Coronavirus Disease 2019 Return to Work Guidance and Recommendations for Vestibular Clinicians.

As states begin issuing progressive deconfinement guidelines, hospitals and institutions are starting to reopen for elective procedures and consultations. Vestibular clinicians are opening their practices to evaluate, test, or treat patients with dizziness and balance problems. The following document, requested by the American Balance Society, collates the current information about the virus, including transmission from asymptomatic carriers, decontamination, and other safety protocols, and provides a return to work guidance for clinicians caring for this population of patients, promoting provider, patient, and staff safety.

Recovery of Unaided Hearing After Cochlear Implantation in Patient With Bilateral Menière's Disease.

OBJECTIVE: To report a novel occurrence of unaided hearing recovery after cochlear implantation in a patient with Menière's disease. PATIENTS: A 49-year-old woman with bilateral Menière's disease and vestibular migraine. INTERVENTIONS: Cochlear implantation. MAIN OUTCOME MEASURES: Postoperative unaided and aided pure tone thresholds and speech recognition measures. RESULTS: Six-month postoperative unaided hearing in the implanted ear was in the moderate sensorineural hearing loss range with a speech reception threshold of 45 dB and word recognition score of 95%, representing a significant improvement from preoperative hearing, which was in the profound sensorineural hearing loss range with an unaided speech awareness threshold of 75 dB and inability to perform speech recognition testing. Aided testing also demonstrated an expected postoperative improvement after 6 months with a CNC word and AzBio in quiet score of 96% and 93%, respectively, from 0% and 9% preoperatively. CONCLUSION: Unaided hearing improvement after cochlear implantation in a patient with Menière's disease is unexpected, but possible and might lend insight into the poorly understood underlying mechanisms of sensorineural hearing loss in patients with Menière's disease.

Predictive Value of Vestibular Evoked Myogenic Potentials in the Diagnosis of Menière's Disease and Vestibular Migraine.

OBJECTIVE: To explore the usefulness of vestibular evoked myogenic potentials (VEMPs) in the diagnosis of Menière's disease (MD) and vestibular migraine (VM). STUDY DESIGN: Retrospective cohort. SETTING: Multidisciplinary neurotology clinic. PATIENTS: Definite MD and definite VM patients between January, 2015 and May, 2017, as well as healthy volunteers. INTERVENTIONS: Cervical and ocular VEMP (cVEMP and oVEMP) testing. MAIN OUTCOME MEASURES: VEMP response, amplitude, and latency. RESULTS: Twenty five definite MD, 34 definite VM, and 13 control subjects were analyzed. MD affected ears had significantly lower cVEMP (p = 0.007) and oVEMP (p < 0.001) amplitudes than control ears. VM ears had significantly lower oVEMP (p = 0.001), but not cVEMP (p = 0.198) amplitudes than control ears. MD affected ears, but not VM ears, had significantly more absent cVEMP (25.9% versus 0%, p = 0.005) and oVEMP responses (40.7% versus 0%, p < 0.001) than control ears. oVEMP latency was significantly shorter for both MD affected (p < 0.001) and VM ears (p < 0.001) than control ears. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated using a neurotology clinic MD prevalence of 7.9% in dizzy patients. A present cVEMP or oVEMP both have more than 93% chance of ruling MD out in the tested ear, while a cVEMP amplitude more than 54.9 µV or oVEMP amplitude more than 5.1 µV both have more than 94% of ruling out MD in the tested ear. CONCLUSIONS: Despite some overlap in VEMP results between MD and VM, when the diagnosis is uncertain between the two disorders due to symptomatic overlap and nonspecific audiometric data, VEMPs can be helpful in guiding treatment toward one disease entity or the other until more evidence points to a definitive diagnosis.