DISCOHAT: An Acronym to Describe the Spectrum of Symptoms Related to Bilateral Vestibulopathy

Paredis, Sophie; Stiphout, Lisa van; Remmen, Eva; Strupp, Michael; Gerards, Marie-Cecile; Kingma, Herman; Rompaey, Vincent Van; Fornos, Angelica-Perez; Guinand, Nils; Berg, Raymond van de

doi:10.3389/fneur.2021.771650

Cited by 9 publications

(11 citation statements)

References 39 publications

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“…Wenn Sie nach dieser Zeit bemerken, dass der Patient nicht zum Ende kommt und noch wichtige Informationen fehlen, können Sie an diesem Punkt mit gezieltem Nachfragen beginnen. Hier können Gedankenstützen wie SO STONED [ 17 ] und DISCOHAT [ 18 ] für eine systematische Erfassung der Informationen nützlich sein (Tab. 1 und 2 ; siehe auch „Herausforderung 3“ und „Herausforderung 4“).…”

Section: Anamneseunclassified

Der „schwierige“ Patient – Vestibularisdiagnostik unter erschwerten Bedingungen

Dlugaiczyk

2022

HNO

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ZusammenfassungDer Patient mit dem Leitsymptom Schwindel stellt häufig eine Herausforderung für den Hals-Nasen-Ohren-Arzt dar. Die folgende Artikelserie beleuchtet unterschiedliche Aspekte des „schwierigen“ Schwindelpatienten. Der vorliegende erste Teil widmet sich den Besonderheiten und Fallstricken bei der Anamneseerhebung und der klinisch-neurootologischen Untersuchung. Dabei werden situationsspezifische Lösungsansätze zu folgenden Themen der Anamneseerhebung aufgezeigt: Definition von Erwartungen und Zielen, „ausschweifende“ Anamnese, Beschreibung des Symptoms Schwindel, mehrere Schwindelentitäten bei einem Patienten, Diskrepanz zwischen Symptomschwere und vestibulären Befunden, kognitive Verzerrungen und der Umgang mit Emotionen. Des Weiteren werden praxisbezogene Hinweise für die neurootologische Untersuchung von Patienten mit Halswirbelsäulenproblemen und Augenbewegungsstörungen sowie bei ängstlichen Patienten gegeben.

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Section: Anamneseunclassified

Der „schwierige“ Patient – Vestibularisdiagnostik unter erschwerten Bedingungen

Dlugaiczyk

2022

HNO

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“…Patients typically suffer from imbalance, worsening in the dark and/or on uneven ground, and movement-induced blurred vision (oscillopsia) ( 4 ). BVP also leads to additional symptoms such as an increased risk of falling, cognitive deficits, impairment of navigation and spatial memory, autonomic dysfunction, anxiety, and depression ( 4 – 11 ). Consequently, BVP leads to reduced quality of life and imposes a significant socioeconomic burden on society ( 12 – 14 ).…”

Section: Introductionmentioning

confidence: 99%

Patterns of Vestibular Impairment in Bilateral Vestibulopathy and Its Relation to Etiology

et al. 2022

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ObjectiveThis study aimed to investigate (1) the patterns of vestibular impairment in bilateral vestibulopathy (BVP) and subsequently, the implications regarding patient eligibility for vestibular implantation, and (2) whether this pattern and severity of vestibular impairment is etiology dependent.MethodsA total of one hundred and seventy-three subjects from three tertiary referral centers in Europe were diagnosed with BVP according to the Bárány Society diagnostic criteria. The subjects underwent vestibular testing such as the caloric test, torsion swing test, video Head Impulse Test (vHIT) in horizontal and vertical planes, and cervical and/or ocular vestibular evoked myogenic potentials (c- and oVEMPs). The etiologies were split into idiopathic, genetic, ototoxicity, infectious, Menière's Disease, (head)trauma, auto-immune, neurodegenerative, congenital, and mixed etiology.ResultsThe caloric test and horizontal vHIT more often indicated horizontal semicircular canal impairment than the torsion swing test. The vHIT results showed significantly higher gains for both anterior canals compared with the horizontal and posterior canals (p < 0.001). The rates of bilaterally absent oVEMP responses were higher compared to the bilaterally absent cVEMP responses (p = 0.010). A total of fifty-four percent of the patients diagnosed with BVP without missing data met all three Bárány Society diagnostic test criteria, whereas 76% of the patients were eligible for implantation according to the vestibular implantation criteria. Regarding etiology, only horizontal vHIT results were significantly lower for trauma, neurodegenerative, and genetic disorders, whereas the horizontal vHIT results were significantly higher for Menière's Disease, infectious and idiopathic BVP. The exploration with hierarchical cluster analysis showed no significant association between etiology and patterns of vestibular impairment.ConclusionThis study showed that caloric testing and vHIT seem to be more sensitive for measuring vestibular impairment, whereas the torsion swing test is more suited for measuring residual vestibular function. In addition, no striking patterns of vestibular impairment in relation to etiology were found. Nevertheless, it was demonstrated that although the implantation criteria are stricter compared with the Bárány Society diagnostic criteria, still, 76% of patients with BVP were eligible for implantation based on the vestibular test criteria. It is advised to carefully examine every patient for their overall pattern of vestibular impairment in order to make well-informed and personalized therapeutic decisions.

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“…It is, therefore, imperative to improve the quality of history taking. To this end, various approaches have been proposed, e.g., asking key questions [15,16], focusing on time course and triggers (TiTrATE paradigm, [17]), on key dimensions (SO STONED paradigm, [18]), and on key symptoms (DISCOHAT paradigm, [19]).…”

Section: Introductionmentioning

confidence: 99%

“…In relation to the TiTrATE paradigm, the dimensions 'how often' and 'triggers' should be emphasized, since these are exactly the same as the 'time course and triggers' mentioned above; they too enable symptoms to be categorized into acute, episodic, or chronic vestibular syndromes. In addition, the DISCOHAT paradigm is specifically able to capture the wide spectrum of symptoms related to vestibulopathy (darkness worsens symptoms, imbalance, supermarket effect, cognitive complaints, oscillopsia, head movements worsen symptoms, autonomic complaints, tiredness) [19].…”

Section: Introductionmentioning

confidence: 99%

“…The DISCOHAT acronym can be used to evaluate chronic vestibular symptoms, especially those related to uni-or bilateral vestibulopathy. As described above, these symptoms are: darkness worsens symptoms, imbalance, supermarket effect (=visually induced dizziness: sensitivity to moving visual stimuli or complex patterns, which is part of PPPD (see below) [8]), cognitive complaints, oscillopsia, head movements worsen symptoms, autonomic complaints, and tiredness [19]. Additionally, screen for otological and neurological symptoms unrelated to the attacks.…”

Section: Introductionmentioning

confidence: 99%

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History Taking in Non-Acute Vestibular Symptoms: A 4-Step Approach

Berg

Kingma

2021

JCM

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History taking is crucial in the diagnostic process for vestibular disorders. To facilitate the process, systems such as TiTrATE, SO STONED, and DISCOHAT have been used to describe the different paradigms; together, they address the most important aspects of history taking, viz. time course, triggers, and accompanying symptoms. However, multiple (vestibular) disorders may co-occur in the same patient. This complicates history taking, since the time course, triggers, and accompanying symptoms can vary, depending on the disorder. History taking can, therefore, be improved by addressing the important aspects of each co-occurring vestibular disorder separately. The aim of this document is to describe a four-step approach for improving history taking in patients with non-acute vestibular symptoms, by guiding the clinician and the patient through the history taking process. It involves a systematic approach that explicitly identifies all co-occurring vestibular disorders in the same patient, and which addresses each of these vestibular disorders separately. The four steps are: (1) describing any attack(s) of vertigo and/or dizziness; (2) describing any chronic vestibular symptoms; (3) screening for functional, psychological, and psychiatric co-morbidity; (4) establishing a comprehensive diagnosis, including all possible co-occurring (vestibular) disorders. In addition, pearls and pitfalls will be discussed separately for each step.

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DISCOHAT: An Acronym to Describe the Spectrum of Symptoms Related to Bilateral Vestibulopathy

Cited by 9 publications

References 39 publications

Der „schwierige“ Patient – Vestibularisdiagnostik unter erschwerten Bedingungen

Der „schwierige“ Patient – Vestibularisdiagnostik unter erschwerten Bedingungen

Patterns of Vestibular Impairment in Bilateral Vestibulopathy and Its Relation to Etiology

History Taking in Non-Acute Vestibular Symptoms: A 4-Step Approach

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