Prevalence and Impact of Bilateral Vestibular Hypofunction

TLDR

Let's parse content. Background: first line: "rofounded bilateral loss of vestibular sensation disables the vestibuloocular and vestibulospinal reflexes that normally maintain stable gaze and posture.Affected individuals experience oscillopsia (illusory movement of the visible world during head movement), chronic disequilibrium, and postural instability that interfere with otherwise routine activities such as walking or driving." Also second line includes Background, Purpose: "1,2[5] Incidence and prevalence data are available for a number of conditions affecting vestibular function [6][7][8] ; however, few data exist regarding the prevalence of BVH.Accurate estimates have been difficult to generate due to the lack of detailed reporting mechanisms focusing on balance or vestibular dysfunction in large surveys.In 2008, the National Health Interview Survey (NHIS) included supplemental dizziness and balance questions intended to assess the prevalence and associated impairments of vestibular disorders.The objective of this study was to assess the prevalence and impact of severe to profound BVH from the results of this large, nationally representative sample of adults.IMPORTANCE Profound bilateral vestibular hypofunction (BVH) causes disabling oscillopsia, chronic disequilibrium, and postural instability, but little is known about its epidemiology and impact.OBJECTIVE To assess prevalence and functional impact of BVH in the US adult population.DESIGN AND SETTING National cross-sectional survey using a national database and corollary validation study.PATIENTS Adult respondents to the 2008 Balance and Dizziness Supplement to the US National Health Interview Survey (N = 21 782)." So Background content includes general context: bilateral vestibular loss causes disabling symptoms; prevalence data limited; NHIS used; objective to assess prevalence and impact. Purpose: same line includes Purpose: "The objective of this study was to assess the prevalence and impact of severe to profound BVH from the results of this large, nationally representative sample of adults." Also "OBJECTIVE To assess prevalence and functional impact of BVH in the US adult population." So Purpose: assess prevalence and functional impact of BVH in US adults. Mechanism: "MAIN OUTCOMES AND MEASURESPrevalence of BVH, socioeconomic and quality-of-life impact of BVH, and fall risk.Criteria for the survey-based diagnosis of BVH included all of the following: presence of visual blurring with head movement; unsteadiness; difficulty walking in darkness or unsteady surfaces and in a straight path; and symptoms being at least "a big problem" and present for at least 1 year, in the absence of other neurologic conditions or eye pathologic conditions affecting vision." So Mechanism: survey-based diagnosis criteria; outcomes measured: prevalence, socioeconomic and QoL impact, fall risk.

Abstract

rofounded bilateral loss of vestibular sensation disables the vestibuloocular and vestibulospinal reflexes that normally maintain stable gaze and posture.Affected individuals experience oscillopsia (illusory movement of the visible world during head movement), chronic disequilibrium, and postural instability that interfere with otherwise routine activities such as walking or driving. 1,2[5] Incidence and prevalence data are available for a number of conditions affecting vestibular function [6][7][8] ; however, few data exist regarding the prevalence of BVH.Accurate estimates have been difficult to generate due to the lack of detailed reporting mechanisms focusing on balance or vestibular dysfunction in large surveys.In 2008, the National Health Interview Survey (NHIS) included supplemental dizziness and balance questions intended to assess the prevalence and associated impairments of vestibular disorders.The objective of this study was to assess the prevalence and impact of severe to profound BVH from the results of this large, nationally representative sample of adults.IMPORTANCE Profound bilateral vestibular hypofunction (BVH) causes disabling oscillopsia, chronic disequilibrium, and postural instability, but little is known about its epidemiology and impact.OBJECTIVE To assess prevalence and functional impact of BVH in the US adult population.DESIGN AND SETTING National cross-sectional survey using a national database and corollary validation study.PATIENTS Adult respondents to the 2008 Balance and Dizziness Supplement to the US National Health Interview Survey (N = 21 782). MAIN OUTCOMES AND MEASURESPrevalence of BVH, socioeconomic and quality-of-life impact of BVH, and fall risk.Criteria for the survey-based diagnosis of BVH included all of the following: presence of visual blurring with head movement; unsteadiness; difficulty walking in darkness or unsteady surfaces and in a straight path; and symptoms being at least "a big problem" and present for at least 1 year, in the absence of other neurologic conditions or eye pathologic conditions affecting vision. RESULTSAdjusted national estimates from this survey indicate the prevalence of BVH in 2008 was 28 per 100 000 US adults (64 046 Americans).Of the participants with BVH, 44% reported changing their driving habits because of their symptoms, 56% reported reduced participation in social activities, and 58% reported difficulties with activities of daily living.Respondents with BVH had a 31-fold increase in the odds of falling in multivariate analyses compared with all respondents, with 25% reporting a recent fall-related injury. CONCLUSIONS AND RELEVANCEAs estimated by the presence of specific symptoms in a nationally representative survey, BVH has considerable socioeconomic and quality-of-life impacts and significantly increases fall risk.These data support the need for new therapeutic strategies for BVH, including vestibular rehabilitation and implantable vestibular prostheses.