الفهرس 
Introduction, Rationale and Aim of the workOnly 14 pages are availabe for public view
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Abstract
Five hundred elderly patients above 60 years who admitted audio- vestibular unit for hearing or vestibular assessment. The aims of study are to estimate prevalence of falls and dizziness in elderly population and to design a cost- effective imbalance and fall prevention screening protocol that can be used in a large scale among the health system. This study was a prospective study obtained from 500 elderly person 318 male (64%),182 female (36%). Age of the study group ranged from 60 years to 83 years, average was 67.32 and SD was 5.4. There was a 332 (66%) person in age group 60-70 year, 154 (31%) persons in age group 70-80 and 14 (3%) persons above80 years. Persons with history of dizziness was 159 (32%). The persons with positive history of diabetes, hypertension, cardiovascular diseases were 184 (36.8%), 212 (42.4%), 174 (34.8%) respectively. Persons with history of falls were 153 (31%), persons with orthostatic hypotension was 16 (3%)and persons with abnormal BMI was 453 (91%).The most common type of hearing loss found in study participants was the sensorineural hearing loss 585 (58%) ears, there was 157 ears with high frequency hearing loss, there was 54 (5%) ears with conductive hearing loss, 86 (9%) ears with mixed hearing loss and 118 (12%) ears with normal hearing sensitivity. The most common degree hearing loss was moderate hearing loss.
The abnormal finding in oculomotor tests for gaze nystagmus in 14 (2.8%) subjects, Saccadic eye movement in 35 (7%) subjects, pursuit tracking in 40 (8%) subjects. In gaze evoked nystagmus there was 9 persons with right gaze evoked nystagmus, 3 persons with left gaze evoked nystagmus, 2 persons with gaze evoked nystagmus in all directions. Abnormal finding in VOR tests for spontaneous nystagmus 13 (2.6%), post head shaking test 25 (5%), Head impulse test 16 (3.2%), positioning nystagmus 52 (10.4%) and positional nystagmus 43 (8.6%). In spontaneous nystagmus there was 8 persons,5 persons with left horizontal-rotatory nystagmus . In positional nystagmus there was 3 with left beating nystagmus on head left, supine central position, 12 persons with left beating nystagmus on head left only, 3 persons with up beating nystagmus on head right and supine central, 8 persons with right beating nystagmus on head right, supine central position, 17 persons with right beating nystagmus on head right only and all types of positional nystagmus decreased with fixation. In positioning nystagmus there was 31 persons with right rotatory nystagmus, 17 persons with left rotatory nystagmus, 3 persons with both right and left rotatory nystagmus,1 person with left horizontal nystagmus.
There was 76 (15%) persons with abnormal Fukuda test, 86 (17%) persons with abnormal CTSIP, 15 (3%) persons with abnormal Romberg test., persons with steady gait was 384 (77%), those with unsteady gait was 116 (23.2%). We found significant correlation between increase age and falls (p value < 0.001) although we do not find association between female gender and falls. We do not find association between dizziness and falls. We found significant association between systemic diseases and falls also orthostatic hypotension and falls but we do not find association BMI and falls. We found correlation between previous history of falls and abnormal office test findings. We found there was no association between increase incidence of falls and type. We found significant correlation between age and falls in univariate analysis (p value 0.0001) but in multivariate analysis there was no significance so that age was not a predictor of falls. In current study dizziness was not predictor for falls in univariate analysis P value (0.12) and multivariate regression analysis P value (0.75). Our results showed the association between study participants of diabetic, hypertensive patients and falls remain statistically significant in univariate analysis and multivariate analysis. According to cardiac patients, we found significant association in univariate analysis and after adjusting of the other factors, the association between cardiovascular diseases and falls lost its significance. BMI has no significant association in univariate analysis and multivariate analysis. The association between study participants of orthostatic hypotension and falls remain statistically significant in univariate analysis and multivariate analysis. We found significant association between head impulse test, post head shaking test, saccadic eye movement, pursuit tracking, spontaneous nystagmus, gaze nystagmus in univariate analysis. After adjusting of the other factors, the association with falls lost its significance except in presence of positioning nystagmus and positional nystagmus where we found significant association between them and falls in univariate and multivariate analysis. So that presence of positioning nystagmus and positional nystagmus are predictors of falls.
We found significant association between abnormal finding in CTSIP and Romberg tests in univariate analysis. After adjusting of the other factors, the association with falls lost its significance for CTSIP test. Abnormalities in Fukuda test and gait test shows significant association in univariate analysis and multivariate analysis. Therefore, the predictors for falls are abnormal gait, abnormal fukuda test and abnormal Romberg tests.
Current study showed that there were no significant difference persons who complaining from hearing loss and persons who complaining from vestibular symptoms as regard demographic data and history. Also, there was no significant difference between the two groups as regard general examination except BMI where there was association between BMI and vestibular complaint. There was no
significant difference between the two groups as regard audiological evaluation. There was no significant difference between the two groups as regard office test except gaze test, smooth pursuit test, fukuda test, gait test where there more association between them and vestibular complaint. There were no previous studies to correlate between two groups.
In conclusion, our study revealed that percentage of history of falls and history of dizziness in elderly subjects was (32%, 31% respectively). Presence of systemic diseases (diabetes, hypertension, cardiovascular diseases), presence of orthostatic hypotension, abnormal office vestibular findings as there a significant association between history of falls and these findings. Our study we found that significant predictors of falls are diabetes mellitus, hypertension, orthostatic hypotension, abnormal gait test, abnormal fukuda test and abnormal Romberg tests, abnormal positioning nystagmus and positional nystagmus.