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Home-based Vestibular Rehabilitation: A Feasible and Effective Therapy for Persistent Postural Perceptual Dizziness (A Pilot Study)

Teh CS, Abdullah NA, Kamaruddin NR, Mohd Judi KB, Fadzilah I, Zainun Z, et al.

Ann Otol Rhinol Laryngol, 2023 May;132(5):566-577.
PMID: 35794811 DOI: 10.1177/00034894221111408

INTRODUCTION: Persistent postural-perceptual dizziness (PPPD) is a chronic functional vestibular disorder where there is persistent dizziness or unsteadiness occurring on most days for more than 3 months duration. Treatment recommendations for PPPD include vestibular rehabilitation therapy (VRT) with or without medications and/or cognitive behavioral therapy.
OBJECTIVES: This paper is a pilot study designed to compare the effects of Bal Ex as a home-based VRT on the quality of life (EQ-5D), dizziness handicap (DHI) and mental health (DASS-21) against hospital-based VRT.
DESIGN: This was an assessor-blinded, randomized controlled pilot study where PPPD patients were randomly selected to undergo Bal Ex, the home-based VRT (intervention group) or hospital-based (control group) VRT. The participants were reviewed at 4 weeks and 12 weeks after the start of therapy to assess the primary endpoints using the subjective improvement in symptoms as reported by patients, changes in DHI scores, DASS-21 scores and EQ5D VAS scores.
RESULTS: Thirty PPPD patients successfully completed the study with 15 in each study group. Within 4 weeks, there were significant improvements in the total DHI scores as well as anxiety levels. By the end of 12 weeks, there were significant improvements in the DHI, DASS-21 and EQ5D. The degree of improvement between Bal Ex and the control was comparable.
CONCLUSION: VRT is an effective modality in significantly improving quality of life, dizziness handicap, depression, and anxiety levels within 3 months in PPPD. Preliminary results show Bal Ex is as effective as hospital-based VRT and should be considered as a treatment option for PPPD.

Matched MeSH terms: Vestibular Diseases*
An unusual case of bilateral vestibulopathy, chronic subjective dizziness and spondyloarthropathy

Wong RS, Abdul Kadir SY

Gen Hosp Psychiatry, 2015 Jul-Aug;37(4):372.e3-4.
PMID: 25840702 DOI: 10.1016/j.genhosppsych.2015.03.011

Vertigo and dizziness are two common symptoms seen in everyday practice. However, in some cases, making a diagnosis can be challenging. This case report shows the relevance of a careful psychiatric history, which led to the diagnosis of chronic subjective dizziness associated with bilateral peripheral vestibulopathy.

Matched MeSH terms: Vestibular Diseases/complications
Fulltext Clinical use of Malay Version of Vertigo Symptom Scale (MWSS) in patients with peripheral vestibular disorder (PVD)

Zainun Z, Zakaria MN, Sidek D, Ismail Z

Med J Malaysia, 2012 Aug;67(4):386-9.
PMID: 23082446

The Vertigo symptom scale (VSS) is a well established tool for the evaluation of vestibular disorders and the associated symptoms of autonomic arousal and somatosensation. By using a validated Malay version of vertigo symptom scale (MVVSS) questionnaire, the severity of the vertigo from patients' perspective can be determined and rated. Before MVVSS can be applied clinically among Malaysians, it was of interest to determine its clinical value in identifying vestibular disorders.

Matched MeSH terms: Vestibular Diseases/diagnosis*; Vestibular Diseases/physiopathology
Fulltext Considerations when Analyzing Vestibular Evoked Myogenic Potential (VEMP) Outcomes Elicited by Chirp Stimulus in Healthy Participants

Zakaria MN, Zainun Z, Cheu Lih A

J Int Adv Otol, 2015 Dec;11(3):271-2.
PMID: 26915164 DOI: 10.5152/iao.2015.1703
Matched MeSH terms: Vestibular Diseases/diagnosis*
Fulltext Sensitivity and specificity of vestibular evoked myogenic potential elicited by different tone bursts to diagnose peripheral vestibular disordered

Zuraida Zainun, Mohd Normani Zakaria, Din Suhaimi Sidek, Zalina Ismail

Malaysian Journal of Medicine and Health Sciences, 2014;10(2):9-17.
MyJurnal

Peripheral vestibular disorder (PVD) is serious and common. Clinically, giving an accurate diagnosis of PVD can be challenging. Vestibular evoked myogenic potential (VEMP) is an objective test to evaluate the integrity of vestibular organs, particularly saccule and/or inferior vestibular nerve. This study was performed to determine the sensitivity and specificity of VEMP using different stimuli. Fourty normal and 65 PVD subjects who fulfilled the inclusion criteria were recruited. While sitting comfortably, VEMP waveforms were recorded with active electrode on sternocleidomastoid muscle and negative electrode on upper forehead. Tone bursts (500, 750 and 1000 Hz) were delivered via headphones at 90 dBnHL and 5/s presentation rate. VEMP parameters for each stimulus (amplitude and latency of P1 and N1 peak) were analyzed accordingly. Receiver operating characteristic (ROC) was performed to determine the sensitivity and specificity of VEMP at different test frequencies. N1 amplitude of 750 Hz stimulus produced the most ideal sensitivity (65% on right and 63% on left) and specificity (83% on right and 78% on left). The importance of using a few tone bursts in VEMP test in order to minimize the false negative in cases might be encountered in clinics as the certain tone burst had inadequate sensitivity in detecting PVD cases. The 750 Hz stimulus produced the most ideal VEMP with adequate values of sensitivity and specificity, at least in this study.

Matched MeSH terms: Vestibular Diseases
Fulltext Comprehensive screening shows that mutations in the known syndromic genes are rare in infants presenting with hyperinsulinaemic hypoglycaemia

Laver TW, Wakeling MN, Hua JHY, Houghton JAL, Hussain K, Ellard S, et al.

Clin Endocrinol (Oxf), 2018 Nov;89(5):621-627.
PMID: 30238501 DOI: 10.1111/cen.13841

OBJECTIVE: Hyperinsulinaemic hypoglycaemia (HH) can occur in isolation or more rarely feature as part of a syndrome. Screening for mutations in the "syndromic" HH genes is guided by phenotype with genetic testing used to confirm the clinical diagnosis. As HH can be the presenting feature of a syndrome, it is possible that mutations will be missed as these genes are not routinely screened in all newly diagnosed individuals. We investigated the frequency of pathogenic variants in syndromic genes in infants with HH who had not been clinically diagnosed with a syndromic disorder at referral for genetic testing.
DESIGN: We used genome sequencing data to assess the prevalence of mutations in syndromic HH genes in an international cohort of patients with HH of unknown genetic cause.
PATIENTS: We undertook genome sequencing in 82 infants with HH without a clinical diagnosis of a known syndrome at referral for genetic testing.
MEASUREMENTS: Within this cohort, we searched for the genetic aetiologies causing 20 different syndromes where HH had been reported as a feature.
RESULTS: We identified a pathogenic KMT2D variant in a patient with HH diagnosed at birth, confirming a genetic diagnosis of Kabuki syndrome. Clinical data received following the identification of the mutation highlighted additional features consistent with the genetic diagnosis. Pathogenic variants were not identified in the remainder of the cohort.
CONCLUSIONS: Pathogenic variants in the syndromic HH genes are rare; thus, routine testing of these genes by molecular genetics laboratories is unlikely to be justified in patients without syndromic phenotypes.

Matched MeSH terms: Vestibular Diseases/genetics