Evaluation of Vestibular Function in Diagnosis of Vestibular Schwannomas.

Vestibular schwannomas (VS) are benign tumors of the vestibular nerve. The common first symptoms are hearing loss and tinnitus, followed by imbalance, vertigo, and facial nerve involvement. The subjective symptoms of VS patients are not consistent with the severity of vestibular lesions and the results of vestibular tests, which often interfere with clinicians' diagnoses. Thus, the main screening and diagnostic methods for VS are audiometry and magnetic resonance imaging (MRI), ignoring the evaluation of vestibular function at the source of pathological lesions. With the development and improvement of vestibular evaluation technology and its wide application in the clinic, modern vestibular examination technology can reflect the severity and frequency of vestibular lesions and compensation from multiple perspectives, providing an objective basis for the diagnosis and treatment of vestibular diseases. In this report, we review the results and characteristics of vestibular tests in VS patients and further clarify the clinical value of vestibular function assessment in the diagnosis and treatment of VS.

Evolution of Cochlear implant mapping and vestibular function in a pediatric case of Labyrinthitis.

BACKGROUND: Vestibular symptoms such as vertigo and imbalance are known to occur in some cochlear implant patients during the immediate postoperative period; however, acute vertigo in implanted children occurring remotely from the postoperative period has not been previously well-described. CASE PRESENTATION: A three-year-old girl with a history of bilateral sequential cochlear implantation presented with acute labyrinthitis associated with sudden onset of vertigo, balance impairment, and decline in right cochlear implant function 2 years after her most recent implant surgery. We describe her audiological and vestibular testing results during both the acute phase and following medical management and recovery. CONCLUSION: Acute labyrinthitis should be considered when sudden onset vertigo and/or imbalance presents in children with cochlear implants outside of the perioperative period. Such symptoms should prompt early assessment of cochlear implant function, so that the device can be reprogrammed accordingly.

Early Assessment of Vestibular Function after Unilateral Cochlear Implant Surgery.

INTRODUCTION: Cochlear implantation (CI) has been reported to negatively affect vestibular function. The study of vestibular function has variably been conducted using different types of diagnostic tools. The combined use of modern, rapidly performing diagnostic tools could prove useful for standardization of the evaluation protocol. METHODS: In a group of 28 subjects undergoing CI, the video head impulse test (vHIT), the cervical vestibular evoked myogenic potentials (cVEMP) and the short form of the Dizziness Handicap Inventory (DHI) questionnaire were investigated preoperatively and postoperatively (implant on and off) in both the implanted and the contralateral, nonimplanted ear. All surgeries were performed with a round window approach (RWA), except for 3 otosclerosis cases in which the extended RWA (eRWA) was used. RESULTS: The vHIT of the lateral semicircular canal showed preoperative vestibular involvement in nearly 50% of the cases, while the 3 canals were contemporarily affected in only 14% of the cases. In all the hypofunctional subjects, cVEMP were absent. A low VOR gain in all of the investigated superior semicircular canals was found in 4 subjects (14%). In those subjects (21.7%) in whom cVEMP were preoperatively present and normal on the operated side, the absence of a response was postoperatively recorded. DISCUSSION/CONCLUSION: The vestibular protocol applied in this study was found to be appropriate for distinguishing between the CI-operated ear and the nonoperated ear. In this regard, cVEMP was found to be more sensitive than vHIT for revealing a vestibular sufferance after CI, though without statistical significance. Finally, the use of RWA surgery apparently did not reduce the occurrence of signs of vestibular impairment.

Cerebellar Metastasis From Ovarian Carcinoma Harboring PIK3CA-Activating Mutation: A "Clear" Explanation for Unexpected "Vertigo".

Brain metastasis is a rare and generally late manifestation of an advanced-stage, high-grade serous ovarian carcinoma. Nowadays, the improved control of intra-abdominal disease by surgery and platinum-based chemotherapy results in a longer survival, allowing distant metastasis to implant and grow in the brain parenchyma. Herein, we describe a unique case of a cerebellar metastasis from clear cell ovarian carcinoma that initially presented as a FIGO Stage IC cancer. Surprisingly, 6 mo after surgery, the patient was in good condition with complete disappearance of symptoms and no evidence of recurrence. This relatively good biologic behavior may be explained by the presence of a PIK3CA-activating mutation in exon 9 which as previously reported in the literature, may be associated with better prognosis. To the best of our knowledge, this is the first reported case of cerebellar metastasis from ovarian clear cell carcinoma. In the presence of neurological symptoms, both clinicians and pathologists must be aware of this rare possibility, to assure correct patient management and effective therapeutic options. Generally, the prognosis of epithelial ovarian cancer patients with brain metastases is poor. PIK3CA mutations could be a good prognostic indicator in clear cell carcinomas.

Prevalence of Pediatric Dizziness and Imbalance in the United States.

OBJECTIVES: Understand the prevalence of vestibular symptoms in US children. STUDY DESIGN: Cross-sectional analysis. SETTING: 2016 National Health Interview Survey. SUBJECTS AND METHODS: Responses from the 2016 National Health Interview Survey for children ages 3 to 17 years were examined to determine the prevalence of vestibular symptoms and provider-assigned diagnoses. RESULTS: Dizziness or imbalance was reported in 3.5 (95% confidence interval, 3.1-3.9) million patients (5.6%) with a mean age of 11.5 years. Dizziness was reported in 1.2 million patients (2.0%) with a mean age of 12.7 years and balance impairment in 2.3 million patients (3.7%) with a mean age of 10.6 years. Prevalence of dizziness and imbalance did not vary by sex (P = .6, P = .2). Evaluation by a health professional was reported for 42% of patients with dizziness and 43% of patients with imbalance, with diagnoses reported in 45% and 48% of patients with dizziness and imbalance, respectively. The most common diagnoses reported for dizziness were depression or child psychiatric disorder (12%), side effects from medications (11%), head/neck injury or concussion (8.4%), and developmental motor coordination disorder (8.3%). The most common diagnoses reported for imbalance were blurred vision with head motion, "bouncing" or rapid eye movements (9.1%), depression or child psychiatric disorder (6.2%), head/neck injury or concussion (6.1%), and side effects from medications (5.9%). CONCLUSION: The national prevalence of childhood vestibular symptoms is more common than previously thought. Reported diagnoses varied greatly from the literature, suggesting a need for increased awareness of causes of vestibular symptoms in children.

Rehabilitation of dynamic visual acuity in patients with unilateral vestibular hypofunction: earlier is better.

PURPOSE: Patients with acute peripheral unilateral hypofunction (UVH) complain of vertigo and dizziness and show posture imbalance and gaze instability. Vestibular rehabilitation therapy (VR) enhances the functional recovery and it has been shown that gaze stabilization exercises improved the dynamic visual acuity (DVA). Whether the effects of VR depend or not on the moment when it is applied remains however unknown, and investigation on how the recovery mechanisms could depend or not on the timing of VR has not yet been tested. METHODS: Our study investigated the recovery of DVA in 28 UVH patients whose unilateral deficit was attested by clinical history and video head impulse test (vHIT). Patients were tested under passive conditions before (pre-tests) and after (post-tests) being subjected to an active DVA rehabilitation protocol. The DVA protocol consisted in active gaze stabilization exercises with two training sessions per week, each lasting 30 min, during four weeks. Patients were sub-divided into three groups depending on the time delay between onset of acute UVH and beginning of VR. The early DVA group (N = 10) was composed of patients receiving the DVA protocol during the first 2 weeks after onset (mean = 8.9 days), the late group 1 (N = 9) between the 3rd and the 4th week (mean = 27.5 days after) and the late group 2 (N = 9) after the 1st month (mean: 82.5 days). We evaluated the DVA score, the angular aVOR gain, the directional preponderance and the percentage of compensatory saccades during the HIT, and the subjective perception of dizziness with the Dizziness Handicap Inventory (DHI). The pre- and post-VR tests were performed with passive head rotations done by the physiotherapist in the plane of the horizontal and vertical canals. RESULTS: The results showed that patients submitted to an early DVA rehab improved significantly their DVA score by increasing their passive aVOR gain and decreasing the percentage of compensatory saccades, while the late 1 and late 2 DVA groups 1 and 2 showed less DVA improvement and an inverse pattern, with no change in the aVOR gain and an increase in the percentage of compensatory saccades. All groups of patients exhibited significant reductions of the DHI score, with higher improvement in subjective perception of dizziness handicap in the patients receiving the DVA rehab protocol in the first month. CONCLUSION: Our data provide the first demonstration in UVH patients that earlier is better to improve DVA and passive aVOR gain. Gaze stabilization exercises would benefit from the plastic events occurring in brain structures during a sensitive period or opportunity time window to elaborate optimal functional reorganizations. This result is potentially very important for the VR programs to restore the aVOR gain instead of recruiting compensatory saccades assisting gaze stability.

Ocular and cervical vestibular-evoked myogenic potentials in idiopathic sudden sensorineural hearing loss (ISSHL) without vertigo: VEMPs in ISSHL.

PURPOSE: Idiopathic sudden sensorineural hearing loss (ISSHL) is a hearing impairment greater than 30 dB at three consecutive frequencies developing in less than 3 days. The aim of this study was to evaluate VEMPs and caloric testing in patients affected by ISSHL without vertigo. METHODS: We retrospectively evaluated 35 subjects affected by ISSHL. The audio-vestibular investigation consisted of pure-tone and speech audiometry, impedance, bithermal caloric testing, oVEMPs and cVEMPs. RESULTS: VEMPS were abnormal in 21 patients (60%): cVEMPs in 12 (34.2%) and oVEMPs in 19 (54.2%). 10 patients (28.5%) presented with both c-and oVEMPs altered. Subjects without vestibular involvement showed a significant lower PTA in the affected ear both at admission and at discharge. Recovery rate was significantly higher in group without vestibular involvement. CONCLUSION: The evaluation of the vestibular system can be useful for predicting the auditory recovery in patients without vertigo also.

Revision surgery after triple semicircular canal plugging and morphologic changes of vestibular organ.

This study aims to investigate the causes of vertigo relapse in patients with Meniere's disease (MD) who had undergone triple semicircular canal plugging (TSCP) and explore the morphologic changes of vestibular organ through revision surgery. Eleven intractable MD patients who underwent TSCP initially and experienced episodic vertigo recurrence later, were enrolled. All patients accepted revision surgery, including seven cases who underwent labyrinthectomy and four cases who underwent repeat TSCP. Pure tone test, caloric test and video-head impulse test (v-HIT) were used to evaluate audiological and vestibular functions. Specimens of canal plugging materials and vestibular end organs were collected from patients who underwent labyrinthectomy during revision surgery. Mineralization and other histological characteristics of canal plugging materials were evaluated by von Kossa staining. Incomplete occlusion or ossification was observed in the semicircular canals (SCs) of all eleven patients, with all three SCs affected in three, the superior SC in five patients, the horizontal SC in two and the posterior SC in one. The results of v-HIT were in accordance with findings discovered intraoperatively. Few mineralized nodules and multiple cavities were found in the von Kossa-stained canal plugging materials. Incomplete occlusion or ossification of SCs was the principal cause of vertigo recurrence in MD patients who underwent TSCP. v-HIT was helpful in determining the responsible SCs.

Clinical significance of cervical and ocular vestibular evoked myogenic potentials in benign paroxysmal positional vertigo: a meta-analysis.

PURPOSE: As the pathological cause of benign paroxysmal positional vertigo (BPPV), the dislocation or degeneration of otoconia in the utricle and saccule is suggested. Vestibular evoked myogenic potential (VEMP) could reflect otolithic dysfunction due to these etiologies of BPPV. The aim of this study was to validate the clinical significance of cervical (c) and ocular (o) VEMP in BPPV by a meta-analysis of previous articles. METHODS: Articles related to BPPV with data on cVEMP and oVEMP were collected. The following keywords were used to search PubMed and Scopus for English language articles: benign paroxysmal positional vertigo or BPPV and vestibular evoked myogenic potential or VEMP. RESULTS: The p13 latency in cVEMP and n1 latency in oVEMP were slightly but significantly prolonged in BPPV patients compared to control patients. AR in oVEMP of BPPV patients also showed higher value than that of control patients. However, the n23 latency and AR in cVEMP and p1 latency in oVEMP showed no significant difference between BPPV and control patients. Furthermore, latencies in VEMPs also showed no significant difference between an affected and a non-affected ear in BPPV patients. CONCLUSIONS: Our results indicated that otolith dysfunction of BPPVs was detected by latencies in VEMPs, and AR in oVEMP more sensitively reflects the difference between affected and non-affected ears in BPPV patients. The otolith dysfunction of BPPV might be induced by the systemic condition. However, the differences of latencies between BPPV patients and control patients were too small to use VEMPs as a prognostic predictor.

Audiological Evaluation of Vestibular Schwannoma Patients with Normal Hearing.

OBJECTIVE: To evaluate the audiological aspects of vestibular schwannoma (VS) patients with normal hearing. STUDY DESIGN: Retrospective study. SETTING: Quaternary referral center for skull base pathologies. PATIENTS: The records on 4,000 patients who had been diagnosed with VS between 1986 and December 2017 were retrospectively reviewed. The patients included in the study were the ones who complied with the strict audiological normality criteria, as follows: a pure tone hearing threshold (at the 6-octave-spaced frequencies from 250 to 8,000 Hz) ≤25 dBHL; a word recognition score >90%; and interaural differences ≤10 dB at each frequency. INTERVENTIONS: Auditory brainstem response (ABR) testing and radiological imaging. MAIN OUTCOME MEASURES: The incidence of normal objective hearing among VS patients, and the diagnostic utility of the ABR and the effect of tumor size and site on the response. RESULTS: The incidence of normal hearing among VS patients was 4.2%. Tinnitus and vertigo were the most common symptoms across tumor grades; 5.6% of the tumors were large and giant tumors. The ABR yielded a sensitivity of 73.6%, with a false negative rate of 26.3% using a cutoff point of 0.2 ms for interaural latency differences. CONCLUSIONS: The diagnosis of VS should not be based on audiometric thresholds alone. Alarming signs of VS should be clear to the physician in order not to miss or delay the diagnosis of the disease. The ABR is useful in the diagnosis of VS, but normal results do not exclude the occurrence of the disease in patients with normal hearing.

Serum oxidative stress, inflammatory response and platelet activation in patients with vascular vertigo.

The aim of this study was to investigate the correlation and clinical significance of oxidative stress and inflammatory response in vascular vertigo (VV). The subjects were divided into three groups: vascular vertigo (group A), non-vascular vertigo (group B) and controls (group C). The serum levels of IL-6 (interleukins-6), SOD (superoxide dismutase), MDA (malondialdehyde) and TNF-α (tumor necrosis factor-α) and CD62P (also called P-Selectin) activation rates were determined and compared among the three groups. The levels of IL-6, TNF-α, MDA and CD62P in group A were significantly higher than those of group B and group C (P less than 0.05). The SOD level of group A was lower than that of group B and group C (P less than 0.05). There was no significant difference between groups B and C in IL-6, TNF- αMDA, SOD and CD62P (P>0.05). In patients with vascular vertigo, TNF-α levels had a weak linear correlation with those of low-density lipoprotein (P = 0.025, r = 0.312). There was no linear correlation between TNF-α and SOD in patients with VV and non-VV. The occurrence of inflammatory reaction and oxidative stress may cause abnormal lipid metabolism in the body and promote the occurrence of VV, and platelet activation may be involved in its formation.

Body balance at static posturography in vestibular migraine / Equilíbrio corporal à posturografia estática na migrânea vestibular

Abstract Introduction: Migraine is one of the most frequent and incapacitating headaches, with a high degree of impairment in quality of life. Its association with vestibular symptoms is common, including imbalance and postural instability. Objective: To evaluate the body balance of patients with vestibular migraine through a static posturography test. Methods: An experimental group of 31 patients with a medical diagnosis of vestibular migraine in the intercritical period of the disease, and a control group of 31 healthy individuals, matched for age and gender, were submitted to the eight sensory conditions of the Tetrax Interactive Balance System. The parameters analyzed were: stability index, which measures the amount of sway, global stability and ability to compensate postural modifications; weight distribution index, which compares deviations in weight distribution; synchronization index, which measures the symmetry in the weight distribution; postural sway frequency, which indicates the frequency range with more sway; and fall risk index, which expresses the probability of falls. Results: The stability index was higher in the experimental group in all eight sensory conditions, with a significant difference between the groups in six of them. The weight distribution index was higher in the experimental group in all conditions, with a significant difference in three of them. The number of cases with preferential sway in F2-F4 was significantly higher in the experimental group in three conditions, and in F5-F6 in two, while the fall risk was significantly higher in the experimental group than in the control group. Conclusion: Patients with vestibular migraine showed compromised body balance at the static posturography test.

Resumo Introdução: Migrânea é uma das cefaleias mais frequentes, incapacitante e com elevado grau de comprometimento na qualidade de vida. É comum sua associação a sintomas vestibulares, inclusive desequilíbrio e instabilidade postural. Objetivo: Avaliar o equilíbrio corporal de pacientes com migrânea vestibular por meio de uma posturografia estática. Método: Foram submetidos às oito condições sensoriais da posturografia do Tetrax Interactive Balance System um grupo experimental de 31 pacientes com diagnóstico médico de migrânea vestibular no período intercrítico da afecção e um grupo controle de 31 indivíduos hígidos pareado quanto à idade e sexo. Os parâmetros analisados foram: índice de estabilidade, que mede a quantidade de oscilação, estabilidade global e habilidade para compensar modificações posturais; índice de distribuição de peso, que compara os desvios na distribuição do peso; índice de sincronização, que mede a simetria na distribuição de peso; frequência de oscilação postural, que aponta a faixa de frequência com mais oscilação; e índice de risco de queda, que expressa à probabilidade de ocorrerem quedas. Resultados: O índice de estabilidade foi maior no grupo experimental em todas as oito condições sensoriais, com diferença significante entre os grupos em seis delas; o índice de distribuição de peso foi maior no grupo experimental em todas as condições, com diferença significante em três delas; o número de casos com oscilação preferencial em F2-F4 foi significantemente maior no grupo experimental em três condições, e, em F5-F6, em duas; o índice de risco de queda foi significantemente maior no grupo experimental do que no grupo controle. Conclusão: Pacientes com migrânea vestibular apresentam comprometimento do equilíbrio corporal à posturografia estática.

Impact of lian gong on the quality of life of individuals with dizziness in primary care / Impacto do lian gong na qualidade de vida de indivíduos com tontura na atenção primária

ABSTRACT OBJECTIVE To assess the effects of the lian gong practice as a rehabilitation strategy in primary health care on the quality of life and functional capacity of people with dizziness. METHODS Randomized controlled clinical trial. Thirty-six people, who were complaining of dizziness or vertigo without the presence of central signs and were referred by the physician of primary health care participated in the study. The individuals were randomly allocated to the three experimental conditions: lian gong group (n = 11), vestibular rehabilitation group (n = 11) and control group (n = 14). The interventions were weekly, in group, with duration of 12 sessions. The participants were evaluated before and after the intervention regarding quality of life by the 36-Item Short Form Health Survey and the functional capacity by the Short Physical Performance Battery. RESULTS The scores of all domains of the Short Form Health Survey increased after intervention in the lian gong group. This variation was higher than that observed in the control group for the domains functional capacity, limitation by physical aspects and general health status, and also higher than that found after the intervention in the Vestibular Rehabilitation Group regarding pain. No differences were found in the Short Physical Performance Battery. CONCLUSIONS Based on the results presented, lian gong improves the quality of life of individuals with dizziness, without altering the functional capacity.

RESUMO OBJETIVO Avaliar os efeitos da prática do lian gong como estratégia de reabilitação na atenção primária à saúde sobre a qualidade de vida e capacidade funcional de pessoas com tontura. MÉTODOS Trata-se de ensaio clínico randomizado-controlado. Participaram 36 voluntários, com queixa de tontura ou vertigem sem a presença de sinais centrais, encaminhados pelo médico da atenção primária à saúde. Os indivíduos foram aleatoriamente alocados para as três condições experimentais: grupo lian gong (n = 11), grupo reabilitação vestibular (n = 11) e grupo controle (n = 14). As intervenções foram semanais, em grupo, com duração de 12 sessões. Os participantes foram avaliados antes e após a intervenção quanto à qualidade de vida pelo 36-Item Short Form Health Survey e quanto à capacidade funcional pelo Short Physical Performance Battery. RESULTADOS Observou-se aumento dos scores de todos os domínios do Short Form Health Survey após intervenção no grupo lian gong. Essa variação foi maior que a observada no grupo controle para os domínios capacidade funcional, limitação por aspectos físicos e estado geral de saúde, e também superior à encontrada após a intervenção grupo reabilitação vestibular no domínio dor. Não houveram diferenças no Short Physical Performance Battery. CONCLUSÕES Com base nos resultados apresentados, o lian gong melhora a qualidade de vida de indivíduos com tontura, sem alterar a capacidade funcional.

Change in endolymphatic hydrops 2 years after endolymphatic sac surgery evaluated by MRI.

OBJECTIVE: This study was performed to determine whether endolymphatic sac surgery improves vestibular and cochlear endolymphatic hydrops 2 years after sac surgery and to elucidate the relationship between the degree of improvement of endolymphatic hydrops and the changes in vertigo symptoms, the hearing level, and the summating potential/action potential ratio (-SP/AP ratio) by electrocochleography (ECochG) in patients with Ménière's disease (MD). METHODS: Twenty-one patients with unilateral MD who underwent sac surgery were included in this study. All patients underwent gadolinium-enhanced magnetic resonance imaging (Gd-MRI) before and 2 years after sac surgery. We evaluated the difference in vestibular and cochlear endolymphatic hydrops between before and after surgery in both ears and compared these findings with the frequency of vertigo attacks, hearing level, and ECochG findings. RESULTS: In affected ears, the presence of vestibular endolymphatic hydrops and the frequency of vertigo attacks significantly decreased after surgery. However, affected ears showed no significant improvement in the presence of cochlear endolymphatic hydrops or the -SP/AP ratio by ECochG; there was also no significant improvement or deterioration in the hearing level. CONCLUSION: The present findings suggest that sac surgery reduces vestibular endolymphatic hydrops and prevents aggravation of cochlear endolymphatic hydrops, and these changes lead to a reduction of vertigo attacks and suppress the progression of hearing impairment associated with vertigo attacks.

How does cochlear implantation affect five vestibular end-organ functions and dizziness?

OBJECTIVE: To evaluate all five vestibular end-organ functions (lateral, anterior, posterior semicircular canal, utricule, and saccule) and to investigate the relationship between Dizziness Handicap Inventory (DHI) and vestibular functions prior to CI (cochlear implantation) and at postoperative day 3 and month 3. METHODS: A total of 42 patients (age 16-70years) with normal vestibular functions preoperatively and undergoing unilateral CI were included in this prospective descriptive study. Video head impulse test (vHIT) for three semicircular canal (SSC) functions, ocular vestibular-evoked myogenic potential (oVEMP) for utricule function, cervical vestibular-evoked myogenic potential (cVEMP) for saccule function and DHI for subjective vertigo symptoms were performed prior to CI and at postoperative day 3 and month 3. RESULTS: There was a significant impairment of vestibular function in 12 patients (28.5%) on the implantation side and significant DHI increase was observed in 13 of 42 (30.9%) patients at postoperative day 3 after CI (p<0.05). We found SSC dysfunction in 7 patients (16,6%) who underwent observation with vHIT, saccule dysfunction in 8 patients (19%) with cVEMP and utricule dysfunction in 5 patients (11.9%) with oVEMP on the operated side 3days after surgery (p<0.05). Posterior SSC functions (5 patients) were more affected than lateral SSC functions (3 patients). At postoperative month 3, six patients (14.2%) still had deteriorating results in the objective tests and significant DHI increase was continued in 4 (9.5%) patients (p<0.05). The deterioration in vHIT continued in only 1 (2.3%) patient (p>0.05). The deterioration in cVEMP continued in 5 (11.9%) patients (p<0.05). The deterioration in oVEMP continued in 2 (4.7%) patients (p>0.05). There was a significant correlation between DHI and objective vestibular tests both in the early and late postoperative period (r=0.795; p<0.05). CONCLUSION: Our study showed that both canal and otolith functions can be damaged after CI especially in the early postoperative period. Surprisingly, posterior SSC functions were more affected than lateral SSC. Therefore, a gold standard vestibular test battery that can evaluate each of three SSC canals and two otoliths functions is essential. Since a single vestibular test for this purpose is not available, we recommend the use of the three available vestibular tests together. This test battery, which is capable of evaluating five vestibular end-organ functions in preoperative and postoperative vestibular evaluations, can provide more accurate results not only for CI but also for most otologic surgeries.

[Vestibular function features and prognosis of vestibular neuritis in children].

Objective: To investigate the clinical characteristics, prognosis and affected branches of vestibular neuritis in children. Methods: Twenty-five patients with vestibular neuritis in ENT department, Beijing Children's Hospital, from October 2015 to October 2016, were collected. All patients were 4-14 (mean 9.8) years old including 17 boys and 8 girls. The clinical manifestations history, pure tone audiometry (PTA), vestibular function tests were done for each patient. We also took the blood samples for pathogenic virus in order to analyze the premorbid risk factors. Results: Rotational vertigo were complained by all presents. There were 17 cases (68%, 17/25) with nausea and vomiting and 19 cases (76%, 19/25) with balance dysfunction. There were 12 cases (60%, 12/20) with positive results in 20 blood samples for virology, among which 6 cases of influenza B virus and 4 cases of herpes simplex virus, 1 case of cytomegalovirus and 1 case of coxsackie were identified. The results of PTA were normal. Bithermal caloric test was abnormal in 22 cases (88%, 22/25). The ocular vestibular-evoked myogenic potential (oVEMP) in 12 cases (48%, 12/25) and cervical vestibular-evoked myogenic potential (cVEMP) in 5 cases (20%, 5/25) were abnormal. The bithermal caloric test along with oVEMP and cVEMP in 4 cases (16%, 4/25) were abnormal. The bithermal caloric test and oVEMP in 7 cases (28%, 7/25) were abnormal. The bithermal caloric test in 11 cases (44%, 11/25) were abnormal. The oVEMP in 1 cases (4%, 1/25) was abnormal. The cVEMP in 1 cases (4%, 1/25) was abnormal. All patients recovered well, but the time varied. The symptoms of 21 patients were complete recovery within 1 month. 3 patients were complete recovery within 2 months (aged 8 - 14 years old). One patient was complete recovery within 6 months (aged 13 years old). Conclusion: Rotary vertigo is most commonly in children with vestibular neuritis, accompany with imbalance and vomiting. The vestibular neuritis in children might be related with upper respiratory tract infection. Audiometry test is normal. Because of the bithermal caloric test and oVEMP are obvious abnormality, therefore it is speculated that the superior vestibular nerve may most commonly be affected. The younger patients with vestibular neuritis recovered more quickly than the older children.

[Suppression head impulse paradigm in healthy adult population: the values and features of the parameters].

Objective: To observe the parameters of the results of suppression head impulse paradigm (SHIMP) in healthy adults, and to provide reference for evaluating vestibular oculomotor reflex function in patients with peripheral vertigo. Methods: Fifty healthy adults, 22 males and 28 females, aged from 23-65 years, with an average age of (38.5±11.6) years, were recruited from January to March 2018. Parameters provided by the video head pulse software included the gains, the latency and the peak velocity of saccades, and comparison was made with head impulse paradigm (HIMP). Results: All subjects were elicited anti-compensatory saccades in SHIMP. The normal values of left and right gains were 1.02 and 1.10 in HIMP, and 0.93 and 1.01 in SHIMP respectively. The left and right saccades latency were (201.1± 50.8)ms and (187.0± 42.9)ms, and the peak saccadic velocity were (302.7±58.5)°/s and (291.5±46.5)°/s in SHIMP; there were small but significant difference between two sides about gains in HIMP and SHIMP, as well as latency in SHIMP(P<0.05); there were small but significant difference between HIMP and SHIMP about gains in ipsilateral(P<0.01); there were no significant difference between two sides about peak saccadic velocity in SHIMP(P>0.05). Conclusions: SHIMP can be used for the examination of vestibular oculomotor reflex function in adult population. It is easy to be operated and is convenient for clinical application. Combined with head pulse test, the function of the semicircular canal can be evaluated together.