Relationship between vestibular schwannoma and endolymphatic hydrops.

BACKGROUND: Both vestibular schwannoma (VS) and Meniere's disease (MD) patients underwent hydrops MRI to clarify the relationship between VS and endolymphatic hydrops (EH). METHODS: Eighty patients with VS or MD underwent an inner ear test battery followed by hydrops MRI, and were then divided into 3 groups. Group A comprised 58 MD patients (62 ears) with positive EH but negative VS. Group B included 18 VS patients (18 ears) with negative EH, while Group C consisted of 4 patients (4 ears) who had VS concomitant with EH. Another 14 MD patients who tested negative for EH on hydrops MRI were initially excluded from this cohort, but were later included for comparison. RESULTS: The decreasing prevalence of EH at the cochlea, saccule and utricle in Group A was identified in 59 (95%), 42 (68%) and 40 (65%) ears, respectively, mimicking a declining sequence of abnormality rates running from audiometry (86%), cervical vestibular-evoked myogenic potential (cVEMP) test (55%) to the ocular (oVEMP) test (53%). However, such decreasing trend was not identified in Groups B and C. In Groups C and A combined, 4 (6%) of 62 EH patients had concomitant VS. Conversely, 4 (18%) of 22 VS patients in Groups C and B combined had concurrent EH. CONCLUSION: A very low (6%) rate of VS in EH patients indicates that VS in EH patients may be coincidental. In contrast, EH was identified in 18% prevalence of VS patients, mirroring the 22% prevalence of cochlear EH demonstrated in VS donors through histopathological studies.

Comparing the recurrence of audio-vestibular disorders following breakthrough infection of COVID-19 vs. those following vaccine administration.

PURPOSE: The term "breakthrough infection" of COVID-19 indicates that subjects who previously received COVID-19 vaccination became infected with COVID-19. This study compared the recurrence of audio-vestibular disorders following breakthrough infection of COVID-19 vs. those following vaccine administration. PATIENTS AND METHODS: Fifty patients with previous known audio-vestibular disorders visited our clinic due to recurrence of inner ear symptoms following breakthrough infection of COVID-19 and were assigned to Group A. Another 50 patients who had recurrent inner ear symptoms following COVID-19 vaccination were assigned to Group B for comparison. The post-breakthrough infection interval is defined from date of breakthrough infection to the onset of inner ear symptoms, while the post-vaccination interval means the time from date of vaccination to the onset of inner ear symptoms. These two intervals were calculated and then compared. RESULTS: The time from latest vaccination to the breakthrough infection of COVID-19 was 4 m (median), likely due to waning of IgG response. To the onset of inner ear symptoms, the post-breakthrough infection interval was 40d (median) for Group A, which was significantly longer than 10d (median) of the post-vaccination interval for Group B. CONCLUSION: The post-breakthrough infection interval (median, 40d) is significantly longer than the post-vaccination interval (median, 10d) to exacerbate pre-existing audio-vestibular disorders. The reason is probably because an interval of 40d is related to IgG peak response following COVID-19 breakthrough infection, while that of 10d is responsible for IgG production after COVID-19 vaccination.

Vertigo/dizziness following COVID-19 vaccination.

PURPOSE: This study assessed the vertigo/dizziness in patients following COVID-19 vaccination. PATIENTS AND METHODS: From July 2021 to June 2022, totaling 50 patients with dizzy spells following COVID-19 vaccination by AZ (AstraZeneca-Oxford University, AZD1222), BNT (Pfizer-BioNTech, BNT162b2) or Moderna (Moderna, mRNA-1273) vaccine were enrolled in this study. The interval from vaccination to the onset of vertigo/dizziness was compared with inter-episodic interval of vertigo/dizziness in the same patients, but without vaccination, during past one year (2020). RESULTS: The incidences of severe systemic complication per 106 shots were 0.86 for Moderna vaccine, 1.22 for AZ vaccine, and 1.23 for BNT vaccine. Conversely, rate of post-vaccination vertigo/dizziness was noted in the Moderna group (66 %), followed by the AZ group (20 %) and the BNT (14 %) group, meaning that type of COVID-19 vaccine may affect various organ systems. The median time to the onset of vertigo/dizziness following vaccination is 10d, which is consistent with the onset of IgG production, and significantly less than inter-episodic interval (84d) in the same patients without vaccination. CONCLUSION: Post-vaccination vertigo/dizziness can manifest as exacerbation of previous neurotological disorder. The median time to the onset of vertigo/dizziness following COVID-19 vaccination is 10d. Since the outcome is fair after supportive treatment, the immunomodulatory effect of the vaccines does not undermine the necessity of the COVID-19 vaccination.

Limitation of updated MR images on the vestibular hydrops in Meniere's disease.

PURPOSE: This study adopted the cervical and ocular vestibular-evoked myogenic potential (cVEMP and oVEMP) tests in Meniere's disease (MD) patients to correlate them with vestibular endolymphatic hydrops (EH) on MR images. METHODS: A total of 25 patients with unilateral definite MD identified by positive cochlear hydrops on MR images were enrolled. All patients underwent audiometry, cVEMP test and oVEMP test, followed by MR imaging for confirmation. RESULTS: A significantly declining sequence of abnormality rates in MD patients was identified from the audiometry (92%), cVEMP test (52%) to the oVEMP test (40%), which was consistent with a significantly decreasing order of prevalence of EH on MR images running from the cochlea (100%), saccule (56%) to the utricle (52%). The cVEMP test for detecting the saccular hydrops revealed a sensitivity of 62%, while the oVEMP test for assessing the utricular hydrops showed a sensitivity of 70%. However, correlating VEMP results with vestibular hydrops did not show any significant relationship. In addition, mean hearing level (MHL) at four frequencies (500, 1000, 2000, and 3000 Hz) of Grade I cochlear hydrops (51 ± 19 dB) did not significantly differ from Grade II cochlear hydrops (53 ± 19 dB). CONCLUSION: Limitations of the updated MR imaging for visualizing the hydrops comprised: (1) failure to correlate vestibular hydrops with VEMP results, and (2) failure to correlate grade of cochlear hydrops with MHL. The reason is probably because updated MR imaging fails to identify distorted contour of the cochlea/utricle/saccule. Further advanced technique using ultrahigh resolution of fine structures in the inner ear compartments is essential to promote a wider use of MR imaging.

The role of serum osmolality in Meniere's disease with acute sensorineural hearing loss.

OBJECTIVE: This study investigated the role of serum osmolality in Meniere's disease (MD) patients with acute sensorineural hearing loss (SNHL). DESIGN: Retrospective study. STUDY SAMPLES: Twenty definite MD patients with acute unilateral SNHL were treated with an osmotic diuretic (Isosorbide, 100 mL daily) and assigned to Group A. Another 20 age- and sex-matched definite MD patients with acute SNHL were not given Isosorbide and assigned to Group B. Both groups underwent audiometry and blood examination for serum osmolality before and after treatment. RESULTS: Group A revealed a significant increase in serum osmolality after treatment. The optimal cut-off values for increased serum osmolality in Group A were +1.5 mOSM/L for predicting hearing improvement at frequencies of 250-1000 Hz, and +2.5 mOSM/L at 2000-4000 Hz. Comparing increased levels of serum osmolality (> +2.0 vs. ≤ +2.0 mOSM/L), Isosorbide dosing at 3.0 L vs. 1.0 L, significantly differed in the odds ratio (OR). Isosorbide at a total dosage of 3.0 L thus improves the hearing threshold by >10 dB at frequencies of 250-2000 Hz. CONCLUSION: The Isosorbide at a total dosage of 3.0 L may increase serum osmolality by > +2.0 mOSM/L, and improve the hearing threshold for hydropic ears at least >10 dB at low- and mid-frequencies.

Evolution of geriatric Meniere's disease during the past two decades.

BACKGROUND: This study compared the incidence of Meniere's disease (MD) in the elderly aged >65 years between the first (2001-2010) and second (2011-2020) decades to investigate the evolution of geriatric MD. METHODS: Totally, 1605 and 2550 patients with definite MD were experienced at the neurotological clinic during the first and the second decades, respectively. All patients were divided into three groups by 30-year age band, namely elderly (aged 65-94 years), adult (aged 35-64 years) and young (aged 5-34 years) groups, and underwent an inner ear test battery. Factors relating to the incidence of MD during the past two decades were analyzed. RESULTS: The elderly MD group comprised 198 (12.4%) of 1605 MD cases during the first decade, and 463 (18.2%) of 2550 MD cases during the second decade, showing a significantly increased incidence of elderly MD. Correlation between annual life expectancy (x) in Taiwan and annual prevalence (y) of the elderly MD in relation to total MD cases revealed y = 0.023x - 1.660 via linear regression analysis. In contrast, the adult MD group significantly differed in terms of age and gender ratio, but not incidence, between the two decades. Conversely, the young MD group exhibited significantly decreased incidence from the first decade (22.3%) to the second decade (13.8%). CONCLUSION: Evolution of geriatric MD during the past two decades reveals an increased incidence of the elderly MD patients, likely due to increased life expectancy coupled with altered life style.

Effect of Video Games on the Otolithic Reflex System.

BACKGROUND: Video gaming (VG) has since the 1980s become increasingly ubiquitous entertainment among the adolescents and young adults. Many young people expe-rienced dizzy spells, but not vertiginous episodes, after playing VG. OBJECTIVES: This study performed ocular vestibular-evoked myogenic potential (oVEMP) and cervical VEMP (cVEMP) tests in subjects before and after engaging on VG to investigate the effect of VG on the otolithic reflex system. METHODS: Twenty subjects who frequently played VG (>3 days per week) for more than 10 years were assigned to the long-term group. Another 20 subjects with engaging on VG <3 days per week or <10 years were assigned to the short-term group. Each subject underwent baseline oVEMP and cVEMP tests first, followed by playing VG for 1 h. Then, all subjects underwent the same paradigm. The "VG-year" is defined as frequency of VG playing within 1 week (day/week) multiplied by total length of VG engagement (year). RESULTS: Engagement on VG rarely affected the oVEMP responses for either short- or long-term players. In contrast, the response rates of cVEMP significantly declined from pre-VG period (80%) to post-VG period (58%) in the short-term group, but not in the long-term group. The cutoff value for predicting absent cVEMP in VG engagement is 21 VG-year. CONCLUSION: Short-term engagement on VG may result in temporary cVEMP loss, while permanent cVEMP loss could be identified in long-term VG players. The cutoff value for predicting absent cVEMP in VG engagement is 21 VG-year, indicating that damage to the sacculo-collic reflex system could be anticipated in a subject who has played VG at least 1 h per session, 7 days weekly for 3 years.

Comparison of the Wii Balance Board System and Foam Posturography System in Assessing Postural Balance.

OBJECTIVE: Falls are a major cause of disability and mortality in the elderly. Postural balance is associated with falls and can be evaluated by posturography. However, conventional posturography is costly and requires a sufficiently large space to perform. Hence, this study developed a portable system to meet the requirement of field studies, and investigated its reliability and validity. DESIGN: A custom-written software application was developed to link a computer to the Nintendo Wii balance board (WBB) and the center of pressure was acquired, which was then compared with that obtained from commercially available foam posturography (FP). Forty younger adults including 20 patients with peripheral vestibular disorders as well as 20 healthy controls, and 50 older patients with peripheral vestibular disorders were enrolled. All subjects underwent postural balance testing using the WBB system (WBSS) and FP system (FPS) in a randomized order. RESULTS: For the intersystem reliability, although the WBSS obtained a significantly smaller mean sway area than the FPS, both systems revealed adequate to excellent reliability with an intraclass correlation coefficient (ICC) of 0.67 to 0.87. The WBBS showed adequate to excellent test-retest reliability (ICC: 0.53 to 0.88). For the validity, the respective cutoff sway areas were 1.03 and 3.09 cm 2 under conditions C and D via the WBBS for discriminating the fallers from nonfallers. CONCLUSION: The WBBS yielded adequate to excellent reliability and validity for accessing postural balance, and had good performance in discriminating the fallers from nonfallers. The WBBS has advantages over the commercial FPS of low cost, easy portability, programmability, and may be better-suited to mass detection and research programs. Most importantly, this WBBS can be performed outside the hospital for testing postural balance, especially in the elderly.

Radiological and functional assessment in patients with lumbar spinal stenosis.

BACKGROUND: Although patients with lumbar spinal stenosis (LSS) may have impaired postural control, current diagnosis of LSS depends mainly on clinical manifestation and radiological assessment, while functional assessment of postural balance remains less investigated. This study thus correlated radiological assessment via MR imaging with functional assessment using foam posturography in LSS patients. METHODS: Forty-seven LSS patients aged 50-85 years were enrolled. All patients received subjective outcome measures first, followed by plain radiography of whole spine and lumbosacral spine, MR imaging, and foam posturography under four conditions. Then, these results were analyzed using stepwise multiple regression analysis. Another 47 age- and sex-matched healthy controls also underwent foam posturography for comparison. RESULTS: The LSS group revealed significant increases in the sway area of foam posturography than the control group regardless of various conditions. Advanced age, poor walking endurance, and neural compression at the L2/3 level on MR images were significantly correlated with the characteristic parameters of foam posturography (p < 0.05). In contrast, subjectively reported pain and plain radiography did not correlate with posturographic results (p > 0.05). CONCLUSIONS: Patients with LSS who exhibit less severe symptoms do not ensure normal postural balance. Functional assessment (foam posturography) on postural balance significantly correlated with radiological assessment (MR imaging) in LSS patients. The use of foam posturography may help assess postural control in LSS patients. It takes a short time and costs less, and would be practical to make this a routine examination in LSS patients.

Evolution of incidence of audiovestibular disorders during the pandemic COVID-19 period.

PURPOSE: Despite sporadic case reports describing hearing problems in patients with coronavirus disease 2019 (COVID-19), whether COVID-19 affects the audiovestibular system remains unclear. This study assessed the evolution of incidence of audiovestibular disorders during the pandemic COVID-19 period. METHOD: Three audiovestibular disorders namely, sudden sensorineural hearing loss (SSHL), autonomic dysfunction, and Meniere's disease (MD) were analyzed and compared from 2016 to 2020. RESULTS: The annual new cases at our clinic comprised overall 2107, 1997, 1984, 2068, and 1829 from 2016 to 2020, respectively, and the respectively annual cases of SSHL were 54, 46, 42, 45 and 38. Accordingly, annual incidences of SSHL in relation to overall cases of audiovestibular disorders were 2.6%, 2.3%, 2.1%, 2.2% and 2.1% from 2016 to 2020, respectively, exhibiting a non-significant difference (p > 0.05). In contrast, incidence of autonomic dysfunction in the year 2020 was 15.3%, which revealed significantly higher than 8.5-13.1% from 2016 to 2019 (p < 0.001). Restated, the incidence of autonomic dysfunction in 2020 displayed a significantly higher percentage than the other 4 years. Conversely, the incidence of MD in 2020 was 9.8%, showing a significant decline compared with the other 4 years (12.6-15.6% from 2016 to 2019, p < 0.001), CONCLUSION: Evolution of incidence of audiovestibular disorders during the pandemic COVID-19 period revealed increase in the incidence of autonomic dysfunction and decrease in that of MD, while incidence of SSHL remained unchanged from 2016 to 2020. Thus, the SARS-CoV-2 may less affect the audiovestibular system.

Evaluation of retrootolithic function using galvanic vestibular-evoked myogenic potentials in patients with benign paroxysmal positional vertigo.

PURPOSE: The purpose is to investigate possible vestibulopathy in patients with benign paroxysmal positional vertigo (BPPV), inner ear tests, including cervical and ocular vestibular-evoked myogenic potentials (cVEMPs and oVEMPs) via various stimulation modes, were adopted. METHODS: Fifty BPPV patients were enrolled in this study. All patients underwent pure tone audiometry, cVEMPs, oVEMPs, and caloric tests. The recurrence status, abnormal rates of inner ear tests, and the characteristic parameters of VEMPs, such as wave latencies and amplitudes, were analyzed. RESULTS: In affected ears, the abnormal rates of acoustic cVEMPs, vibratory oVEMPs, galvanic cVEMPs, and galvanic oVEMPs were 62%, 28%, 36%, and 14%, respectively. The abnormalities of acoustic cVEMPs were significantly larger than those of vibratory oVEMPs, and acoustic/vibratory VEMPs had significantly higher abnormal rates than the corresponding galvanic VEMPs. CONCLUSION: BPPV patients may have both otolithic and neural dysfunctions. Otolithic organ damage occurs more frequently than retrootolithic neural degeneration, and the saccular macula might have a greater extent of damage than the utricular macula.

Assessing the cervico-ocular reflex system via modifying the ocular vestibular-evoked myogenic potential test.

PURPOSE: The aim of this study was to devise a novel test for assessing the cervico-ocular reflex (COR) system via head vibration (termed h-COR) or neck vibration (termed n-COR) method. MATERIALS AND METHODS: Thirteen patients with complete loss of bilateral vestibulo-ocular reflex (VOR) showing oscillopsia were assigned to Group A, while 13 patients with bilateral VOR loss but no oscillopsia were Group B. Another 13 healthy elderly served as a control. The COR test was performed via modifying the ocular vestibular-evoked myogenic potential (oVEMP) test by tapping at the forehead with head rotation (h-COR) or at mid-dorsal neck with head straight (n-COR). RESULTS: Both h-COR and n-COR tests displayed similar cI-cII waveforms. None of the Group A or healthy elderly showed present h-COR, while 8% of Group A and 31% of the healthy elderly revealed present n-COR. In contrast, present h-COR and n-COR were elicited in 85 and 77% of Group B, respectively. Restated, significantly higher response rate of COR in Group B (without oscillopsia) than Group A (with oscillopsia) indicates that present COR is related to the alleviation of oscillopsia. CONCLUSIONS: Head vibration method (h-COR test) is superior to neck vibration method (n-COR test) for assessing the COR system.

Magnetic resonance imaging: Role on diagnosing all types of endolymphatic hydrops.

BACKGROUND/PURPOSE: This study utilized the recently advanced technique in MR imaging to establish its role on diagnosing all types of endolymphatic hydrops (EH). METHODS: Twenty-two patients (26 ears) with clinical EH were admitted due to acute hearing loss and/or vertiginous attack. Each patient underwent an inner ear test battery comprising audiometry, cervical and ocular vestibular-evoked myogenic potential tests, and caloric test, followed by MR imaging for confirmation. RESULTS: Of the 22 clinical EH patients, 12 patients were referred to primary EH (Meniere's disease), 8 patients were secondary EH (including delayed EH in 5), and 2 patients were EH of embryopathic origin. MR imaging of 26 affected ears demonstrated EH in the cochlea only for 14 ears, in the utricle and saccule only for 1 ear, and in all three endorgans for 3 ears, accounting for a sensitivity of 69% (18/26). The 8 affected ears showing negative MR images were EH patients with hearing recovery 1, just after vertiginous attack 3, and chronic low-tone hearing loss 4. In contrast, 3 out of 18 unaffected ears demonstrated asymptomatic EH in the cochlea, representing a specificity of 83% (15/18). CONCLUSION: The sensitivity and specificity of MR imaging for confirming all types of EH were 69% and 83%, respectively. Although diagnostic criteria can identify primary and delayed EH, MR imaging may provide a supplementary tool for diagnosing secondary, embryopathic, or asymptomatic EH, if patients are not with hearing recovery, chronic low-tone hearing loss, or just after vertiginous attack.

A model study of resonance effect on ocular vestibular-evoked myogenic potential.

BACKGROUND/PURPOSE: This study measured the acceleration magnitude using a dummy model filled with various air-material ratios to elucidate the mechanism of resonance effect on ocular vestibular-evoked myogenic potential (oVEMP). METHODS: With the percentages of air volume altered by filling various materials (water, glycerol, or ethanol) in an acrylic-made hollow spherical model, a minishaker was utilized to deliver vibration stimuli to the model. Then, acceleration magnitude of each model was measured. RESULTS: Since the air was most occupied at the upper part of the model (z-axis), acceleration magnitude along the z-axis was selected for comparison. An increasing trend of the z-axis acceleration magnitude ranging 0.110-0.759 g was identified in air-water model with air volume percentage ranged 40-100%. On the other hand, a significant increasing trend of acceleration magnitude along the z-axis (0.157-0.759 g) was noted in air-glycerol model with 80-100% of air volume. While in air-ethanol model, a significant increasing trend in acceleration magnitude along the z-axis ranged 0.121-0.759 g correlating with 40-100% of air volume. CONCLUSION: The mechanism for eliciting oVEMP is via the first-order bone vibration coupled with the second-order resonance effect. Both percentage of air volume (i.e. frontal sinus) and density of filling media (i.e. skull property) may contribute to the resonance effect, which then increases the acceleration magnitude so as to enhance the elicitation of oVEMP.

Resonance Effect of the Frontal Sinus on Ocular Vestibular-Evoked Myogenic Potential Recordings.

OBJECTIVE: This study performed ocular vestibular-evoked myogenic potential (oVEMP) test via Fpz bone vibration (termed Fpz-oVEMP) and Fz bone vibration (termed Fz-oVEMP) using a minishaker. The aim of this study was to evaluate the resonance effect of the frontal sinus on the oVEMP recordings, so as to establish an optimal clinical protocol for eliciting oVEMPs by bone vibration. DESIGN: Thirty healthy volunteers (15 children and 15 adults) and 15 adults with frontal sinusitis were enrolled in this study. All subjects underwent oVEMP test via Fpz and Fz bone vibration stimuli, and volume of the frontal sinus was measured by CT scan. RESULTS: Because healthy adults (3.20 ± 1.08 mL) had significantly larger frontal sinus volume than healthy children (2.04±1.87 mL), the former (100%) showed higher response rates of Fpz-oVEMP than the latter (30%), but not Fz-oVEMP. When the frontal sinus volume is >1.91 mL (approximately at the age of 14 years), Fpz-oVEMP displayed larger reflex amplitude than Fz-oVEMP did. In contrast, Fpz-oVEMP (30%) displayed lower response rate than Fz-oVEMP (73%) in patients with frontal sinusitis. CONCLUSIONS: Both developmental (frontal sinus volume) and pathological (frontal sinus inflammation) factors may affect the oVEMP responses via altering resonance function. For the developmental factor, frontal sinus volume >1.91 mL may initiate the resonance effect on oVEMPs, as evidenced by higher response rate with larger reflex amplitude of Fpz-oVEMP than Fz-oVEMP. For the pathological factor, frontal sinusitis may hamper the resonance effect on oVEMPs, as shown by the lower response rate of Fpz-oVEMP than Fz-oVEMP. Hence, oVEMP test may be performed via Fpz bone vibration first in healthy adults, while via Fz bone vibration first in children aged under 14 years or subjects with frontal sinusitis.

Geriatric sudden deafness.

PURPOSE: Sudden sensorineural hearing loss, briefly sudden deafness (SD), in the elderly remains less investigated despite rapidly aging population in most countries around the world. This study investigated whether aging process affects the treatment outcome of SD in the elderly. PATIENTS AND METHODS: Eighty patients with SD, comprising 40 geriatric patients aged >65 years and 40 non-geriatric patients aged 55-64 years, were enrolled in this study. All patients underwent an inner ear test battery including audiometry, and cervical vestibular-evoked myogenic potential (cVEMP), ocular VEMP (oVEMP), and caloric tests. RESULTS: Pre-treatment mean hearing level in the geriatric group (94 ± 16 dB) did not significantly differ from non-geriatric group (89 ± 20 dB). After treatment for 3 months, mean hearing gain in the geriatric group (22 ± 18 dB) with an improvement rate of 65%, did not significantly differ from non-geriatric group (21 ± 28 dB) with 58% improvement rate. Both inter-subject and intra-subject analyses revealed that the aging process greatly influenced the cVEMP and oVEMP responses, while less influenced the caloric responses. CONCLUSION: The treatment outcome of SD in geriatric patients aged >65 years did not significantly differ from that in non-geriatric patients aged 55-64 years, indicating that aging process did not affect treatment outcome of SD. Unlike treatment outcome for the presbycusis is unsatisfactory, treatment outcome for the elderly with SD could be favorable.

Sudden deafness: a comparison between age groups.

OBJECTIVES: This study compared sudden deafness (SD) cases in 20-year age bands to investigate their causes and treatment outcome. DESIGN: Retrospective study. STUDY SAMPLES: 178 unilateral SD patients were divided into four 20-year age-groups, namely Groups I (aged 0-19 years, n = 6), II (aged 20-39 years, n = 33), III (aged 40-59 years, n = 63), and IV (aged 60-79 years, n = 76). METHODS: An inner ear test battery and/or serology assay were performed. RESULTS: Incidence of SD in relation to overall neurotological cases did not significantly differ among the four groups. Groups I and II showed two or three audiographic patterns, while Groups III and IV had six audiographic patterns indicating that the aetiology of Groups I and II may be of the same origin, while Groups III and IV had multiple aetiologies. The hearing improvement rate was significantly higher in Groups III (62%) and IV (62%) than in Groups I (16%) and II (33%). CONCLUSION: SD inevitably affects individuals of all ages. Significant differences in the audiographic patterns and speculative causes may account for various outcomes of treatment in each 20-year age band. Those SD patients aged 40-59 and 60-79 years showed significantly better treatment outcomes than those aged 0-19 and 20-39 years.

Prediction of Unilateral Meniere's Disease Attack Using Inner Ear Test Battery.

OBJECTIVES: In the clinical setting, a variety of inner ear test results are obtained from patients with unilateral Meniere's disease (MD). In this study, the authors use inner ear test results as parameters to illustrate the relationship between inner ear function and vertigo attack frequency. DESIGN: We retrospectively enrolled 50 unilateral MD patients. In addition to clinical symptoms, the results of pure-tone audiometry and caloric, acoustic cervical vestibular-evoked myogenic potential (cVEMP), galvanic cVEMP, vibratory ocular VEMP (oVEMP), and galvanic oVEMP tests were collected via chart review. The multiple linear regression method was used to examine which independent variables have a statistically significant influence on vertigo attacks. RESULTS: In affected ears, the abnormal rate of the caloric, acoustic cVEMP, galvanic cVEMP, vibratory oVEMP, and galvanic oVEMP tests was 74%, 76%, 48%, 34%, and 30%, respectively. According to the regression model, the abnormal galvanic cVEMP response and abnormal galvanic oVEMP response had significantly negative correlations with the frequency of vertigo attacks after logarithmic transformation. A predictive model for disease attack frequency using significant parameters and their regression coefficients was proposed: (Equation is included in full-text article.) CONCLUSIONS:: Using the proposed model with galvanic VEMP, clinicians could develop better strategies to manage vertigo attacks in patients with MD.

Contemporary review of the causes and differential diagnosis of sudden sensorineural hearing loss.

Objectives: This article provides an overview of the causes and differential diagnosis of sudden deafness (SD) and sudden sensorineural hearing loss (SSHL).Design: Contemporary review.Study sample: This review is based on peer-reviewed articles published in those journals listed on journal of citation reports. Through the PubMed database of the US National Library of Medicine, Scopus, and Google Scholar using the keywords of "sudden deafness", "acute hearing loss", and "sudden sensorineural hearing loss", totally 1493 papers were considered and 166 relevant papers were selected.Results: Sensorineural hearing loss of sudden onset may be classified as primary SD and secondary SSHL. Proposed aetiologies of primary SD comprised viral infection, vascular insufficiency, autoimmune disorder and stress theory, while causes of secondary SSHL include neoplasm, stroke and irradiation.Conclusion: SD/SSHL is a syndrome that comprises various entities, and results from a variety of aetiologies. An inner ear test battery in SD/SSHL patients helps determine its aetiology, and provides comprehensive information on the affected territory. Identification of the cause and differential diagnosis of the different types of SD/SSHL may provide substantial benefits such as determining the prognosis, identifying associated risk factors and preventing further hearing loss.

Eradicating Otomycosis with Terbinafine Solution: Basic and Clinical Investigation.

BACKGROUND: Otomycosis still remains intractable in clinical practice, likely because topical antifungal agents lack efficacy or are potentially toxic to the inner ear end organs. OBJECTIVES: The aim of this study was to investigate whether terbinafine solution is a potential candidate for treating intractable otomycosis in humans. In addition, the toxic effect on the inner ear was also assessed by animal models treated with terbinafine. METHODS: Guinea pigs were instilled with 0.1 mL terbinafine (10 and 25 mg/mL) in the left round window membrane. At 2 weeks after treatment, all animals underwent an inner ear test battery and were then sacrificed for morphological study. Clinically, 20 patients with otomycosis were treated with terbinafine solution at a dosage of 0.4 mg. RESULTS: All terbinafine-treated animals showed intact inner ear function when total dosage of terbinafine was <2.5 mg, which was further confirmed by morphological study. Subsidence of otomycosis was achieved in all 20 patients 1 week after treatment with terbinafine (0.4 mg) without untoward effect. No evidence of recurrence was noted 1 year after treatment. CONCLUSION: The paucity of inner ear toxicity of terbinafine even at a dosage of 2.5 mg was identified in guinea pig models morphologically and physiologically. Topical application of terbinafine solution at a dosage of 0.4 mg may be a potential treatment for otomycosis in humans.