Clinical features of persistent postural-perceptual dizziness with isolated otolith dysfunction as revealed by VEMP and vHIT findings

Frontiers in Neurology

Neurology

Reiko Tsunoda¹  Hiroaki Fushiki¹  Takumi Kato¹  Masato Azami²  Ryozo Tanaka³  Tomohiko Kamo⁴  Hirofumi Ogihara⁵ 

[1] Otolaryngology, Mejiro University Ear Institute Clinic, Saitama, Japan;Otolaryngology, Mejiro University Ear Institute Clinic, Saitama, Japan;Department of Physical Therapy, Faculty of Health Sciences, Japan University of Health Sciences, Satte, Japan;Otolaryngology, Mejiro University Ear Institute Clinic, Saitama, Japan;Department of Physical Therapy, Faculty of Health Sciences, Mejiro University, Saitama, Japan;Otolaryngology, Mejiro University Ear Institute Clinic, Saitama, Japan;Department of Physical Therapy, Faculty of Rehabilitation, Gunma Paz University, Takasaki, Japan;Otolaryngology, Mejiro University Ear Institute Clinic, Saitama, Japan;Division of Physical Therapy, Department of Rehabilitation, Faculty of Health Sciences, Nagano University of Health and Medicine, Nagano, Japan;

关键词: persistent postural-perceptual dizziness;    vestibular evoked myogenic potentials;    isolated otolith dysfunction;    Romberg ratio;    dizziness handicap inventory;   

DOI  :  10.3389/fneur.2023.1129569

 received in 2022-12-22, accepted in 2023-02-27,  发布年份 2023

来源: Frontiers

【 摘 要 】

BackgroundPersistent postural-perceptual dizziness (PPPD) is a relatively new disease entity, with diagnostic criteria published by the Bárány Society. PPPD is often preceded by a peripheral or central vestibular disorder. It is not clear how coexisting deficits due to preceding vestibular disorders affect PPPD symptoms.ObjectiveThis study aimed to characterize the clinical features of PPPD with or without isolated otolith dysfunction using vestibular function tests.MethodsThe study included 43 patients (12 males and 31 females) who were diagnosed with PPPD and completed oculomotor-vestibular function tests. The Dizziness Handicap Inventory (DHI), Hospital Anxiety and Depression Scale (HADS), Niigata PPPD Questionnaire (NPQ), and Romberg test for stabilometry were examined. The 43 patients with PPPD were classified into four categories based on vestibular evoked myogenic potential (VEMP) and video head impulse test (vHIT) results: normal function for both semicircular canals and otoliths (normal), isolated otolith dysfunction (iOtoDys), isolated semicircular canal dysfunction (iCanalDys), and dysfunction of both otoliths and semicircular canals (OtoCanalDys).ResultsAmong the 43 patients with PPPD, the iOtoDys group was the largest (44.2%), followed by the normal group (37.2%), iCanalDys group (9.3%), and OtoCanalDys group (9.3%). Eight of the 19 iOtoDys patients showed both abnormal cVEMP and oVEMP responses unilaterally or bilaterally (both sacculus and utriculus damage type), whereas 11 showed either an abnormal cVEMP or an abnormal oVEMP response (either sacculus or utriculus damage type). In a three-group comparison of the both sacculus and utriculus damage type, the either sacculus or utriculus damage type, and the normal group, the mean total, functional, and emotional DHI scores were significantly higher for the both sacculus and utriculus damage type than for the either sacculus or utriculus damage type. The Romberg ratio, a measure of stabilometry, was significantly higher for the normal group than for the both sacculus and utriculus damage type and the sacculus or utriculus damage type in the iOtoDys group.ConclusionsThe coexistence of sacculus and utriculus damage may exacerbate dizziness symptoms in patients with PPPD. Determining the presence and extent of otolith damage in PPPD may provide useful information on the pathophysiology and treatment strategies of PPPD.

【 授权许可】

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Copyright © 2023 Azami, Fushiki, Tsunoda, Kamo, Ogihara, Tanaka and Kato.