Test Batteries and the Diagnostic Algorithm for Chronic Vestibular Syndromes

Objective: To develop a diagnostic algorithm for chronic vestibular syndromes by determining significant items that differ among diagnoses.Methods: Two hundred thirty-one patients with chronic vestibular syndromes lasting for >3 months were included. Full vestibular tests and questionnaire su...

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Autores principales:	Meiko Kitazawa, Yuka Morita, Chihiro Yagi, Kuniyuki Takahashi, Shinsuke Ohshima, Tatsuya Yamagishi, Shuji Izumi, Izumi Koizuka, Arata Horii
Formato:	article
Lenguaje:	EN
Publicado:	Frontiers Media S.A. 2021
Materias:	chronic vestibular syndromes diagnosis algorithm persistent postural-perceptual dizziness unilateral vestibular hypofunction chronic dizziness due to anxiety Neurology. Diseases of the nervous system RC346-429
Acceso en línea:	https://doaj.org/article/45ac65f0b71a470ea2439ce98b4ed954
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spelling	oai:doaj.org-article:45ac65f0b71a470ea2439ce98b4ed9542021-11-18T08:52:29ZTest Batteries and the Diagnostic Algorithm for Chronic Vestibular Syndromes1664-229510.3389/fneur.2021.768718https://doaj.org/article/45ac65f0b71a470ea2439ce98b4ed9542021-11-01T00:00:00Zhttps://www.frontiersin.org/articles/10.3389/fneur.2021.768718/fullhttps://doaj.org/toc/1664-2295Objective: To develop a diagnostic algorithm for chronic vestibular syndromes by determining significant items that differ among diagnoses.Methods: Two hundred thirty-one patients with chronic vestibular syndromes lasting for >3 months were included. Full vestibular tests and questionnaire surveys were performed: bithermal caloric test, cervical and ocular vestibular-evoked myogenic potential assessment, video head impulse test (vHIT), posturography, rotatory chair test, dizziness handicap inventory, hospital anxiety and depression scale (HADS), and Niigata persistent postural-perceptual dizziness (PPPD) questionnaire (NPQ). Differences in each item of the vestibular tests/questionnaires/demographic data were tested among the diagnoses. A receiver operating characteristic (ROC) curve was created for the significant items. The value that provided the best combination of sensitivity/specificity on the ROC curve was adopted as a threshold for diagnosing the targeted disease. Multiple diagnostic algorithms were proposed, and their diagnostic accuracy was calculated.Results: There were 92 patients with PPPD, 44 with chronic dizziness due to anxiety (CDA), 31 with unilateral vestibular hypofunction (UVH), 37 with undifferentiated dizziness (UD), and 27 with other conditions. The top four diagnoses accounted for 88% of all chronic vestibular syndromes. Five significant items that differed among the four diseases were identified. The visual stimulation and total NPQ scores were significantly higher in the patients with PPPD than in those with UVH and UD. The percentage of canal paresis (CP %) was significantly higher in the patients with UVH than in those with PPPD, CDA, and UD. The patients with CDA were significantly younger and had higher anxiety scores on the HADS (HADS-A) than those with UVH and UD. Moreover, catch-up saccades (CUSs) in the vHIT were more frequently seen in the patients with UVH than in those with PPPD. The most useful algorithm that tested the total and visual stimulation NPQ scores for PPPD followed by the CP%/CUSs for UVH and HADS-A score/age for CDA showed an overall diagnostic accuracy of 72.8%.Conclusions: Among the full vestibular tests and questionnaires, the items useful for differentiating chronic vestibular syndromes were identified. We proposed a diagnostic algorithm for chronic vestibular syndromes composed of these items, which could be useful in clinical settings.Meiko KitazawaYuka MoritaChihiro YagiKuniyuki TakahashiShinsuke OhshimaTatsuya YamagishiShuji IzumiIzumi KoizukaArata HoriiFrontiers Media S.A.articlechronic vestibular syndromesdiagnosisalgorithmpersistent postural-perceptual dizzinessunilateral vestibular hypofunctionchronic dizziness due to anxietyNeurology. Diseases of the nervous systemRC346-429ENFrontiers in Neurology, Vol 12 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	chronic vestibular syndromes diagnosis algorithm persistent postural-perceptual dizziness unilateral vestibular hypofunction chronic dizziness due to anxiety Neurology. Diseases of the nervous system RC346-429
spellingShingle	chronic vestibular syndromes diagnosis algorithm persistent postural-perceptual dizziness unilateral vestibular hypofunction chronic dizziness due to anxiety Neurology. Diseases of the nervous system RC346-429 Meiko Kitazawa Yuka Morita Chihiro Yagi Kuniyuki Takahashi Shinsuke Ohshima Tatsuya Yamagishi Shuji Izumi Izumi Koizuka Arata Horii Test Batteries and the Diagnostic Algorithm for Chronic Vestibular Syndromes
description	Objective: To develop a diagnostic algorithm for chronic vestibular syndromes by determining significant items that differ among diagnoses.Methods: Two hundred thirty-one patients with chronic vestibular syndromes lasting for >3 months were included. Full vestibular tests and questionnaire surveys were performed: bithermal caloric test, cervical and ocular vestibular-evoked myogenic potential assessment, video head impulse test (vHIT), posturography, rotatory chair test, dizziness handicap inventory, hospital anxiety and depression scale (HADS), and Niigata persistent postural-perceptual dizziness (PPPD) questionnaire (NPQ). Differences in each item of the vestibular tests/questionnaires/demographic data were tested among the diagnoses. A receiver operating characteristic (ROC) curve was created for the significant items. The value that provided the best combination of sensitivity/specificity on the ROC curve was adopted as a threshold for diagnosing the targeted disease. Multiple diagnostic algorithms were proposed, and their diagnostic accuracy was calculated.Results: There were 92 patients with PPPD, 44 with chronic dizziness due to anxiety (CDA), 31 with unilateral vestibular hypofunction (UVH), 37 with undifferentiated dizziness (UD), and 27 with other conditions. The top four diagnoses accounted for 88% of all chronic vestibular syndromes. Five significant items that differed among the four diseases were identified. The visual stimulation and total NPQ scores were significantly higher in the patients with PPPD than in those with UVH and UD. The percentage of canal paresis (CP %) was significantly higher in the patients with UVH than in those with PPPD, CDA, and UD. The patients with CDA were significantly younger and had higher anxiety scores on the HADS (HADS-A) than those with UVH and UD. Moreover, catch-up saccades (CUSs) in the vHIT were more frequently seen in the patients with UVH than in those with PPPD. The most useful algorithm that tested the total and visual stimulation NPQ scores for PPPD followed by the CP%/CUSs for UVH and HADS-A score/age for CDA showed an overall diagnostic accuracy of 72.8%.Conclusions: Among the full vestibular tests and questionnaires, the items useful for differentiating chronic vestibular syndromes were identified. We proposed a diagnostic algorithm for chronic vestibular syndromes composed of these items, which could be useful in clinical settings.
format	article
author	Meiko Kitazawa Yuka Morita Chihiro Yagi Kuniyuki Takahashi Shinsuke Ohshima Tatsuya Yamagishi Shuji Izumi Izumi Koizuka Arata Horii
author_facet	Meiko Kitazawa Yuka Morita Chihiro Yagi Kuniyuki Takahashi Shinsuke Ohshima Tatsuya Yamagishi Shuji Izumi Izumi Koizuka Arata Horii
author_sort	Meiko Kitazawa
title	Test Batteries and the Diagnostic Algorithm for Chronic Vestibular Syndromes
title_short	Test Batteries and the Diagnostic Algorithm for Chronic Vestibular Syndromes
title_full	Test Batteries and the Diagnostic Algorithm for Chronic Vestibular Syndromes
title_fullStr	Test Batteries and the Diagnostic Algorithm for Chronic Vestibular Syndromes
title_full_unstemmed	Test Batteries and the Diagnostic Algorithm for Chronic Vestibular Syndromes
title_sort	test batteries and the diagnostic algorithm for chronic vestibular syndromes
publisher	Frontiers Media S.A.
publishDate	2021
url	https://doaj.org/article/45ac65f0b71a470ea2439ce98b4ed954
work_keys_str_mv	AT meikokitazawa testbatteriesandthediagnosticalgorithmforchronicvestibularsyndromes AT yukamorita testbatteriesandthediagnosticalgorithmforchronicvestibularsyndromes AT chihiroyagi testbatteriesandthediagnosticalgorithmforchronicvestibularsyndromes AT kuniyukitakahashi testbatteriesandthediagnosticalgorithmforchronicvestibularsyndromes AT shinsukeohshima testbatteriesandthediagnosticalgorithmforchronicvestibularsyndromes AT tatsuyayamagishi testbatteriesandthediagnosticalgorithmforchronicvestibularsyndromes AT shujiizumi testbatteriesandthediagnosticalgorithmforchronicvestibularsyndromes AT izumikoizuka testbatteriesandthediagnosticalgorithmforchronicvestibularsyndromes AT aratahorii testbatteriesandthediagnosticalgorithmforchronicvestibularsyndromes
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Test Batteries and the Diagnostic Algorithm for Chronic Vestibular Syndromes

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