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PLoS One. 2020 Mar 9;15(3):e0228768. doi: 10.1371/journal.pone.0228768. eCollection 2020.

Prospective cohort study on the predictors of fall risk in 119 patients with bilateral vestibulopathy.

Author information

1
Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium.
2
Department of Otorhinolaryngology & Head and Neck Surgery, Antwerp University Hospital, Edegem, Belgium.
3
Department of Otorhinolaryngology and Head and Neck Surgery, Division of Balance Disorders, Faculty of Health Medicine and Life Sciences, Maastricht University Medical Center, School for Mental Health and Neuroscience, Maastricht, Netherlands.
4
Service of Otorhinolaryngology Head and Neck Surgery, Department of Clinical Neurosciences, Geneva University Hospitals, Geneva, Switzerland.
5
Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Science, University of Antwerp, Belgium; Multidisciplinary Motor Centre Antwerp (M2OCEAN), University of Antwerp, Antwerp, Belgium.
6
Faculty of Physics, Tomsk State Research University, Tomsk, Russia.

Abstract

OBJECTIVES:

To identify predictive factors for falls in patients with bilateral vestibulopathy (BV). Specific variables contributing to the general work-up of a vestibular patient were compared between BV patients experiencing falls and those who did not.

DESIGN:

Prospective multi-centric cohort study.

SETTING:

Department of Otorhinolaryngology & Head and Neck Surgery at two tertiary referral centers: Antwerp University Hospital and Maastricht University Medical Center.

PARTICIPANTS:

In total, 119 BV patients were included. BV diagnosis was defined in accordance with the diagnostic BV criteria, established by the Bárány Society in 2017.

MAIN OUTCOME MEASURES:

Patients were divided into fallers and non-fallers, depending on the experience of one or more falls in the preceding 12 months. Residual vestibular function on caloric testing, rotatory chair testing, video head impulse test (vHIT) and cervical vestibular evoked myogenic potentials (cVEMP) was evaluated as a predictive factor for falls. Furthermore, hearing function (speech perception in noise (SPIN)), sound localization performance, etiology, disease duration, sport practice, scores on the Dizziness Handicap Inventory (DHI) and the Oscillopsia Severity Questionnaire (OSQ) were compared between fallers and non-fallers.

RESULTS:

Forty-five (39%) patients reported falls. In a sub-analysis in the patients recruited at UZA (n = 69), 20% experienced three or more falls and three patients (4%) suffered from severe fall-related injuries. The DHI score and the OSQ score were significantly higher in fallers. Residual vestibular function, SPIN, sound localization performance, etiology, disease duration, age and sport practice did not differ between fallers and non-fallers.

CONCLUSIONS:

Falls and (severe) fall-related injuries are frequent among BV patients. A DHI score > 47 and an OSQ score > 27.5 might be indicative for BV patients at risk for falls, with a sensitivity of 70% and specificity of 60%. Residual vestibular function captured by single vestibular tests (vHIT, calorics, rotatory chair, cVEMP) or by overall vestibular function defined as the number of impaired vestibular sensors are not suitable to distinguish fallers and non-fallers in a BV population.

Conflict of interest statement

The authors have declared that no competing interests exist.

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