Bénédicte L'Heureux-Lebeau1, Alain Godbout, Djamal Berbiche, Issam Saliba. 1. *Division of Otolaryngology and Head and Neck Surgery, †Department of Physical Therapy, and the ‡Department of Statistics-University of Montreal, Montreal University Hospital Center (CHUM), Montreal, Quebec, Canada.
Abstract
OBJECTIVE: To assess the utility of the paraclinical tests in patients presenting with clinical diagnosis of cervicogenic dizziness. STUDY DESIGN: Case controlled. SETTING: Otolaryngology clinic of a tertiary referral hospital center. PATIENTS: Twenty-five subjects with cervicogenic dizziness and 25 subjects with benign paroxysmal positional vertigo. MAIN OUTCOME MEASURES: Symptoms description, Dizziness Handicap Inventory-short form (DHI), Trait anxiety score, cervical joint position error, the smooth pursuit neck torsion and cervical torsion tests on videonystagmography, and standing balance test (timed 10-meter walk with head turns). RESULTS: The results showed differences in reported symptoms, in mean cervical joint position error (p = 0.001), and cervical torsion test (p = 0.001) between the two groups. There was no between-group difference for DHI scores (p = 0.137), trait anxiety scores (p = 0.240), and walking test: time (p = 0.797), steps (p = 0.963). The Youden index is 0.60 for the predictive value of the cervical joint position error, and the smooth pursuit and the cervical torsion tests. CONCLUSION: This study showed differences in sensorimotor disturbances between the two groups, particularly in the control of head and eye movements and cervical proprioception. Patients with cervicogenic dizziness were more likely to (1) have a sensation of drunkenness and lightheadedness, (2) have pain induced during the physical examination of the upper cervical vertebrae, (3) have an elevated joint position error of 4.5 degrees during the cervical relocation test, and (4) exhibit more than 2 degrees per second nystagmus during the cervical rotation test. The walking test was not able to differentiate the two groups.
OBJECTIVE: To assess the utility of the paraclinical tests in patients presenting with clinical diagnosis of cervicogenic dizziness. STUDY DESIGN: Case controlled. SETTING: Otolaryngology clinic of a tertiary referral hospital center. PATIENTS: Twenty-five subjects with cervicogenic dizziness and 25 subjects with benign paroxysmal positional vertigo. MAIN OUTCOME MEASURES: Symptoms description, Dizziness Handicap Inventory-short form (DHI), Trait anxiety score, cervical joint position error, the smooth pursuit neck torsion and cervical torsion tests on videonystagmography, and standing balance test (timed 10-meter walk with head turns). RESULTS: The results showed differences in reported symptoms, in mean cervical joint position error (p = 0.001), and cervical torsion test (p = 0.001) between the two groups. There was no between-group difference for DHI scores (p = 0.137), trait anxiety scores (p = 0.240), and walking test: time (p = 0.797), steps (p = 0.963). The Youden index is 0.60 for the predictive value of the cervical joint position error, and the smooth pursuit and the cervical torsion tests. CONCLUSION: This study showed differences in sensorimotor disturbances between the two groups, particularly in the control of head and eye movements and cervical proprioception. Patients with cervicogenic dizziness were more likely to (1) have a sensation of drunkenness and lightheadedness, (2) have pain induced during the physical examination of the upper cervical vertebrae, (3) have an elevated joint position error of 4.5 degrees during the cervical relocation test, and (4) exhibit more than 2 degrees per second nystagmus during the cervical rotation test. The walking test was not able to differentiate the two groups.
Authors: Carlos Bernal-Utrera; Juan José González-Gerez; Manuel Saavedra-Hernandez; Miguel Ángel Lérida-Ortega; Cleofás Rodríguez-Blanco Journal: Trials Date: 2019-08-09 Impact factor: 2.279