Current evidence of peripheral vestibular symptoms secondary to otitis media

Monsanto, Rafael da Costa; Kasemodel, Ana Luiza Papi; Tomaz, Andreza; Paparella, Michael M.; Penido, Norma de Oliveira

doi:10.1080/07853890.2018.1470665

Cited by 33 publications

(38 citation statements)

References 58 publications

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“…It is important to differentiate vestibular vertigo from non-vestibular dizziness since the etiology of dizziness is often multifactorial, especially in elderly patients [ 6 , 7 ]. Although not the chief complaint, patients with COM frequently report vestibular symptoms including vertigo, postural instability, and disequilibrium [ 8 ]. Vestibular function test abnormalities are also commonly detected even in asymptomatic patients, which may indicate central compensation in daily situations [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

Presentation of dizziness in individuals with chronic otitis media: data from the multinational collaborative COMQ-12 study

Tailor

Phillips

Nunney

et al. 2021

Eur Arch Otorhinolaryngol

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Purpose In chronic otitis media (COM), disease chronicity and severity of middle ear inflammation may influence the development of inner ear deficits, increasing the risk of vestibular impairment. This secondary analysis of the multinational collaborative Chronic Otitis Media Questionnaire-12 (COMQ-12) dataset sought to determine the prevalence of vestibular symptoms in patients with COM and identify associated disease-related characteristics. Methods Adult patients with a diagnosis of COM in outpatient settings at nine otology referral centers across eight countries were included. We investigated the presence of vestibular symptoms (dizziness and/or disequilibrium) using participant responses to item 6 of a native version of the COMQ-12. Audiometric data and otoscopic assessment were also recorded. Results This analysis included 477 participants suffering from COM, with 56.2% (n = 268) reporting at least mild inconvenience related to dizziness or disequilibrium. There was a significant association between air conduction thresholds in the worse hearing ear and presence of dizziness [adjusted odds ratio (AOR), 1.01; 95% CI 1.00–1.02; p = 0.0177]. Study participants in European countries (AOR 1.53; 95% CI 1.03–2.28; p = 0.0344) and Colombia (AOR 2.48; 95% CI 1.25–4.92; p = 0.0096) were more likely to report dizziness than participants in Asian countries. However, ear discharge and cholesteatoma showed no association with dizziness in the adjusted analyses. Conclusion Vestibular symptoms contribute to burden of disease in patients with COM and associates with hearing disability in the worse hearing ear. Geographical variation in presentation of dizziness may reflect financial barriers to treatment or cultural differences in how patients reflect on their health state.

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Section: Introductionmentioning

confidence: 99%

Presentation of dizziness in individuals with chronic otitis media: data from the multinational collaborative COMQ-12 study

Tailor

Phillips

Nunney

et al. 2021

Eur Arch Otorhinolaryngol

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“…However, in the present study, spontaneous or positional nystagmus was not observed in most of healthy controls (94%). Recent systematic review reported that nystagmus was present in 36% of OME patients, 93% of AOM patients, and 56% of patients with chronic otitis media [ 27 ]. The aim of the present study focused on the presence of nystagmus in AOM or OME patients without dizziness, and nystagmus was observed in most of AOM or OME patients even if they did not complain of dizziness, which was the most interesting finding of the present study.…”

Section: Discussionmentioning

confidence: 99%

“…A systematic review study has demonstrated that most patients with AOM or OME, who have nonspecific vestibular symptoms or no vestibular symptoms, may have abnormal vestibular function tests [ 27 ]. The present study further revealed that OME or AOM patients without dizziness exhibited both irritative- or paretic-type direction-fixed nystagmus and direction-changing positional nystagmus.…”

Section: Discussionmentioning

confidence: 99%

Nystagmus in adult patients with acute otitis media or otitis media with effusion without dizziness

2021

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The present study aimed to investigate the incidence and patterns of nystagmus in adult patients with acute otitis media (AOM) or otitis media with effusion (OME) without dizziness or vertigo, and discuss possible mechanisms. From February 2018 to November 2018, 34 consecutive patients with AOM or OME without dizziness were included. Nystagmus was examined with video Frenzel glasses. Of 34 adult AOM or OME patients without dizziness, nystagmus was observed in 28 patients (82%). In unilateral AOM or OME (n = 30), the most commonly observed nystagmus pattern was irritative-type direction-fixed nystagmus (n = 13), followed by paretic-type direction-fixed nystagmus (n = 8), and direction-changing positional nystagmus (n = 4). In bilateral AOM or OME (n = 4), direction-fixed nystagmus and direction-changing positional nystagmus were observed in two and one patients, respectively. Nystagmus was observed in as many as 82% of adult AOM or OME patients even though they did not complain of dizziness, and the pattern of nystagmus was either direction-fixed or direction-changing. Direct effect of inflammatory mediators penetrated from the middle ear and biochemical alteration in the inner ear fluids due to blood-perilymph barrier dysfunction may result in the presence of nystagmus in AOM or OME patients without dizziness.

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“…We found a high prevalence of vestibular symptoms in our patients with CSOM (72.5%), which was higher than previous studies in this regard (40%-60%). 3,10,26,27 We hypothesized 2 potential reasons for such differences: (1) we selected patients with signs of active middle ear inflammation, while most of those other studies did not specify whether or not they included patients without active middle ear inflammation, and (2) our patients had, on average, longstanding CSOM. In Brazil, patients from the public health system do not have direct access to a specialist; therefore, adequate treatment might be delayed, increasing the risks of developing sequelae and complications.…”

Section: Discussionmentioning

confidence: 99%

“…Michelson et al 22 and Pelosi et al 30 described that patients with utricular dysfunction usually complain of unspecific dizziness rather than vertigo, findings that were paralleled by ours. Although otolithic dysfunction often leads to milder symptoms than other causes of vestibular dysfunction 31 and may be adequately compensated by the central nervous system, 3 it may lead to (1) difficulties in maintaining postural stability in challenging situations 4,22,32,33 and (2) greater risk of falling, which correlates with high morbidity and mortality rates. 22,30,31 Our study has several limitations.…”

Section: Discussionmentioning

confidence: 99%

Subjective Visual Vertical Testing in Patients With Chronic Suppurative Otitis Media

Monsanto

Kasemodel

Tomaz

et al. 2020

Otolaryngol.--head neck surg.

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Objective To analyze the results of the subjective visual vertical test using the “bucket method” in patients with chronic suppurative otitis media (CSOM). Study Design Cross-sectional, controlled study. Setting Outpatient otology clinic in a tertiary care hospital. Subjects and Methods Patients had CSOM, defined as the presence of chronic infection or inflammation of the middle ear cleft, associated with a perforation of the tympanic membrane, frequent or intractable middle ear suppuration, with or without cholesteatoma. Controls were selected using a nonprobability, purposive sampling method. We excluded patients with neurologic or metabolic diseases, cognitive deficits, otosclerosis, vestibular migraine, Ménière’s disease, past use of ototoxic medication, or head and neck cancer. The volunteers were subjected to the subjective visual vertical test using the “bucket method.” The results obtained in our study and control groups were analyzed using nonparametric tests. Results Our study comprised 51 patients with CSOM and 50 controls. In the CSOM group, we observed that 72.5% of the patients had vestibular symptoms in the past year, and 70.5% had abnormalities identified in at least 1 vestibular function test. The subjective visual vertical test revealed that patients with CSOM (with and without cholesteatoma) had significantly higher deviations of the true vertical as compared with controls (CSOM, 3.66°; controls, 0.76°; P < .001). Conclusion Our results revealed that CSOM was associated with high rates of vestibular symptoms, abnormal vestibular function tests, and abnormal subjective vertical visual results.

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Current evidence of peripheral vestibular symptoms secondary to otitis media

Cited by 33 publications

References 58 publications

Presentation of dizziness in individuals with chronic otitis media: data from the multinational collaborative COMQ-12 study

Presentation of dizziness in individuals with chronic otitis media: data from the multinational collaborative COMQ-12 study

Nystagmus in adult patients with acute otitis media or otitis media with effusion without dizziness

Subjective Visual Vertical Testing in Patients With Chronic Suppurative Otitis Media

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