Elvira Cortese

Background: Despite clear diagnostic criteria established in 2017, delivering and explaining the diagnosis of persistent postural‐perceptual dizziness (PPPD) can be challenging. Methods: We outline a step‐by‐step approach to clearly explain the diagnosis, underlying mechanisms and treatment options to patients with PPPD, followed by a brief overview of current treatment approaches. This approach is adapted from the Cambridge‐Calgary Consultation Model and previous recommendations for functional neurological disorders but is mainly based on our expertise accrued over decades and input from patients with PPPD. Results: The practical clinical framework for the assessment and management of PPPD includes structured history‐taking, bedside examination and patient‐centred communication strategies aimed at improving diagnostic confidence and therapeutic engagement. Conclusion: Our experience indicates that the clinical approach used may shape patients' understanding, engagement and overall management trajectory in PPPD. Good communication is essential for the diagnosis and management of this condition.

Background: Acute vertigo is a common but diagnostically challenging presentation in emergency departments (EDs), where rapid distinction of life-threatening conditions—like stroke—is critical. Patient and clinician perspectives are often overlooked, and real ED needs and possibilities remain poorly understood. While smartphone-based clinical decision support tools (CDSTs) show promise, evidence on required features for trust and adoption is limited. The UK’s 2025 10-Year Health Plan highlights digital innovation and AI in urgent care, underscoring the need to address these gaps. Objective: To explore the experiences of emergency physicians and patients with acute vertigo during the diagnostic process; identify real-world challenges, needs and opportunities within the ED setting; and assess participants’ perceptions of the acceptability of implementing a smartphone-based decision-support tool (CDST) to aid in acute vertigo diagnosis. Design: Qualitative study using semi-structured interviews and reflexive thematic analysis. Setting: Emergency Department of University College London Hospitals NHS Foundation Trust (UCLH), UK. Participants: 10 emergency physicians with experience in managing acute vertigo and 10 patients who had recently presented to the ED with symptoms of acute vertigo. Results: The analyses identified challenges and needs when diagnosing acute vertigo in the ED and participants’ views on future smartphone-based CDST development to assist the diagnostic process. Clinicians emphasised diagnostic complexity, limited training and system-level constraints—like lack of space, time and resources—as major challenges. Patients emphasised the need for better communication and clearer diagnostic pathways. Both groups saw potential in smartphone-based CDSTs to improve diagnostic efficiency and accuracy by offering structured assessments and helping clinicians identify serious conditions. Conclusions: This study offers insights into real-world constraints of diagnosing acute vertigo in the ED. Findings suggest that aligning CDST design with clinical workflows, user trust and environmental realities may facilitate adoption and impact in emergency care settings.

Accurate diagnosis of acute vertigo (AV) in emergency settings is crucial due to varied underlying causes. Challenges include differentiating non-life-threatening conditions, like vestibular migraine, from severe issues, such as stroke. The “TiTrATE - STANDING Adapted” algorithm was created to help non-specialist emergency physicians diagnose posterior circulation strokes in AV patients, overcoming the limitations of current practices that require specialized knowledge and equipment. This study involved a prospective validation and retrospective analysis of 67 patients at the National Hospital for Neurology and Neurosurgery and University College London Hospital. Patients underwent objective oculomotor assessments through video oculography and pure tone audiometry, conducted by an experienced audiologist in the acute stage. The accuracy of the “TiTrATE - STANDING Adapted” algorithm was compared to final diagnoses made by specialists, which included a comprehensive review of medical histories, objective test results, and imaging studies. The “TiTrATE - STANDING Adapted” algorithm demonstrated a sensitivity of 90%, with low specificity (57.9%), resulting in a high rate of false positives (24 out of 67) and a global accuracy of 62.7%. Conditions such as vestibular migraine and chronic vascular issues (e.g., orthostatic hypotension) were often misclassified, impacting the overall specificity. Integrating TiTrATE, HINTS Plus, and STANDING into a single diagnostic algorithm for acute vertigo in the ED could enhance accuracy and streamline decision-making. However, the combined model must perform at least as well as its individual components. Key improvements needed before implementation include adding vestibular migraine criteria, refining stroke exclusion guidelines, and ongoing validation to boost diagnostic precision and patient outcomes.

Background. Evidence-based information on genetic sensorineural hearing loss in Latin America is limited, hindering the advancement of related clinical practice and the development of relevant healthcare policies in the field. This study describes sociodemographic and clinical characteristics of a group of Chilean participants with congenital, childhood, progressive or late-onset sensorineural hearing loss of unknown etiology; all non-genetic causes of hearing loss were excluded. Methods. A quantitative study, with a non-experimental, observational, cross-sectional design and a descriptive scope. From 978 patients diagnosed with SNHL, 286 subjects fulfilled the inclusion criteria, and 138 patients accepted to participate. Results. The most frequent audiological-profile was symmetrical-bilateral-profound-SNHL with a sloping pattern. The median age at audiological diagnosis was 24.5 months (IQR:12-53) and at first-time Hearing-Assistive-Device-use (HAD-use) was 30 months (IQR:13-69). 71% of HAD were financed by public resources. Conclusion. The age at audiological diagnosis in SNHL of suspected genetic causes is still far from international standards. These results are valuable for public health research and policy development, not only for the Chilean population, but also for other Hispanic communities and other middle-high income countries.

En la actualidad se hace referencia en la bibliografía a una gran variedad de métodos para evaluar la disfunción del conducto faringotimpánico (DCFT), la gran mayoría de ellos requiere de instrumental de alta complejidad y personal altamente capacitado. Pese a lo mencionado, ninguno de dichos métodos ha sido validado como herramienta gold standard para el diagnóstico de esta patología. En este contexto, se presenta una herramienta complementaria para el diagnóstico de la DCFT, el Eustachian Tube Dysfunction Questionnaire -7 ítemes (ETDQ-7); cuestionario autoadministrado que considera 7 preguntas en base a una escala de Likert, fue creado para evaluar la sintomatología asociada a la disfunción del conducto con una puntuación que va desde lo más leve (1 punto) a lo más grave (7 puntos) de acuerdo con los síntomas percibidos, y posee un puntaje máximo de 49 puntos, correspondiente a una disfunción severa. La presente revisión tiene como objetivo buscar, organizar, clasificar y describir la información disponible en publicaciones científicas indexadas sobre el ETDQ-7 como herramienta para el diagnóstico clínico complementario de la DCFT. Se incluyeron 11 artículos científicos que hacen referencia al uso del ETDQ-7 en diferentes países. Los resultados recabados sugieren que el ETDQ-7 sería una valiosa herramienta, de alta sensibilidad, especificidad y validez clínica, que permitiría discriminar la presencia de la DCFT. No se encontró evidencia respecto a la aplicación o validación de este cuestionario en nuestro país.