[Association between sleep disorders and vestibular vertigo].

Sleep disorders have a high comorbidity rate with vestibular diseases. The results of some small sample clinical studies have confirmed the effect of sleep deprivation on vestibular function. However, the mechanism of the effect of sleep disorder on vestibular system is still unclear. This article analyzes the possible mechanism of the effect of sleep disorders on vestibular function from the aspects of neuroanatomy and neurotransmitters, and summarizes the relationship between sleep disorder and benign paroxysmal positional vertigo, Meniere's disease, vestibular migraine and other diseases.

Triple semicircular canal occlusion with endolymphatic sac decompression for intractable Meniere's disease.

Background: Meniere's disease (MD) is characterized by idiopathic endolymphatic hydrops (ELH). Frequent vertigo attacks is the most disabling symptom of MD. Objective: This study evaluated the efficacy of triple semicircular canal occlusion combined with endolymphatic sac decompression in the treatment of frequent vertigo in patients with MD. Methods: Eleven patients with complete medical records were included in this study conducted from May 2021 to April 2022. All patients were enrolled to undergo triple semicircular canal occlusion (TSCO) with endolymphatic sac decompression (ESD). Various tests including pure tone audiometry (PTA), vestibular evoked myogenic potentials (VEMPs), the video head impulse test (v-HIT), caloric test data, the Dizziness Handicap Inventory (DHI), the Berg Balance Scale (BBS), and the Tinnitus Handicap Inventory (THI) were performed both before and after the surgery. Results: The successful control rate of vertigo was 100% (9/9) in the average 23-month postoperative follow-up period, with complete control rate of 88.89% (8/9) and substantial control rate of 11.11% (1/9). Conclusion: Triple semicircular canal occlusion combined with ESD may be an effective treatment option for managing frequent vertigo attacks in patients with MD. This combination therapy has the potential to become a significant addition to the treatment framework for MD.

[An analyzation on the characterization of frequency tuning of vestibular evoked myogenic potential in patients with unilateral vestibular hypofunction].

Objective: To explore the value of adding 1 kHz cervical vestibular evoked myogenic potential（cVEMP） and ocular vestibular evoked myogenic potential（oVEMP） in the auxiliary diagnosis of unilateral vestibular hypofunction. Methods:A retrospective analysis of 84 patients with unilateral vestibular hypofunction receiving two or more vestibular function tests was conducted,29 cases of unilateral Ménière's disease, 27 cases of benign paroxysmal positional vertigo （BPPV）, 8 cases of idiopathic sudden sensorineural hearing loss （ISSHL） with vertigo, and 20 cases of ISSHL without vertigo were included. SPSS 25.0 software was used for statistical analysis to observe the difference of frequency amplitude ratio （FAR） at 500 Hz/1 kHz of cVEMP and oVEMP between the experimental and control groups. Results:①The cVEMP elicitation rates were 95.24% （80/84） and 98.81% （83/84） for 500 Hz and 1 kHz, respectively; and the oVEMP elicitation rates were 78.57% （66/84） and 91.67% （77/84） for 500 Hz and 1 kHz, respectively. ②Except for the lateral difference of FAR in oVEMP of the posterior semicircular canal BPPV group and cVEMP of the horizontal semicircular canal BPPV group （P<0.05）, no significant lateral difference was observed in the other disease groups （P>0.05）. Conclusion:In patients with unilateral vestibular hypofunction, cVEMP and oVEMP showed different frequency tuning changes in different semicircular canal BPPV groups. Additionally, 1 kHz cVEMP and oVEMP as regular stimulation frequencies in clinical test, which has certain clinical reference significance for determining the diagnosis and prognosis of BPPV on the weak ear and in different semicircular canal involvement.

[Efficacy of percutaneous vagal stimulation in the treatment of chronic tinnitus].

Objective:The aim of this study is to investigate the efficacy of transcutaneous vagus nerve stimulation（taVNS） in the treatment of chronic tinnitus. Methods:taVNS was used to treat chronic decompensated tinnitus, 10 days as a course of treatment. Record and analyze the improvement of the patient's subjective symptoms during treatment. The THI, PSQI and DASS-21 scores were performed at 10 days, 3 months and 6 months after treatment. The improvement of tinnitus in taVNS group and control group at the above recorded time points was compared, and the THI score of taVNS group was compared before and after treatment. Results:① During the taVNS treatment, 93.65% of the patients achieved improvement in subjective symptoms, and 28.6% of the patients voluntarily accepted the second course of taVNS treatment; ② The sleep improvement was optimal when the treatment was 10 days, and some patients had poor sleep status after 3 or 6 months; ③ The anxiety of taVNS group was improved during and after treatment, and the best effect time was 3 months and 6 months after treatment; ④ There was no significant difference in THI score between the two groups, but there was significant improvement in taVNS group at 3 months and 6 months after treatment. Conclusion:taVNS treatment can significantly improve the sleep disorder, anxiety disorder and tinnitus disturbance of tinnitus patients, and the curative effect is good after 3 months and 6 months of prevention.

Effect of balloon dilation eustachian tuboplasty combined with tympanic tube insertion in the treatment of chronic recurrent secretory otitis media.

PURPOSE: To investigate the long-term clinical effect of balloon dilation eustachian tuboplasty (BET) combined with tympanic tube insertion (TTI) in the treatment of chronic recurrent secretory otitis media (CRSOM). MATERIALS AND METHODS: A retrospective study of 30 cases of CRSOM treated with BET combined with TTI under general anesthesia between August 2014 and September 2016. Thirty cases of CRSOM treated with TTI in the same period were taken as the control group. All cases were followed over 24 months. The scores of eustachian tube (ET) function preoperation, 1 month, 6 months, 12 months, and 24 months postoperation were collected and analyzed, respectively. A satisfaction questionnaire was used to evaluate the therapy at 24-months postoperation. RESULTS: The symptoms were significantly improved and the ET score was obviously increased postsurgery in most cases treated with BET plus TTI compared with those treated with TTI alone. The highest ET score was obtained at 6 months post BET. Five (14%) cases (6 ears) of CRSOM recurred. The 24-month postoperation follow-up questionnaire showed that 84.6% of the patients were satisfied with the treatment, while ten cases (25%) in the TTI group recurred. CONCLUSION: BET combined with TTI surgery is an effective therapy for patients with CRSOM.

NLRC5: potential novel non-invasive biomarker for predicting and reflecting the progression of IgA nephritis.

BACKGROUND: The nucleotide oligomerization domain-like receptor subfamily C5 (NLRC5) is primarily expressed in the adaptive and innate immune systems. NLRC5 was recently discovered to regulate immunity and inflammatory responses. Abnormal immune and inflammatory responses are considered critical pathogenesis in IgA nephritis (IgAN). However, the role of NLRC5 in IgAN is unknown. We previously showed that NLRC5 can be detected in patients with IgAN; herein, we further examined the pathophysiological significance of NLRC5 in the serum and renal deposits of patients with IgAN. This study is the first to find that NLRC5 is closely correlated with IgAN. METHODS: IgAN patients (n = 50) who were diagnosed by renal biopsy provided blood and renal biopsy tissue, and age-matched healthy control subjects (blood donators n = 22; tissue donators n = 5) were included. Renal biopsies were diagnosed, and blood biochemical parameters were tested. Serum creatinine, urea, proteinuria, haematuria, albumin, and immunoglobulin A levels were recorded. Serum NLRC5 concentrations were detected by enzyme-linked immunosorbent assay, and tissue NLRC5 expression in kidney tissue was detected by immunohistochemical analysis. ROC curve analysis was used to evaluate the diagnostic value of the serum NLRC5 concentration in IgAN. RESULTS: Serum NLRC5 concentration was significantly decreased in the IgAN group compared to that in the healthy control group (P < 0.0001), especially in S1 (Oxford classification) patients (P < 0.0001). Furthermore, serum NLRC5 concentration had a negative correlation with Lee's grade (r = 0.3526, P = 0.0060) and proteinuria levels (r = 0.4571, P = 0.0004). Tissue NLRC5 expression was significantly increased in the IgAN group compared to that in the healthy control group (P < 0.0001); a more significant increase was identified in the S1 group (P < 0.05) and had a positive correlation with Lee's grade (r = 0.497, P < 0.0001). We proposed a cut-off value of 1415 pg/ml for serum NLRC5 concentration, which was able to predict IgAN with 77.27% sensitivity and 87.5% specificity. CONCLUSIONS: Serum NLRC5 concentrations in IgAN are significantly decreased, and tissue NLRC5 expression is significantly increased in IgAN renal tissue, which is consistent with pathological severity. This finding suggests that NLRC5 could potentially be a diagnostic index and represents a prognostic factor in IgAN patients.

[Children's hearing behavior observations and high risk individual genetic screening for late-onset hearing loss early detection and intervention exploring a basic-level hospitals model].

OBJECTIVE: To explore the methods to detect and intervene children's late-onset hearing loss early which are suitable for basic-level hospitals. METHOD: Udiology and imaging diagnosis had been given to the children who passed the newborn hearing screening but showed auditory behavior disorders in the growth process, and individualized interventions were given according to the results of diagnosis. Seven children with high risk for hereditary deafness were sent to superior hospital and had molecular screening of common mutations of inherited deafness carried out, then corresponding prevention guidance and intervention were given to them. RESULT: Fifty-two cases with late-onset hearing loss or verbal disorders were detected by auditory behavior observations,including 4 cases of auditory neuropathy, 4 cases of unilateral sensorineural deafness, 27 cases of secretory otitis media. 13 cases of bilateral sensorineural deafness and 4 cases of autism. Seven newborns with high risk of hereditary deafness were sent to the Third Affiliated Hospital of Sun Yat-Sen University and received molecular screening of common mutations of inherited deafness. One case with GJB2 compound heterozygous mutations was detected and followed up to 4 years old, he was found bilateral moderate hearing loss and accepted the hearing aids at 2 years old. Mitochondrial DNA 1555 a > G heterogeneity mutation in 2 cases and GJB2 235 delC single heterozygous mutations in 3 cases, no mutation in 1 case, all these 6 cases have been followed-up until now, their hearing are normal. CONCLUSION: Children's auditory behavior observations and the superior hospitals referral performing high risk individual screening for newborns with high risk for hereditary deafness can detect children's late-onset hearing loss in time, this model is suitable for basic-level hospitals.

[Social psychological factors causes of acute exacerbation or re-decompensation of clinically significant chronic tinnitus].

OBJECTIVE: To analyze social-psychological causes of acute exacerbation or re-decompensation of chronic tinnitus and provide theoretical basis for controlling and preventing tinnitus exacerbation and re-decompensation. METHOD: Systemic audiological tests and tinnitus handicap inventory were performed on 136 chronic tinnitus patients with acuteexacerbation or re-decompensation. For the patients with new hearing loss, a further investigation of living conditions and assessment of social support rating scale were utilized. The patients with relatively definite causes were treated accordingly. RESULT: (1) There were 89 patients complained of new changes of hearing, all of whom could tell the definite time point of tinnitus exacerbation, and 5 of them felt the exacerbation of hearing loss meanwhile. (2) Forty-two patients encountered adverse events on life or working, and tinnitus exacerbation occurred within several weeks to 3 months afterwards. Most of these patients could not tell the definite time point of tinnitus exacerbation or re-decompensation. Five cases of tinnitus exacerbation didn't tell any adverse events on life or working, but showed mood disorders, and the anti-anxiety treatment was effective to them. (3) Forty-seven cases without new hearing loss scored significantly lower in SSRS than healthy adults. CONCLUSION: Emerging hearing loss is the main cause of acute exacerbation of chronic tinnitus. To find it in time and give effective treatment can save newly presented hearing loss, cure or relieve tinnitus. Adverse events in life(or working) and short of social support is another important cause of acute exacerbation of chronic tinnitus or decompensation recurrence, which suggests that social-psychological factors besides of hearing loss should be concerned in diagnosis and treatment of tinnitus.

[Study on gender difference of tinnitus in medical staff].

OBJECTIVE: To investigate whether there is gender difference in the incidence and severity of tinnitus in medical staff (including doctors, nurses, and technicians). METHOD: A total of 354 people (all are medial stuff from hospitals in Guangzhou) were invited to be involved in the investigation and granted a self-reported questionnaire of tinnitus (designed by the authors; based on the scoring method of severity of tinnitus (Liu et al.). Statistical analysis on the data was performed using SPSS Statistics 17.0. RESULT: (1) The incidence of tinnitus of the sample was 43.22%, with that in female higher than in male (P < 0.05), and that in nurses higher than in doctors or technicians (P < 0.01). (2) The effect of working position factor on the incidence of prolonged tinnitus was significant (P < 0.01). However, no statistically significant gender difference was detected in the incidence of prolonged tinnitus. (3) There was no statistically significant difference of tinnitus severity scores between different genders or among different positions (P > 0.05). (4) There was statistically significant difference among the four sub-items of the questionnaire (P < 0.01), with the mean score of "occurred environment" higher than "the impact on sleeping", "the impact on everyday life", and "the impact on emotion". CONCLUSION: (1) The effort-reward imbalance might be the key factor of the gender difference in the incidence of tinnitus. (2) For patients of tinnitus, improving the knowledge about their symptoms as well as levels of psychological resilience would be helpful to relieve the mental impairment of tinnitus.

[Vertigo due to enlarged vestibule with lateral semicircular canal dysplasia: an analysis of clinical characteristics].

OBJECTIVE: To explore the clinical characteristics and possible pathological mechanisms of vertigo due to enlarged vestibule with lateral semicircular canal dysplasia. METHODS: A retrospective review was conducted for 5 cases of peripheral vertigo due to enlarged vestibule with lateral semicircular canal dysplasia. Their characteristics of medical history, precipitating factors, course of vertigo, auditory tests, vestibular tests and imaging examine results were analyzed. RESULTS: The clinical characteristics were as follows. (1) Specifics of medical history: 4 cases suffered delays in gross motor development and potential equilibrium dysfunctions. One case failed to recount an earlier medical history, but could maintain normal hearing and vestibular functions for a long time in adulthood. (2) Most cases could identify the precipitating factors of initial attacks, such as head-bumping, nose-blowing and constipation, etc. resulting in sudden rises of intracranial or abdominal pressures. (3) Paroxysmal vertigo and progressive hearing loss were mimicking Meniere disease or large vestibular aqueduct syndrome. But its course of vertigo was different from those of Meniere disease and large vestibular aqueduct syndrome with regards to hearing levels and audiograms. (4) Some cases had positional vertigo. But the results of Dix-Hallpike and Roll tests were different from benign paroxysmal positioning vertigo (BPPV). (5) The inner ear imaging showed enlarged vestibule with lateral semicircular canal dysplasia. CONCLUSION: The enlarged vestibule with lateral semicircular canal dysplasia is a rare etiology of peripheral vertigo. The history of delays in gross motor development and potential equilibrium dysfunctions in childhood may offer important diagnostic clues. And audiological and vestibular tests, high-resolution computed tomography and magnetic resonance may help to ascertain the diagnosis.

[Vertigo due to neurovascular cross-compression: diagnosis and treatment].

OBJECTIVE: To explore the clinical characteristics, pathological mechanism, diagnose, differential diagnosis and the treatment of vascular compressive vestibular neuropathy. METHOD: The authors retrospectively studied 2 cases of vascular compressive vestibular neuropathy about clinical characteristics, auditory tests, vestibular tests and imaging examine results, pharmacotherapy results and reviewed the related documents. RESULT: There were some common clinical characteristics: (1) Vertigo and disequilibrium could be elicited by any physical activity and head movement and abated with complete bed rest; (2) Symptoms and signs can't be improved by vestibular suppressant medications; (3) When taken Dix-Hallpike test, true vertigo or a spinning sensation appeared during head movement, when head skilled at any position,the symptoms disappeared; (4) The suffering lateral often showed high frequency sensorineural hearing loss ,the ABR of the suffering lateral showed prolonged inter wave latency of I-III wave; (5) Vestibular tests showed central lesion; (6) Occupying lesion can be ruled out by CT and MRI, MRI showed neurovascular compression of vestibular nerve; (7) Taking carbamazepine plus baclofen or only Tegretol orally can alleviate symptoms. A great deal of surgeries confirmed neurovascular compression of cranial nerve U as a disease entity, the offending artery mainly anterior inferior cerebellar artery. Microvascular decompression of cranial nerve VIII can successfully relieve vertigo. CONCLUSION: Neurovascular compression of cranial nerve VIII is a disease entity beyond question. It's major characters were vertigo and disequilibrium which elicited by any physical activity and head movement, magnetic resonance tomographic angiography can give valuable information for diagnosis and treatment. Microvascular decompression can effectively relieve vertigo.

[Analysis of factors affecting the pure tone threshold glycerol test].

OBJECTIVE: To probe the factors that affect the pure-tone threshold glycerol test and the distribution of frequencies in positive glycerol test. METHOD: We tested the pure-tone threshold before and after glycerol intake in patients with Meniere's disease, and then analyzed the positive rates,distribution of positive frequencies and the time when the maximum threshold changes appeared. RESULT: The positive rate of pure-tone glycerol test was 72.09%, of which the threshold descending rate was 47.67%, and the threshold rebounding rate was 24.42%; the pure-tone threshold changes of descending group and rebounding group were (17.41 +/- 9.92) dB, (13.53 +/- 4.64) dB respectively, and the differences were significant. The distribution of positive frequencies were 250 Hz, 125 Hz, 500 Hz, 1 kHz, 4 kHz, 2 kHz, 8 kHz in descending order. The maximum pure-tone threshold changes mostly appeared within 2 or 3 hours after glycerol intake. CONCLUSIONS: Patient selection, test occasion and the judgement criteria may affect the positive rate of glycerol test; the positive frequencies distribute in the low-frequency region mainly; the maximum pure-tone threshold changes mostly appeared within 2 or 3 hours after glycerol intake.

[Acute aggravation of chronic tinnitus: a study of the hearing characteristic and prognosis].

OBJECTIVE: To investigate the hearing change when chronic tinnitus acute aggravated and the affect of prognosis due to hearing change. METHODS: The pure tone threshold and acoustic immittance were used for every case in the acute aggravation of chronic tinnitus (AACT) group, and for some of AACT group members the auditory brainstem response (ABR), distort-product otoacoustic emission (DPOAE), electrocochleogram (EcochG), glycerin test and MRI were used at the same time for further diagnosis. For the chronic tinnitus, the patients accepted the intervention of tinnitus retraining therapy (TRT) both for the AACT group and the control group. As for the recent hearing loss appeared in the AACT group members, the patients were treated the cases as the sudden deafness, and then the hearing characteristic of the AACT group was analyzed and the effect of the chronic tinnitus both for the AACT group and control group after the TRT for 3, 6, 9 and 12 months was evaluated. RESULTS: Three kinds of hearing changes appeared when chronic tinnitus acute aggravated. Based on the dated high frequencies hearing loss ranged 4-8 kHz, recent hearing loss appeared in 1-2 middle frequencies near the impaired high frequencies; Based on the dated single middle frequency hearing loss, another middle frequency hearing impaired near the dated hearing loss frequency, the sawtooth-like audiogram changed to groove-like audiogram; Hearing fluctuation in low frequency area, hearing threshold increased 10-30 dB in 125-1000 Hz but kept unchanged in the high frequency area. The recent local frequency hearing loss healed after the vasodilator and neurotrophic drugs therapy, but the dated hearing loss can't rehabilitate. Along with the rehabilitation of recent local hearing loss, 25 of 32 cases chronic tinnitus victims get to habituation; this finding showed that the experience of tinnitus aggravation and relief accelerated the habituation. Until the 12 months after the TRT, the curative effect difference between AACT group and control group showed statistical significance. CONCLUSIONS: When the chronic tinnitus acute aggravated, 3 kinds of local area hearing impaired. Timely diagnosis and effective treatment had brought not only hearing rehabilitation but also promotion to habituation of chronic tinnitus.

[The audiograms of 462 tinnitus victims who never perceived hearing loss].

OBJECTIVE: To investigate the risk factors of tinnitus and provide evidence for tinnitus prevention. METHOD: Retrospectively analyzed the audiograms and the risk factors of 462 tinnitus victims who never perceived hearing loss, find the relationship between every risk factor and tinnitus. RESULT: The rate of tinnitus victims with high frequency hearing loss was the 46.1%, with low frequency hearing loss was 15.8%, with single middle frequency notch was 11.04%, with an audiogram like upset-basin was 7.58%, with normal audiogram was 14.07%, with other type of audiograms was 5.41%. The age distribution in the high frequency hearing loss group was mainly between 30 and 40 years, in the upset-basin hearing loss group was mainly older than 50 years, and in the other groups, mainly between 20 and 30 years. In the high frequency hearing loss group, male to female ratio was 158/55, in the low frequency hearing loss group and single middle frequency notch group ,male to female ratio was 14/59 and 12/39 respectively. In another three groups, the male to female ratio was nearly 1. Risk factors for high frequency hearing loss group, low frequency hearing loss, single middle frequency notch group and in the upset-basin hearing loss group were noise, fatigue, long-time musical instrument contact and ageing respectively. CONCLUSION: Among the tinnitus victims who never perceived hearing loss, 86% of them have hearing impairment in high frequency area, low frequency area or single middle frequency. The rate of high frequency hearing loss was 46.01%, the major risk factor was noise, most of victims were men. The rate of low frequency hearing loss was 15.8%, the major risk factor was fatigue and nervous, most of the victims were women. The rate of single middle frequency notch was 11.04%, the major risk factor was long-time musical instrument contact. The rate of upset-basin hearing loss was 7.58%, ageing was the major risk factor.