these six diseases. Vestibular schwannoma had significantly greater asymmetry in electronystagmography and smaller gains in smooth pursuit in comparison with the other disease. Factorial analysis did not aid the clustering of these diseases.

Adolescent↗
PubMed1989

[Surgical and physical therapy treatment of benign paroxysmal positional vertigo].

Two treatments for the benign paroxysmal positional vertigo are presented and evaluated in this article. The first type of treatment is the surgical section of the posterior ampullary nerve according to Gacek and the second is physiotherapeutic by the manoeuvre of Semont. The section of the posterior ampullary nerve has been realised between 1980 and 1986 on 5 patients suffering from persistent and disabling positional vertigo. All 5 patients were relieved from their vertigo immediately after the operation. One patient developed a post-operative hearing loss. The physiotherapeutic manoeuvre of Semont, which has been developed in order to liberate otolithic deposits from the cupula of the posterior semi-circular canal is applied in our clinic since 1985 as treatment of the benign paroxysmal positional vertigo. The efficiency of the manoeuvre was tested at first in a retrospective study on 50 patients. A single manoeuvre cured 20 of these patients and 15 others were cured after a second manoeuvre. Then, a controlled and prospective study was performed: the clinical course of 40 patients without treatment was compared with 37 patients treated with Semont's manoeuvre. In the group of patients without treatment, only 17 were spontaneously cured from their positional vertigo after 18 days of evolution. In the group treated by Semont's manoeuvre 19 patients were completely healed from vertigo and 16 others were greatly improved. On the basis of these favourable results the authors recommend to treat all cases of paroxysmal positional vertigo at first with Semont's manoeuvre. The section of the posterior ampullary nerve should be restricted to the rare cases with persistent and disabling vertigo.(ABSTRACT TRUNCATED AT 250 WORDS)

Follow-Up Studies↗
PubMed2026

Genetic Association Between Sleep Traits and Vertigo Risk: A Two-sample Bidirectional Mendelian Randomization Study.

BACKGROUND: Observational studies suggest the potential association between sleep traits and vertigo; however, causal evidence remains limited. OBJECTIVE: This study aimed to explore the relationship between genetically predicted sleep traits and vertigo with the Mendelian randomization (MR) method. METHODS: Instrumental variables for sleep traits (snoring, sleep duration, insomnia, daytime sleepiness, daytime napping, and chronotype) were adopted from genomewide association studies (GWAS) data of European ancestry from UK Biobank. The summary-level datasets of vertigo were retrieved from the GWAS of FinnGen. Inversevariance weighted (IVW) method was adopted as the main analysis. RESULTS: IVW analysis revealed a significant association between genetically predicted daytime napping (OR = 1.51, 95% CI =1.08-2.12, P = 0.016) and chronotype (OR = 1.13, 95% CI =1.01-1.26, P = 0.033), both of which were associated with an increased risk of vertigo. However, we did not find evidence for a causal effect of snoring, overall sleep duration, long sleep duration, short sleep duration, insomnia, and excessive daytime sleepiness on vertigo. No reverse causality was detected. CONCLUSION: Our findings suggest that abnormal sleep patterns may serve as risk factors for vertigo disorders and offer opportunities for the prevention and management of vertigo disorders.

Humans↗
PubMed1993

Single treatment approaches to benign paroxysmal positional vertigo.

OBJECTIVE: To determine the effectiveness of two different physical therapy approaches for benign paroxysmal positional vertigo. DESIGN: Randomized study. SETTING: Outpatient clinic. PATIENTS: Consecutive sample of 60 patients with benign paroxysmal positional vertigo. INTERVENTION: Patients received either a single treatment based on the hypothesis that the vertigo and nystagmus of benign paroxysmal positional vertigo are due to debris adhering to the cupula of the posterior semicircular canal (cupulolithiasis) or a single treatment based on the hypothesis that the debris is free floating in the long arm of the posterior canal (canalithiasis). Patients were reevaluated 1 to 2 weeks after the treatment and again 4 to 6 months later. OUTCOME: Treatment outcome was classified as either asymptomatic, more than 70% improved as rated by the patient, or no change. RESULTS: The treatment designed for cupulolithaisis resulted in remission of vertigo and nystagmus in 70% of the patients and in improvement of the symptoms in another 20%. The treatment designed for canalithiasis resulted in remission of vertigo and nystagmus in 57% of the patients and in improvement in another 33%. There was no statistically significant difference between treatments. CONCLUSIONS: These single-treatment approaches are equally effective treatments for benign paroxysmal positional vertigo. Further studies are needed to look at the long-term effectiveness of these treatments.

Adult↗