Current diagnostic procedures for diagnosing vertigo and dizziness

Walther, Leif Erik

doi:10.3205/cto000141

Cited by 18 publications

(8 citation statements)

References 238 publications

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“…A detailed collection of medical history would be beneficial to the diagnosis of most vertigo/dizziness diseases. 15,30,31 Structured questionnaires have been proposed in the diagnostic process in the patients with vertigo and dizziness. 16,32 Recently, a 6-item questionnaire has been used in the diagnosis of BPPV with considerable accuracy.…”

Section: Discussionmentioning

confidence: 99%

“…Due to the diverse nature of vestibular disorders, as well as the traditional practices in the management of vertigo and dizziness, patients with vestibular symptoms were usually triaged either to departments of neurology, otorhinolaryngology, orthopedics, ophthalmology, or psychology before the establishment of the Clinic for Vertigo and Dizziness (CVD). With the launch of the CVD designed to integrate different disciplinary professionals to work together under a set of consensual procedures based on the current wisdom in vestibular disorder research, 15 it became possible for patients to be managed within the new one entity. This study protocol has been reviewed and approved by the Ethics Committee of Shaanxi Provincial People's Hospital.…”

Section: Clinical Settingsmentioning

confidence: 99%

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Changing Paradigm for Vertigo/Dizziness Patients: a Retrospective Before-After Study from Tertiary Hospitals in Northwestern China

Liu

et al. 2021

J GEN INTERN MED

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BACKGROUND: Single disciplinary management of patients with vertigo and dizziness is an important challenge for most physicians in China. OBJECTIVE: To assess the impact of a new paradigm of practice (Clinic for Vertigo and Dizziness, CVD) performed by a multidisciplinary team (MDT) on diagnostic spectrum, medical costs, and patient satisfaction. DESIGN: Retrospective before-after study. PARTICIPANTS: Sample of 29,793 patients with vertigo/ dizziness as primary complaint. MEASURES: Changes in diagnostic spectrum, medical costs, and patient satisfaction before and after the establishment of a CVD based on a 4-year database in three tertiary hospitals in northwestern China. KEY RESULTS: The most common diagnoses of patients with vertigo and dizziness were Meniere's disease (25.77%), cervical disease (25.00%), cerebral vascular disease (13.96%), vestibular syndrome (10.57%), and other etiologies (6.34%) before the CVD establishment. In contrast, after the CVD establishment, the most common diagnoses were BPPV (23.92%), vestibular migraine (15.83%), Meniere's disease (14.22%), CSD/PPPD (11.61%), and cerebral vascular diseases (4.45%). Extended implementation of a structured questionnaire for vertigo/dizziness and vestibular-oriented examinations (nystagmus, positional tests, HINTS) at the CVD resulted in a remarkable decline in the utility of CT/MRI and X-ray examination (p < 0.001). Meanwhile, medical costs in patients with vertigo/dizziness dropped by 11.5% (p < 0.001), with a significant improvement in patient satisfaction after the establishment of CVD (p < 0.001). CONCLUSIONS AND RELEVANCE: Our study suggested that the MDT paradigm of CVD practice may facilitate the medical management of patients with vertigo/dizziness and improve patient satisfaction.

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Section: Discussionmentioning

confidence: 99%

Section: Clinical Settingsmentioning

confidence: 99%

Changing Paradigm for Vertigo/Dizziness Patients: a Retrospective Before-After Study from Tertiary Hospitals in Northwestern China

Liu

et al. 2021

J GEN INTERN MED

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“…The unilateral paresis of a semicircular canal (SCC) can be diagnosed by a head impulse test (HIT) as a rapid and reproducible clinical tool 2 – 4 . Several studies agree that HIT combined with 2 other clinical tests (nystagmus and skew) (HINTS) could distinguish acute peripheral vertigo from central vertigo with a sensitivity of 100% and a specificity of 96%, which would be superior to the performance of early MRI 3 , 5 – 9 . A more recent publication reported that HINTS performances were higher when performed by trained neurologists in comparison to tests conducted by emergency physicians: 96.7% of sensitivity and 94.8% of specificity versus 83% and 44%, respectively.…”

Section: Introductionmentioning

confidence: 92%

“…The correct execution and interpretation of HIT is complex since it involves both a correct head movement and observational capacities 2 , 5 , 24 . The speed of the head impulse is directly related to the amplitude of the saccade and therefore influences its visibility 12 .…”

Section: Introductionmentioning

confidence: 99%

Effects of saccade delay, side of deficit, and training on detection of catch-up saccades during head-impulse test in virtual-reality-enhanced mannequin

Charlery-Adèle

Guigou

Ryard

et al. 2023

Sci Rep

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In this study, a training simulator for the examination of dizzy patients based on a virtual-reality-enhanced mannequin (VREM) was developed to evaluate the detection of catch-up saccades during head impulse test (HIT) and the effect of training in VREM. For novices (n = 35), 2 trials were conducted before and after a training session. Experts (n = 7) were submitted to an evaluation session. In each trial, a left or a right horizontal canal deficit with an overt catch-up saccade (delay between 110 and 320 ms) was randomly presented. Participants scored the difficulty in performing the maneuver, in recognizing the saccades, and the self-confidence in the diagnosis using a visual analogue scale (VAS). Saccade delay significantly influenced the performance. Training significantly improved the sensitivity in the residents (69.1% before to 97.9% after the training, p < 0.001, Fisher's exact test, n = 560 tests), surpassing experts’ performances (p < 0.001, versus 87% in experts, Fisher's exact test). The specificity also increased to the expert level (78% before to 95% after the training, and 95% in experts, p < 0.001, Fisher’s exact test). The VAS showed a decrease difficulty to execute the HIT, with an increase in the confidence after training. VREM improved the HIT execution performance and the confidence in novice practitioners.

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“…In line with general trend in clinical and research procedures (Candidi et al, 2013;Walther, 2017), a thorough clinical otoneurological examination (including pure tone audiometry and impedance, binocular electrooculography analysis with positional manoeuvres, HeadShakingTest, clinicalHead Impul-seTest[cHIT] as well as limb coordination, gait observation and Romberg stance Test) was performed to exclude those neuro-otological and/or balance multisensory disruptions possibly interfering with the following tests (Bronstein, Lempert, & Seemungal, 2010;Micarelli et al, 2016). Then, all golfers and HC subjects underwent:…”

Section: Otoneurological Testingmentioning

confidence: 99%

Visual dependency and postural control on swing performance in golf players

Micarelli

Viziano

Lanzillotta

et al. 2019

European Journal of Sport Science

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Individuals have to reweight the respective contribution of the different sources of sensorial information for regulating posture and balance, especially during fine task execution. Given the evidences indicating strategy during swing performance as associated with prioritization of task-relevant visuospatial information for skill execution, the aim of the present work is to assess differences in visual dependency (VD) and postural control in a population of expert (EXP) and non-expert (NEXP) golfers when compared with healthy subjects (HC) and to discover possible relationships between these outcomes and swing performance. Thus, 15 golfers (EXP = 7; NEXP = 8) and 32 matched HC underwent otoneurological testing including video Head Impulse Test, posturography and Rod and Disk Test (RDT). Golf players also underwent a swing session procedure, which performance was measured by means of the Flightscope X2 Dopplerradar launch monitor system. EXP subjects demonstrated significant (p < 0.05) lower values in i) counter-clockwise (CCW) and clockwise (CW) dynamic conditions when compared with both NEXP and HC subjects RDT outcome measures and ii) surface and length posturography values as compared with HC subjects. When treating golf players outcomes as 'a continuum', CCW and CW scores were found to positively correlate with both lateral distance and horizontal launch angle and to negatively correlate with spin rpm. In conclusion, the present study suggests that the highlevel of visual-independency demonstrated by EXP subjects may be functionally related in expert golfers to an effective motor strategy preferentially not referring to an inappropriate reliance on visual input.

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Current diagnostic procedures for diagnosing vertigo and dizziness

Cited by 18 publications

References 238 publications

Changing Paradigm for Vertigo/Dizziness Patients: a Retrospective Before-After Study from Tertiary Hospitals in Northwestern China

Changing Paradigm for Vertigo/Dizziness Patients: a Retrospective Before-After Study from Tertiary Hospitals in Northwestern China

Effects of saccade delay, side of deficit, and training on detection of catch-up saccades during head-impulse test in virtual-reality-enhanced mannequin

Visual dependency and postural control on swing performance in golf players

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