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Long-term follow-up after acute unilateral vestibular loss and comparison between subjects with and without remaining symptoms
Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Neuroscience and Locomotion, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Department of Health and Society, Division of Physiotherapy. Linköping University, Faculty of Health Sciences.
Linköping University, Department of Neuroscience and Locomotion, Oto-Rhiono-Laryngology and Head & Neck Surgery. Linköping University, Faculty of Health Sciences.
2005 (English)In: Acta Oto-Laryngologica, ISSN 0001-6489, Vol. 125, no 9, 946-953 p.Article in journal (Refereed) Published
Abstract [en]

Conclusions. About half of the subjects in this study reported remaining symptoms 3–6 years after acute unilateral vestibular loss. Differences could be seen between subjects with and without remaining symptoms regarding health-related quality of life, anxiety and depression.

Objective. To evaluate the presence of self-rated remaining symptoms 3–6 years after acute unilateral vestibular loss, and to compare subjects with and without such symptoms.

Material and methods. Firstly, 51 subjects answered a questionnaire which included the EuroQol EQ-5D, the Hospital Anxiety and Depression Scale, the University of California Los Angeles Dizziness Questionnaire, visual analogue scales and the Dizziness Handicap Inventory. Secondly, nine subjects with and nine without remaining symptoms participated in an extended testing procedure, including electronystagmography (ENG), determination of vestibular-evoked myogenic potentials (VEMPs) and clinical balance tests.

Results. In the first part of the study, 27 subjects reported remaining symptoms, 3 reported 1 additional period of symptoms and 21 had not experienced any symptoms at all in the 3–6 years since acute unilateral vestibular loss. In the second part, the group with remaining symptoms rated a lower health-related quality of life and a higher level of anxiety and depression. There were no differences between the two groups in terms of ENG tests, VEMPs or clinical balance tests.

Place, publisher, year, edition, pages
2005. Vol. 125, no 9, 946-953 p.
National Category
Social Sciences
Identifiers
URN: urn:nbn:se:liu:diva-29392DOI: 10.1080/00016480510043477Local ID: 14726OAI: oai:DiVA.org:liu-29392DiVA: diva2:250206
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2012-09-27Bibliographically approved
In thesis
1. Vestibular rehabilitation therapy in dizziness and disequilibrium
Open this publication in new window or tab >>Vestibular rehabilitation therapy in dizziness and disequilibrium
2005 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Dizziness and disequilibrium can be caused by several dysfunctions within the balance system, and are common symptoms especially in higher ages. The general aim of this thesis was to evaluate the effects of vestibular rehabilitation therapy in patients with dizziness and disequilibrium, and to examine the influence of age, vestibular function and psychological aspects on recovery.

Four study samples were included in the thesis: physically active elderly, central vestibular dysfunction (CVD), acute unilateral vestibular loss (AUVL), and in the last study both AUVL and CVD. The measurements static and dynamic clinical balance tests, V AS, EuroQol, Hospital Anxiety and Depression Scale, UCLA Dizziness Questionnaire, Dizziness Handicap Inventory, Dizziness Beliefs Scale, electronystagmography, vestibular-evoked myogenic potentials, and computerized dynamic posturography were used.

The change in balance performance over a 7-year period was evaluated in 17 physically active elderly. Both static clinical balance tests and maximum walking speed showed impaired balance. The amount of sway measured by computerized dynamic posturography had not changed, but increased latencies of force response to sudden backward translations of the platform were seen.

The effects of balance training were evaluated in 23 elderly patients with dizziness and disequilibrium caused by CVD. Patients were randomized to exercise group or control group. The exercise group received group balance training twice a week for eight weeks. Improvements were seen only in the exercise group in clinical balance tests, dynamic posturography, maximum walking speed and subjective ratings.

The effects of home training with and without additional individualized physical therapy were evaluated in a randomized controlled study of 54 patients during six months after AUVL. Similar recovery was seen in the two training groups. Higher age correlated with worse performance on clinical balance tests on follow-ups but not with change over time. Higher age also correlated with higher subjective ratings of vertigo at the six-month follow-up. Greater caloric vestibular asymmetry correlated with worse performance on clinical balance tests and higher subjective ratings.

In a long-term follow-up after 3-6 years, about half of the patients reported residual symptoms after the AUVL. Patients with and without reported symptoms differed with respect to health-related quality of life, anxiety and depression, but not in clinical balance tests, electronystagmography or vestibular-evoked myogenic potentials.

The test-retest and inter-rater reliability of, and the relationships between, clinical balance tests and subjective ratings and questionnaires were assessed in 50 patients with residual symptoms of dizziness and disequilibrium after AUVL or CVD. Sharpened Romberg's test with eyes closed, standing on foam with eyes closed, standing on one leg with eyes open, and walking in a figure-of-eight were the most reliable and appropriate clinical balance tests. Clinical balance tests were seldom correlated with subjective ratings and questionnaires, which shows the importance of measuring both aspects of dizziness and disequilibrium.

In conclusion, balance performance deteriorates with aging, vestibular rehabilitation therapy may improve balance and decrease symptoms of dizziness and disequilibrium, and it is important to use clinical balance tests together with subjective ratings and questionnaires in these patients.

Place, publisher, year, edition, pages
Linköping: Linköpings universitet, 2005. 73 p.
Series
Linköping University Medical Dissertations, ISSN 0345-0082 ; 914
Keyword
vestibular, dizziness, disequilibrium
National Category
Social Sciences
Identifiers
urn:nbn:se:liu:diva-31947 (URN)17782 (Local ID)91-85299-27-8 (ISBN)17782 (Archive number)17782 (OAI)
Public defence
2005-10-28, Berzeliussalen, Hälsouniversitetet (Ingång 65), Campus US, Linköpings Universitet, Linköping, 09:00 (Swedish)
Opponent
Available from: 2009-10-09 Created: 2009-10-09 Last updated: 2012-09-27Bibliographically approved

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Kammerlind, Ann-SofiLedin, TorbjörnSkargren, ElisabethÖdkvist, Lars

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