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PP005

THE CLINICAL CHARACTERISTICS AND THE NATURAL COURSE OF THE RECURRENT VESTIBULOPATHY

Wednesday, 28 September, 2011 - 12:30
Board 1

Recurrent vestibulopathy (RV) is a disease showing the recurrent symptom of episodic vertigo lasting for several minutes to several hours without any audiological or neurological abnormalities. The etiology of RV is still unknown, and proposed mechanisms suggest association with endolymphatic hydrops, abnormal vascular compression in the eighth cranial nerve, viral infection, etc., and depending on the natural course it may cause benign recurrent vertigo, benign paroxysmal positional vertigo (BPPV), migraine, Ménière’s disease, etc.
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IntroductionRecurrent vestibulopathy (RV) is a disease showing the recurrent symptom of episodic vertigo lasting for several minutes to several hours without any audiological or neurological abnormalities. The etiology of RV is still unknown, and proposed mechanisms suggest association with endolymphatic hydrops, abnormal vascular compression in the eighth cranial nerve, viral infection, etc., and depending on the natural course it may cause benign recurrent vertigo, benign paroxysmal positional vertigo (BPPV), migraine, Ménière’s disease, etc.ObjectivesThe aim of this study is to evaluate clinical characteristics and natural course of patients diagnosed as RV. MaterialsWe analyzed retrospectively the medical records of 138 patients who were diagnosed with RV. An otolaryngologist conducted telephone interviews with the patients using a dizziness questionnaire. In case dizziness continued or accompanying audiological symptoms, migraine or neurological abnormalities was suspected, the patient visited the vertigo clinic and had oto-neurological examination, pure tone audiometry, etc.Results1) Clinical patterns

Among the 138 patients diagnosed with RV whose clinical patterns had been followed up, 98 (71%) responded to the telephone interview.

2) Natural course

Most of the patients diagnosed with RV were recovered from the dizziness symptom in 80 (82%) (inactive RV), continued in 12 (12%) (active RV), and developed into Ménière’s disease in 4 (4%) and into migraine in 2 (2%). No patient with RV has been developed to central origin vertigo during the period of follow-up.

3) Prognosis factors

In the results, the distribution of sex and age, unilateral caloric paresis, etc. were not statistically significant, but the frequency of dizziness was statistically significantly different between the two groups. (2.1 (±1.0) vs. 1.3 (±0.7) times per year) (p<0.05)

In patients with recurrent vertigo, if diagnosis cannot be made easily as a disease having definite or clear diagnostic criteria, it is diagnosed temporarily as RV and later depending on the natural course the diagnosis may be changed.

As to the limitations of this study, telephone interviews were convenient in collecting data in a short period but the method has a recall bias because the subjects have to recall their past dizziness, and cannot assess current dizziness accurately and objectively.

ConclusionsFrom the results of this study, it have favorable prognosis over time even without specific treatment. In some patients, however, the symptom developed into migraine, Ménière’s disease. RV is a logical diagnosis of a distinctive clinical disorder with unknown cause but with probable peripheral vestibular origin.References1) Leliever WC, Barber HO. Recurrent Vestibulopathy, Laryngoscope 1981;91;1-6.

2) Wallace IR, Barber HO. Recurrent vestibulopathy. J Otolaryngol 1983;12:61-3.

3) Rutka JA, Barber HO. Recurrent vestibulopathy: third review. J Otolaryngol 1986;15:105-7.

4) Gacek RR, Gacek MR. A classification of recurrent vestibulopathy. Adv Otorhinolaryngol. 2002;60:89-104.

5)Drachman DA, Hart CW. An approach to dizzy patient. Neurology 1972;22:323-34.