Role of the functional head impulse test in evaluating vestibulo-ocular reflex abnormalities in individuals with Parkinson's disease.

PURPOSE: To assess vestibular-ocular reflex (VOR) function in patients with Parkinson's disease (PD) using a new method called functional head impulse test (fHIT). STUDY DESIGN: Case-control study. SETTING: Tertiary medical center. PARTICIPANTS: Twenty individuals with PD were recruited for PD group, and twenty healthy individuals for the control group. Ages of both groups ranged from 47 to 76 years. MAIN OUTCOME MEASURES: According to the modified Hoehn-Yahr score, PD group was classified as an early stage with a range of 1-2.5 and a mid-late stage with a range of 3-5. Percentage of correct answers (%CA) was calculated using fHIT for lateral, anterior and posterior semicircular canal (SCC) planes. RESULTS: PD group had statistically lower fHIT %CA in the right lateral, left lateral, and left posterior SCC planes compared to control group (p < .05). There was no statistical difference between two PD severity groups and functional VOR abnormality. CONCLUSION: It was concluded that the functional VOR in the right lateral and left lateral and left posterior SCC plane was affected in individuals with PD. Our results show that impaired VOR and reduced dynamic visual acuity should be considered in individuals with PD for vestibular rehabilitation exercises.

Why did we encounter gusher in a stapes surgery case? Was it enlarged medial aperture of the cochlear aqueduct?

BACKGROUND AND PURPOSE: Preoperative prediction of cerebrospinal fluid (CSF) gusher is important for stapes surgery. According to the current opinion settled among otologists and radiologists, the issues of whether enlarged cochlear aqueduct might be a cause of CSF gusher in stapes surgery and which segment of the aqueduct should be taken into account to diagnose enlarged cochlear aqueduct in computerized tomography (CT) are controversial. The case we encountered led us to hypothesize that enlarged cochlear aqueduct might cause CSF gusher in stapes surgery and that shape and diameter of medial aperture of the cochlear aqueduct are important in this prediction. METHODS AND RESULTS: Enlarged medial aperture of the cochlear aqueduct with a shape differed from that of the other side was retrospectively diagnosed in thin-slice CT in a patient who had been undergone middle ear and stapes surgery for conductive hearing loss. This finding went unnoticed in preoperative CT. In the small fenestra stapedotomy operation, CSF gusher occurred through opening in the ill-defined, fixed and thickened stapes footplate. A piece of temporalis fascia and reshaped incus were appropriately placed which stopped the gusher. Re-evaluation of preoperatively taken CT showed that anterior-posterior and superior-inferior diameters of the medial aperture were 11.7 mm and 2.87 mm in CSF gusher side versus 2.95 mm and 1.88 mm on the other side, respectively. Its shape in gusher side differed from that of the other side. CONCLUSION: This report is the first to show video-documented CSF gusher in a patient with enlarged medial aperture of the cochlear aqueduct. It appears to be plausible to propose that these findings have to change the otologists' and radiologists' perspective to the cochlear aqueduct. It can be deduced that difference in shapes of the medial aperture in both sides might be an indicator of potential CSF gusher.

Protein profiling of anastomosed facial nerve treated with mesenchymal stromal cells.

BACKGROUND AIMS: The types of proteins released from mesenchymal stromal cells (MSC) are still unclear. Our aim was to compare apoptosis scores and the expression of myelin-associated glycoprotein (MAG), myelin basic protein (MBP), neural cell adhesion molecule (NCAM)-1,matrix metalloproteinase (MMP)-1A, tissue inhibitor of metalloproteinase (TIMP)-1, TIMP-1/MMP-1A ratio, nerve growth factor (NGF), brain-derived neurotrophic factor (BDNF), ciliary neurotrophic factor (CNTF), neurotrophin (NT)-3, NT-4, glial cell-derived neurotropic factor (GDNF), leukemia inhibitory factor (LIF), basic fibroblast growth factor (FGF)-2, insulin-like growth factor (IGF)-1, platelet-derived growth factor (PDGF)-α and transforming growth factor (TGF)-ß1 in anastomosed facial nerves that had been treated with or without MSC. METHODS: In seven rats, the buccal branch of the right facial nerve was transected, anastomosed and treated with MSC (anastomosed + MSC group). The left buccal branch was anastomosed only (anastomosed-only group). The left mandibular branch served as an intact nerve group. On days 18-20, the distal segments of the branches were examined in terms of expression of the mentioned proteins and apoptosis scores using polymerase chain reaction (PCR) and terminal deoxynucleotidyl transferase-mediated digoxigenin-UTP nick end labeling (TUNEL) assays. RESULTS: MSC application significantly increased CNTF, PDGF-α, LIF, TGF-ß1, BDNF and NT-3 expression (P < 0.05). MAG expression slightly decreased whereas NCAM-1, MMP-1A and FGF-2 slightly increased(P > 0.05). Changes in other proteins and apoptosis scores were not significant. CONCLUSIONS: These results suggest that MSC increases expression of CNTF, PDGF-α, LIF,TGF-ß1, BDNF and NT-3. MAG, NCAM-1, MMP-1A and FGF-2 expressions were slightly changed in this stage of nerve regeneration. The comparison of apoptotic activity was not conclusive. Overall, it appears that MSC might have differential effects on the mentioned tissue-related proteins and trophic/growth factors.

TMJ herniation associated with lymphangioma of the parotid region.

OBJECTIVE: The objective of this study was to present clinical, audiological, and radiologic findings of a rare case of the temporomandibular joint herniation associated with lymphangioma of the parotid region. CLINICAL REPORT: A 21-year-old man with the complaints of a mass on the right side of the face, otalgia, and hearing loss in the right ear was referred to our department. The examination revealed a herniating temporomandibular joint into the right external auditory meatus when the patient closed his mouth. He had also hearing loss when he closed his mouth. Upon opening the mouth, the temporomandibular joint returned into its normal position within the glenoid fossa, and the hearing became normal. The patient had also lymphangioma involving mainly the parotid region. CONCLUSIONS: Temporomandibular joint herniation into the external auditory meatus may be rarely due to parotid lymphangioma, which leads to pseudo-conductive hearing loss.

Meta-analysis of hearing outcomes of chronic otitis media surgery in the only hearing ear.

OBJECTIVE: To assess the hearing outcomes of surgery for patients with chronic otitis media (COM) with or without cholesteatoma in case of the only hearing ear (OHE). METHODS: This meta-analysis included COM patients with hearing in only one ear. The PubMed, Scopus, and Cochrane databases were reviewed. RESULTS: Thirteen studies were included, 252 excluded. The total number of operated ears was 229. The patients' ages ranged from 6 to 78 years. A change greater than 10 dB in hearing thresholds in the OHE was considered as a significant result. When both the COM with (cCOM) and without cholesteatoma (ncCOM) cases were considered, the air bone gap (ABG), air conduction (AC) and bone conduction (BC) thresholds were stable or improved in 91.06% (95% CI:81.94-97.19%), 87.91% (82.14-92.34%), and 94.99% (95% CI:90.20-97.97%) of patients, respectively. Stable or improved ABG, AC and BC thresholds were observed in 92.36% (95% CI:81.67-97.86%), 87.36% (95% CI:71.46-96.23%), and 94.85% (95% CI:81.36-99.49%) of those with ncCOM, respectively. For patients with cCOM, the results were 85.96% (95% CI:81.36-99.49%), 85.20% (95% CI:76.04-91.87%), and 97.01% (95% CI:89.62-99.63%), respectively. There were no significant differences in these thresholds between either category. CONCLUSION: Hearing deterioration in AC and BC thresholds can be expected in about 13-15% and 5-3%, respectively, of patients, with ncCOM or cCOM. Our results should not be construed as a guide for determining surgery eligibility in patients with COM in the OHE.

One Genetic Defect and Two Related Entities in Monozygotic Twins: Otosclerosis and Superior Semicircular Canal Near Dehiscence Syndrome.

The purpose of this study was to evaluate the clinical and genetic findings of 53-year-old monozygotic twins who had bilateral otosclerosis and right-sided superior semicircular canal near dehiscence (SSCND). Monozygotic twins at the age of 53 presented with conductive hearing loss and normal tympanic membranes. Detailed audiovestibular testing and computed tomography scan revealed that both patients had concurrent otosclerosis and SSCND. Conservative management (hearing aids) was the treatment for these patients. Exome sequencing (ES) for the twins and their affected mother identified a heterozygous missense variant in the EYA4 (c.1744G>A; p.Glu582Lys) gene. This is the first case report to present these separate entities identified in monozygotic twins with a heterozygous missense variant in the EYA4 gene. Our ES data may imply a possible causal relationship or association between variants in the EYA4 gene and concurrent otosclerosis and SSCND.

Promising Outcome of Radiation Therapy for Chondroblastoma of Temporal Bone in Childhood: A Case Report.

Chondroblastoma is a rare cartilaginous benign bone tumor. Chondroblastoma in the temporal bone is also quite rare. Total excision is the main treatment. Data regarding tumor response to radiation therapy (RT) is insufficient. We describe a case of chondroblastoma that was treated with RT following subtotal tumor resection. In this case, the patient was a 14-year-old male who presented with a three-month history of ear fullness and hearing loss in his right ear. Magnetic resonance imaging revealed a mass partly filling the right external auditory canal and the inferior part of the middle ear. Histopathological findings indicated chondroblastoma. Subtotal tumor resection was performed due to risk of complications. RT was planned upon the growth of the tumor during follow-up. Treatment with subtotal resection and postoperative RT has been successful and the patient had no recurrence in the course of the 12-year follow-up. In chondroblastoma, complete surgical resection is still the gold standard. But the success of subtotal resection followed by adjuvant RT should also be kept in mind for cases where the total excision would pose high morbidity.

Can Narrow Band Chirp Stimulus Shake the Throne of 500 Hz Tone Burst Stimulus for Cervical Vestibular Myogenic Potentials?

BACKGROUND AND OBJECTIVES: The aim of the study was to compare effects of tone-burst (TB) and narrow-band (NB) Claus Elberling (CE)-chirp stimuli on amplitude, latency and interaural asymmetry ratio (IAR) of cervical vestibular evoked myogenic potentials (cVEMP) in healthy individuals. SUBJECTS AND METHODS: The study included 50 healthy volunteers. cVEMP procedure was carried out using 500 Hz TB and NB-CE-chirp stimulus (360-720 Hz, up-chirp) in random order. cVEMP were recorded at 100 dB nHL. For each ear and each stimulus, P1 latency, N1 latency and P1N1 amplitude were measured. IAR was also calculated. RESULTS: Mean age was 26.66±9.48 years. cVEMP's in response to both TB and NB CE-chirp stimuli were obtained in all subjects. No statistically significant difference in P1 latency, N1 latency, and P1N1 amplitude was found between the right and left ears for both TB and NB CE-chirp stimuli (p>0.05). In both sides, P1 and N1 latencies were significantly shorter in NB CE-chirp stimulation compared to TB stimulation (p=0.000). In both sides, no statistically significant difference was found in P1N1 amplitude between two types of stimuli (p>0.05). CONCLUSIONS: The chirp stimulus produces robust but earlier cVEMP than TB does. This largest series study on NB chirp cVEMP shows that NB chirp is a good and new reliable alternative.

Do otosclerosis and stapedotomy affect semicircular canal functions? Preliminary results of video head impulse test.

BACKGROUND: Otosclerosis and stapedotomy have some effects on the vestibular system, but there are very limited data on their effects on semicircular canals (SCCs). OBJECTIVE: The aim of the study is to investigate if otosclerosis and stapedotomy have an effect on SCCs and video head impulse test (vHIT). MATERIAL AND METHODS: This retrospective study included 11 otosclerosis patients who had undergone stapedotomy and 30 healthy participants. Twenty-two ears of 11 patients with otosclerosis were divided into two groups based on whether the ear had been operated (12 ears) or not (10 ears). All participants underwent vHIT. We compared gains of all SCCs, presence of saccades among the operated ears, unoperated ears and control ears. RESULTS: Significant difference (p<.05) was noted in comparisons of gain of lateral SCCs among all groups. Control group had the highest gain, followed by unoperated and operated groups, respectively. Comparison of incidence of covert saccade showed significant difference (p<.05) for lateral and posterior SCCs. CONCLUSIONS AND SIGNIFICANCE: Otosclerosis and otosclerosis surgery may have some effects on SCC functions and thereby vHIT. Lateral SCC is the most affected SCC in terms of gain. These findings appear to add important contributions to our knowledge.

Differences in bone conduction ocular vestibular evoked myogenic potentials to 500 Hz narrow band chirp stimulus and 500 Hz tone burst.

OBJECTIVE: This study aims to investigate the differences of N1 latency, P1 latency and N1P1 amplitude in response to bone conducted 500 Hz tone burst and narrowband CE chirp stimulus in ocular vestibular evoked myogenic potentials (oVEMPs). METHODS: Forty-two healthy volunteers were included in this prospective study. Subjects with abnormal otological examinations and otological diseases were excluded. oVEMPs were randomly recorded in response to BC 500 Hz narrowband (NB) chirp stimulus and BC 500 Hz tone burst. The stimulus intensity was 50 dB nHL for both 500 Hz tone burst and 500 Hz NB CE chirp stimulus. P1 latency, N1 latency, and N1P1 amplitude were measured, and these measurements were compared between these two types of stimuli. RESULTS: Both types of stimuli elicited oVEMP in all subjects. N1 latency and P1 latency were significantly shorter (6.41 ms vs 10.84 ms; 10.64 ms vs 15.56 ms, respectively) for chirp stimulus (p < 0.05). N1P1 amplitude was significantly higher (11.64 vs 7.18 µV) for NB chirp stimulus (p < 0.05). CONCLUSION: It is reasonable to conclude that the NB CE chirp stimulus is effective to elicit robust BC oVEMP in healthy subjects.

Routine Vestibular Tests May Point Out Vestibular Subtype of Seasickness Only.

BACKGROUND: The vestibular system is important in the pathogenesis of seasickness. Our objective is to investigate whether routine vestibular tests detect seasickness.METHODS: Included were 17 professional naval personnel (mean age of 29.76 4.73 yr) diagnosed as having seasickness and 29 healthy age- and gender-matched controls. Cervical (c) vestibular evoked myogenic potentials (VEMP) and ocular (o) VEMP and bithermal caloric tests were performed after ear, nose, and throat examination, pure tone audiometry, and magnetic resonance imaging. Severity of seasickness was evaluated based on the Graybiel scale. P1 latency, N1 latency, P1N1 amplitude, and interaural asymmetry ratios (IAR) of cVEMP and oVEMP were compared between the patients and control groups. Abnormal findings in the caloric test were noted. Presence of an abnormality in any of the three vestibular tests (cVEMP, oVEMP, or caloric test) was accepted as a positive vestibular finding.RESULTS: According to the Graybiel Scale, severe malaise and frank sickness were observed in 3 patients (18.7%) and 13 patients (81.3%), respectively. Graybiel scoring could not be performed in one patient due to general discomfort and bad general condition. In the caloric test, each of three patients (17.65%) showed canal paresis, an incomplete test because of severe nausea, and vomiting and hyperactive response. There were no significant differences in P1 latency, N1 latency, P1N1 amplitude, or IAR of cVEMP and oVEMP (P > 0.05). There were three patients (17.65%) and two patients (11.76%) who had abnormal IAR for cVEMP and oVEMP, respectively.CONCLUSION: Routine vestibular tests may detect some findings in only a minority of patients with seasickness.Satar B, Akin Ocal FC, Karacayli C, Coban VK. Routine vestibular tests may point out vestibular subtype of seasickness only. Aerosp Med Hum Perform. 2020; 91(11):852860.

Normative Data of Ocular Vestibular Evoked Myogenic Potentials in Response to Chirp Stimulus.

OBJECTIVES: This study aims at comparing the tone-burst (TB) and narrow-band (NB) CE-chirp stimuli in terms of amplitude, latency, and interaural asymmetry ratio (IAR) in ocular vestibular evoked myogenic potentials (oVEMP). MATERIALS AND METHODS: In this prospective study, we enrolled 60 healthy subjects (27 men, 33 women) with a mean age of 25.83 (range, 18-48) years. Otological examination was normal in all the subjects. The subjects did not have any otological disease. All the subjects underwent oVEMP testing. We used 500 Hz TB stimulus and 500 Hz NB CE-chirp stimulus in random order. oVEMP test was performed at 100 dB normalized hearing level. P1 latency, N1 latency, and P1N1 amplitude were measured for each ear and stimulus, and IAR was calculated. RESULTS: Ocular VEMPs were obtained from all the subjects for both the stimuli. P1 and N1 latencies were significantly shorter in chirp stimulus than in TB stimulus for both the sides (p<0.0001). P1 and N1 amplitudes were significantly higher for chirp stimulus than for TB stimulus for both the sides (p<0.0001). There was no significant difference between the ears in IAR between the 2 types of stimuli. CONCLUSION: Narrow-band CE-chirp stimulus is an effective stimulus to evoke oVEMP with higher amplitudes and shortened latencies.

Recognizing Decompensated Meniere's Disease Using High Frequency Rotational Test.

OBJECTIVES: The purpose of this study is to investigate the effectiveness of the high-frequency rotational test for discrimination of patients with decompensated from those with compensated Meniere's disease. MATERIALS AND METHODS: Patients with unilateral Meniere's disease were divided into two groups (compensated and decompensated), based on the presence of clinically significant positional nystagmus as a determinant of the compensation status. All patients and subjects underwent pure tone audiometry, video nystagmography, and the vestibular autorotation test (VAT). The gain, phase, and asymmetry values of VAT were evaluated to range between 2 and 6 Hz. RESULTS: Phase values of horizontal vestibulo-ocular reflex (VOR) at 2.0, 2.3, and 2.7 Hz were significantly higher in the decompensated group (p<0.05). There was no significant difference in gain values, phase values, of vertical VOR and horizontal asymmetry values. CONCLUSION: Our study confirmed that horizontal phase values were determined as sensitive markers in VAT to discriminate decompensated from compensated Meniere's disease.

Evaluation of cochlear implant users' performance using middle and late latency responses.

Aim of the study was to investigate whether postoperative middle and late latency responses (MLR and LLR) give some clues of postoperative performance of cochlear implant (CI) users. The study was performed in ten prelingual and six postlingual-CI patients with the age ranging from 6 to 48 years (mean 19.7 +/- 15.7 years). The following criteria were sought for inclusion: (1) to have active 15 electrodes for a Nucleus implant and six electrodes for a Medel implant at least and (2) to be cooperative for the tests. Ten healthy subjects with no hearing and balance problem were also included into the study as a control group. All implanted patients had auditory perception and linguistic development tests pre- and postoperatively, MLR and LLR testing postoperatively. Latencies and amplitudes of MLR and LLR were measured. Patients were divided into groups based on the onset of hearing loss (pre- and postlingual), auditory performance (good and moderate), and also duration of postimplantation period. Latency and amplitude of potentials were compared among the pre- and postlingual-CI patients and the control group. The same parameters were compared among the patients with good and moderate auditory performance scores and the control group. Finally, the parameters were analyzed in patients implanted within last 12 months and those implanted earlier. Latency of MLR and LLR was found to be shorter in postlingually deaf implantees compared to prelingually deaf implantees. Amplitudes of MLR and LLR tended to be higher in postlingually deaf implantees compared to prelingually deaf implantees. The better postoperative performance was associated with shorter latency and higher amplitude of MLR and LLR. MLR and LLR latencies were very close to each other in patients implanted within last 12 months and those implanted earlier. MLR and LLR amplitudes were higher in patients implanted earlier than 13 months. However, mentioned comparisons failed to yield statistical strength. Based on these results, it would be reasonable to conclude that postoperative MLR and LLR might give some clues about postoperative performance of CI users.

Pentoxifylline response in alloxan-induced diabetic rats.

CONCLUSION: This study in rats shows that pentoxifylline may reverse detrimental effects of diabetes mellitus (DM) on the auditory system. OBJECTIVE: To investigate whether delayed auditory brainstem responses (ABRs) induced by DM improve following pentoxifylline treatment in rats. MATERIALS AND METHODS: Baseline ABRs were recorded in 25 ears of 13 normal-hearing rats. DM was induced by a single injection of alloxan (75 mg/kg of body weight) in all rats. Following a 1-month diabetic period, ABRs were recorded in six diabetic rats. Then, pentoxifylline treatment was administered for 6 weeks (20 mg/kg in drinking water), and final ABR testing was performed. Absolute latencies of waves I, III and V, and inter-peak latency differences (IPL) of I-V were measured in each stage of the experiment. These parameters were compared to each other in a pair-wise manner. RESULTS: All wave latencies and IPL I-V were prolonged following induction of DM. Delay in waves III and V, and IPL I-V was significant (p<0.05). Pentoxifylline improved all of the wave latencies and IPL I-V, but significant improvement was observed in waves III and V (p<0.05). There was no significant difference between baseline measurements and measurements following pentoxifylline treatment.

Transcutaneous electrical stimulation of subjective tinnitus. A placebo-controlled, randomized and comparative analysis.

AIM: The effect of the transcutaneous application of the electrical stimulus on tinnitus perception has been reviewed in a placebo-controlled, randomized and comparative analysis to eventually determine the outcome of the therapeutic role of the therapy. METHOD: There are 42 patients who were randomized into 2 groups according to their order of admission. Group A consists of 31 patients who were subjected to transcutaneous electrical stimulation 3 times a week for 1 month. Group B includes 11 patients who had electrical stimulus attachment but where no stimulus was given (placebo group). The stimulator is a custom-made device which generates direct and alternative current in 10-200 Hz frequency. An alternative low-frequency (not >100 Hz) pulsed current was used for tinnitus therapy through a preauricular skin electrode. The amplitude of stimulus ranged between 50 and 2,000 mA. The pulse frequency was 30 Hz. Each session lasted for 25 min for both groups. Statistical analysis was performed. RESULT: The rate of improvement following the therapy was 42.8% (18/42) in the electrical therapy group and 28.5% (4/14) in the placebo group. CONCLUSION: Electrical suppression of the tinnitus does not offer a promising outcome for patients with tinnitus in the presented study.

Low-cholesterol diet and antilipid therapy in managing tinnitus and hearing loss in patients with noise-induced hearing loss and hyperlipidemia.

The aim of our study was to outline the prevalence of hyperlipidemia in patients who had high-frequency hearing loss and tinnitus due to noise exposure. We investigated the role of a low-cholesterol diet and antihyperlipidemic therapy to alleviate the severity of tinnitus and possibly promote hearing gain after therapy in patients with acoustic trauma. Forty-two hyperlipidemic patients with subjective tinnitus and hearing loss due to noise exposure were enrolled for the study. We placed patients on a low-cholesterol diet or antihyperlipidemic therapy and followed them for up to 24 months; then we designated two groups as either "unresponsive" (n = 22; no response to either of the therapies and still experiencing hyperlipidemia) or "responsive" (n = 20; lower cholesterol or triglyceride levels). We then compared tinnitus scores and hearing levels in the two groups. The difference between tinnitus scores in the unresponsive and responsive groups and the change in tinnitus scores before and after therapy in the responsive group were significant. When we compared self-rated tinnitus severity results in two groups after therapy, we found the difference was significant (p < .05). The difference between average air-conduction thresholds at high frequencies after the treatment in the two groups was also significant. The incidence of hyperlipidemia is high among patients with noise-induced hearing loss, and significant improvement by way of lowered tinnitus intensity and higher frequencies in average hearing thresholds can be achieved after lowering the serum lipid level.