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Objective: The aim of the present study was to investigate the effects of the February 6, 2023, earthquakes in Turkey and recurrent aftershocks on balance and post-traumatic stress in surviving victims., Methods: Our study included 1004 participants aged 18-65 years who were exposed to the February 6 earthquakes and aftershocks in Turkey. After obtaining online consent from all participants, the Vertigo Symptom Scale (VSS), the Dizziness Handicap Index (DHI), and the Posttraumatic Post-Traumatic Disorder Checklist Scale (PCL-5) were administered online, and the interactions between the variable sets were examined using a correlational screening model., Results: As a result of the structural equation model established with the observed variables, it was found that VSS total scores had a statistically significant positive effect on PCL-5 (β1 = 0.56; p = 0.001 < 0.05). In addition, statistically significant positive high-level correlations were found between VSS and DHI (cov VSS-DHI = 0.71), and a positive low level correlation with the number of days with dizziness (cov VSS-number of days with dizziness = 0.34), and a positive low level correlation with frequency of days with dizziness (cov VSS-frequency of days with dizziness = 0.37). A statistically significant positive low-level relationship was found between DHI and the number of days with dizziness (cov DHI-number of days with dizziness = 0.34) and a positive low-level correlation between DHI and the frequency of days with dizziness (cov DHI-frequency of days with dizziness = 0.29)., Conclusion: The structural equation modeling analysis showed that post-traumatic stress disorder had a significant effect on balance and dizziness., Competing Interests: Conflict of interest The authors declare that they have no conflict of interest., (Copyright © 2024. Published by Elsevier B.V.)

Persistent postural-perceptual dizziness (PPPD) is a functional neuro-otologic disorder that is the most frequent cause of chronic vestibular syndrome. The core vestibular symptoms include dizziness, unsteadiness, and non-spinning vertigo, which are exacerbated by an upright posture or walking, active or passive motion, and exposure to moving or complex visual stimuli. PPPD is mostly precipitated by acute or episodic vestibular diseases; however, its symptoms cannot be accounted for by its precipitants. PPPD is not a diagnosis of exclusion, but may coexist with other structural diseases. Thus, when diagnosing PPPD, the patient's symptoms must be explained by PPPD alone or by PPPD in combination with a structural illness. PPPD is most frequently observed at approximately 50 years of age, with a female predominance. Conventional vestibular tests do not reveal any specific signs of PPPD. However, the head roll-tilt subjective visual vertical test and gaze stability test after exposure to moving visual stimuli may detect the characteristic features of PPPD, that is, somatosensory- and visually-dependent spatial orientation, respectively. Therefore, these tests could be used as diagnostic tools for PPPD. Regarding the pathophysiology of PPPD, neuroimaging studies suggest shifts in interactions among visuo-vestibular, sensorimotor, and emotional networks, where visual inputs dominate over vestibular inputs. Postural control also shifts, leading to the stiffening of the lower body. To treat PPPD, selective serotonin reuptake inhibitors/serotonin noradrenaline reuptake inhibitors, vestibular rehabilitation, and cognitive behavioral therapy are used alone or in combination., Competing Interests: Declaration of competing interest The authors have no conflict of interest to be disclosed., (Copyright © 2023. Published by Elsevier B.V.)

Objective: A few studies have analyzed the physical activity in patients with dizziness. Levels of physical activity using 3-axial accelerometer were reported to be lower in patients with chronic dizziness compared to healthy adults. However, the sample size was small and confounding factors were not adjusted in the study. As the age, balance, anxiety, and depression likely contribute to dizziness, the contribution of physical activity to dizziness should be evaluated after adjusting for these potential confounders. We investigated the relationship between physical activity, postural stability, anxiety, and handicap in patients with dizziness using multivariate analysis., Methods: This cross-sectional study included 59 patients with dizziness. The physical activity was measured using a 3-axial accelerometer. We also assessed the Dizziness Handicap Inventory (DHI), Hospital and Anxiety and Depression Scale (HADS), and the total center of pressure path length eyes open and eyes closed (COP&#95;EO, COP&#95;EC). To be eligible for analysis, the participants were required to wear the accelerometer for at least four days, with at least 10 h/day of wear time each day., Results: There were significant differences in the light physical activity (LPA) and moderate to vigorous intensity physical activity (MVPA) between the mild (DHI ≦30) and severe (DHI > 60) groups. Factors that significantly affected the DHI&#95;T score, in order of greater β, were LPA, COP&#95;EC, female, and HADS&#95;A (β = -0.546, 0.459, 0.437, 0.239, respectively)., Conclusions: The present study demonstrated that the patients in the severe group had shorter LPA and MVPA times than that of the patients in the mild group. Additionally, LPA was associated with DHI&#95;T in patients with dizziness. Therefore, physical activity, especially LPA (e.g., activities of daily living), may need to be assessed in patients with dizziness., (Copyright © 2021. Published by Elsevier B.V.)

Objective: Irritability is an emotional stress symptom that causes or exacerbates dizziness. Antidepressants may be helpful for some conditions that are accompanied by irritability; however, they do not completely inhibit irritability. Yokukansan (YKS), a traditional Japanese herbal medicine, has been used for neurosis, insomnia, and children's irritability and night crying. The study investigated the efficacy of YKS in nystagmus in patients with chronic dizziness and irritability., Methods: Twenty-two cases with chronic dizziness and irritability were reviewed retrospectively. The patients were divided into two groups: control patients (0-7 days of treatment) and YKS-treated patients (YKS cases; >7 days of treatment). Dizziness before and during (after, in the controls) YKS treatment was evaluated by scoring the nystagmus intensity on a 5-point scale. The average scores were calculated within a maximum of 6 months before and during or after treatment. The normalized scores were also calculated. The optimal treatment regimen was calculated via receiver operating characteristic (ROC) curve analysis., Results: There were six control cases (1 male, 5 females; mean age: 59.5 years). There were 16 YKS cases (3 males, 13 females; mean age: 61.8 years). While the group mean nystagmus intensity scores significantly decreased from 1.18 to 0.73 in the YKS cases, it did not change in the control cases. The group mean of the normalized nystagmus intensity scores during treatment was 0.73 in the YKS cases. The results of the ROC curve analysis indicated the optimal cut-off period of the YKS treatment was 10 days., Conclusion: The oral administration of YKS for more than 10 days was optimal. The treatments with YKS could be a good option for the treatments of vertigo., Competing Interests: Declaration of Competing Interest No conflict of interest., (Copyright © 2021. Published by Elsevier B.V.)

Objectives: Due to its rarity and similar sound, typewriter tinnitus (TT) can be misdiagnosed as middle ear myoclonic tinnitus (MEMT). We aim to clarify the characteristics of TT compared to MEMT, and the long-term therapeutic response to carbamazepine., Methods: Fourteen patients with TT and 28 patients with MEMT were enrolled., Results: TT patients were older than MEMT patients, and their tinnitus symptoms were mostly unilateral. Tinnitus symptoms, which is associated with dizziness, facial spasm, and head motion, were more common in TT, whereas MEMT were more related to noise. Acoustic reflex decay perturbation and low loudness discomfort level were diagnostic signs in MEMT patients, while decreased level of wave II in ABR was the most reliable sign in TT patients. All TT patients exhibited partial or complete response to carbamazepine, but there was a relapse rate after withdrawal of the drug was 60%. Increase in age and longer duration of symptoms were the risk factors of relapse of TT., Conclusion: The different characteristics observed in this study will be helpful to diagnose TT and MENT. Duration of tinnitus was the most important long-term prognostic factor of the carbamazepine trial, which indicates the importance of its earlier diagnosis., Competing Interests: Declaration of Competing Interest There is no conflict of interest., (Copyright © 2020. Published by Elsevier B.V.)

Objective: The aim of the present study was to evaluate the association of neuro-otological examination, blood tests, and scoring questionnaire data with treatment-resistant intractability of persistent dizziness in Ménière's disease., Methods: We managed 1520 successive vertigo/dizziness patients at the Vertigo/Dizziness Center in Nara Medical University from May 2014 to April 2018. Five hundred and twenty-two patients were diagnosed with Ménière's disease (522/1520; 34.3%) according to the 2015 diagnostic guideline of the International Classification of Vestibular Disorders. Among the patients with Ménière's disease there were 102 with intractable rotatory vertigo attacks for more than 3-6 months (102/522; 19.5%), including 20 bilateral cases (20/102; 19.6%), and 88 with intractable unremitting floating sensation rather than rotatory vertigo attacks for more than 3-6 months (88/522; 16.9%), including 28 bilateral cases (28/88; 31.8%). Sixty out of 88 cases with intractable unremitting floating sensation were unilateral and were enrolled for hospitalization to undergo neuro-otological examinations including pure-tone audiometry (PTA), the caloric test (C-test), vestibular evoked cervical myogenic potentials (cVEMP), subjective visual vertical (SVV) test, glycerol test (G-test), electrocochleogram (ECoG), inner ear magnetic resonance imaging (ieMRI), blood tests including anti-diuretic hormone (ADH) and bone alkaline phosphatase (BAP), and self-rating questionnaires of depression score (SDS). Data are presented as positive (+) ratios of the number of patients with examination and questionnaire data outside of the normal range., Results: The ratios (+) were as follows: C-test=33.3% (20/60), cVEMP=25.0% (15/60), SVV=50.0% (30/60), G-test=55.0% (33/60), ECoG=63.3% (38/60), ieMRI=86.7% (52/60), ADH=35.0% (21/60), BAP=11.7% (7/60), and SDS=40.0% (24/60). Multivariate regression analysis revealed that the periods of persistent dizziness were significantly longer in unilateral Ménière's patients with C-test(+), SVV(+), and SDS(+) compared with those with negative findings. Additionally, the periods in bilateral cases were significantly longer than those in unilateral ones., Conclusions: Although approximately 70% of patients with Ménière's disease are usually treatable through the appropriate conservative medical therapy, the presence of canal paresis, gravity-sensitive dysfunction, neurosis/depression, and bilaterality may make the persistent dizziness intractable and may thus require additional treatments., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objective: To evaluate all five vestibular end-organ functions (lateral, anterior, posterior semicircular canal, utricule, and saccule) and to investigate the relationship between Dizziness Handicap Inventory (DHI) and vestibular functions prior to CI (cochlear implantation) and at postoperative day 3 and month 3., Methods: A total of 42 patients (age 16-70years) with normal vestibular functions preoperatively and undergoing unilateral CI were included in this prospective descriptive study. Video head impulse test (vHIT) for three semicircular canal (SSC) functions, ocular vestibular-evoked myogenic potential (oVEMP) for utricule function, cervical vestibular-evoked myogenic potential (cVEMP) for saccule function and DHI for subjective vertigo symptoms were performed prior to CI and at postoperative day 3 and month 3., Results: There was a significant impairment of vestibular function in 12 patients (28.5%) on the implantation side and significant DHI increase was observed in 13 of 42 (30.9%) patients at postoperative day 3 after CI (p<0.05). We found SSC dysfunction in 7 patients (16,6%) who underwent observation with vHIT, saccule dysfunction in 8 patients (19%) with cVEMP and utricule dysfunction in 5 patients (11.9%) with oVEMP on the operated side 3days after surgery (p<0.05). Posterior SSC functions (5 patients) were more affected than lateral SSC functions (3 patients). At postoperative month 3, six patients (14.2%) still had deteriorating results in the objective tests and significant DHI increase was continued in 4 (9.5%) patients (p<0.05). The deterioration in vHIT continued in only 1 (2.3%) patient (p>0.05). The deterioration in cVEMP continued in 5 (11.9%) patients (p<0.05). The deterioration in oVEMP continued in 2 (4.7%) patients (p>0.05). There was a significant correlation between DHI and objective vestibular tests both in the early and late postoperative period (r=0.795; p<0.05)., Conclusion: Our study showed that both canal and otolith functions can be damaged after CI especially in the early postoperative period. Surprisingly, posterior SSC functions were more affected than lateral SSC. Therefore, a gold standard vestibular test battery that can evaluate each of three SSC canals and two otoliths functions is essential. Since a single vestibular test for this purpose is not available, we recommend the use of the three available vestibular tests together. This test battery, which is capable of evaluating five vestibular end-organ functions in preoperative and postoperative vestibular evaluations, can provide more accurate results not only for CI but also for most otologic surgeries., (Copyright © 2018 Elsevier B.V. All rights reserved.)

Objectives: To provide an overview of vestibular migraines presentation, pathology, and diagnosis, as well as an update on current diagnostic criteria., Methods: A review of the most recent literature on vestibular migraines was performed., Results: Vestibular migraine is a process with significant impact on the quality of life for those afflicted with the disease, with attacks of spontaneous or positional vertigo and migraine symptoms lasting several minutes to 72h. Inner ear disease can co-exist with migraine and the vestibular symptoms occurring with vestibular migraine can mimic inner ear disorders providing a challenge for clinicians in establishing diagnosis. Recent diagnostic criteria for vestibular migraine proposed by a joint committee of the Bárány Society and the International Headache Society provide an important standard for clinical diagnosis and research endeavor., Conclusion: Vestibular migraine is a challenging disease process to both diagnose and treat. Proper diagnosis and treatment requires a thorough understanding of the current literature., (Copyright © 2017 Elsevier B.V. All rights reserved.)

Objective: To determine the relationship between Eustachian tube function and inner ear function in patulous Eustachian tube (pET)., Methods: We encountered a patient with pET accompanied by dizziness that was induced by nasal respiration. Eye movements were recorded using video-oculography, and Eustachian tube function was assessed using a Eustachian tube function analyzer. Horizontal and vertical components of pupil position were assessed to test fixation, positional, and positioning nystagmus. Impedance testing with a Eustachian tube function analyzer was performed to confirm tympanometry results. We recorded these outcomes until the patient's symptoms improved., Results: When pET improved, the patient's symptoms were alleviated., Conclusion: The present pET patient had mild vestibular symptoms. Therefore, pET patients with dizziness might be misdiagnosed with, for example, superior semicircular canal dehiscence, psychogenic vertigo, or Ménière's disease. For patients with few clinical symptoms or laboratory findings, clinicians need to consider dizziness-induced pET as a possible diagnosis., (Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.)

Objective: The aim was to characterize dizziness, vertigo, poor maintenance of posture, and sudden instabilities (called presbyequilibrium) among institutionalized elderly to model and identify possible treatable causes., Methods: A questionnaire based study focusing on symptoms among 72 elderly persons from a single residential facility and followed them for 3 years., Results: Dizziness, vertigo, poor maintenance of posture, and black-outs were reported by 68% of the 72 elderly and make them at risk for falls, and reduced quality of life. The most common complaint was postural instability, with a tendency to fall. "Spinning" vertigo and "floating" sensation had a strong inter-correlation and correlated with habitual falls. The various dizziness symptoms often occurred in combinations. Attacks of self-experienced syncope never occurred alone but always in combination with "spinning vertigo" or "tendency to fall". In factorial analysis, presbyequilibrium could be divided into six categories. Two of these categories correlated with falls., Conclusions: Among elderly, presbyequilibrium is commonly characterized by a combination of phenomena involving perceptual, orientation, postural, and autonomic manifestations. It is often difficult to obtain an accurate history from the elderly and the presence of vestibular symptoms is frequently overlooked. Taking a careful history and utilizing the classification of symptoms that emerged from the factorial analysis may give a deeper understanding of the etiology of presbyequilibrium, thereby facilitating appropriate rehabilitation., (Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.)

Objective: Recording of vestibular evoked myogenic potentials (VEMP) can facilitate the evaluation of otolith function. The dizziness caused by otolith lesions is not completely understood. To clarify which symptoms of dizziness originate from the otolith organs, we examined the relationship between symptoms and VEMP results in patients with undiagnosed dizziness., Methods: The subjects were 18 patients with undiagnosed dizziness aged less than 40 years who underwent VEMP examination. The VEMP results were evaluated using the interaural ratio of p13-n23 amplitude., Results: Abnormal VEMP results were obtained in five of seven patients who experienced a sensation of falling (p=0.013), in none of the three patients who experienced a swaying sensation (p>0.05), and in one of eight patients who experienced a floating sensation (p>0.05). Five of six patients with abnormal VEMP results complained of disequilibrium lasting a few seconds., Conclusions: Dizziness with a sensation of falling lasting for a few seconds was related to abnormal VEMP results, suggesting that it resulted from saccular dysfunction. VEMP examination may be considered a useful modality in the diagnosis of dizziness of unknown origin.

Objectives: To evaluate the relationship between cerebral T2 hyperintensity on MRI and visual suppression of vestibulo-ocular reflex (VOR) in elderly patients with dysequilibrium symptoms., Methods: Eighty-nine elderly patients with no MRI abnormalities in the infratentorial region aged 60-89 years complaining dysequilibrium symptoms were studied. Cases with whom a definitive diagnosis of peripheral or central disease could be established were not included. T2 hyperintense lesions in the cerebrum: basal ganglia, subcortical white matter and periventricular white matter were evaluated. VOR in darkness and fixation-suppressed VOR using pseudo-sinusoidal rotation stimuli were recorded to calculate visual suppression rate. Correlation between visual suppression rate and semi-quantitative scores for severity of T2 hyperintensity in the cerebrum was investigated., Results: Patients with T2 hyperintensity in the cerebrum exhibited significantly lower visual suppression rate than those without lesions in the cerebrum. Multiple regression analysis showed that visual suppression rate was significantly and negatively correlated with severity of lesions in the basal ganglia, but not with patient age, severity of subcortical white matter lesions, or that of periventricular white matter lesions., Conclusions: In elderly patients with dizziness with a non-specific history and otoneurological findings, fixation suppression of vestibular nystagmus was associated with T2 hyperintensities in the basal ganglia.

Objective: To investigate the cause of dizziness after Epley's maneuver using stabilometry., Methods: Subjects were 35 patients with posterior canal type BPPV. First we performed stabilometry, next Epley's maneuver, then stabilometry was performed again. The enveloped area and the locus length per second of stabilometry were compared., Results: Seventeen patients reported a feeling of dizziness after the treatment, whereas the other 18 patients did not. The patients were divided into two groups: 17 patients with dizziness (WD) and 18 patients without dizziness (WOD) after the treatment. In the WD group, the enveloped area (P=0.0495) and the locus length per second (P=0.0099) before Epley's maneuver were significantly lower than those after Epley's maneuver. In the WOD group, there was no significant difference in the stabilometry parameter between values obtained before and after Epley's maneuver. There were no significant differences found in either parameter between these two groups either before or after applying Epley's maneuver., Conclusions: Epley's maneuver is a treatment for the posterior semicircular canal. Malfunction of the otolith organ remains. It is considered that the cause of dizziness after Epley's maneuver comes from otolith dysfunction.