Prevalence, Determinants, and Consequences of Vestibular Hypofunction. Results From the KORA-FF4 Survey

Eva Grill, Maria Heuberger, Ralf Strobl, Murat Saglam, Rolf Holle, Birgit Linkohr, Karl-Heinz Ladwig, Annette Peters, Erich Schneider, Klaus Jahn, Nadine Lehnen, Eva Grill, Maria Heuberger, Ralf Strobl, Murat Saglam, Rolf Holle, Birgit Linkohr, Karl-Heinz Ladwig, Annette Peters, Erich Schneider, Klaus Jahn, Nadine Lehnen

Abstract

Objective: Uni- or bilateral vestibular hypofunction (VH) impairs balance and mobility, and may specifically lead to injury from falls and to disability. The extent of this problem in the general population is still unknown and most likely to be underestimated. Objective of this study was to determine the prevalence, determinants, and consequences of VH in the general population. Methods: Data originates from the cross-sectional second follow-up (FF4) in 2013/14 of the KORA (Cooperative Health Research in the Region of Augsburg)-S4 study (1999-2001) from Southern Germany. This was a random sample of the target population consisting of all residents of the region aged 25-74 years in 1999. We included all participants who reported moderate or severe vertigo or dizziness during the last 12 months and a random sub-sample of participants representative for the general population without vertigo or dizziness during the last 12 months were tested. VH was assessed with the Video-Head Impulse Test (vHIT). Trained examiners applied high-acceleration, small-amplitude passive head rotations ("head impulses") to the left and right in the plane of the horizontal semicircular canals while participants fixated a target straight ahead. During head impulses, head movements were measured with inertial sensors, eye movements with video-oculography (EyeSeeCam vHIT). Results: A total of 2,279 participants were included (mean age 60.8 years, 51.6% female), 570 (25.0%) with moderate or severe vertigo or dizziness during the last 12 months. Of these, 450 were assessed with vHIT where 26 (5.8%) had unilateral VH, and 16 (3.6%) had bilateral VH. Likewise, 190 asymptomatic participants were tested. Of these 5 (2.6%) had unilateral VH, and 2 (1.1%) had bilateral VH. Prevalence of uni- or bilateral VH among tested symptomatic participants was 2.4% in those < 48 years, and 32.1% in individuals aged 79 and over. Age-adjusted prevalence was 6.7% (95% CI 4.8%; 8.6%). VH was associated with worse health, falls, hearing loss, hearing impairment, and ear pressure. Conclusion: VH may affect between 53 and 95 million adults in Europe and the US. While not all affected persons will experience the full spectrum of symptoms and consequences, adequate diagnostic and therapeutic measures should become standard of care to decrease the burden of disease.

Keywords: Video-HIT; aged; head impulse test; prevalence; vertigo; vestibular hypofunction.

Figures

Figure 1
Figure 1
Flow diagram of participants in the KORA FF4-study assessed with Video-Head Impulse Testing (vHIT). Vertigo refers to moderate or severe vertigo or dizziness during the last 12 months. Vestibular hypofunction on vHIT was defined as a gain of the vestibular-ocular reflex

References

    1. Jen JC. Bilateral vestibulopathy: clinical, diagnostic, and genetic considerations. Semin Neurol. (2009) 29:528–33. 10.1055/s-0029-1241035
    1. Zingler VC, Weintz E, Jahn K, Huppert D, Cnyrim C, Brandt T, et al. . Causative factors, epidemiology, and follow-up of bilateral vestibulopathy. Ann N Y Acad Sci. (2009) 1164:505–8. 10.1111/j.1749-6632.2009.03765.x
    1. Kremmyda O, Hufner K, Flanagin VL, Hamilton DA, Linn J, Strupp M, et al. . Beyond dizziness: virtual navigation, spatial anxiety and hippocampal volume in bilateral vestibulopathy. Front Hum Neurosci. (2016) 10:139. 10.3389/fnhum.2016.00139
    1. Popp P, Wulff M, Finke K, Ruhl M, Brandt T, Dieterich M. Cognitive deficits in patients with a chronic vestibular failure. J Neurol. (2017) 264:554–63. 10.1007/s00415-016-8386-7
    1. Deroualle D, Borel L, Deveze A, Lopez C. Changing perspective: the role of vestibular signals. Neuropsychologia (2015) 79 (Pt B):175–85. 10.1016/j.neuropsychologia.2015.08.022
    1. Yates BJ, Bolton PS, Macefield VG. Vestibulo-sympathetic responses. Compr Physiol. (2014) 4:851–87. 10.1002/cphy.c130041
    1. Guinand N, Boselie F, Guyot JP, Kingma H. Quality of life of patients with bilateral vestibulopathy. Ann Otol Rhinol Laryngol. (2012) 121:471–7. 10.1177/000348941212100708
    1. Ward BK, Agrawal Y, Hoffman HJ, Carey JP, Della Santina CC. Prevalence and impact of bilateral vestibular hypofunction: results from the 2008 US National Health Interview Survey. JAMA Otolaryngol Head Neck Surg. (2013) 139:803–10. 10.1001/jamaoto.2013.3913
    1. Rambold HA. Economic management of vertigo/dizziness disease in a county hospital: video-head-impulse test vs. caloric irrigation. Eur Arch Otorhinolaryngol. (2015) 272:2621–8. 10.1007/s00405-014-3205-1
    1. Bartl K, Lehnen N, Kohlbecher S, Schneider E. Head impulse testing using video-oculography. Ann N Y Acad Sci. (2009) 1164:331–3. 10.1111/j.1749-6632.2009.03850.x
    1. Heuberger M, Saglam M, Todd NS, Jahn K, Schneider E, Lehnen N. Covert anti-compensatory quick eye movements during head impulses. PLoS ONE (2014) 9:e93086. 10.1371/journal.pone.0093086
    1. Heuberger M, Grill E, Saglam M, Ramaioli C, Müller M, Strobl R, et al. . Usability of the video head impulse test: lessons from the population-based prospective KORA study. Front Neurol. (2018) 9:659. 10.3389/fneur.2018.00659
    1. Blodow A, Heinze M, Bloching MB, von Brevern M, Radtke A, Lempert T. Caloric stimulation and video-head impulse testing in Meniere's disease and vestibular migraine. Acta Otolaryngol. (2014) 134:1239–44. 10.3109/00016489.2014.939300
    1. Mossman B, Mossman S, Purdie G, Schneider E. Age dependent normal horizontal VOR gain of head impulse test as measured with video-oculography. J Otolaryngol Head Neck Surg. (2015) 44:29. 10.1186/s40463-015-0081-7
    1. Maier W, Holle R, Hunger M, Peters A, Meisinger C, Greiser KH, et al. . The impact of regional deprivation and individual socio-economic status on the prevalence of Type 2 diabetes in Germany. A pooled analysis of five population-based studies. Diabet Med. (2013) 30:e78–86. 10.1111/dme.12062
    1. Meisinger C, Lowel H, Thorand B, Doring A. Leisure time physical activity and the risk of type 2 diabetes in men and women from the general population. The MONICA/KORA Augsburg Cohort Study. Diabetologia (2005) 48:27–34. 10.1007/s00125-004-1604-3
    1. Kirchberger I, Meisinger C, Heier M, Zimmermann AK, Thorand B, Autenrieth CS, et al. . Patterns of multimorbidity in the aged population. Results from the KORA-age study. PLoS ONE (2012) 7:e30556. 10.1371/journal.pone.0030556
    1. Ruckert IM, Baumert J, Schunk M, Holle R, Schipf S, Volzke H, et al. . Blood pressure control has improved in people with and without type 2 diabetes but remains suboptimal: a longitudinal study based on the German DIAB-CORE consortium. PLoS ONE (2015) 10:e0133493. 10.1371/journal.pone.0133493
    1. World Health Organization-International Society of Hypertension Guidelines for the Management of Hypertension Guidelines subcommittee. J Hypertens. (1999) 17:151–83.
    1. Lemeshow S, Hosmer DW. A review of goodness of fit statistics for use in the development of logistic regression models. Am J Epidemiol. (1982) 115:92–106. 10.1093/oxfordjournals.aje.a113284
    1. R Core Team A Language and Environment for Statistical Computing.: R Foundation for Statistical Computing, Vienna: (2014).
    1. Neuhauser HK, von Brevern M, Radtke A, Lezius F, Feldmann M, Ziese T, et al. . Epidemiology of vestibular vertigo: a neurotologic survey of the general population. Neurology (2005) 65:898–904. 10.1212/01.wnl.0000175987.59991.3d
    1. Rauch SD, Velazquez-Villasenor L, Dimitri PS, Merchant SN. Decreasing hair cell counts in aging humans. Ann N Y Acad Sci. (2001) 942:220–7. 10.1111/j.1749-6632.2001.tb03748.x
    1. Baloh RW, Jacobson KM, Socotch TM. The effect of aging on visual-vestibuloocular responses. Exp Brain Res. (1993) 95:509–16. 10.1007/BF00227144
    1. Yamasoba T, Lin FR, Someya S, Kashio A, Sakamoto T, Kondo K. Current concepts in age-related hearing loss: epidemiology and mechanistic pathways. Hear Res. (2013) 303:30–8. 10.1016/j.heares.2013.01.021
    1. Tian JR, Mokuno E, Demer JL. Vestibulo-ocular reflex to transient surge translation: complex geometric response ablated by normal aging. J Neurophysiol. (2006) 95:2042–54. 10.1152/jn.00635.2005
    1. Agrawal Y, Carey JP, Della Santina CC, Schubert MC, Minor LB. Diabetes, vestibular dysfunction, and falls: analyses from the National Health and Nutrition Examination Survey. Otol Neurotol. (2010) 31:1445–50. 10.1097/MAO.0b013e3181f2f035
    1. Lee H, Sininger L, Jen JC, Cha YH, Baloh RW, Nelson SF. Association of progesterone receptor with migraine-associated vertigo. Neurogenetics (2007) 8:195–200. 10.1007/s10048-007-0091-3
    1. Ohmen JD, White CH, Li X, Wang J, Fisher LM, Zhang H, et al. . Genetic evidence for an ethnic diversity in the susceptibility to Meniere's disease. Otol Neurotol. (2013) 34:1336–41. 10.1097/MAO.0b013e3182868818
    1. Kim S, Oh YM, Koo JW, Kim JS. Bilateral vestibulopathy: clinical characteristics and diagnostic criteria. Otol Neurotol. (2011) 32:812–7. 10.1097/MAO.0b013e31821a3b7d
    1. Mueller M, Schuster E, Strobl R, Grill E. Identification of aspects of functioning, disability and health relevant to patients experiencing vertigo: a qualitative study using the international classification of functioning, disability and health. Health Qual Life Outcomes (2012) 10:75. 10.1186/1477-7525-10-75
    1. Mueller M, Strobl R, Jahn K, Linkohr B, Peters A, Grill E. Burden of disability attributable to vertigo and dizziness in the aged: results from the KORA-Age study. Eur J Public Health (2014) 24:802–7. 10.1093/eurpub/ckt171
    1. Neuhauser HK, Radtke A, von Brevern M, Lezius F, Feldmann M, Lempert T. Burden of dizziness and vertigo in the community. Arch Intern Med. (2008) 168:2118–24. 10.1001/archinte.168.19.2118
    1. Grunfeld EA, Morland AB, Bronstein AM, Gresty MA. Adaptation to oscillopsia: a psychophysical and questionnaire investigation. Brain (2000) 123 (Pt 2):277–90. 10.1093/brain/123.2.277
    1. Sun DQ, Ward BK, Semenov YR, Carey JP, Della Santina CC. Bilateral vestibular deficiency: quality of life and economic implications. JAMA Otolaryngol Head Neck Surg. (2014) 140:527–34. 10.1001/jamaoto.2014.490
    1. Hall CD, Herdman SJ, Whitney SL, Cass SP, Clendaniel RA, Fife TD, et al. . Vestibular rehabilitation for peripheral vestibular hypofunction: an evidence-based clinical practice guideline: from the American Physical Therapy Association Neurology Section. J Neurol Phys Ther. (2016) 40:124–55. 10.1097/NPT.0000000000000120
    1. Grill E, Penger M, Kentala E. Health care utilization, prognosis and outcomes of vestibular disease in primary care settings: systematic review. J Neurol. (2016) 263 (Suppl. 1):S36–44. 10.1007/s00415-015-7913-2
    1. Wuehr M, Nusser E, Decker J, Krafczyk S, Straube A, Brandt T, et al. . Noisy vestibular stimulation improves dynamic walking stability in bilateral vestibulopathy. Neurology (2016) 86:2196–202. 10.1212/WNL.0000000000002748
    1. Volkening K, Bergmann J, Keller I, Wuehr M, Muller F, Jahn K. Verticality perception during and after galvanic vestibular stimulation. Neurosci Lett. (2014) 581:75–9. 10.1016/j.neulet.2014.08.028

Source: PubMed

赞助者和合作者

医疗条件

药物干预

3
订阅