Application of vestibular function examination in the analysis of damaged site in patients with acute vestibular neuritis / 临床耳鼻咽喉头颈外科杂志

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 test（vHIT） and vestibular evoked myogenic potentials（VEMPs）. 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 potentials（cVEMP） and ocular vestibular evoked myogenic potentials（oVEMP） 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 cVEMP（P<0.01）. Combination analysis of different vestibular function tests: there are twenty-six patients（45.61%, superior and inferior vestibular nerve） with abnormal caloric irrigation test, video head impulse test, and VEMPs. There are twenty-five patients（43.86%, superior vestibular nerve） with abnormal caloric irrigation test, horizontal semicircular canal vHIT, anterior semicircular canal vHIT, and oVEMP. There are 4 patients（7.02%, inferior vestibular nerve） with abnormal posterior semicircular canal vHIT and cVEMP. There are two patients（3.51%, ampullary vestibular nerve） 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 neuritis（P<0.01）. 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.

A comparative study of detection methods for assessing superior and inferior vestibular nerve damages in patients with vestibular neuritis / 临床耳鼻咽喉头颈外科杂志

Objective:This study aims to compare the examination results of the vestibular evoked myogenic potential（VEMP） and video head impulse testing（vHIT） in patients with vestibular neuritis（VN）, 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 VEMP（oVEMP）, cervical VEMP（cVEMP） and vHIT, and the examination results were analyzed. Results:Examination results of oVEMP showed that 96%（24/25） patients had one-ear abnormalities with the amplitude decline or no waveform introduced, and 4%（1/25） patient had no waveform introduced of both ears. The overall abnormal rate examined by oVEMP was 100%（26/26）. Examination results of cVEMP showed that 36%（9/25） patients had one-ear abnormalities with the amplitude decline or no waveform introduced, and 4%（1/25） patients had no waveform introduced of both ears. The overall abnormal rate examined by cVEMP was 40%（10/25）, and 60%（15/25） patients had normal waveforms of both ears. Examination results of vHIT showed that 100%（25/25） patients had semicircular canal gain decline of one side, 92%（23/25） had anterior Semicircular canal decline of one side, and 36%（9/25） had posterior semicircular canal decline of one side. VEMP and vHIT results were compared. Examination results of VEMP showed that 60%（15/25） VN patients had superior vestibular nerve damage, and 40%（10/25） had both superior and inferior vestibular nerve damages. Examination results of vHIT showed that 64%（16/25） VN patients had superior vestibular nerve damage, and 36%（9/25） 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 vHIT（χ²=0.085, P>0.05）. The matching ratio of VEMP and vHIT results was 80%（20/25）, and the non-matching ratio was 20%（5/25）. 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.

Sindrome Vestibular Agudo posterior a la infección por SARS-COV2 / Acute Vestibular Syndrome after SARS-COV2 infection

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

The clinical application of mobile internet remote guidance platform for vestibular rehabilitation / 中华耳鼻咽喉头颈外科杂志

Objective: To guide the patients with vertigo who are suitable for vestibular rehabilitation therapy (VRT), and to evaluate the curative effect through a remote guidance platform based on mobile internet. Methods: Adult outpatients, who were diagnosed as vestibular disorders and required VRT, were selected and conducted baseline evaluation and formulated vestibular rehabilitation plan according to their symptoms, diagnosis and vestibular function examination results. These patients downloaded and installed the mobile internet remote guidance platform app for VRT, and then registered and uploaded medical records. According to the VRT plan formulated by clinicians for patients, the platform launched corresponding exercise guidance videos to guide them to complete 4-week VRT exercise at home. Before and after VRT, the patients were scored with Visual Analogue Scale (VAS), Activities-specific Balance Confidence (ABC), Dizziness Handicap Inventory (DHI) and Self-rating Anxiety Scale (SAS). The rehabilitation effects were statistically analyzed by SigmaStat 4.0 software. Results: From October 2019 to October 2021, 233 patients with vertigo completed the registration of vestibular rehabilitation guidance platform, of whom 187 patients insisted on 4-week rehabilitation training and completed the scale evaluation. Among 187 patients, 65 were male and 122 were female; Age was (49.8±16.0) years; The medical history ranged from one to 192 months, with a median of eight months. Compared with that before rehabilitation exercise, the subjective feeling of vertigo in 170 patients was improved, and the overall effective rate was 90.9% (170/187). The subjective symptoms of vertigo were basically improved after rehabilitation training in patients with unilateral vestibular dysfunction, vestibular neuritis, sudden deafness with vertigo, Hunt syndrome and acoustic neuroma. There were significant differences in ABC, DHI and SAS scores before and after VRT (P<0.05). Of those patients with Meniere's disease in the intermittent period and the patients with Meniere's disease who underwent surgical treatment, more than 90% of their subjective symptoms of vertigo or dizziness improved after VRT, and there were significant differences in the scores of ABC, DHI and SAS before and after VRT exercise (P<0.05). In patients with vestibular migraine, 36.7% (11/30) had no improvement or even aggravation of subjective symptoms of vertigo after VRT, however, the DHI score after rehabilitation exercise was lower than that before exercise, and the difference was statistically significant (P<0.05). In patients with bilateral vestibular dysfunction, although most (6/8) subjective symptom scores were improved compared with those before exercise, there was no significant difference in ABC, DHI and SAS scores before and after rehabilitation (P>0.05). Conclusion: VRT with the help of vestibular rehabilitation mobile internet remote guidance platform can effectively improve the subjective symptoms of vertigo, balance ability and anxiety in patients with unilateral vestibular lesions.

Correlation analysis of 3D-FLAIR MRI characteristics of the inner ear and vestibular function in the patients with vestibular neuritis / 中华耳鼻咽喉头颈外科杂志

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.

Enfoque del paciente con vértigo / Approach to patients with vertigo

El vértigo es definido como la sensación de movimiento ilusorio del cuerpo o de los objetos que le rodean. Es una de las causas más comunes de consulta en los departamentos de emergencia, y 2 a 3% de la población mundial consulta anualmente por este síntoma. De acuerdo al compromiso vestibular en el oído interno o en el sistema nervioso central o ambos, puede clasificarse en vértigo periférico, central o de origen mixto, siendo la principal causa del periférico el vértigo posicional paroxístico benigno. La valoración semiológica y anamnesis es fundamental para el diagnóstico. En el examen físico inicial, la diferenciación de un vértigo de origen central de otro de origen periférico, puede realizarse mediante el análisis del nistagmo, la valoración del impulso cefálico y la desviación ocular, que se integran en un sistema denominado HINTS, por sus siglas en inglés (Head Impulse, Nystamus type, Test of Skew), y por la realización de pruebas que evalúen también la vía vestíbulo-cerebelosa. Además, la realización de una audiometría tonal, aumentaría la sensibilidad diagnóstica de 71 a 89% en la evaluación inicial. El diagnóstico apropiado es la base para el tratamiento y control de esta condición clínica en el mediano y largo plazo.

Vertigo is defined as an abnormal sensation of body motion or of its surrounding objects. It is a common chief complaint in emergency departments comprising 2 to 3% of these consultations worldwide. Vertigo is classified as peripheral or central, according to its origin, and can also be occasionally mixed, the most common cause of peripheral involvement being benign paroxysmal positional vertigo. The initial findings on clinical evaluation of patients are the clues for making a correct diagnosis. The differentiation between central and peripheral vertigo can be optimized by analysing nystagmus, by using the skew test and the head impulse test (HINTS), as also by performing the appropriate tests to evaluate the integrity of the vestibular-cerebellar pathway. In addition, tonal threshold audiometry could raise the diagnostic sensibility from 71 to 89% on initial approach. Appropriate diagnosis is the principal key for managing this clinical condition.

Health-related quality of life and disability in patients with acute unilateral peripheral vestibular disorders / Qualidade de vida relacionada à saúde e incapacidade em pacientes com distúrbios vestibulares periféricos unilaterais agudos

Abstract Introduction: Health-related quality of life is used to denote that portion of the quality of life that is influenced by the person's health. Objectives: To compare the health-related quality of life of individuals with vestibular disorders of peripheral origin by analyzing functional, emotional and physical disabilities before and after vestibular treatment. Methods: A prospective, non randomized case-controlled study was conduced in the ENT Department, between January 2015 and December 2015. All patients were submitted to customize a 36 item of health survey on quality of life, short form 36 health survey questionnaire (SF-36) and the Dizziness Handicap Inventory for assessing the disability. Individuals were diagnosed with acute unilateral vestibular peripheral disorders classified in 5 groups: vestibular neuritis, Ménière Disease, Benign Paroxysmal Positional Vertigo, cochlear-vestibular dysfunction (other than Ménière Disease), or other type of acute peripheral vertigo (as vestibular migraine). Results: There was a statistical significant difference for each parameter of Dizziness Handicap Inventory score (the emotional, functional and physical) between the baseline and one month both in men and women, but with any statistical significant difference between 7 days and 14 days. It was found a statistical significant difference for all eight parameters of SF-36 score between the baseline and one month later both in men and women; the exception was the men mental health perception. The correlation between the Dizziness Handicap Inventory and the SF-36 scores according to diagnostics type pointed out that the Spearman's correlation coefficient was moderate correlated with the total scores of these instruments. Conclusion: The Dizziness Handicap Inventory and the SF-36 are useful, proved practical and valid instruments for assessing the impact of dizziness on the quality of life of patients with unilateral peripheral vestibular disorders.

Resumo Introdução: Qualidade de vida relacionada à saúde é usada para designar a parte da qualidade de vida que é influenciada pela saúde do indivíduo. Objetivos: Comparar a qualidade de vida relacionada à saúde de indivíduos com distúrbios vestibulares de origem periférica, analisar incapacidades funcionais, emocionais e físicas antes e após o tratamento vestibular. Método: Um estudo de caso-controle prospectivo, não randomizado, foi conduzido no Departamento de Otorrinolaringologia, entre janeiro de 2015 e dezembro de 2015. Todos os pacientes foram submetidos a uma pesquisa de saúde personalizada de 36 itens sobre qualidade de vida, ao formulário abreviado de avaliação de saúde 36 (SF-36) e ao Dizziness Handicap Inventory para avaliar a incapacidade. Os indivíduos foram diagnosticados com distúrbios vestibulares periféricos unilaterais agudos, classificados em cinco grupos: neurite vestibular, doença de Ménière, vertigem posicional paroxística benigna, disfunção cócleo-vestibular (exceto Doença de Ménière) ou outro tipo de vertigem periférica aguda (como enxaqueca vestibular). Resultados: Houve uma diferença estatisticamente significante para cada parâmetro de escore no Dizziness Handicap Inventory (emocional, funcional e físico) entre a avaliação basal e depois de um mês, tanto em homens quanto em mulheres, mas sem diferença estatística significativa entre sete dias e 14 dias. Foi encontrada uma diferença estatisticamente significante para todos os oito parâmetros do escore no SF-36 entre a avaliação basal e um mês mais tarde, tanto em homens quanto em mulheres; a exceção foi a percepção de saúde mental nos homens. A correlação entre Dizziness Handicap Inventory e o SF-36 de acordo com o tipo de diagnóstico mostrou que o coeficiente de correlação de Spearman foi moderado quando correlacionado com o escore total desses instrumentos. Conclusão: O Dizziness Handicap Inventory e o SF-36 demonstraram ser instrumentos úteis, práticos e válidos para avaliar o impacto da tontura na qualidade de vida de pacientes com distúrbios vestibulares periféricos unilaterais.

Utilidad de la prueba calórica mínima / Usefulness of the minimum caloric test

La prueba calórica mínima (PCM) es un examen diseñado para estudiar el canal semicircular lateral (CSCL) y, especialmente, el canal semicircular posterior (CSCP), el cual no es examinado por la prueba calórica clásica (PCC). Nuestro objetivo es evaluar el aparato vestibular a través de la PCM, cuando la PCC no explica los síntomas de algunos pacientes. Se incluyeron aquellos pacientes que consultaron entre enero y julio de 2003 por un síndrome vertiginoso cuya sintomatología no era explicada por la PCC. Fueron evaluados mediante PCM. Se identificaron 12 pacientes con estas características. En todos los casos la PCM permitió establecer un diagnóstico más preciso. Como conclusión, la PCM en casos seleccionados complementa la PCC, otorgando información adicional relevante para el manejo de los pacientes con patología vestibular.