Postural sway in individuals with type 2 diabetes and concurrent benign paroxysmal positional vertigo

ABSTRACT Background and purpose: diabetes has been shown to affect the peripheral vestibular end organs and is associated with an increase in the frequency of benign paroxysmal positional vertigo (BPPV). People with diabetes have higher postural sway; however, the impact of symptomatic BPPV on postural sway in individuals with diabetes is unclear. The purpose of this cross-sectional study was to examine postural sway in people with type 2 diabetes who have symptomatic, untreated BPPV (BPPVDM). Methods: fifty-two participants (mean age 56.9 ± 5.6 years) were enrolled: controls (n = 14), diabetes (n = 14), BPPV only (n = 13) and BPPVDM (n = 11). An inertial motion sensor was used to detect pelvic acceleration across five standing conditions with eyes open/closed on firm/foam surfaces. Range of acceleration (cm/s2), peak velocity (cm/s) and variability of sway [root mean square (RMS)] in the anterior-posterior (AP) and medial-lateral (ML) directions were used to compare postural sway between groups across conditions. Results: participants with BPPVDM had higher ranges of acceleration in the AP (p = 0.02) and ML (p = 0.02) directions, as well as higher peak velocity (p < 0.001) and RMS values (p = 0.006) in the AP direction compared to the control and diabetes groups. Standing on foam with eyes closed and tandem stance were challenging conditions for people with BPPVDM. Conclusion: clinicians may consider using standing on foam with eyes closed and tandem standing with eyes open to assess postural control in people with BPPVDM to identify postural instability.

[1]  M. Ross,et al.  Morphological evidence of vestibular pathology in long-term experimental diabetes mellitus. II. Connective tissue and neuroepithelial pathology. , 1987, Acta oto-laryngologica.

[2]  Tamara B. Harris,et al.  Diabetes-related complications, glycemic control, and falls in older adults , 2008 .

[3]  E. Prokopakis,et al.  Canalith Repositioning Procedures among 965 Patients with Benign Paroxysmal Positional Vertigo , 2012, Audiology and Neurotology.

[4]  Gerard Boyle,et al.  Correlation of accelerometry with clinical balance tests in older fallers and non-fallers. , 2008, Age and ageing.

[5]  M. Strupp,et al.  A multicenter observational study on the role of comorbidities in the recurrent episodes of benign paroxysmal positional vertigo. , 2014, Auris, nasus, larynx.

[6]  G. Paludetti,et al.  The use of dynamic posturography to detect neurosensorial disorder in IDDM without clinical neuropathy. , 1999, Journal of diabetes and its complications.

[7]  R. Cumming,et al.  Diabetes and risk of fracture: The Blue Mountains Eye Study. , 2001, Diabetes care.

[8]  H. Ying,et al.  Characterization of Vestibulopathy in Individuals with Type 2 Diabetes Mellitus , 2015, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[9]  F O Black,et al.  Clinical application of dynamic posturography for evaluating sensory integration and vestibular dysfunction. , 1990, Neurologic clinics.

[10]  Susan L Whitney,et al.  The sensitivity and specificity of the Timed "Up & Go" and the Dynamic Gait Index for self-reported falls in persons with vestibular disorders. , 2004, Journal of vestibular research : equilibrium & orientation.

[11]  F Prince,et al.  Evaluation of postural stability in elderly with diabetic neuropathy. , 2000, Diabetes care.

[12]  A. Noczyńska,et al.  Are there any disturbances in vestibular organ of children and young adults with Type I diabetes? , 2002, Diabetologia.

[13]  S. Karahan,et al.  Electrophysiologic vestibular evaluation in type 2 diabetic and prediabetic patients: Air conduction ocular and cervical vestibular evoked myogenic potentials , 2015, International journal of audiology.

[14]  H. Cohen,et al.  Benign Paroxysmal Positional Vertigo and Comorbid Conditions , 2004, ORL.

[15]  J. Cauley,et al.  Nontraumatic fracture risk with diabetes mellitus and impaired fasting glucose in older white and black adults: the health, aging, and body composition study. , 2005, Archives of internal medicine.

[16]  R. Moe-Nilssen,et al.  Trunk accelerometry as a measure of balance control during quiet standing. , 2002, Gait & posture.

[17]  Lorenzo Chiari,et al.  ISway: a sensitive, valid and reliable measure of postural control , 2012, Journal of NeuroEngineering and Rehabilitation.

[18]  Tamara M. McMahon,et al.  Retrospective data suggests that the higher prevalence of benign paroxysmal positional vertigo in individuals with type 2 diabetes is mediated by hypertension. , 2016, Journal of vestibular research : equilibrium & orientation.

[19]  Michael C Schubert,et al.  Diabetes, Vestibular Dysfunction, and Falls: Analyses From the National Health and Nutrition Examination Survey , 2010, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[20]  J. Tampas,et al.  The Effect of Age on the Vestibular Evoked Myogenic Potential and Sternocleidomastoid Muscle Tonic Electromyogram Level , 2011, Ear and hearing.

[21]  Ali Moghtaderi,et al.  Validation of Michigan neuropathy screening instrument for diabetic peripheral neuropathy , 2006, Clinical Neurology and Neurosurgery.

[22]  S. Bandinelli,et al.  Diabetes, peripheral neuropathy, and lower-extremity function. , 2014, Journal of diabetes and its complications.

[23]  Michael C Schubert,et al.  Disorders of balance and vestibular function in US adults: data from the National Health and Nutrition Examination Survey, 2001-2004. , 2009, Archives of internal medicine.

[24]  Susan L. Whitney,et al.  Clinical Practice Guideline: Benign Paroxysmal Positional Vertigo , 2008, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[25]  G. Jacobson,et al.  The influence of unilateral saccular impairment on functional balance performance and self-report dizziness. , 2011, Journal of the American Academy of Audiology.

[26]  F. Horak,et al.  Postural sway as a marker of progression in Parkinson's disease: a pilot longitudinal study. , 2012, Gait & posture.

[27]  S. Whitney,et al.  Impact of Diabetic Complications on Balance and Falls: Contribution of the Vestibular System , 2015, Physical Therapy.

[28]  C. Foster,et al.  Vestibular rehabilitation. , 1994, Bailliere's clinical neurology.

[29]  M S Redfern,et al.  A comparison of accelerometry and center of pressure measures during computerized dynamic posturography: a measure of balance. , 2011, Gait & posture.

[30]  H. Francis,et al.  Predictors of Vestibular Schwannoma Growth and Clinical Implications , 2010, Otology & neurotology : official publication of the American Otological Society, American Neurotology Society [and] European Academy of Otology and Neurotology.

[31]  Yea-Ru Yang,et al.  Balance Ability in Patients with Benign Paroxysmal Positional Vertigo , 2006, Otolaryngology--head and neck surgery : official journal of American Academy of Otolaryngology-Head and Neck Surgery.

[32]  Jennica Bellanca,et al.  The development of an accelerometer-based measure of human upright static anterior- posterior postural sway under various sensory conditions: test-retest reliability, scoring and preliminary validity of the Balance Accelerometry Measure (BAM). , 2013, Journal of vestibular research : equilibrium & orientation.

[33]  C. Bard,et al.  Postural Stability in Diabetic Polyneuropathy , 1995, Diabetes Care.

[34]  Thuy-Tien L. Dam,et al.  Fracture risk in diabetic elderly men: the MrOS study , 2014, Diabetologia.

[35]  Steven J. Brown,et al.  Diabetic Peripheral Neuropathy Compromises Balance During Daily Activities , 2015, Diabetes Care.

[36]  C L Shupert,et al.  Organizing sensory information for postural control in altered sensory environments. , 1996, Journal of theoretical biology.

[37]  T. Köse,et al.  Balance in posterior and horizontal canal type benign paroxysmal positional vertigo before and after canalith repositioning maneuvers. , 2008, Gait & posture.