Clinical Evaluation of the Schellong Test in Dizzy Patients.

Imamura, Shun-ichi; Nozawa, Izuru; Imamura, Mayumi; Hashimoto, Kaori; Usukura, Youko; Hisamatsu, Ken-ichi; Murakami, Yoshihiko

doi:10.3757/jser.54.208

Cited by 3 publications

(5 citation statements)

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“…The Schellong test is similar to the orthostatic testing protocol used in this study. It has been advocated in several studies as a screening method for OH in the evaluation of dizziness, vertigo, or disequilibrium in association with symptoms of autonomic dysfunction 6,7,25,26 . Results met the criteria for OH in 15% of cases in this study.…”

Section: Discussionsupporting

confidence: 60%

Autonomic related vertigo

Pappas¹

2003

The Laryngoscope

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Objectives:To demonstrate clinical evidence that vestibular symptomatology can occur in relation to autonomic dysfunction. Characterization of clinical findings and treatment response would then allow autonomic related vertigo to be differentiated from other vertiginous conditions that present in a like manner. Study Desigm This was a retrospective review of 113 patients that described symptoms consistent with spontaneous, rotational vertigo and autonomic dysfunction. Methods: Vestibular, otologic, and autonomic symptoms are presented along with the results of audiologic, orthostatic, and autonomic testing. Medical management included fluid loading, dietary changes, exercise, and patient education. Treatment results were analyzed according to the effectiveness in control of vestibular and otologic symptoms. Results were compared with a control group that demonstrated a similar vestibular and otologic presentation without autonomic symptomatology. Renults: All patients described spontaneous, rotational vertigo, with complete or substantial vertigo control obtained in 93 (85%) of 110 patients. Postural vertigo and distinct lightheadedness were also documented in 53% and 97% of cases, respectively. Vertigo failed to improve or worsened with prior treatment of low sodium diet or diuretic in 53 (91%) of 58 cases. Vertigo improvement was subsequently achieved in 48 (86%) of 56 cases with an autonomic treatment regimen. Long-term vertigo control was obtained in 56 (88%) of64 patients followed for at least 18 months. Tinnitus was reported in 97 (86%) patients, aural fullness in 93 (82%) patients, and subjective hearing loss (HL) Orthostatic blood pressure and heart rate testing met the criteria for orthostatic hypotension in 16 (16%) of 104 patients. Autonomic testing was obtained in 34 cases, with orthostatic intolerance demonstrated in 33 (97%) patients and orthostatic hypotension demonstrated in 13 (38%) patients. Overall, orthostatic hypotension was documented through combined testing results in 23 (21%) of 107 patients. Vertigo was reproduced during autonomic testing in 17 (77%) of 22 patients, and otologic symptoms were reproduce in 9 (47%) of 19 patients. Comparison of the study population with a control group without autonomic symptoms revealed statistically significant differences in orthostatic testing and treatment results. There was no statistical difference noted in findings between patients of this study that demonstrated or failed to demonstrate orthostatic hypotension. Conclusions: There is a subgroup of patients with spontaneous vertigo who also demonstrate symptoms and findings consistent with poor autonomic regulation. These patients report vertigo improvement with a treatment strategy that aims to improve autonomic dysfunction through expansion of effective circulating volume. Clinical findings and treatment results of this study suggest an underlying autonomic influence in the production of vertigo and otologic symptoms.

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Section: Discussionsupporting

confidence: 60%

Autonomic related vertigo

Pappas¹

2003

The Laryngoscope

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“…However, this test has been used in patients with vertigo, dizziness and disequilibrium because it can be performed simply and easily anywhere using only a sphygmomanom eter. Therefore, there have been many reports regarding the Schellong test for patients who complain of vertigo, dizziness and disequilibrium in the field of otorhinolaryn gology [3][4][5][6][7], Boku et al [4] pointed out that the incidence of a positive Schellong test in subjects with vertigo did not differ significantly from that in normal subjects, but, as has been found in other studies [3,5,6], the systolic pres sure decrease after standing in the two groups was signifi cantly different. Matsunaga [7] also found that the inci dence of positive Schellong test results in subjects below 29 years of age with vertigo was significantly different from that in normal subjects.…”

Section: Discussionmentioning

confidence: 86%

“…In our previous study [3] of patients with vertigo, dizzi ness and disequilibrium who did not show abnormal neuro-otological findings, the incidence of OD was high, espe cially in females. Wessely et al [16] pointed out that the relation of low blood pressure to fatigue, faintness and dizziness, which are thought to be the criteria of OD, is most pronounced in younger subjects (18-24 years old).…”

Section: Discussionmentioning

confidence: 99%

“…We have recently noted an increase in the number of patients seeking treatment at our clinic who complained of vertigo, dizziness and/or disequilibrium with OD iden tified by the questionnaire and/or the Schellong test; the increase is more predominant in females than in males and the patients show no unusual neuro-otological exami nation results [3], In clinical practice, it is not uncommon to encounter normal subjects, especially young females, who report that they sometimes experience orthostatic dizziness and/or fainting on standing. Therefore it is diffi cult to draw a clear distinction between OD and normal subjects.…”

Section: K Arg Ermentioning

confidence: 99%

“…In Japan, this condition is empirically recognized from the results of a diagnostic questionnaire which was developed by the Japan OD Study Group [1], The Schellong test (orthostatic test) [2] was also developed as a screening method for OD or orthostatic hypotension, and has been applied to the assessment of patients with vertigo, dizziness and disequi librium. While there have been many reports describing the utility of the Schellong test [3][4][5][6][7][8], it is not without dis advantages. One is that the incidence of positive test results in patient groups is sometimes similar to that in groups of normal subjects, and the other is that the criteria for OD and the fundamental measurements of the Schel long test were developed for use only in children.…”

Section: Introductionmentioning

confidence: 99%

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Study on Orthostatic Dysregulation and the Schellong Test in Healthy Young Females

Nozawa

Hisamastu²,

Imamura³

et al. 1996

ORL

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We carried out a questionnaire survey regarding the symptoms of orthostatic dysregulation (OD) and administered the Schellong test to 301 healthy young females ranging in age from 18 to 21 years. OD was identified in 62 (20.6%) of the subjects based on the questionnaire. Although orthostatic dizziness was relatively common in the entire group of young females (171/301, 56.8%), this symptom was much more prevalent in the subjects with OD (58/62, 93.5%). There was also a highly significant difference between the systolic pressure decrease during the Schellong test procedure in 22 subjects with OD with frequent orthostatic dizziness and that in the 239 subjects without OD. Although the clinical value of the Schellong test in the assessment of OD and other related conditions has been brought into question because of its relatively poor specificity, we conclude that this test procedure may be useful in screening for OD or autonomic nerve dysfunction, since it presents the advantage of easy application in clinical practice.

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Influence of the orthostatic decrease in blood pressure on orthostatic vertigo

Sawai¹,

Yamanaka²,

Murai³

et al. 2009

Equilibrium Res

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Some patients have different vertiginous symptoms such as faintness, rotatory sensation or swaying sensation when rising to the standing position. These symptoms, hereafter referred to as orthostatic vertigo (OV), are believed to occur due to hypoperfusion of the brain with the orthostatic decrease in blood pressure (BP). However, it is unclear whether the orthostatic decrease in blood pressure is directly involved in the onset of OV. Therefore, we studied the influence of the orthostatic change in BP on OV. All 780 subjects in the present study had orthostatic changes in their BP examined, including 239 cases with OV and 541 cases without OV. Orthostatic hypotension (OH) was defined as a systolic BP decrease of more than 20 mmHg when standing. In subjects with a BP of 140 mmHg and over before standing, the orthostatic decrease in BP was more than 20 mmHg in cases with OV, significantly different from those without OV. In the case of a BP over 160 mmHg, subjects with OV showed a severe OH greater than 30 mmHg. In contrast, when the BP was under 140 mmHg, OH was not detected even in those subjects with OV. Under 110 mmHg BP, there was no difference of orthostatic decrease in blood pressure between in cases with OV and those without OV. These results suggest that it is necessary to consider the BP before standing when assessing the incidence of OV due to OH.

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Clinical Evaluation of the Schellong Test in Dizzy Patients.

Cited by 3 publications

References 1 publication

Autonomic related vertigo

Autonomic related vertigo

Study on Orthostatic Dysregulation and the Schellong Test in Healthy Young Females

Influence of the orthostatic decrease in blood pressure on orthostatic vertigo

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