[Practical instructions for recording vestibular evoked myogenic potentials]. / Praktische Hinweise zur Messung vestibulär evozierter myogener Potenziale.

Recording of vestibular evoked myogenic potentials (VEMPs) is a well-established method for functional diagnostics of the otolith organs. VEMPs are vestibular reflexes of the sacculus und utriculus to acoustic stimulation by air-conducted sound or bone-conducted vibration and are recorded by surface electrodes from the cervical (cVEMP) and ocular (oVEMP) muscles. The results of VEMP recordings are part of the neuro-otologic test battery and enable diagnosis of various vestibular disorders or differentiation between non-vestibular and peripheral vestibular vertigo. However, the methods for recording VEMPs vary substantially, although recording and stimulation parameters as well as methods of data analysis have a significant influence on the results. This article provides an overview of recommended parameters as well as practical instructions for the recording, analysis, and interpretation of VEMPs.

Vestibular dysfunction in lateral semicircular canal dysplasia.

Introduction: Lateral semicircular canal (LSCC) dysplasia is the most common inner ear malformation. The severity of dysplasia can appear in various spectrums, from a short and broad LSCC with normal or small-sized central bony island (CBI) to a single fluid-filled cavity confluent with the vestibule without CBI. However, reports on the association between LSCC dysplasia and the loss of vestibular function are still lacking. In this study, the results of vestibular function tests [caloric test and video-head impulse test (vHIT)] in patients with LSCC dysplasia were analyzed and compared between groups with and without CBI. Methods: This study retrospectively enrolled 17 patients (23 ears) who had LSCC dysplasia following computed tomography or magnetic resonance imaging and underwent vestibular function tests. Results: LSCC dysplasia was observed unilaterally in 11 patients and bilaterally in six patients. Nine of 23 ears had CBIs, and 14 ears had no CBI. Three of 17 patients experienced dizziness. Abnormal caloric tests were detected in 11 of the 16 patients who underwent the caloric tests (69%); in contrast, 11 of 12 patients who underwent the vHIT (92%) had normal LSCC vestibulo-ocular reflex (VOR) gain on vHIT. A significant correlation was found between the maximum slow-phase velocity of the caloric test and LSCC VOR gain of the vHIT (correlation coefficient 0.792, p = 0.004). The CBI-absent group showed significantly lower SPV and LSCC VOR gains than the CBI-present group (p = 0.001 and 0.004, respectively). Discussion: LSCC dysplasia impairs VOR function, especially in the absence of CBI.

A comparison of the video head impulse test and the functional head impulse test in chronic unilateral vestibular loss.

OBJECTIVE: To examine the correlation of video head impulse test, functional head impulse test and Dizziness Handicap Inventory results in patients with chronic unilateral vestibular loss, and to compare the results with healthy controls. METHODS: Forty-eight patients diagnosed with chronic unilateral vestibular loss and 35 healthy individuals, aged 18-65 years, were included. The video head impulse test, functional head impulse test and Dizziness Handicap Inventory were administered. RESULTS: A significant positive correlation was found between functional head impulse test and video head impulse test results for the study group in all semicircular canals (p < 0.05). There was no significant correlation between Dizziness Handicap Inventory, functional head impulse test and video head impulse test results (p > 0.05). The functional head impulse test and video head impulse test results of the control group were significantly higher than those of the study group in all semicircular canals planes (p < 0.05). CONCLUSION: In chronic unilateral vestibular loss patients, with high head accelerations, the functional head impulse test indicates deterioration in vestibulo-ocular reflex functionality. It would be beneficial to include the video head impulse test and functional head impulse test in clinical practice as complementary tests in vestibulo-ocular reflex evaluation.

Analysis of postural stability using foam posturography in patients with persistent postural-perceptual dizziness.

BACKGROUND/OBJECTIVE: Persistent postural-perceptual dizziness (PPPD) is worsened in a standing posture, or by body movement, or visual stimulation. We aimed to evaluate postural stability in PPPD patients using foam posturography and to investigate the dependence on visual and somatosensory input in the standing posture. METHODS: Foam posturography was performed on 53 PPPD patients, and data from the PPPD patients were compared with the data from an age- and sex-matched healthy controls. The PPPD patients were divided into four groups based on the findings of vestibular function tests and the effect of vestibular function on posturographic data was examined. RESULTS: Romberg's ratios were significantly higher in PPPD patients than in controls. The median Romberg's ratios in PPPD patients with normal vestibular function were also higher than those in controls. However, foam ratio was significantly lower in PPPD patients than in controls. The median foam ratios in PPPD patients with vestibular dysfunction were also lower than those in controls. CONCLUSIONS: In a standing posture, PPPD patients may be more dependent on visual input and less dependent on somatosensory input than healthy subjects. Higher dependence on visual and lower dependence on somatosensory input in PPPD may be a feature unaffected by vestibular function.

Effects of Cross-linked Hyaluronic Acid in a Rat Model of Vestibular and Cochlear Toxicity.

Objective: To investigate the effects of cross-linked hyaluronic acid (CLHA) in an experimental model of vestibulotoxicity and cochleotoxicity. Methods: Twenty-eight female Wistar albino rats (200-250 g) were divided into four groups. Group A received 0.06 mL of 13.33 mg/mL gentamicin, Group B received 0.06 mL of CLHA, Group C received 0.03 mL of 26.66 mg/mL gentamicin and 0.03 mL CLHA, and Group D received 0.06 mL of 0.09% saline. All groups underwent auditory brainstem response testing at 4-32 kHz, signal-to-noise ratio of distortion product otoacoustic emission measurements at 1.5-8 kHz and vestibular tests on days 0,1,7,10. The rats were sacrificed, and their labyrinths were histologically assessed and scored. Results: The hearing thresholds of Groups A and C were similar and significantly higher than those of the other groups at all frequencies, beginning from day 1. The vestibular and histological scores of Groups A and C were similar and significantly higher than those of the other groups from day 1. The audiological results, vestibular scores, and histological scores of Groups B and D were similar, except for a temporary middle ear effusion and hearing threshold shift in Group B. No significant deterioration was observed in the audiological, vestibular, and histological analyses of Groups B and D. Conclusion: That both Group A and Group C similarly showed worsening audiological, vestibular, and histological tests suggests that CLHA did not alter the pharmacokinetics and histologic results of gentamicin.

Subjective Visual Vertical and Vestibular Evoked Myogenic Potential in Meniere's disease,

Abstract Objective To evaluate otolith function by comparing the findings of the Subjective Visual Vertical, the cervical Vestibular Evoked Myogenic Potential and the ocular Vestibular Evoked Myogenic Potential tests in patients in the inter-crisis period of unilateral definite Meniere's disease. Methods The sample consisted of an experimental group (n = 22; 10 men and 12 women, mean age 47.32 ± 12.82 years) with definite unilateral Meniere's disease and a control group (n = 14; 5 men and 9 women, with a mean age of 41.64 ± 13.45 years). They all underwent vestibular evaluation by means of Subjective Visual Vertical with the bucket method and, cervical and ocular Vestibular Evoked Myogenic Potential tests. The data were collected and subjected to statistical analysis. Results The results of the comparison of the Subjective Visual Vertical, the cervical Vestibular Evoked Myogenic Potential, the ocular Vestibular Evoked Myogenic Potential and, the association of cervical Vestibular Evoked Myogenic Potential with the ocular Vestibular Evoked Myogenic Potential showed no significant difference, indicating concordance among the tests. Conclusion The identified abnormalities and the concordance between the combined proportion of the Subjective Visual Vertical, the cervical Vestibular Evoked Myogenic Potential and the ocular Vestibular Evoked Myogenic Potential findings indicate that the association of these three tests contributes to the identification of sustained and transient otolith dysfunction in the inter-crisis of unilateral definite Meniere's disease. Level of evidence 2.

Evaluation of Types of Vertigo With Electronystagmography: An Experience From a Tertiary Care Hospital in West Bengal, India.

Background Electronystagmography (ENG) is a diagnostic test that measures the electrical activity of the muscles that control eye movements. ENG has the potential to identify the cause of vertigo by assessing the function of the vestibular system. Vertigo can be of two types - peripheral or central. In addition, a combination of peripheral and central types may coexist. Peripheral vertigo is caused by pathology in the inner ear and central vertigo is caused by pathology in the brainstem or cerebellum. Objective This study aimed to evaluate the applicability of ENG in assisting the diagnosis of the type of vertigo in a remote tertiary care center in West Bengal, India. Materials and methods This cross-sectional study was conducted in tertiary care hospital in West Bengal, India. Any patient presenting first time with a complaint of vertigo was approached and recruited for the study after taking written informed consent. We collected demographics and conducted a complete ear, nose, and throat examination, including otoscopy and audiological evaluation. A consensus between two expert otorhinolaryngologists was reached for the categorization of vertigo. Then, ENG was performed to assess the vestibular function to help aid the categorization. Magnetic resonance imaging (MRI) and computed tomography (CT) scans were done in central vertigo patients according to the necessity to diagnose the cause. Data were presented in descriptive statistical terms and categorical data were compared by Chi-square test. Result A total of 84 patients (male 31, female 53) with a median age of 25 years (Q1-Q3: 21-30.25) participated in the study. We found 75% of the patients were complaining of instability, 50% rotatory objective vertigo, 29.76% falling tendency, 22.62% blackout, and 2.38% sinking sensation. The majority of the patients (63%) had two or more symptoms. A total of 68 (80.95%) patients could be categorized into peripheral (46 [54.76%]) and central (22 [26.19%]) types. When we added ENG to the tests, we could categorize all the patients and found that 48 (57.14%) had peripheral, 27 (32.14%) had central, and nine (10.71%) had mixed lesions. Conclusion ENG when used in conjunction with clinical examination, otoscopy, and an audiological examination can help to categorize all patients into peripheral, central, or mixed lesion types of vertigo. Hence, ENG can be an important tool in identifying the type of vertigo and can aid in appropriate treatment decisions.

Application of supervised machine learning algorithms for the evaluation of utricular function on patients with Meniere's disease: utilizing subjective visual vertical and ocular-vestibular-evoked myogenic potentials.

BACKGROUND: Research on the otolith organs remains inconclusive. OBJECTIVES: This study seeks to further elucidate utricular function in patients with Meniere's disease (MD) in three ways: (1) We aimed to disambiguate the role of the Subjective Visual Vertical (SVV) and Ocular Vestibular Evoked Myogenic Potential (o-VEMP) tests regarding which utricular subsystem each is measuring. (2) We sought to characterize the acute and chronic state of MD by identifying differences in the relationship of SVV and o-VEMP results across patients with acute and chronic MD. (3) We attempted to find a machine-learning algorithm that could predict acute versus chronic MD using SVV and o-VEMP. METHODS: A prospective study with ninety subjects. RESULTS: (1) SVV and o-VEMP tests were found to have a moderate linear relationship in patients with acute MD, suggesting each test measures a different utricular subsystem. (2) Regression analyses statistically differed across the two patient populations, suggesting that SVV results were normalized in chronic MD patients. (3) Logistic regression and Naïve Bayes algorithms were found to predict acute and chronic MD accurately. SIGNIFICANCE: A better understanding of what diagnostic tests measure will lead to a better classification system for MD and more targeted treatment options in the future.

Vestibular dysfunction in people who fall: A systematic review and meta-analysis of prevalence and associated factors.

OBJECTIVES: To evaluate the prevalence and factors associated with vestibular dysfunction in people who fall. DATA SOURCES: All electronic records from MEDLINE, CINAHL, Embase and psycINFO databases were searched to 9 December 2022. REVIEW METHODS: Participants were adults with at least one fall within the previous year who were exposed to at least one vestibular function test. Any published peer reviewed trial designs were accepted. Included studies were assessed for risk of bias using a modified Epidemiological Appraisal Instrument. The quality of each meta-analysis was assessed using modified Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: Ten trials (468 participants) were identified, six of which had high methodological quality. Vestibular dysfunction was found in 61% (48.01-72.32) I2 = 78% of participants. The most prevalent type of dysfunction was from tests of vestibulo-ocular reflex at 61% (49.79 to 70.49) I2 = 68%, followed by benign paroxysmal positional vertigo at 22% (10.30-40.32) I2 = 87% and central dysfunction at 11% (2.24-37.76) I2 = 50%. People who fall with vestibular dysfunction had reduced walking function compared to those without dysfunction -0.51 (-0.85 to -0.16) I2 = 11%. Dizziness was not related to vestibular dysfunction in people who fall 0.25 (-0.10 to 0.60), I2 = 0%. The quality of the body of evidence ranged from very low to high. CONCLUSION: More than one in two people who fall have vestibular dysfunction. Clinicians cannot rely on dizziness report to indicate need for vestibular screening in those who fall. A vestibular screen should be incorporated into a comprehensive falls assessment.

Correlation between nystagmus intensity and vestibular-ocular reflex gain in benign paroxysmal positional vertigo: A prospective, clinical study.

BACKGROUND: Video head impulse test (vHIT) and videonystagmography (VNG) provide significant benefits in evaluating benign paroxysmal positional vertigo (BPPV) and determining the semicircular canal localization of the otoconia. OBJECTIVE: This study aimed to investigate the relationship between vestibular-ocular reflex (VOR) gains measured via vHIT and the slow-phase velocity (SPV) of nystagmus in patients with the posterior semicircular canal (PSCC)-BPPV. METHODS: Sixty-two patients were included in this study and divided into the study (n = 32, patients with isolated PSCC-BPPV) and control (n = 30, age- and sex-matched healthy individuals) groups. While VOR gains were measured with vHIT in both groups and compared between groups, the SPV values of nystagmus observed during the Dix-Hallpike maneuver in the study group were recorded using VNG and compared with the VOR gains of the study group. RESULTS: There were significant differences in posterior canal VOR gains between the study and control groups (p < 0.001 and p < 0.01, respectively). Although the affected PSCC had decreased VOR gains versus the control group, it was still within the normal range. However, there was no significant relationship between the VOR gains of the affected PSCC and the SPV of the nystagmus. CONCLUSIONS: vHIT can help detect semicircular canal dysfunction in patients with PSCC-BPPV. The SPV values of nystagmus on VNG during the Dix-Hallpike maneuver do not correlate with the level of VOR gain.

Subjective Visual Vertical and Vestibular Evoked Myogenic Potential in Meniere's disease.

OBJECTIVE: To evaluate otolith function by comparing the findings of the Subjective Visual Vertical, the cervical Vestibular Evoked Myogenic Potential and the ocular Vestibular Evoked Myogenic Potential tests in patients in the inter-crisis period of unilateral definite Meniere's disease. METHODS: The sample consisted of an experimental group (n=22; 10 men and 12 women, mean age 47.32±12.82 years) with definite unilateral Meniere's disease and a control group (n=14; 5 men and 9 women, with a mean age of 41.64±13.45 years). They all underwent vestibular evaluation by means of Subjective Visual Vertical with the bucket method and, cervical and ocular Vestibular Evoked Myogenic Potential tests. The data were collected and subjected to statistical analysis. RESULTS: The results of the comparison of the Subjective Visual Vertical, the cervical Vestibular Evoked Myogenic Potential, the ocular Vestibular Evoked Myogenic Potential and, the association of cervical Vestibular Evoked Myogenic Potential with the ocular Vestibular Evoked Myogenic Potential showed no significant difference, indicating concordance among the tests. CONCLUSION: The identified abnormalities and the concordance between the combined proportion of the Subjective Visual Vertical, the cervical Vestibular Evoked Myogenic Potential and the ocular Vestibular Evoked Myogenic Potential findings indicate that the association of these three tests contributes to the identification of sustained and transient otolith dysfunction in the inter-crisis of unilateral definite Meniere's disease.

Refining the Video Head Impulse Test Diagnostic Accuracy: A Case-Control Study.

INTRODUCTION: Current clinical practice considers the vestibulo-ocular reflex (VOR) gain as registered by the video head impulse test (vHIT) as the primary measure for semicircular canal function, while the role of the re-fixation saccades (RSs) is still under evaluation. The goal of the study was to appraise the added benefit of RS towards the improvement of vHIT diagnostic accuracy in cases of suspected left horizontal semicircular canal dysfunction. METHODS: The vHIT recordings of 40 patients with left-sided horizontal VOR gains <0.8 were retrospectively evaluated for the presence of RS. The study groups included 20 patients with a final diagnosis of left horizontal semicircular canal dysfunction and 20 patients for whom vestibular dysfunction was ruled out. RESULTS: Gain values >0.72 were found in all patients with no vestibular disease and in 4 (20%) patients having vestibulopathy. Significantly higher average left-sided RS velocity and frequency were found among the vestibular patients. VOR gain <0.72 was found to be highly specific for the diagnosis of vestibular dysfunction. However, for gain values in the range of 0.72-0.79, the presence of RS with frequency >80% largely improved vHIT diagnostic accuracy. CONCLUSIONS: Although VOR gain <0.8 is considered to reflect dysfunction, a significant false-positive rate for left-sided horizontal vHIT was found for gains in the range of 0.72-0.79. The presence of RS with frequency >80% could improve vHIT diagnostic ability in these patients.

Modern vestibular tests can accurately separate stroke and vestibular neuritis.

OBJECTIVES: To separate posterior-circulation stroke (PCS) and vestibular-neuritis (VN) using quantitative vestibular tests. METHODS: Patients were prospectively recruited from the emergency room within 72 h of presentation. Video-nystagmography (VNG), three-dimensional video head-impulse testing (vHIT), vestibular-evoked myogenic potentials (VEMPs), and subjective visual-horizontal (SVH) were performed. RESULTS: There were 128 PCS and 134 VN patients. Common stroke-territories were: posterior-inferior cerebellar artery, basilar-perforators, multi-territory and anterior-inferior cerebellar artery (41.4%, 21.1%, 14.1%, 7.8%). VN included superior, inferior and pan-neuritis (53.3%, 4.2%, and 41.5%). Most VN and stroke patients presented with acute vestibular syndrome (96.6%, 61.7%). In VN, we recorded horizontal (98.5%) or vertical/torsional spontaneous nystagmus (1.5%) and in PCS, absent-nystagmus (53.9%), horizontal (32%) or vertical/torsional (14.1%) nystagmus. The mean slow-phase velocity of horizontal nystagmus was faster in VN than PCS (11.8 ± 7.2 and 5.2 ± 3.0°/s, p < 0.01). Ipsilesional horizontal-canal (HC) vHIT-gain was lower in VN than in stroke (0.47 ± 0.24, 0.92 ± 0.20, p < 0.001). Ipsilesional catch-up saccades occurred earlier, and their amplitude, prevalence, and velocity were greater in VN than PCS (p < 0.01). Ipsilesional SVH deviation > 2.5° occurred more often in VN than in stroke (97.6% and 24.3%, p < 0.01). Abnormal bone-conducted ocular-VEMP asymmetry ratio was more common in VN than PCS (50% and 14.4%, p < 0.01). Using the ten best discriminators (VNG, vHIT, SVH, and oVEMP metrics), VN was separated from PCS with a sensitivity of 92.9% and specificity of 89.8%. Adding VNG and vHIT to the bedside head-impulse-nystagmus-and-test-of-skew (HINTS) test enhanced sensitivity and specificity from 95.3% and 63.4% to 96.5% and 80.6%. CONCLUSION: Quantitative vestibular testing helps separate stroke from vestibular neuritis and, when used, could improve diagnostic accuracy in the emergency room.

Vestibular migraine or Meniere's disease: a diagnostic dilemma.

Meniere's disease (MD) represents one of the vertigo disorders characterized by triad symptoms (recurrent vertigo, fluctuating hearing loss, tinnitus or ear fullness). The diagnosis of MD relies on the accurate and detailed taking of medical history, and the differentiation between MD and vestibular migraine (VM) is of critical importance from the perspective of the treatment efficacy. VM is a highly prevalent vertigo condition and its typical symptoms (headache, vestibular symptoms, cochlear symptoms) mimic those of MD. Furthermore, the misdiagnosis in MD and VM could lead to VM patients mistakenly receiving the traumatic treatment protocol designed for MD, and sustaining unnecessary damage to the inner ear. Fortunately, thanks to the advances in examination technologies, the barriers to their differentiation are being gradually removed. These advances enhance the diagnostic accuracy of vertigo diseases, especially VM and MD. This review focused on the differentiation of VM and MD, with an attempt to synthesize existing data on the relevant battery of differentiation diagnosis (covering core symptoms, auxiliary tests [audiometry, vestibular tests, endolymphatic hydrops tests]) and longitudinal follow-up. Since the two illnesses are overlapped in all aspects, no single test is sufficiently specific on its own, however, patterns containing all or at least some features boost specificity.

The impact of vestibular symptoms and electronystagmography results on recovery from sudden sensorineural hearing loss.

OBJECTIVES: Idiopathic sudden sensorineural hearing loss (SSNHL) represents a frequently encountered otological entity, of various types and severity, with an array of associated symptoms including vertigo. This is a devastating life-changing condition with a blurry prognosis. The objective of this study was to determine the clinical association of vestibular impairment by electronystagmography (ENG) and caloric tests, and their ability to predict prognosis. METHODS: An observational, crossectional study was carried out amongst patients admitted with SSNHL. Each consenting patient had an audiometry test performed on admission as well as ENG and caloric tests. Treatment included oral steroids and carbogen with intratympanic steroids used only as salvage treatment. Follow-up was completed after 6 months when hearing gains were evaluated. Finally, an association was sought between the rate of recovery and ENG and caloric test results. RESULTS: Of 35 patients included, marked recovery was seen in patients without vertigo when compared to those with vertigo (p=0.003). A statistically significant association was found between the presence of vertigo and hearing deterioration (p=0.008). More so, normal electronystagmography results were associated with marked recovery (p=0.04). CONCLUSIONS: The vestibular end organs are both subjectively and objectively affected in SSNHL as demonstrated by the abnormal ENG and caloric tests in our study despite the small sample size. Concomitant vestibular involvement carries poorer prognosis and routine identification may help foresee the recovery of patients with SSNHL and as such, aid in patient counseling. ENG and caloric tests are easily available and may be recommended for all patients with SSNHL.

Controle postural na doença de Menière / Postural control in Menière's disease

RESUMO Objetivo Avaliar o controle postural na doença de Menière. Métodos 34 pacientes com doença de Menière definida (grupo experimental) e 34 indivíduos hígidos (grupo controle), homogêneos quanto à idade e ao gênero, foram submetidos à posturografia do Tetrax Interactive Balance System (Tetrax IBS TM) em oito condições sensoriais. Índice de estabilidade, índice de distribuição de peso, índice de sincronização da oscilação postural direita/esquerda e dedos/calcanhar, frequência de oscilação postural e índice de risco de queda foram analisados. Resultados O índice de estabilidade foi maior no grupo experimental, com diferença significativa entre os grupos, em todas as condições sensoriais testadas. O risco de queda foi maior no grupo experimental do que no grupo controle. A oscilação postural foi maior no grupo experimental em todas as faixas de frequência, com diferença significativa em algumas delas. Não houve diferença significativa entre os grupos nos índices de distribuição de peso e de sincronização, nas oito condições sensoriais avaliadas. Conclusão Pacientes com doença de Menière apresentam comprometimento do controle postural, caracterizado por alterações do índice de estabilidade, em frequências de oscilação postural e no índice de risco de queda.

ABSTRACT Purpose To evaluate postural control in Menière's disease. Methods 34 patients with Menière's disease (experimental group) and 34 healthy individuals (control group) were submitted to Tetrax Interactive Balance System posturography under eight sensory conditions. Stability, weight distribution, synchronization, risk of falling and postural oscillation frequency were analyzed. Results Stability index was higher in the experimental group with significant difference between the groups in all sensory conditions. Risk of falling was higher in the experimental group than in the control. Postural oscillation was higher in the experimental group in all frequency ranges, with significant difference in some of them. There was no significant difference between the groups in the weight distribution and synchronization indexes. Conclusion In this study, Menière's disease patients presented impaired postural control, characterized by postural instability and oscillation and risk of falling.

[Clinical application progress of subjective visual vertical test].

Subjective visual vertical test is considered as an effective technique to evaluate otolith organ function and central pathway of gravity perception. This test is non-invasive, easy to operate and has little stimulation. At present, there are few such studies in China. This paper reviews the concept, measurement principle and method, influencing factors, application, advantages and disadvantages of subjective visual vertical test.

Evaluation of the vestibulo-ocular reflex in patients with chronic otitis media / Avaliação do reflexo vestíbulo-ocular em pacientes com otite média crônica

Abstract Introduction In recent years, scientific evidence has shown that chronic otitis media may cause balance and vestibular dysfunction. Objective To compare the results of the video head impulse test (gain and symmetry of the vestibulo-ocular reflex and presence of covert and overt saccades) in patients with chronic otitis media and controls. Methods Cross-sectional study of patients with chronic otitis media (study group), aged between 18 and 60 years. The patients in the study group were further divided according to the chronic otitis media type as (1) non-suppurative, (2) suppurative, and (3) cholesteatomatous. For the comparative analysis, we selected volunteers with no history of ear and vestibular diseases (control group), who met the same inclusion and exclusion criteria as the study group. Patients in both groups underwent a video head impulse test. Results The study group consisted of 96 volunteers, and the control group of 61 individuals. The prevalence of vestibular symptoms was 66% in the study group and 3.2% in the control group (p< 0.001). The results show a higher prevalence of changes in the vestibulo-ocular reflex gain (22.9%) and corrective saccades (12.6%) in the chronic otitis media group compared to the control group (p< 0.001). Despite the higher prevalence of changes in gain, the average vestibulo-ocular reflex gains in the chronic otitis media groups were within the pre-defined values ​​of normality; however, the mean vestibulo-ocular reflex gain in the anterior semicircular canal was statistically worse in the cholesteatomatous chronic otitis media group compared to controls (p< 0.001). Regarding the corrective saccades, the prevalence of saccades was statistically higher in the suppurative and cholesteatomatous chronic otitis media subgroups compared to the non-suppurative and control groups (p= 0.004). Conclusion The present study demonstrated that chronic otitis media is associated with a higher prevalence of vestibular symptoms and also a higher prevalence of changes in gain and corrective saccades when compared to controls.

Resumo Introdução Nos últimos anos, evidências científicas demonstraram que a otite média crônica se associa a alterações de equilíbrio e disfunção vestibular. Objetivo Comparar os resultados do teste do impulso cefálico por vídeo (ganho e simetria do reflexo vestíbulo-ocular e presença de sacadas cobertas e descobertas) em pacientes com otite média crônica e controles. Método Estudo transversal que envolveu pacientes com otite média crônica (grupo de estudo), entre 18 a 60 anos. Os pacientes no grupo estudo ainda foram divididos de acordo com o tipo de otite média crônica em (1) não supurativa, (2) supurativa e (3) colesteatomatosa. Para análise comparativa, selecionamos voluntários sem história de doenças otológicas e vestibulares (grupo controle), que obedeceram aos mesmos critérios de inclusão e exclusão do grupo de estudo. Os pacientes de ambos grupos foram submetidos ao teste de impulso cefálico por vídeo. Resultados O grupo estudo foi composto por 96 voluntários e o grupo controle por 61 indivíduos. A prevalência de sintomas vestibulares foi de 66% no grupo de estudo e 3,2% no grupo controle (p < 0,001). Os resultados mostram maior prevalência de alterações do ganho do reflexo vestíbulo-ocular (22,9%) e de sacadas corretivas (12,6%) no grupo otite média crônica em comparação ao grupo controle (p < 0,001). Apesar da maior prevalência de alterações de ganho, a média dos ganhos do reflexo vestíbulo-ocular dos grupos de otite média crônica estava dentro dos valores pré-definidos de normalidade; porém, a média do ganho do reflexo vestíbulo-ocular no canal semicircular anterior foi estatisticamente pior no grupo otite média crônica colesteatomatosa em comparação aos controles (p< 0,001). Em relação às sacadas corretivas, a prevalência de sacadas foi estatisticamente maior nos subgrupos otite média crônica supurativa e colesteatomatosa em comparação aos grupos não supurativa e controle (p = 0,004). Conclusão A otite média crônica se associa à maior prevalência de sintomas vestibulares e também maior prevalência de alterações no ganho e de sacadas corretivas em comparação a controles.

Vestibular and balance function in veterans with chronic dizziness associated with mild traumatic brain injury and blast exposure.

The purpose of this study was to examine vestibular and balance function in individuals with chronic dizziness associated with mTBI/blast. A prospective case-control study design was used to examine ocular motor, vestibular function, and postural stability in veterans with symptoms of dizziness and/or imbalance following an mTBI or blast exposure (n = 77) and a healthy control group (n = 32). Significant group differences were observed for saccadic accuracy, VOR gain during slow harmonic acceleration at 0.01 Hz, cervical vestibular evoked myogenic potentials asymmetry ratio, composite equilibrium score on the sensory organization test, total Dynamic Gait Index score, and gait. The frequency of test abnormalities in participants with mTBI/blast ranged from 0 to 70% across vestibular, ocular motor, and balance/gait testing, with the most frequent abnormalities occurring on tests of balance and gait function. Seventy-two percent of the mTBI/blast participants had abnormal findings on one or more of the balance and gait tests. Vestibular test abnormalities occurred in ~34% of the individuals with chronic dizziness and mTBI/blast, and abnormalities occurred more frequently for measures of otolith organ function (25% for cVEMP and 18% for oVEMP) than for measures of hSCC function (8% for SHA and 6% for caloric test). Abnormal ocular motor function occurred in 18% of the mTBI/blast group. These findings support the need for comprehensive vestibular and balance assessment in individuals with dizziness following mTBI/blast-related injury.

Relationship between Signal Intensity of the Labyrinth and Cochleovestibular Testing and Morphologic Features of Vestibular Schwannoma.

Objectives The aim of this article was to evaluate the relationship between signal intensity of the labyrinth and vestibulocochlear function and morphologic features of vestibular schwannoma (VS). Design Cross-sectional Study. Setting Tertiary referral center. Participants Fifty-four patients with sporadic, untreated VS. Main Outcome Measure Signal intensity of the cochlea and vestibule (SIRc and SIRv: signal intensity of cochlea/vestibule compared with cerebellar signal intensity; AURc and AURv: SIRc/SIRv of the affected side compared with the unaffected side) in 1.5T T2-weighted images was correlated with size (Hannover classification), cystic status, distance from the fundus of the internal auditory canal, video head impulse test (vHIT), and audiometry. Results Signal intensity of the vestibule was higher than that of the cochlea ( p < 0.01). Large tumors had lower SIRc than smaller tumors ( p = 0.03); Hannover T1 tumors had higher SIRc ( p < 0.01), SIRv ( p < 0.01), AURc ( p < 0.01) and AURv ( p < 0.01) than the rest; heterogenous and cystic tumors had higher SIRv than solid large tumors ( p = 0.02); superior vestibular nerve pattern on vHIT had higher SIRv and AURv than inferior vestibular nerve and mixed patterns ( p = 0.03 and 0.004, respectively); and there was a weak correlation between AURv and speech discrimination ( r = 0.33, p = 0.04). Conclusion A more abnormal signal intensity of the labyrinth is associated with larger size and solid status of VS. There was a positive relationship between signal intensity of the labyrinth and speech discrimination scores on audiogram.