Advancements in Functional Magnetic Resonance Imaging for Persistent Postural-Perceptual Dizziness

Persistent postural-perceptual dizziness, defined in 2017, is a chronic functional vestibular disorder. Which is characterized by persistent dizziness, unsteadiness, and/or non-spinning vertigo. However, the exact mechanisms remain unclear. In recent years, FMRI studies have provided key insights into the pathogenesis of PPPD. This review summarized functional imaging studies of persistent postural dizziness and its predecessors in recent years and found changes in the activity and functional connectivity of important areas of visual processing, multisensory vestibular and spatial cognition in patients with PPPD. In addition, factors such as stimulation mode, personality traits, mental comorbidities and external vestibular lesions have important effects on brain functional activities and connectivity patterns, and further stratified studies on these factors are needed in the future to further clarify and draw exact conclusions on the pathological mechanism of PPPD.

短期针刺治疗良性阵发性位置性眩晕复位后残余头晕的研究

目的观察短期针刺治疗良性阵发性位置性眩晕(BPPV)手法复位成功后残余头晕(residual dizziness,RD)症状的临床疗效。方法对手法复位成功后存在RD症状的BPPV患者80例,随机分为针刺组和对照组,每组40例。治疗组予短期针刺治疗,主穴为晕听区、平衡区等。常规针刺,留针30 min,1次/d,3次为一个疗程。对照组仅予以随访观察。分别于治疗前及治疗后第1、4周对两组患者进行眩晕障碍量表(dizziness handicap inventory,DHI)中文版及视觉模拟尺量表(VAS)评分,比较两组结果。结果治疗后第1周,除对照组中DHI情绪评分项目外,针刺组和对照组治疗后DHI各项评分、总分、VAS评分均较治疗前降低(P<0.05);治疗后第4周,针刺组和对照组治疗后DHI各项评分、总分、VAS评分均较治疗前及治疗后第1周降低(P<0.05);治疗后第1周,治疗组的DHI情绪、DHI功能评分、总分、VAS评分均低于对照组(P<0.05);治疗后第4周,治疗组的DHI功能评分及总分均低于对照组(P<0.05)。结论短期中医针刺治疗能有效减轻BPPV复位成功后的RD症状,尤其在发病后短期内能有效缓解患者头晕症状。

Implementation outcomes of a sensory integration therapy program with computerized dynamic posturography in patients with balance and sensory dysfunction

Objective:We describe the first-year implementation experience of an Instrumented Sensory Integration Therapy Program in Audiological&Balance Center patients.Design:This is a retrospective descriptive study.Participants included Seventy-three adults with diagnoses of acute,episodic,or chronic vestibular syndromes.They were classified into the following two groups:group 1 included 46 individuals treated with ISIT plus VRT,and group 2 included 27 individuals treated only with ISIT.Results:The Sensory Organization Test(SOT)for both groups showed a statistical significance for all three sensory inputs;visual systems(G1:p=0.0003;G2:p=0.0337),vestibular system(G1:p<0.0001;G2:p=0.0003),and balance as demonstrated by compound balance score(G1:p<0.0001;G2:p=0.0035),and balance percentage deficit(G1:p<0.0001;G2:p=0.0078).Conclusions:The severity and complexity of functional neurological disorders in the context of vestibular syndromes seem to require between 10 and 20 therapy sessions,and combined ISIT plus VRT appears to be more effective than ISIT as a monotherapy.

以头晕为首发表现的遗传性尿素循环障碍特点分析

作为一名耳内科医师,经常会听到头晕、头昏及眩晕等众多主诉,患者常常难以明确描述其临床症状。眩晕分为广义和狭义两大类。广义的眩晕(dizziness)指非前庭系统性眩晕或头昏;狭义的眩晕(vertigo)指前庭系统性眩晕,是由于生理或病理性刺激引起患者有外物转动的错觉,是一种空间定位障碍产生的运动错觉,即人体与周围环境之间的相互空间关系在皮层感觉中枢的反应出现失真[1]。尿素循环障碍(urea cycle disorders,UCDs)是一组由于先天酶缺陷引发的以高血氨为特征的代谢性疾病,严重者在新生儿阶段就可以出现拒食、嗜睡、呕吐、抽搐、

尼麦角林治疗椎-基底动脉缺血性眩晕疗效观察

目的：探讨尼麦角林对椎-基底动脉缺血性眩晕的临床疗效。方法：治疗组用尼麦角林6mg加入0．9％生理盐水100ml静脉滴注，每日一次，共用2w。对照组用维脑路通100ml静脉滴注每日一次，共用2w。其他口服药相同。结果：治疗组30例，显效8例，有效21例，无效1例，总有效率为97％；对照组30例，显效8例，有效15例，无效7例，总有效率78％。结论：尼麦角林能显著改善椎一基底动脉缺血性眩晕的症状，其疗效肯定，且未见不良反应，因此，尼麦角林可作为治疗的首选药物之一。

Angioplasty and stenting for severe vertebral artery orifice stenosis: effects on cerebellar function remodeling verified by blood oxygen level-dependent functional magnetic resonance imaging

Vertebral artery orifice stenting may improve blood supply of the posterior circulation of the brain to regions such as the cerebellum and brainstem. However, previous studies have mainly focused on recovery of cerebral blood flow and perfusion in the posterior circulation after interventional therapy. This study examined the effects of functional recovery of local brain tissue on cerebellar function remodeling using blood oxygen level-dependent functional magnetic reso- nance imaging before and after interventional therapy. A total of 40 Chinese patients with severe unilateral vertebral artery orifice stenosis were enrolled in this study. Patients were equally and randomly assigned to intervention and control groups. The control group received drug treat- ment only. The intervention group received vertebral artery orifice angioplasty and stenting ＋ identical drug treatment to the control group. At 13 days after treatment, the Dizziness Handicap Inventory score was compared between the intervention and control groups. Cerebellar function remodeling was observed between the two groups using blood oxygen level-dependent functional magnetic resonance imaging. The improvement in dizziness handicap and cerebellar function was more obvious in the intervention group than in the control group. Interventional therapy for severe vertebral artery orifice stenosis may effectively promote cerebellar function remodeling and exert neuroprotective effects.

Applications of dynamic visual acuity test in clinical ophthalmology

Dynamic visual acuity test(DVAT)plays a key role in the assessment of vestibular function,the visual function of athletes,as well as various ocular diseases.As the visual pathways conducting dynamic and static signals are different,DVATs may have potential advantages over the traditional visual acuity tests commonly used,such as static visual acuity,contrast sensitivity,and static perimetry.Here,we provide a review of commonly applied DVATs and their several uses in clinical ophthalmology.These data indicate that the DVAT has its unique clinical significance in the evaluation of several ocular disorders.

Normative data for TM electrocochleography measures

Objective: Establish normative data for tympanic electrocochleography(TM ECoch G) parameters in normal hearing adults without Meniere's disease's(MD) symptoms. Describe TM ECoch G variables that help to distinguish normal from MD ears.Material and methods: We enrolled 100 subjects(N =200 ears), 59 females, aged between 19 and 71 years from 09/2010 to 04/2014. Inclusion criteria: normal otomicroscopy, hearing thresholds≤25 dB nHL from 250 to 4000 Hz, normal tympanogram, no symptoms of MD according to the AAO-HNS 1995 criteria and Gibson's score <7. We excluded subjects with dizziness, aural fullness or other symptoms of endolymphatic hydrops. The following parameters were analyzed: SP/AP amplitude ratio, SP/AP area ratio and the difference between AP latency with rarefaction and condensation stimuli.Results: There was no significant difference between right and left ears(Intraclass correlation coefficient < 0.6). SP/AP amplitude ratio varied between 0.084 and 0.356 and SP/AP area ratio between 0.837 and 1.671(percentiles 5 and 95). The AP latency difference to rarefaction and condensation clicks was between 0.0 and 0.333 ms.Conclusion: Normative data for TM ECoch G parameters were established in 100 normal hearing subjects without MD. These data can be used to distinguish normal from pathological findings and in follow-up of MD patients.

Electromagnetic Waves Collected by a Dental Amalgam Filling Induced Balance Dysregulation and Dizziness over a Period Exceeding 10 Years

This case report describes a woman aged approximately 50 years who has suffered from balance dysregulation and dizziness for more than 10 years. Although the subject underwent several examinations to confirm the etiology of her symptoms, the root cause remained unknown. The symptoms were thought to be caused by electromagnetic wave hypersensitivity because the subject experienced uneasiness and dizziness when a cell phone was held close to her body. A cell phone was used to diagnose the collection of harmful electromagnetic waves, and an amalgam filling was determined to be the cause. The amalgam filling was removed under strict protection, and the subject’s symptoms completely disappeared soon after the filling was removed.

Cervical intervertebral disc degeneration and dizziness

Clinical studies have found that patients withcervical degenerative disease are usually accompanied by dizziness.Anterior cervical surgery can eliminate not only chronic neck pain,cervical radiculopathy or myelopathy,but also dizziness.Immunohistochemical studies show that a large number of mechanoreceptors,especially Ruffini corpuscles,are present in degenerated cervical discs.The available evidence suggests a key role of Ruffini corpuscles in the pathogenesis of dizziness caused by cervical degenerative disease(i.e.cervical discogenic dizziness).Disc degeneration is characterized by an elevation of inflammatory cytokines,which stimulates the mechanoreceptors in degenerated discs and results in peripheral sensitization.Abnormal cervical proprioceptive inputs from the mechanoreceptors are transmitted to the central nervous system,resulting in sensory mismatches with vestibular and visual information and leads to dizziness.In addition,neck pain caused by cervical disc degeneration can play a key role in cervical discogenic dizziness by increasing the sensitivity of muscle spindles.Like cervical discogenic pain,the diagnosis of cervical discogenic dizziness can be challenging and can be made only after other potential causes of dizziness have been ruled out.Conservative treatment is effective for the majority of patients.Existing basic and clinical studies have shown that cervical intervertebral disc degeneration can lead to dizziness.

Effects of Kampo medicine hangebyakujutsutemmato on persistent postural-perceptual dizziness:A retrospective pilot study

BACKGROUND Persistent postural-perceptual dizziness(PPPD)is a functional disorder,typically preceded by acute vestibular disorders.It is characterized by a shift in processing spatial orientation information,to favor visual over vestibular and somatosensory inputs,and a failure of higher cortical mechanisms.To date,no therapies for PPPD have been approved.Kampo medicine hangebyakujutsutemmato(HBT)has been reported to alleviate disturbances of equilibrium.We hypothesized that HBT would be a beneficial treatment for PPPD.AIM To examine the efficacy of HBT for the treatment of PPPD.METHODS Patients with PPPD were enrolled and divided into two groups:The HBT group(n=24)and the non-HBT group(n=14).The participants completed questionnaire surveys[Niigata PPPD questionnaire(NPQ),dizziness handicap inventory,hospital anxiety and depression scale(HADS),orthostatic dysregulation questionnaire,pittsburg sleep quality index(PSQI),and motion sickness scores]before and after HBT treatment.Additionally,to identify HBT responders,multivariate regression analysis was performed using the results of the ques-tionnaire surveys and equilibrium tests;including stabilometry,and caloric,vestibular evoked myogenic response,and head-up tilt tests.RESULTS Thirty-eight outpatients were included in this study,of which 14 patients(3 men,11 women;mean age,63.5±15.9 years)received treatment without HBT,and 24(1 man,23 women;mean age,58.2±18.7 years)received combination treatment with HBT.Following HBT treatment,NPQ scores decreased significantly(baseline 40.1±10.0 vs 2 mo 24.6±17.7,P<0.001).No statistically significant changes were observed in the NPQ scores in the non-HBT group(baseline 38.6±12.2 vs 2 mo 39.4±14.4,P=0.92).Multivariable regression analysis revealed that the results of stabilometry(P=0.02)and the caloric(P=0.03),and head-up tilt tests(P<0.001),HADS(P=0.003),and PSQI(P=0.01)were associated with HBT responsiveness in PPPD patients.CONCLUSION HBT may be an effective adjunct therapy for PPPD.Patients with autonomic dysfunction,unstable balance,semicircular canal paresis,anxiety,and poor sleep quality may be high responders to HBT.

Clinical Application of Blood-letting Therapy

Blood-letting therapy is extensively used in acupuncture clinic. In recent years, the author has applied blood-letting therapy to treat various kinds of diseases, with satisfactory therapeutic results reported in the following.

Traditional Chinese Medicine Nursing Protocols for Sudden Deafness( Sudden Sensorineural Hearing Loss)

Sudden deafness is one of the commonest acute symptoms in otolaryngology.In recent years,the incidence of sudden deafness is on the rise all over the world,but its etiology is still unclear,and the prognosis is greatly different.Traditional Chinese medicine(TCM)believes that the onset of sudden deafness is related to the liver,gallbladder,heart and triple energizer meridians.This article mainly explored the key points of common syndromes,TCM nursing methods and health guidance of sudden deafness.

Dental Treatment for Dizziness and Joint Mobility Disorder Caused by Harmful Electromagnetic Waves

With the development of an IT (Information Technology) society, the opportunity to use electronic devices, such as cell phones and personal computers, has increased. These electronic devices pro-vide many benefits to society. However, there have been a number of reports of electromagnetic hypersensitivity (EHS) related to the use of electronic devices. The symptoms of EHS may include headaches, fatigue, tinnitus, dizziness, memory loss, irregular heartbeat, and skin trouble. Since the pathogenic mechanism of such conditions is not yet clear, further research is required. This report shows how a subject’s dizziness and joint mobility disorder, caused by electromagnetic waves emitted by electronic devices, were cured by removing an onlay from the patient’s mouth and replacing it with a gold alloy onlay. The result indicates that the subject’s symptoms were caused by EHS. Although the symptoms were improved after the dental treatment, the underlying mechanism of the symptoms and the reason why this treatment is successful remain unclear. Further research is required to clarify these issues.

Standardized Ginkgo Biloba Extract in the Treatment of Vertigo and/or Tinnitus: A Review of the Literature

Standardized Ginkgo biloba extract (GBE) is an established herbal treatment used for a variety of indications, including vertigo and/or tinnitus. The evidence base in human clinical studies for a clear benefit of GBE in vertigo and/or tinnitus is limited and contradictory due to poor reporting as well as variations in study quality and outcome measures used. The aim of this review is to identify and discuss the rationale for using GBE in the treatment of vertigo and/or tinnitus based on the known pleiotropic actions of GBE and the pathophysiology of vertigo and/or tinnitus. The rationale will be substantiated by a review of the literature in order to identify and evaluate clinical trials investigating the efficacy of GBE in individuals with vertigo and/or tinnitus. The review identified randomized controlled trials (RCTs) investigating the effectiveness of GBE in vertigo and/or tinnitus published in PubMed up to 1st January 2020. In total, 17 RCTs were included 8 of the 9 studies investigating tinnitus and/or vertigo/dizziness found improvements, and 6 of 8 included studies investigating solely tinnitus showed positive effects. Based on the known mechanisms of action of GBE as well as evidence from animal models and human clinical trials identified in this review, GBE is a rational alternative treatment that might provide benefits to individuals with vertigo and/or tinnitus. However, further well-defined RCTs in patients with defined pathological entities are necessary to further substantiate the beneficial effects of GBE for vertigo and/or tinnitus.

Association between Hearing Loss and Vestibular Disorders: A Review of the Interference of Hearing in the Balance

Introduction: Dizziness is very prevalent and makes a great impact on people’s life. Because of anatomical and functional similarities of hearing and vestibular systems, it is noted that there is a big relation between hearing loss and vestibular disorders. Depending on the age onset of hearing loss, it can cause even delay on motor development. Objective: To find literature that demonstrates the relation between hearing and balance. Confirming that hearing loss or even intervention to improve quality of hearing can interfere on vestibular system. Methodology: Revision of literature was carried out, preferring recent research only in English. Conclusion: Cochlea and vestibular systems have a close relationship;changes in one of them can cause big damage in the other. So, a complete evaluation of vestibular system is recommended before ear surgeries. Video Head Impulse Test is a new procedure able to evaluate high frequency movements of the head. It was an additional exam of vestibular status and came to help detect problems that were not diagnosed before. Efforts must be directed in order to protect the balance.

Identification of early-stage Meniere’s disease as a cause of unilateral tinnitus

Introduction:Meniere’s disease(MD)is characterized by episodic symptoms,including vertigo,hearing loss,and tinnitus.Objectives:in this study,cases of unilateral tinnitus were investigated for MD.Method:Twenty-two patients who presented with chronic unilateral tinnitus on puretone audiograms showing an average threshold better than 25 dB HL and thresholds in the lower frequencies worse than those in the higher frequencies by more than 10 dB were suspected to have early-stage MD and underwent electrocochleography(ECochG).Patients showing ECochG findings conclusive for MD were compared to a control group of patients presenting with chronic unilateral tinnitus on pure-tone audiograms showing an average threshold better than 25 dB and thresholds in the higher frequencies worse than those in the lower frequencies by more than 10 dB.Results:Eighteen of the 22 patients included in this study showed elevated summating potential amplitude to action potential amplitude ratios in ECochG(suggestive of endolymphatic hydrops due to MD)and were followed up for 2 months;14 of them experienced at least two attacks of vertigo or unsteadiness.In contrast,only one patient in the control group reported two or more attacks of vertigo or unsteadiness in the 2 month observation period.The incidence of this finding in the two groups was significantly different.Conclusion:Patients with early-stage MD can present with only unilateral tinnitus.Thus,the addition of“pure-tone audiograms showing lower-frequency thresholds worse than higher-frequency thresholds”to the probable MD category in the globally.

“Sitting-up vertigo as an expression of posterior semicircular canal heavy cupula and posterior semicircular canal short arm canalolithiasis”

Background:Vestibular symptoms on sitting-up are frequent on patients seen by vestibular specialists.Recently,a benign paroxysmal positional vertigo(BPPV)variant which elicits vestibular symptoms with oculomotor evidence of posterior semicircular canal(P-SCC)cupula stimulation on sitting-up was described and named sitting-up vertigo BPPV.A periampullar restricted P-SCC canalolithiasis was proposed as a causal mechanism.Objective:To describe new mechanisms of action for the sitting-up vertigo BPPV variant.Methods:Eighteen patients with sitting-up vertigo BPPV were examined with a pre-established set of positional maneuvers and follow-up until they resolved their symptoms and clinical findings.Results:All patients showed up-beating torsional nystagmus(UBTN)and vestibular symptoms on coming up from either Dix-Hallpike(DHM)or straight head-hanging maneuver.Sixteen out of 18 patients presented a sustained UBTN with an ipsitorsional component to the tested side on half-Hallpike maneuver(HH).A slower persistent contratorsional down-beating nystagmus was found in eleven out18 patients tested on nose down position(ND).Conclusions:Persistent direction changing positional nystagmus on HH and ND positions indicative of PSCC heavy cupula was found in 11 patients.A sustained UBTN on HH with the absence of findings on ND,which is suggestive of the presence of P-SCC short arm canalolithiasis,was found on 5 patients.All patients were treated with canalith repositioning maneuvers without success,but they resolved their findings by means of Brandt-Daroff exercises.We propose P-SCC heavy cupula and P-SCC short arm canalolithiasis as two new putative mechanisms for the sitting-up vertigo BPPV variant.

Transient ventricular arrhythmia as a rare cause of dizziness during exercise:A case report

BACKGROUND Dizziness is a common symptom in adults and usually due to peripheral causes affecting semicircular canal function or central causes affecting the pons,medulla,or cerebellum.Arrhythmia is a recognized cause of dizziness in people with structural or ischemic heart disease.We report a case of exercise-induced transient ventricular tachycardia and dizziness in a man with no evidence of organic heart disease.CASE SUMMARY A 42-year-old man presented with a 6 mo history of transient exercise-induced dizziness and prodromal palpitations.The patient was otherwise asymptomatic.Physical examination,otoscopy,vestibular tests,cerebellar tests,laboratory investigations,and imaging investigations were all unremarkable.Twenty-four hour Holter monitoring revealed four episodes of transient ventricular tachycardia during exercise.The patient was started on metoprolol and subsequently underwent radiofrequency catheter ablation.The patient reported a full recovery and no dizziness during daily activities.These results were maintained at the 6 mo follow-up.CONCLUSION Ventricular tachycardia is an uncommon but potentially serious cause of dizziness.The outcome of this case illustrates the benefits of careful clinical examination and communication with specialized centers.High clinical suspicion of arrhythmia in a patient with dizziness merits consultation with a cardiologist and referral to a specialized center to ensure timely diagnosis and treatment.

Experience in Acupuncture Treatment of Dizziness and Vertigo——A Report of 3 Cases

Dizziness and vertigo is a commonly encountered disease in clinic. There has been the saying from ancient times that "there would be no dizziness if without wind", " there would be no dizziness if without phlegm", "there would be no dizziness if without deficiency", and " there would be no dizziness if without fire". However, in the author's view, the dizziness and vertigo caused by blood stasis blocking the collaterals is most commonly seen in clinic, which should deserve more attention. The following is an introduction about the author's experience in treating 3 cases of dizziness and vertigo with acupuncture.