VDT (visual display terminal) syndrome has been reported since the 1980s as widely connected with the business or other use of personal computers (PCs). The typical manifestations of VDT syndrome are eye fatigue, dry eye, headache, neck pain, lumbago, anxiety and depression.
Vertigo induced by VDT work is described herein. The characteristic of this vertigo is female dominant. We postulate the pathogenesis of this vertigo as follows: 1. The difference in the spatial cognitive process between males and females. It has been suggested that in the spatial representations of environments, males tend to use metric information in their brain, whereas females use external landmark information. When returning to the real world after working for prolonged periods at a VDT, people who use exocentric information confront some difficulty in direction-finding, and this process could well lead to provoke spells of dizziness in the real world. This might be the reason to explain female dominance regarding this type of vertigo. 2. VDT work requires frequent vertical saccade and results in vertigo. 3. Headache, migraine and neck pain induce vertigo, recognized as vestibular migraine. The rate of incidence of vestibular migraine is also dominant in females. 4. It is well known that depression and anxiety also induce the vertigo. The most important way of treatment is to avoid prolonged periods of VDT work.
However, the relationships between cognitive processes, frequent vertical saccade, vestibular migraine and vertigo are not fully understood. Further investigation is still required.
Introduction: The vertigo symptom scale-short form (VSS-sf), which has three factors, the vestibular-balance symptom with long duration, the vestibular-balance symptom with short duration, and the autonomic symptom, was developed for measurement of the therapeutic effect in vestibular diseases. However, clinical use of the VSS-sf has not been reported in Japan, and there are very few analyses using scores of the factors or each item of the VSS-sf. The aims of this study is to report both clinical use of the VSS-sf in Japan and analyses using scores of the factors or each item of the VSS-sf.
Methods: Participants included both adult inpatients and outpatients with either non-central dizziness/vertigo or vertebrobasilar insufficiency which occurred more than one month before, diagnosed by expert neuro-otologists. Participants completed three questionnaires: the VSS-sf, the dizziness handicap inventory, and the hospital anxiety and depression scale (HADS). We conducted a multiple regression analysis with the scores of the three factors of the VSS-sf, to evaluate how much influence there was from vestibular and autonomic symptoms on any handicap due to dizziness. We analyzed the scores of each item of the VSS-sf to examine profiles of the symptoms in major vestibular diseases.
Results: The results of 159 participants were analyzed. Standard partial regression coefficients of anxiety, depression, and the vestibular-balance symptom with long duration were significant, however, those of the vestibular-balance symptom with short duration and the autonomic symptom were not. Most frequent autonomic symptoms were headache, chill/flashes, and palpitation in Ménière's disease, benign paroxysmal positional vertigo, vestibular neuronitis, and psychogenic dizziness.
Conclusion: The VSS-sf can be conducted without major problems in Japan, and may be useful for patients with vestibular diseases, not only to measure therapeutic effect but also to analyze the influence of, or relation between the vestibular-balance symptom/autonomic symptoms and other clinical variables.
Analyzing databases of 1,599 elderly patients (≧65) who visited my clinic for vertigo/dizziness in the past 9 years and 5 months, I describe herein the causes and backgrounds of, and countermeasures against their symptoms. BPPV and Meniere's disease comprised 74.2% and 16.2%, respectively, having the same values as in all-generation patients; sensorineural hearing loss/tinnitus, central disorders, and decline of vestibular functions were significantly more frequent in the elderly patients. They had various complications: hypertension in 27.5%; orthopedic diseases in 24.5%; insomnia in 23.9%; hyperglycemia in 10.7%; cardiac diseases in 10.3%; diabetes in 7.3%; obesity in 4.3%; cerebral infarction in 3.3%; and respiratory diseases in 2.9%. The incidence of insomnia, orthopedic diseases (women and some men), and cardiac diseases (some men and women) was significantly higher in the elderly patients in this study compared with the general population of the same age group. Although symptoms of BPPV disappeared in 88.5% after 1to 2 visits, a higher proportion of older patients demonstrated more inveterate or recurrent examples. Combinations associated with having retired from the workplace, fatigue, taking sedatives/sleeping drugs, or orthopedic complications impairing these patients' activities of daily living (ADL) resulted in BPPV. Taking medicine was not effective; on the other hand, recommendations to improve the balance of their ADL were effective to improve symptoms and prevent recurrence.
A 41-year-old man was found to have collapsed in his room. It was discovered that he had no money and had not eaten for approximately one week. Blood tests showed that Vit B1 (thiamine) was 9 ng/ml. He exhibited upbeat nystagmus (UBN) on the gaze nystagmus and positional nystagmus tests. Electronystagmography (ENG) showed the same findings. This patient was diagnosed as having Wernicke's encephalopathy (WE). WE is chacterized by the triad of oculomotor dysfunction, ataxia and consciousness disorders. Although chronic alcoholism is a well-known cause of WE, reports of this disorder due to nutritional deficiencies associated with dietary intake and inanition are limited. Regarding the incidence of vertical nystagmus, UBN was five times more frequent than downbeat nystagmus. Many patients of WE complain of dizziness associated with oculomotor disorders. Such patients are very likely to require treatment by otorhinolaryngologists in the future.
A hearing test is carried out in almost all patients complaining of vertigo or dizziness. However, a vestibular function test is rarely performed for patients with sudden deafness. Normal vestibular function cannot necessarily be assumed in cases where patients with sudden deafness have not complained of vestibular-related symptoms. We investigated 71 patients with sudden deafness in whom vestibular function tests with electronystagmography (ENG) were performed in our hospital. They visited our hospital within one month after the onset of hearing loss. 32 patients (45%) had sudden deafness with vestibular-related symptoms, 39 patients (55%) had no vestibular symptom. At the time of an initial consultation, we performed the positional nystagmus test with an infrared CCD camera. In the infrared CCD camera test, nystagmus was detected in 20 cases (51%) among 39 patients without vestibular symptoms. In the ENG test, abnormal findings were detected in 24 cases (62%) among 39 patients without vestibular symptoms. Based on these findings, we therefore advocate that both cochlear and vestibular function tests should be performed in patient with sudden deafness even when they have not complained of vestibular-related symptoms.