RESUMO
Objective:To explore the correlation between the parameters of suppression head impulse paradigmï¼SHIMPï¼ and changes in dizziness handicap inventoryï¼DHIï¼ scores. Additionally, to evaluate the degree of vertigo and prognosis of patients with acute vestibular neuritis through SHIMP parameters. Methods:Thirty-three patients with acute vestibular neuritis were enrolled for DHI evaluation, vHIT and SHIMP. A secondary DHI score were evaluated after after two weeks, once patients no longer exhibited spontaneous nystagmus. The decrease in the second DHI score was used as the efficacy indexï¼EIï¼. All patients were divided into significantly effective group, effective group and ineffective group based on EI. Differences of the VOR gain values of SHIMP and the anti-compensatory saccade were compared among the three groups. Results:There were 13 cases in the significant effective group, 11 cases in the effective group, and 9 cases in the ineffective group. â The mean gain of the horizontal semicircular canal in the significant effective group, the effective group, and the ineffective group wasï¼0.50±0.11ï¼, ï¼0.44±0.12ï¼, andï¼0.34±0.08ï¼, respectively. The difference between the significant effective group and the ineffective group was statistically significantï¼P<0.01ï¼. The gain of horizontal semicircular canal was positively correlated with EIï¼r=0.538 5, P<0.01ï¼ ãâ¡The occurrence rate of the anti-compensatory saccade in the significant effective group, the effective group, and the ineffective group wasï¼51.23±19.59ï¼, ï¼33.64±17.68ï¼, andï¼13.78±11.81ï¼, respectively. Pairwise comparisons between each group showed statistical significanceï¼P<0.05ï¼. The occurrence rate of anti-compensatory saccade was positively correlated with EIï¼r=0.658 2, P<0.01ï¼. Conclusion:The horizontal semicircular canal gain and the occurrence rate of the anti-compensatory saccade in SHIMP for patients with acute vestibular neuritis were closely correlated with decrease in DHI score.
Assuntos
Teste do Impulso da Cabeça , Neuronite Vestibular , Humanos , Neuronite Vestibular/fisiopatologia , Neuronite Vestibular/diagnóstico , Teste do Impulso da Cabeça/métodos , Feminino , Masculino , Tontura , Doença Aguda , Vertigem , Pessoa de Meia-Idade , Prognóstico , Adulto , Canais Semicirculares/fisiopatologiaRESUMO
Objective:To observe the results of dynamic visual acuity screening tests in patients with peripheral vertigo and explore its clinical significance. Methods:The number of 48 healthy volunteers were enrolled as control group and 25 peripheral vertigo patients as experimental group. In the experimental group, there are 12 patients with vestibular neuritis, 1 patient with Hunt syndrome, 5 patients with sudden deafness with vertigo and 7 patients with bilateral vestibular dysfunction. Horizontal and vertical dynamic visual acuity screening tests were performed on them. The number of lost rows of horizontal and vertical dynamic visual acuity was compared between the control group and the experimental group to figure out if there is a statistical difference. The number of lost rows of horizontal and vertical dynamic visual acuity was compared within the experimental group to figure out if there is a statistical difference. The two groups of 18 cases of unilateral vestibular function decline and 7 cases of bilateral vestibular function decline in the experimental group were compared with the control group, and figure out if there is a statistical difference. Results:The median number of lost rows of horizontal dynamic visual acuity in 48 healthy volunteers was 1.5 and median number of lost rows of vertical dynamic visual acuity was 1.0 in the control group. The median number of lost rows of horizontal dynamic visual acuity of 26 healthy volunteers was 6 and median number of lost rows of vertical dynamic visual acuity was 5 in the experimental group. Compared to the experimental group, the number of lost rows both have statistical significance in horizontal and vertical dynamic visual acuityï¼P<0.01ï¼. The comparison of horizontal and vertical lost rows within the test group also have statistical significanceï¼P<0.01ï¼. Twenty five patients with exceptional vestibular disease in the experimental group were divided into unilateral vestibular function reduction groupï¼n=18ï¼ and bilateral vestibular function reduction groupï¼n=7ï¼. Compared with the control group, there was significant differences in the number of horizontal and vertical lost rowsï¼P<0.01ï¼ within the three groups. After pairwise comparison, the number of lost rows of horizontal and vertical in the control group was significantly lower than that in the unilateral vestibular function reduction group and the bilateral vestibular function reduction groupï¼P<0.01ï¼. There was a highly significant correlation between the number of horizontally lost rows of DVA and the mean vHIT values of bilateral horizontal semicircular canals in 25 patientsï¼P<0.01ï¼; and a highly significant correlation between the number of vertically lost rows of DVA and the mean vHIT values of vertical semicircular canals in 4 groups bilaterallyï¼P<0.01ï¼. Conclusion:The Dynamic Visual Acuity Screening Test is a useful addition to existing tests of peripheral vestibular function, particularly the vHIT test, and provides a rapid assessment of the extent of 2 Hz VOR impairment in patients with reduced vestibular function.
Assuntos
Doenças Vestibulares , Neuronite Vestibular , Humanos , Teste do Impulso da Cabeça/métodos , Vertigem/diagnóstico , Doenças Vestibulares/diagnóstico , Neuronite Vestibular/diagnóstico , Canais Semicirculares , Acuidade Visual , Reflexo Vestíbulo-OcularRESUMO
PURPOSE: Diabetic neuropathy can lead to decreased peripheral sensation and motor neuron dysfunction associated with impaired postural control and risk of falling. However, the relationship between decreased peripheral sensation and impaired vestibular function in diabetes mellitus is poorly investigated. Therefore, the aim of this study was to investigate the relationship between peripheral and autonomic measurements of diabetic neuropathy and measurements of vestibular function. METHODS: A total of 114 participants with type 1 diabetes (n = 52), type 2 diabetes (n = 51) and controls (n = 11) were included. Vestibular function was evaluated by video head impulse testing. Peripheral neuropathy was assessed by quantitative sensory testing and nerve conduction. Autonomic neuropathy using the COMPASS 31 questionnaire. Data were analyzed according to data type and distribution. RESULTS: Measurements of vestibular function did not differ between participants with type 1 diabetes, type 2 diabetes or controls (all p-values above 0.05). Subgrouping of participants according to the involvement of large-, small- or autonomic nerves did not change this outcome. Correlation analyses showed a significant difference between COMPASS 31 and right lateral gain value (ρ = 0.23, p = 0.02,), while no other significant correlations were found. CONCLUSION: Diabetic neuropathy does not appear to impair vestibular function in diabetes, by means of the VOR. CLINICAL TRIALS: NCT05389566, May 25th, 2022.
Assuntos
Diabetes Mellitus Tipo 1 , Diabetes Mellitus Tipo 2 , Neuropatias Diabéticas , Neuronite Vestibular , Humanos , Neuropatias Diabéticas/complicações , Neuropatias Diabéticas/diagnóstico , Diabetes Mellitus Tipo 2/complicações , Estudos Transversais , Neuronite Vestibular/complicações , Diabetes Mellitus Tipo 1/complicaçõesRESUMO
A woman in her 70s presented to primary care clinic complaining of acute onset dizziness for 1 day that was initially diagnosed as vestibular neuritis and treated with steroids. The next day, she presented to the emergency department with worsening symptoms. Imaging revealed no intracranial process; however, non-contrast CT imaging revealed a soft-tissue mass in the posterior ethmoid sinus. The vertigo completely resolved before an otolaryngologist surgically removed the nasal mass, which actually originated from the right cribriform plate and extended to the anterior middle turbinate head. The final pathology was consistent with seromucinous hamartoma.
Assuntos
Hamartoma , Neuronite Vestibular , Feminino , Humanos , Cavidade Nasal/patologia , Conchas Nasais/patologia , Osso Etmoide/patologia , Vertigem , Hamartoma/patologiaRESUMO
Objective:This study aims to compare the examination results of the vestibular evoked myogenic potentialï¼VEMPï¼ and video head impulse testingï¼vHITï¼ in patients with vestibular neuritisï¼VNï¼, thus exploring the methods to distinguish superior and inferior vestibular nerve damages in VN patients, and their feasibility. Methods:A total of 25 patients with unilateral VN treated in the Otology Department of the First Hospital of Qinhuangdao from May 2018 to July 2021 were recruited. They were respectively tested for ocular VEMPï¼oVEMPï¼, cervical VEMPï¼cVEMPï¼ and vHIT, and the examination results were analyzed. Results:Examination results of oVEMP showed that 96%ï¼24/25ï¼ patients had one-ear abnormalities with the amplitude decline or no waveform introduced, and 4%ï¼1/25ï¼ patient had no waveform introduced of both ears. The overall abnormal rate examined by oVEMP was 100%ï¼26/26ï¼. Examination results of cVEMP showed that 36%ï¼9/25ï¼ patients had one-ear abnormalities with the amplitude decline or no waveform introduced, and 4%ï¼1/25ï¼ patients had no waveform introduced of both ears. The overall abnormal rate examined by cVEMP was 40%ï¼10/25ï¼, and 60%ï¼15/25ï¼ patients had normal waveforms of both ears. Examination results of vHIT showed that 100%ï¼25/25ï¼ patients had semicircular canal gain decline of one side, 92%ï¼23/25ï¼ had anterior Semicircular canal decline of one side, and 36%ï¼9/25ï¼ had posterior semicircular canal decline of one side. VEMP and vHIT results were compared. Examination results of VEMP showed that 60%ï¼15/25ï¼ VN patients had superior vestibular nerve damage, and 40%ï¼10/25ï¼ had both superior and inferior vestibular nerve damages. Examination results of vHIT showed that 64%ï¼16/25ï¼ VN patients had superior vestibular nerve damage, and 36%ï¼9/25ï¼ had both superior and inferior vestibular nerve damages. There was no significant difference in the ratio of VN patients with superior and inferior vestibular nerve damages examined by VEMP or vHITï¼χ²=0.085, P>0.05ï¼. The matching ratio of VEMP and vHIT results was 80%ï¼20/25ï¼, and the non-matching ratio was 20%ï¼5/25ï¼. Conclusion:Consistent results obtained from both VEMP and vHIT can preliminarily identify the type of vestibular nerve damage. If their results are not consistent, it is recommended not to identify the scope of the vestibular nerve damage.
Assuntos
Potenciais Evocados Miogênicos Vestibulares , Neuronite Vestibular , Humanos , Neuronite Vestibular/diagnóstico , Nervo Vestibular , Teste do Impulso da Cabeça/métodos , Canais Semicirculares , Potenciais Evocados Miogênicos Vestibulares/fisiologiaRESUMO
OBJECTIVE: To compare the occurrence of sudden sensorineural hearing loss following immunization with BNT162b2 (Comirnaty®; Pfizer BioNTech) or mRNA-1273 (Spikevax®; Moderna) to the occurrence among unvaccinated individuals. STUDY DESIGN: Cohort study. SETTING: Nationwide Danish health care registers comprised all Danish residents living in Denmark on October 1, 2020, who were 18 years or older or turned 18 in 2021. METHODS: We compared the occurrence of sudden sensorineural hearing loss following immunization with BNT162b2 (Comirnaty®; Pfizer BioNTech) or mRNA-1273 (Spikevax®; Moderna) (first, second, or third dose) against unvaccinated person time. Secondary outcomes were a first-ever hospital diagnosis of vestibular neuritis and a hearing examination, by an ear-nose-throat (ENT) specialist, followed by a prescription of moderate to high-dose prednisolone. RESULTS: BNT162b2 or mRNA-1273 vaccine was not associated with an increased risk of receiving a discharge diagnosis of sudden sensorineural hearing loss (adjusted hazard ratio [HR]: 0.99, confidence interval [CI]: 0.59-1.64) or vestibular neuritis (adjusted HR: 0.94, CI: 0.69-1.24). We found a slightly increased risk (adjusted HR: 1.40, CI, 1.08-1.81) of initiating moderate to high-dose oral prednisolone following a visit to an ENT specialist within 21 days from receiving a messenger RNA (mRNA)-based Covid-19 vaccine. CONCLUSION: Our findings do not suggest an increased risk of sudden sensorineural hearing loss or vestibular neuritis following mRNA-based COVID-19 vaccination. mRNA-Covid-19 vaccination may be associated with a small excess risk of a visit to an ENT specialist visit followed by a prescription of moderate to high doses of prednisolone.
Assuntos
COVID-19 , Perda Auditiva Neurossensorial , Neuronite Vestibular , Humanos , Vacina de mRNA-1273 contra 2019-nCoV , Vacina BNT162 , Estudos de Coortes , COVID-19/epidemiologia , COVID-19/prevenção & controle , Vacinas contra COVID-19/efeitos adversos , Dinamarca/epidemiologia , Perda Auditiva Neurossensorial/induzido quimicamente , Perda Auditiva Neurossensorial/epidemiologia , Imunização , Prednisolona , RNA Mensageiro , Vacinação , AdultoRESUMO
OBJECTIVE: To examine the relationship between widely used otolith function tests: the Subjective Visual Horizontal (SVH) and Vestibular Evoked Myogenic Potentials (VEMP). METHODS: A retrospective analysis was performed on 301 patients who underwent SVH, ocular and cervical VEMP (oVEMP and cVEMP) tests on the same day. Correlations between the mean SVH tilt and amplitude asymmetry ratios for bone-conducted (BC) oVEMP and air-conducted (AC) cVEMP were examined. Diagnoses included vestibular neuritis, stroke, vestibular migraine, Meniere's disease, sudden sensorineural hearing loss (SSNHL) and vestibular schwannoma. RESULTS: SVH results were concordant with the oVEMP in 64% of cases and the cVEMP in 51%. Across all patients, SVH demonstrated a significant moderate correlation with BC oVEMP amplitude asymmetry ratios (r = 0.55, p < 0.001) and a weak correlation with AC cVEMP amplitude asymmetry ratios (r = 0.35, p < 0.001). A stronger correlation between SVH and oVEMPs was observed in patients with vestibular neuritis (r = 0.67, p < 0.001) and SSNHL (r = 0.76, p = 0.001). CONCLUSIONS: SVH correlates better with oVEMP than cVEMP symmetry. SIGNIFICANCE: This finding reinforces the hypothesis of a common utricular origin for both SVH and oVEMPs which is distinct from the saccular origin of cVEMPs.
Assuntos
Perda Auditiva Neurossensorial , Doença de Meniere , Potenciais Evocados Miogênicos Vestibulares , Neuronite Vestibular , Humanos , Potenciais Evocados Miogênicos Vestibulares/fisiologia , Neuronite Vestibular/diagnóstico , Estudos Retrospectivos , Doença de Meniere/diagnóstico , OlhoRESUMO
Objective:To analyze the site of vestibular nerve damaged in patients with acute vestibular neuritis. Methods:Fifty-seven patients with acute vestibular neuritis were recruited, and each patient underwent caloric irrigation test, video head impulse testï¼vHITï¼ and vestibular evoked myogenic potentialsï¼VEMPsï¼. The results were further analyzed. Results:Analysis of abnormal rates of different vestibular function tests: the abnormal rate of caloric irrigation test, horizontal semicircular canal vHIT, anterior semicircular canal vHIT, and posterior semicircular canal vHIT were 92.98%, 92.98%, 92.98%, and 52.63%, respectively. The abnormal rate of cervical vestibular evoked myogenic potentialsï¼cVEMPï¼ and ocular vestibular evoked myogenic potentialsï¼oVEMPï¼ were 52.63% and 89.47%. The abnormal rate of caloric irrigation test, horizontal semicircular canal vHIT, anterior semicircular canal vHIT, and oVEMP were significantly higher than posterior semicircular canal vHIT and cVEMPï¼P<0.01ï¼. Combination analysis of different vestibular function tests: there are twenty-six patientsï¼45.61%, superior and inferior vestibular nerveï¼ with abnormal caloric irrigation test, video head impulse test, and VEMPs. There are twenty-five patientsï¼43.86%, superior vestibular nerveï¼ with abnormal caloric irrigation test, horizontal semicircular canal vHIT, anterior semicircular canal vHIT, and oVEMP. There are 4 patientsï¼7.02%, inferior vestibular nerveï¼ with abnormal posterior semicircular canal vHIT and cVEMP. There are two patientsï¼3.51%, ampullary vestibular nerveï¼ with abnormal caloric irrigation test, horizontal semicircular canal vHIT, and anterior semicircular canal vHIT. The rate of superior and inferior vestibular neuritis and superior vestibular neuritis were significantly higher than inferior vestibular neuritis and ampullary vestibular neuritisï¼P<0.01ï¼. Conclusion:Acute vestibular neuritis subtypes can be divided into four categories: superior and inferior vestibular neuritis, superior vestibular neuritis, inferior vestibular neuritis, and ampullary vestibular neuritis. Video head impulse test can accurately assess the site of vestibular nerve damage in patients with acute vestibular neuritis. In addition, vHIT combined with VEMPs can provide objective evidence for the diagnosis of ampullary vestibular neuritis.
Assuntos
Neuronite Vestibular , Vestíbulo do Labirinto , Humanos , Neuronite Vestibular/diagnóstico , Nervo Vestibular , Canais Semicirculares , Teste do Impulso da Cabeça/métodosRESUMO
PURPOSE: The present study aimed to investigate the clinical features of patients with direction-changing spontaneous nystagmus (DCSN) and gain insight into its underlying mechanisms. METHODS: Medical records and vestibular function test results collected in our dizziness clinic between February 2013 and February 2020 were retrospectively reviewed. Spontaneous nystagmus was recorded while sitting upright using videonystagmography for 2 min to confirm the spontaneous changes in nystagmus direction. Causative disease diagnoses were based on the patients' clinical history, audiometry results, vestibular function tests, and imaging studies. RESULTS: Of 4786 patients, DCSN was observed in 41 (0.86%). Causative disease diagnoses included vestibular neuritis (n = 9), lateral semicircular canal cupulopathy (n = 9), cerebellopontine angle tumor (n = 8), vestibular paroxysmia (n = 2), vestibular migraine (n = 2), vestibular nucleus infarction (n = 1), sudden sensorineural hearing loss with vertigo (n = 2), Meniere's disease (n = 2), Ramsay Hunt syndrome (n = 1), labyrinthine fistula due to middle ear cholesteatoma (n = 1), lateral semicircular canal dysplasia (n = 1), post tympanomastoidectomy dizziness (n = 1), and head trauma (n = 2). CONCLUSIONS: Although the periodicity of DCSN could not be determined because of insufficiently long observation times, it was observed in various central and peripheral vestibulopathies. Careful examination of spontaneous nystagmus over a sufficient period may ensure the detection of DCSN when evaluating dizziness.
Assuntos
Nistagmo Patológico , Neuronite Vestibular , Humanos , Tontura/etiologia , Tontura/complicações , Estudos Retrospectivos , Vertigem/etiologia , Vertigem/complicações , Nistagmo Patológico/diagnóstico , Nistagmo Patológico/etiologia , Neuronite Vestibular/diagnósticoRESUMO
OBJECTIVES: This study focuses on the diagnostic precision of caloric testing in detecting vestibular neuritis (VN). MATERIALS AND METHODS: In this study, 99 patients (36 men, 63 women, mean age: 44.63 years [Formula: see text] 12.08 SD) with superior VN were involved, and 157 participants with a normal functioning vestibular system were also investigated. All patients underwent a complete neurotological examination, including the caloric test with electronystagmography registration. The canal paresis (CP) and directional preponderance (DP) values were analysed. RESULTS: A VN on the right side was diagnosed in 31.3% and on the left side in 68.7%. When the CP parameters between the control and VN patients were contrasted, a statistically significant difference was observed (p < 0.00001*, Mann-Whitney U test), indicating higher values in the latter group. The prediction of VN based on the CP value was successful in 71%, and statistical analysis indicated a significant result [p < 0.0001*; OR: 5.730 (95% CI 3.301-9.948)]. The DP values were also significantly higher in the VN group (p < 0.00001*). The prediction of VN according to the DP value was successful in 69.8%. A significant result was also observed in this case [p < 0.001*; OR: 4.162 (95% CI 2.653-8.017)]. When both CP and DP were considered, a predictive value of 84.8% with a significant outcome [p < 0.0001*; OR: 82.7 (95% CI 28.4-241.03)] was detected. CONCLUSIONS: Including the CP and DP parameters of the caloric test, VN could be detected in around 85%. Therefore, the caloric helps diagnose the disorder, but both parameters must be considered.
Assuntos
Neuronite Vestibular , Masculino , Humanos , Feminino , Adulto , Neuronite Vestibular/diagnóstico , Testes Calóricos , Seguimentos , EletronistagmografiaRESUMO
Objective:To evaluate the value of high intensity stimulation training of semicircular canal of SRM-â £ vertigo diagnosis and treatment system in the rehabilitation of vestibular neuritis. Methods:To analyze 68 patients with vestibular neuritis treated in Department of Otorhinolaryngology Head and Neck Surgery, Shijiazhuang People's Hospital from January 2020 to January 2021, conduct spontaneous nystagmus and head toss test, and perform spontaneous nystagmus and rotation test of SRM-â £vertigo system, compare the positive rate of the side of disease was between the two. To randomly divide 68 patients into treatment group 1, 2 and control group, the control group with drugs, treatment group 1 with drugs and vestibular rehabilitation training exercise, treatment group 2 with additional high intensity stimulation training of semicircular canal at one week after onset, on the basis of drug therapy and vestibular rehabilitation training exercise. At 2 weeks and 1 month, through swivel chair test negative rate, DHI score, compare the efficacy of the three groups. Results:Spontaneous nystagmus combined with head toss test confirmed 80.9% of the side of the disease, spontaneous nystagmus and rotation test of SRM-â £ vertigo system confirmed 100%, the difference is statistically significantï¼P<0.05ï¼. Compared with the control group and the treatment group 1, the negative conversion rate of the rotation test in the treatment group 2 at the second week and the first month of treatment, the difference is statistically significantï¼P<0.05, the second week χ²=6.474, the first month χ²=6.245ï¼; the DHI score of treatment group 2 was statistically significant compared with that of control group and treatment group 1 at the second week and first month of treatmentï¼P<0.05, the second week F=13.578, the first month F=28.599ï¼. Conclusion:SRM-â £ vertigo diagnosis and treatment system semicircular canal high intensity stimulation training has a certain role in the rehabilitation treatment of vestibular neuritis. It is simple to operate, patient tolerance and compliance are good, and it is worth promoting.
Assuntos
Nistagmo Patológico , Neuronite Vestibular , Humanos , Neuronite Vestibular/diagnóstico , Neuronite Vestibular/terapia , Vertigem/diagnóstico , Vertigem/terapia , Canais Semicirculares , Nistagmo Patológico/diagnóstico , Nistagmo Patológico/terapia , Testes de Função VestibularRESUMO
Objective:To explore the correlation between the parameters of video head impulse test ï¼vHITï¼and dizziness handicap inventory ï¼DHIï¼ score in patients with vestibular neuritis. Methods:Clinical data of 46 patients with vestibular neuritis were retrospectively analyzed. All the patients underwent DHI evaluation and vHIT examination. They were divided into mild handicap group, moderate handicap group and severe handicap group according to DHI score. The correlations between the parameters of vHIT and DHI score were compared among the three groups. The important parameters of vHIT were compared including vestibulo-ocular reflex ï¼VORï¼ gain, gain asymmetry ratio ï¼GAï¼, abnormal saccade dispersion ï¼PR%ï¼. Results:Of the 46 patients, 10 were in the mild handicap group, 21 in the moderate handicap group, and 15 in the severe handicap group. â In the comparison of the mean value of lateral semicircular canal VOR gain, the vHIT gain of patients with mild, moderate and severe handicap were 0.64±0.06, 0.53±0.11 and 0.37±0.10, respectively, the mean value of VOR gain was negatively correlated with DHI score among the three groupsï¼r=-0.545, P<0.001ï¼, and the pairwise comparisons among the three groups was statistically significantï¼P<0.05ï¼. In comparison of the mean values of lateral semicircular canal GA, the GA values of mild, moderate and severe handicap groups were 46.40±21.81, 47.59±15.17 and 56.57±17.39, respectively, there was no significant linear correlation between GA values and DHI scores among the three groupsï¼r=0.246, P>0.05ï¼, there was no significant difference between the three groupsï¼P>0.05ï¼. In comparison of the mean PR% of the lateral semicircular canal, the mean PR% of patients with mild, moderate and severe handicap group were 32.00±10.62, 53.82±17.09 and 76.00±10.01, respectively, PR% was positively correlated with DHI scoreï¼r=0.726, P<0.001ï¼, and the comparison among the three groups was statistically significantï¼P<0.05ï¼. â¡The vertical semicircular canal vHIT gain of patients with mild, moderate and severe handicap was 0.63±0.06, 0.52±0.15 and 0.38±0.16, respectively, the mean of VOR gain was negatively correlated with DHI score among the three groupsï¼r=-0.487, P<0.01ï¼, the comparison of mild-severe and moderate-severe group was statistically significantï¼P<0.05ï¼, while there was no significant difference between the mild and moderate groupï¼P>0.05ï¼. In the comparison of the mean values of vertical semicircular canal GA, the GA values of mild, moderate and severe handicap groups were 40.40±15.31, 46.10±19.59 and 47.87±18.05, respectively, there was no significant linear correlation between GA values and DHI scores among the three groupsï¼r=0.047, P>0.05ï¼, there was no significant difference in GA among the three groupsï¼P>0.05ï¼. The PR% of patients with mild, moderate and severe handicap were 42.40±15.39, 54.14±17.60 and 64.93±10.95, respectively, there was a positive significant correlation between PR% and DHI scoreï¼r=0.454, P<0.05ï¼, there was statistically significant in the comparison of mild-severe groupï¼P<0.05ï¼, while there was no statistical significance between the other groupsï¼P>0.05ï¼. Conclusion:The VOR gain and PR% value of vHIT in patients with vestibular neuritis are closely related to the DHI score, which can evaluate the vestibular function and the degree of vertigo.
Assuntos
Teste do Impulso da Cabeça , Neuronite Vestibular , Humanos , Neuronite Vestibular/diagnóstico , Estudos Retrospectivos , Reflexo Vestíbulo-Ocular , Vertigem/diagnóstico , Canais Semicirculares , HiperplasiaRESUMO
Introducción: El Sars-CoV 2 puede afectar al nervio vestibulococlear debido a su neurotropismo. Este trabajo tiene como objetivo reportar el caso de un paciente con vértigo agudo posterior a la infección por COVID-19. Materiales y Métodos: Paciente masculino de 64 años que consultó por un ataque de vértigo agudo, de predominio en el lado izquierdo, quince días después de su convalecencia por una infección por COVID-19. Se realizaron estudios neurootológicos y de resonancia magnética. Resultados: La resonancia magnética descartó la presencia de lesiones que pudieran explicar las manifestaciones clínicas. A altas frecuencias, la audiometría tonal reveló una pérdida auditiva neurosensorial en ambos lados. vHIT (video Head Impulse Test) y VEMP cervical (potenciales miogénicos evocados vestibulares) mostraron afectación del lado izquierdo. Los VEMP oculares mostraron afectación bilateral. El paciente mejoró con rehabilitación vestibular, pero las manifestaciones de vHIT persistieron a los 6 y 12 meses. Discusión: El vértigo agudo en este paciente podría haber sido el resultado de una neuronitis vestibular, secundaria a la infección previa por Sars-CoV2. Sin embargo, no se deben descartar diferentes mecanismos virales directos
: Sars-CoV 2 may affect the vestibulocochlear nerve due to its neurotropism. This work aims to report the case of a patient with acute vertigo following COVID-19 infection. Materials and Methods: A 64-year-old male patient consulted for an acute vertigo attack, predominantly to the left side, fifteen days after his convalescence due to a COVID-19 infection. Neuro-otological and MRI studies were carried out. Results: MRI ruled out the presence of lesions that could explain clinical manifestations. At high frequencies, tonal audiometry revealed a sensorineural hearing loss on both sides. vHIT (video Head Impulse Test) and cervical VEMP (Vestibular Evoked Myogenic Potentials) showed left side involvement. Ocular VEMP showed bilateral involvement. The patient improved with vestibular rehabilitation, but vHIT manifestations persisted at 6 and 12 months. Discussion: Acute vertigo in this patient might have been the result of vestibular neuronitis, secondary to the previous Sars-CoV2 infection. However, different direct viral mechanisms should not be ruled out
Assuntos
Humanos , Masculino , Pessoa de Meia-Idade , Vertigem/reabilitação , Vestíbulo do Labirinto/patologia , Neuronite Vestibular/diagnóstico , COVID-19/imunologiaRESUMO
Objective:To investigate the impact of time interval from symptoms onset to vestibular rehabilitation on the recovery of patients in the acute phase of vestibular neuritis. Methods:Thirty-one patients with vestibular neuritis treated in outpatient and inpatient settings from December 2019 to July 2021 were selected and randomly divided into vestibular rehabilitation group and general treatment group. The vestibular rehabilitation group was subdivided into early-intervention group ï¼1-week after symptom onsetï¼ and late-intervention group ï¼2-week after symptom onsetï¼ according to the interval from the onset to vestibular rehabilitation. The differences in DP, UW, VOR, DHI, BBS and SAS values at 1 month and 3 months after treatment were compared among early-intervention groupï¼11 casesï¼, late-intervention group ï¼10 casesï¼ and general treatment groupï¼10 casesï¼. Results:For patients in the vestibular rehabilitation group and the general treatment group, DP, UW, VOR gain, DHI score and SAS score were significantly different after treatment ï¼ P<0.05ï¼ and no significant difference was found in BBS score ï¼P>0.05 ï¼. Pairwise comparisons between early-intervention and late-intervention group showed that the DP, UW and VOR gain were significantly different ï¼P<0.05ï¼, while the score of DHI and SAS were not significantly different ï¼P>0.05ï¼. Conclusion:Vestibular rehabilitation therapy can accelerate vestibular compensation, relieve vertigo symptoms and anxiety symptoms in patients with vestibular neuritis. It is better to be carried out within 1 week after symptom onset.
Assuntos
Neuronite Vestibular , Vestíbulo do Labirinto , Ansiedade , Tontura/diagnóstico , Humanos , Neuronite Vestibular/diagnósticoRESUMO
Objective:To investigate the expression level of serum 25-ï¼OHï¼ D and its correlation in patients with vestibular neuritisï¼VNï¼. Methods:30 acute VN patients and 50 age-and sex-matched healthy controls who attended the Otolaryngology, Head and Neck Surgery Department of the First Hospital of Shanxi Medical University from October 2020 to October 2021 were selected. The demographic and clinical data of all subjects were recorded, the levels of serum 25-ï¼OHï¼ D and inflammatory markers were measured and compared, and the changes of serum 25-ï¼OHï¼ D levels in convalescent patients with VN were followed up. Results:The serum level of 25-ï¼OHï¼ D in the acute phase VN group was significantly lower than that in healthy controls[ï¼10.14±2.92ï¼ ng/mL vs ï¼20.61±4.70ï¼ ng/mL, P<0.01], and the deficiency rate of 100.0%ï¼30/30ï¼ was significantly higher than 54.0%ï¼27/50ï¼. Moreover, the serum level of 25-ï¼OHï¼ D in the recovery periodï¼3 months laterï¼ was significantly higher[ï¼10.14±2.92ï¼ ng/mL vs ï¼15.94±4.88ï¼ ng/mL, P<0.01], and the deficiency rate was significantly decreased by 76.7%ï¼23/30ï¼. However, the serum 25-ï¼OHï¼ D level was significantly lower in both the VN group than that in both the acute period and the recovery group, and the deficiency rate was significantly higher than that in the control group. Multivariate binary Logistic regression model analysis showed that low-level serum 25-ï¼OHï¼ D was associated with the onset of VN, with an OR value of 0.193ï¼95%CI=0.043-0.861, P=0.031ï¼. In addition, the results of this study showed that peripheral blood leukocyteï¼WBCï¼ and neutrophil / lymphocyte ratioï¼NLRï¼ levels in the acute VN group were significantly higher than in healthy controls[ï¼7.65±3.02ï¼ ×108/L vs ï¼5.50±2.50ï¼ ×108/L, P<0.01; ï¼2.46±2.95ï¼ ×100% vsï¼1.67±0.92ï¼ ×100%, P<0.01 ], and there was no significant difference in Platelet / lymphocyte ratioï¼PLRï¼ and and average platelet volumeï¼MPVï¼ levels in the two groupsï¼P>0.05ï¼. There were no significant differences in age distribution, sex ratio, body mass index, persistent health problems, or lifestyle groupsï¼P>0.05ï¼. Conclusion:This study is the first to detect serum 25-ï¼OHï¼ D level and inflammation index level, and dynamically assess the serum 25-ï¼OHï¼ D level in different stages, found that low serum 25-ï¼OHï¼ D is associated with the onset of VN, physiological concentration of serum 25-ï¼OHï¼ D is a protective factor of VN, vitamin D supplementation therapy may be a new target of VN treatment.
Assuntos
Neuronite Vestibular , Deficiência de Vitamina D , Humanos , Neuronite Vestibular/complicações , Vitamina D/análogos & derivados , Deficiência de Vitamina D/complicações , VitaminasRESUMO
Vestibular neuritis was first reported in 1952 by Dix and Hallpike, and 30% of patients reporting a flu-like symptom before acquiring the disorder. The most common causes are viral infections, often resulting from systemic viral infections or bacterial labyrinthitis. Here we presented a rare case of acute vestibular neuritis after the adenoviral vector-based COVID-19 vaccination. A 51-year-old male pilot awoke early in the morning with severe vertigo, nausea, and vomiting after receiving the first dose of the ChAdOx1 nCoV-19 vaccine 11 days ago. Nasopharyngeal SARS-CoV-2 RT-PCR test and chest CT scan were inconclusive for COVID-19 pneumonia. Significant findings were a severe spontaneous and constant true-whirling vertigo which worsened with head movement, horizontal-torsional spontaneous nystagmus, abnormal caloric test, positive bedside head impulse tests, and inability to tolerate head-thrust test. PTA, MRI of the brain and internal auditory canal, and cerebral CT arteriography were normal. According to the clinical, imaging, and laboratory findings, he was admitted to the neurology ward and received treatment for vestibular neuritis. His vertigo increased gradually over 6-8 h, peaking on the first day, and gradually subsided over 7 days. Ten days later, the symptoms became tolerable; the patient was discharged with advice for home-based vestibular rehabilitation exercises. Despite the proper treatment and rehabilitation, signs of dynamic vestibular imbalances persisted after 1 year. Based on the Federal Aviation Administration (FAA) regulations, the Air Medical Council (AMC) suspended him from flight duties until receiving full recovery. Several cases of vestibular neuritis have been reported in the COVID-19 patients and after the COVID-19 vaccination. This is the first case report of acute vestibular neuritis after the ChAdOx1 nCoV-19 vaccination in a healthy pilot without past medical history. However, the authors believe that this is a primary clinical suspicion that must be considered and confirmed after complete investigations.
Assuntos
Vacinas contra COVID-19 , COVID-19 , Neuronite Vestibular , Humanos , Masculino , Pessoa de Meia-Idade , ChAdOx1 nCoV-19 , COVID-19/complicações , Vacinas contra COVID-19/efeitos adversos , SARS-CoV-2 , Vertigem/etiologia , Neuronite Vestibular/diagnóstico , Neuronite Vestibular/complicações , Neuronite Vestibular/terapia , Viroses/complicaçõesRESUMO
Objective: The characteristics of 3D-FLAIR MRI images of the inner ear of patients with vestibular neuritis were preliminarily studied to explore the possible pathogenesis of vestibular neuritis, and the correlation analysis was conducted in combination with vestibular function to provide a basis for accurate diagnosis of vestibular neuritis. Methods: A total of 36 patients with vestibular neuritis (VN) from December 2019 to October 2020 were collected from the Vertigo Department of Shandong Provincial ENT Hospital, Cheeloo College of Medicine, Shandong University. There were 36 cases (18 females, 18 males) with unilateral acute vestibular neuritis, 17 cases of left ear and 19 cases of right ear. According to the results of 3D-FLAIR MRI in the inner ears, the patients were divided into the enhanced group and the non-enhanced group (the health side served as the normal control group). The results of vestibular function examination in the two groups were compared. SPSS19.0 software was used for statistical processing to analyze the relationship between the vestibular function and the characteristics of 3D-FLAIR imaging in the inner ears. Results: Abnormal enhancement of 3D-FLAIR was found in 31 cases (86.1%) of the 36 cases, including 14 cases of both vestibular nerve and vestibular terminal organ enhancement, eight cases of superior vestibular nerve enhancement alone, seven cases of vestibular terminal organ enhancement alone, and two cases of cochlear enhancement alone. Observation of abnormal reinforcement of vestibular nerve showed: twenty-one cases of superior vestibular nerve reinforcement, one case of superior and inferior vestibular nerve reinforcement. No abnormalities were found in 3D-FLAIR of inner ear in 5 cases. According to the analysis of vestibular function results, there were 19 cases (52.8%) with total vestibular involvement, sixteen cases (44.4%) with superior vestibular involvement alone, and one case (2.8%) with inferior vestibular involvement alone. Comparison of vestibular function between the five cases (non-enhancement group) and the 31 cases (enhanced group) in the 3D-FLAIR group of the inner ears showed that the CP values of caloric tests in the enhanced group were higher (60.81±3.49 vs 34.12±7.37), with statistically significant difference (t=-2.898, P<0.01). Conclusion: In patients with vestibular neuritis, 3D-FLAIR MRI scan of the inner ear provides visual imaging evidence for clinical practice, considering that the lesion site of vestibular neuritis is not only in the vestibular nerve, but also in the vestibular end organ. Patients with 3D-FLAIR enhanced in the inner ear may have more significant vestibular function damage.
Assuntos
Neuronite Vestibular , Vestíbulo do Labirinto , Testes Calóricos , Feminino , Humanos , Imageamento Tridimensional/métodos , Imageamento por Ressonância Magnética/métodos , Masculino , Neuronite Vestibular/diagnósticoRESUMO
Objective: To explore the dynamic changes of vestibular autorotation test (VAT) before and after vestibular rehabilitation treatment in patients with unilateral vestibular hypofunction (UVH). Methods: A retrospective study was carried out,48 patients who were diagnosed with UVH and under vestibular rehabilitation in department of otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, from January 2019 to January 2021 were enrolled. Among them, there were 21 males and 27 females, with an average age of 46.9 years old, including 25 cases of Meniere's disease, 13 cases of sudden deafness with vertigo and 10 cases of vestibular neuritis. The course of disease ranged from 5 days to 10 years. Demographic characteristics, detailed case data and routine examination were collected for the patients. The horizontal gain/phase, vertical gain/phase, and asymmetry of VAT at different frequencies before and after vestibular rehabilitation were collected. The absolute value of the difference between the measured value of 2.0-5.9 Hz before and after rehabilitation and the standard value were statistically analyzed. Results: Before vestibular rehabilitation, the incidence of abnormal gain was 62.5% (30/48), the incidence of abnormal phase was 56.3% (27/48), and the incidence of asymmetry was 16.7% (8/48). After 4-6 weeks of vestibular rehabilitation, the incidence of gain abnormality was 22.9% (11/48), the incidence of phase abnormality was 31.3% (15/48), and the incidence of asymmetry was 12.5% (6/48).The horizontal gain at frequency of 2.0-3.9 Hz showed statistically significant difference compared with before vestibular rehabilitation (P<0.05), and the horizontal gain at frequency of 4.3-5.9 Hz showed that there was no significant difference (P>0.05); the horizontal phase at 5.9 Hz showed that the difference was statistically significant (P=0.043), and there was no significant difference before and after rehabilitation treatment at 2.0-5.5 Hz (P>0.05); the vertical gain at 4.3 Hz showed the difference was statistically significant (P=0.020), and the remaining frequency showed no significant difference (P>0.05); No frequency of asymmetry and vertical phase showed the difference before and after rehabilitation was statistically significant (P>0.05). Conclusion: VAT can be used to monitor the change trend of multiple frequency bands before and after vestibular rehabilitation in UVH, in order to provide reference for the formulation of personalized rehabilitation strategies.