Long-term follow-up of patients with vestibular neuritis by caloric testing and directional preponderance calculation.

OBJECTIVES: This study focuses on the diagnostic precision of caloric testing in detecting vestibular neuritis (VN). MATERIALS AND METHODS: In this study, 99 patients (36 men, 63 women, mean age: 44.63 years [Formula: see text] 12.08 SD) with superior VN were involved, and 157 participants with a normal functioning vestibular system were also investigated. All patients underwent a complete neurotological examination, including the caloric test with electronystagmography registration. The canal paresis (CP) and directional preponderance (DP) values were analysed. RESULTS: A VN on the right side was diagnosed in 31.3% and on the left side in 68.7%. When the CP parameters between the control and VN patients were contrasted, a statistically significant difference was observed (p < 0.00001*, Mann-Whitney U test), indicating higher values in the latter group. The prediction of VN based on the CP value was successful in 71%, and statistical analysis indicated a significant result [p < 0.0001*; OR: 5.730 (95% CI 3.301-9.948)]. The DP values were also significantly higher in the VN group (p < 0.00001*). The prediction of VN according to the DP value was successful in 69.8%. A significant result was also observed in this case [p < 0.001*; OR: 4.162 (95% CI 2.653-8.017)]. When both CP and DP were considered, a predictive value of 84.8% with a significant outcome [p < 0.0001*; OR: 82.7 (95% CI 28.4-241.03)] was detected. CONCLUSIONS: Including the CP and DP parameters of the caloric test, VN could be detected in around 85%. Therefore, the caloric helps diagnose the disorder, but both parameters must be considered.

Vestibular dysfunction in cochlear implant candidates: Prevalence and outcomes.

PURPOSE: Cochlear implantation (CI) has been shown to reduce vestibular function postoperatively in the implanted ear. The objective of this study was to identify the prevalence of preoperative vestibular weakness in CI candidates and identify any risk factors for postoperative dizziness. STUDY DESIGN: Retrospective cohort study. MATERIALS AND METHODS: Patients who underwent CI and had preoperative videonystagmography (VNG) at the Silverstein Institute from January 1, 2017 to May 31, 2020 were evaluated. The primary endpoint was dizziness lasting more than one month postoperatively. RESULTS: One hundred and forty nine patients were evaluated. Preoperative VNG revealed that 46 (30.9%) had reduced vestibular response (RVR) on one side and 32 (21.5%) had bilateral vestibular hypofunction (BVH). Postoperative dizziness occurred in 14 (9.4%) patients. Patients with postoperative dizziness were more likely to have abnormal preoperative VNG (RVR or BVH), compared to patients without postoperative dizziness (78.6% versus 49.6%, p = 0.0497). In cases of RVR, implantation of the weaker or stronger vestibular ear did not affect the postoperative dizziness (16.1% versus 6.7%, p = 0.38). Postoperative VNG in patients with dizziness showed decreased caloric responses in the implanted ear (28.4 to 6.4 degrees/s, p = 0.02). CONCLUSION: Preoperative caloric weakness is prevalent in CI candidates and abnormal preoperative vestibular testing may be a predictor of postoperative dizziness. CI has the potential to cause vestibular injury and preoperative testing may aid in both counseling and decision-making.

Video-nystagmographic evidence in more than 700 consecutive cases of road traffic whiplash injury.

PURPOSE: Whiplash injury is a frequent traumatic lesion occurring mainly in road accidents, which may also cause dizziness severe enough to impact everyday life. Vestibular examination is routinely performed on these patients, although the role of the neuro-otologist is still not clearly defined. The main endpoint of this study was to describe the videonystagmography (VNG) evidence in a large cohort of patients who underwent road traffic whiplash injury. METHODS: 717 consecutive patients who reported whiplash-associated disorders due to a road traffic accident underwent clinical examination and VNG. RESULTS: Patients with saccadic test latency anomalies more frequently complained of vertigo, nausea and cochlear symptoms after trauma (p = 0.031, 0.028 and 0.006), while patients with bilateral vestibular weakness at caloric stimulation more often displayed neck pain after trauma (p = 0.005). Patients complaining of positional or cochlear symptoms or with accuracy anomalies at the saccadic test were significantly older than those with no positional, no cochlear symptoms and without accuracy anomalies (p = 0.022, p = 0.034 and p = 0.001). Patients with bilateral vestibular hypofunction were significantly younger (p < 0.001). CONCLUSIONS: VNG evidence, particularly vestibular function and saccadic tests, may be related to damage in the cervical region due to whiplash trauma. These findings suggest that neuro-otologic examination may play a role in properly identifying those who suffer damage caused by whiplash trauma, and in characterizing the severity and prognosis of whiplash-associated disorders.

Road traffic whiplash injury in the elderly: Clinical and video-nystagmographic features.

PURPOSE: Whiplash is a type of trauma typically caused by a rear end collision in a road accident. About one in two patients who experience whiplash report dizziness and balance problems, which can severely affect their activities in daily life. In industrialized countries, the number of elderly people with a driving license has increased in recent years. The aims of the present study were to describe the video-nystagmographic features in a consecutive series of elderly patients experiencing whiplash injury in a road accident, comparing them with similar injuries in a group of young adults. METHODS: Twenty-seven patients aged 65 years or more and a control group of 32 young adults between 18 and 21 years old were retrospectively selected. All patients underwent oto-vestibular assessment and video-nystagmography. RESULTS: After whiplash trauma, vertigo was more common in elderly patients with decreased peak velocity during the saccadic ocular motricity test (p = 0.017) and with evidence of bilateral vestibular hypofunction after caloric stimulation (p = 0.033). Comparing the two age groups, neck pain after the trauma was reported significantly more by young adults (p = 0.003), who also showed more frequently bilateral vestibular hypofunction (p = 0.025). CONCLUSION: Clinical and instrumental findings seem to support the hypothesis of a functional lesion to the brainstem regions after a whiplash injury. There is an undeniable need, however, for tools capable of objectively assessing the functional or anatomical damage resulting from whiplash-associated disorders, for both clinical and medico-legal reasons.

The association between video-nystagmography and sensory organization test of computerized dynamic posturography in patients with vestibular symptoms.

OBJECTIVE: Vertigo is a complex symptom which imposes diagnostic and treatment challenges. Laboratory evaluation of vertigo includes video-nystagmography (VNG) and computerized dynamic posturography (CDP) for the evaluation of different aspects of this complaint. There are vague indications for each test and potential disagreements between them. The aim of this study is to examine the association between the test results of the VNG and sensory organization test (SOT) of CDP in patients referred for both vestibular tests. METHODS: Retrospective data regarding 56 patients age 17-82 years were collected. Patients suffered vestibular complaints and were referred for VNG and CDP evaluation on the same day. The level of agreement between VNG (including caloric test) and the vestibular input of the SOT for each patient was calculated. RESULTS: Among the study group, 10 showed abnormal caloric test results, of which 3 (5.4%) had normal vestibular input in the SOT, and 7 (12.5%) had impaired input (p = 0.724). Spontaneous nystagmus was recorded in 13 patients by VNG, of which 2(3.6%) had normal vestibular input and 11(19.6%) had impaired vestibular input (p = 0.056). CONCLUSIONS: This study shows no statistically significant association between the VNG test and SOT test results. Our results emphasize the difference between the tested aspects in each laboratory test, and the need to define specific indications for each of them. There is a marginally significant association between impaired vestibular input and spontaneous nystagmus, demonstrating the non-localizing nature of this sign.

Pendular Seesaw Nystagmus in a Patient With a Giant Pituitary Macroadenoma: Pathophysiology and the Role of the Accessory Optic System.

Seesaw nystagmus is characterized by cyclic eye movements with a conjugate torsional component and a dissociated vertical component. In the first half of the cycle, one eye elevates and intorts, whereas the other eye depresses and extorts. The pattern is reversed in the remaining half of the cycle. We describe a patient with a giant pituitary adenoma who developed pendular seesaw nystagmus. Disturbance in the visuovestibular system is postulated to contribute to this form of seesaw nystagmus. Lesions compressing the optic chiasm and the accessory optic system could interrupt the transmission of retinal error signals to the inferior olivary nucleus and the interstitial nucleus of Cajal, thus interfering with the adaptive mechanism of the vestibulo-ocular reflex and leading to pendular seesaw nystagmus.

Total caloric eye speed in patients with vestibular migraine.

PURPOSE: Vestibular migraine is a common cause of dizziness that lacks a known objective test. This study examined total eye speed on caloric testing as a diagnostic marker for vestibular migraine. MATERIALS AND METHODS: Retrospective chart review of patients seen in a tertiary otologic practice between 2004 and 2016 who had undergone caloric testing with water irrigation and had a diagnosis of vestibular migraine (n=34). A group of patients with benign paroxysmal positional vertigo (n=10) were used as a control group. Patients were grouped into quartiles based on total eye speed. RESULTS: Only patients in the lowest quartile (total eye speed<79) had a diagnosis of vestibular migraine. All other quartiles included a mix of control and vestibular migraine patients. CONCLUSION: Low total eye speed may be suggestive of a diagnosis of vestibular migraine, but most patients with vestibular migraine do not have low total eye speed.

Sudden Deafness during Antepartum versus Postpartum Periods.

OBJECTIVE: This study reviewed our experience in treating sudden deafness in antepartum (pregnant) and postpartum women during the past 2 decades. METHODS: From 1997 to 2016, we have recorded sudden deafness in 16 antepartum (mean age, 32 years) and 3 postpartum (mean age, 31 years) women. Sudden deafness occurred during the 1st, 2nd, and 3rd trimesters in 5, 4, and 7 antepartum women, respectively. In contrast, the mean interval between giving birth and symptom onset in the 3 postpartum women was 18 days. Each patient underwent an inner ear test battery. RESULTS: In 8 antepartum women treated by dextran infusion, the outcome as regards hearing was improved in 7 patients (88%) and unchanged in 1 patient. In contrast, the other 8 antepartum women selected no treatment, and only 1 patient (12%) achieved hearing improvement, exhibiting a significantly better outcome when receiving dextran treatment. For the postpartum women, 2 patients had hearing improvement when treated by antioxidants, while 1 patient retained unchanged hearing without treatment. CONCLUSION: Medication is needed in sudden deafness in antepartum or postpartum women rather than waiting for a natural course. No adverse effects have been identified in any of the mothers or offspring 1 year after delivery.

The Importance of Labyrinthine Examination in the Prognosis and Therapy for Balance in Spinocerebellar Ataxia.

INTRODUCTION: Spinocerebellar ataxias (SCAs) are a heterogeneous group of neurodegenerative diseases that are characterized by the presence of progressive cerebellar ataxia. OBJECTIVE: Identify vestibular disorders and demonstrate the importance of labyrinthine examination in the prognosis and therapy for balance in patients with SCAs. MATERIALS AND METHODS: The study had a retrospective cross-sectional design and evaluated 57 patients, mean age of 41.6 years and standard deviation of 13 years. Patients underwent the following procedures: anamnesis, ENT examination and vestibular exam using electronystagmography (ENG). RESULTS: The most frequent complaints were gait imbalance (71.9%), dysarthria (49.1%), dizziness (43.8%) and dysphagia (36.8%). 84.2% of the tests showed alterations. The most common tests with alterations were the caloric test (78.9%), slow saccades (61.4%) and the rotating chair test (49.1%). CONCLUSION: The clinical history of the patient and oculomotor alterations in the labyrinthine examination provide sufficient information for the proper use of virtual rehabilitation protocols in the treatment of imbalance, making it the most effective therapy method. It was evident that changes in ENG are related to the severity of the SCA or the clinical stage of the disease. The labyrinthine examination proved to be an important concomitant tool to clinical and genetic study.

[The vestibular craniovertebral joints]. / Die vestibulären Kopfgelenke.

INTRODUCTION: The significance of cervical proprioception for human balance has thus far not been sufficiently elucidated. The aim of this study was to provoke selective cervico-vestibular stimulation using the trunk excursion test (TET) we ourselves constructed. This chair is designed to enable evaluation of cervico-ocular reactions during isolated trunk excursion and possible effects of aging. METHODS: The previously used head excursion test (HET) was statistically compared to the TET. In both methods, 100 healthy subjects of two age groups (group(26): median age = 26 years, n = 50; group(50): median age = 50 years, n = 50) were randomized for comparison of similar neck-to-trunk-positions. RESULTS: HET enabled detection of significant nystagmus modulation in horizontal and vertical dimensions; whereas in pure cervical stimulation using the new TET, this was only evident in the horizontal dimension and only during trunk torsion. Comparison of the two methods confirmed significantly stronger nystagmus modulation through head excursion. In terms of the HET, group(50) showed significantly more vertical nystagmus activity than group(26). However, no significant difference was found between the groups in terms of their reactions to trunk excursion in the TET. In a group-specific comparison of the methods, group(26) showed a significant increase in horizontal nystagmus in head compared to trunk excursion, whereas group(50) generally displayed a significantly greater response to provocation by head excursion in HET. Analysis of the significant vertical nystagmus modulation produced with the TET method showed predominance of upbeat- (UBN) over downbeat-nystagmus (DBN). Through head excursion with the HET, DBN was more frequently evoked in group(50) than in group(26). No significant age-dependent difference could be derived in UBN. CONCLUSION: The results of the pilot study indicate that head-to-trunk provocation is a suitable means of evaluating cervicotonic provocation nystagmus. Only by evaluation of adequate excursion limits and consistent analysis of patients with cervical deficiency can the effects of the method be further assessed.

[The specific features of the vestibular function in the patients presenting with sensorineural hearing loss of vascular genesis].

The authors consider the specific features of the vestibular function in the patients with sensorineural hearing loss of vascular genesis. The study included 60 patients at the age from 28 to 75 years presenting with sensorineural impairment of hearing of vascular genesis. All of them were examined with the use of the extended otoneurological method. The data obtained were compared with the structural changes and hemodynamic characteristics of vertebral arteries (VA) and internal carotid arteries (ICA) and with the results of magnetic resonance imaging (MRI) of the brain.

Unilateral horizontal semicircular canal occlusion induces serotonin increase in medial vestibular nuclei: a study using microdialysis in vivo coupled with HPLC-ECD.

Unilateral single semicircular canal occlusion (USSCO) is an effective treatment for some cases of intractable vertigo. All patients suffer behavioural imbalance caused by surgery, and then recover with a resumption of vestibular function. However, the compensation mechanism has not been fully evaluated. Findings suggest that serotonin (5-HT) is released from nerve terminals, and plays a vital role in the plasticity of the central nervous system. In this study, we performed surgery of unilateral single semicircular canal occlusion (USSCO) on guinea pigs, and investigated the change of 5-HT by in vivo microdialysis of the medial vestibular nucleus (MVN) coupled with high-performance liquid chromatography and electrochemical detection (HPLC-ECD). A total of 12 guinea pigs were divided randomly into two groups, namely the USSCO group and the control group. Animals in the USSCO group underwent surgery of lateral horizontal semicircular canal occlusion, and those in the control group experienced the same operation but just to expose the horizontal semicircular canal without occlusion. Vestibular disturbance symptoms were observed in the case of the USSCO group, e.g. head tilting, and forced circular movements and spontaneous nystagmus at postoperative days 1 and 3. The basal level of 5-HT was determined to be 316.78 ± 16.62 nM. It elevated to 448.85 ± 24.56 nM at one day following occlusion (P = 0.001). The increase was completely abolished with the vestibular dysfunction recovery. The results showed that unilateral horizontal semicircular canal occlusion could increase the 5-HT level in MVN. 5-HT may play a significant role in the process of central vestibular compensation with residual vestibular function.

Neurotological parameters and prognosis of Bell's palsy patients.

BACKGROUND: To investigate the relationship with prognosis, various neurotological examinations evaluating all four nerves within the internal auditory canal were performed in patients with Bell's palsy. METHODS: A total of 69 consecutive patients with Bell's palsy were included. They were treated uniformly with steroid and an antiviral agent and underwent neurotological examinations consisting of electronystagmography, pure-tone audiometry (PTA), electroneurography (ENoG), caloric test, rotatory chair test and cervical vestibular evoked myogenic potentials (cVEMP). According to the final recovery state, patients were divided into two groups: a complete recovery group and an incomplete recovery group. The incidence of abnormal findings in each test was compared between the two groups. RESULTS: Fifty-six patients recovered completely and 13 patients recovered incompletely. No association was observed between the rate of ipsilesional PTA threshold and the rate of abnormal caloric test, function tests and recovery state. However, the initial state of facial palsy, ENoG and the rate of abnormal cVEMP were significantly correlated with the rate of recovery. CONCLUSION: The results indicate that Bell's palsy may be more comparable to mononeuritis multiplex and that cVEMP could be a useful tool for predicting the prognosis of Bell's palsy.

Sudden hearing loss and Crohn disease: when Cogan syndrome must be suspected.

Cogan's syndrome is a rare systemic vasculitis of unknown origin. It is characterized by the presence of worsening audiovestibular and ocular symptoms that may manifest simultaneously or sequentially. No specific diagnostic laboratory tests or imaging studies exist. The diagnosis is clinical and should be established as early as possible so as to initiate prompt treatment with steroids and prevent rapid progression to deafness or blindness and potentially fatal systemic involvement. We report a case of association between Cogan's syndrome and ileal Crohn's disease which we believe deserves attention since, after an accurate review of the literature, we have found approximately 250 reports of patients with Cogan's syndrome, only 13 of whom with concurrent chronic inflammatory bowel disease; of these 13 cases, none experienced improvement after therapy. In the light of the good outcome obtained in our case, we proposed a valid treatment option with boluses of steroids, combined with early systemic immunosuppression and intra-tympanic steroid injections.

Otoneurological symptoms in Brazilian fishermen exposed over a long period to carbon monoxide and noise.

UNLABELLED: Fishing, one of the oldest productive activities, is an important sector of the Brazilian economy as well as the world economy. To evaluate the vestibular behavior in population of fishermen. It was realized as a retrospective and cross-sectional study. Thirty fishermen [mean age 49.5 (± 8.5) years] whose age ranged from 33 years to 67 years were submitted to anamnesis, otorhinolaryngological evaluation, and vestibular examination through the electronystagmography (ENG). The most evident otoneurological symptoms were: Tinnitus (66.7%), dizziness (63.3%), and hearing loss (53.3%). The most evident clinical symptoms were: Fatigue (36.7%), anxiety (23.3%), and depression (16.7%). There were alterations in the vestibular examination of 13 (43.3%) fishermen in the caloric test. There was a prevalence of alteration in the peripheral vestibular system and there was a major frequency of the peripheral vestibular irritative syndrome (30.0%). CONCLUSION: The otoneurological complaints were frequent in the population studied that verifies the importance of allowing labyrinth examinations and the need for adopting preventive measures related to noise exposure to carbon monoxide (CO), since they can cause and/enhance various manifestations of labyrinthine vestibular impairment that can affect the quality of life of these workers.

Vestibular disorders in Bell's palsy: A prospective study.

OBJECTIVES: To ascertain the prevalence of vestibular abnormalities in individuals with Bell's palsy (BP) compared with a normal population and to correlate these findings with clinical evolution. METHOD: A prospective study involving 120 individuals submitted to computerized vector-electronystagmography (VENG) was conducted. The sample included 60 BP patients and 60 control subjects, matched for gender and age. RESULTS: Twenty-five percent of the Bell's palsy patients had results consistent with deficient peripheral vestibular syndrome. All exams were normal in the control group (p< 0.001). No relationship between vestibular abnormalities and degree of palsy improvement was observed. CONCLUSION: Patients with Bell's palsy exhibited 25% vestibular abnormalities on vector- electronystagmography exams. Vestibular abnormalities were more frequent in patients with BP compared to normal control individuals. No relationship between vestibular abnormalities and degree of palsy improvement was observed.

An analysis of vestibular evoked myogenic potentials in patients with benign paroxysmal positional vertigo.

OBJECTIVE: Vestibular evoked myogenic potentials (VEMPs) selectively test the vestibular end-organ. The aim of this study was to analyze how the site of the diseased canal, type of particulate deposition, duration of symptoms, severity of nystagmus, recurrence, and age affect the VEMP in patients with benign paroxysmal positional vertigo (BPPV). METHODS: One hundred two patients were enrolled in the study between 2009 and 2012. There were 36 men and 66 women with ages ranging from 16 to 71 years (mean age, 42.28 ± 11.29 years). Patients with BPPV were tested with roll-on and head-hanging maneuvers under video-electronystagmography monitoring and with air conduction cervical VEMP testing. Patients were grouped for duration, severity, recurrence, age, site of canal involvement, and so on, and the results were compared in each subgroup. Kruskal-Wallis and Mann-Whitney U tests were used for the comparative analysis. RESULTS: Twenty-four patients (23.5%) had a gross VEMP abnormality (absence of VEMP in 6 and greater than 25% depression of the amplitude in 18). Abnormality of VEMPs was not correlated with factors including age, severity of nystagmus, number of maneuvers applied, and the site of canal involvement (P < .05). However, persistence or recurrence of symptoms has an effect on VEMP results (P = .016). CONCLUSION: Vestibular evoked myogenic potential is a useful tool to study the otolithic function in patients with BPPV and should be included in the test battery.

Benign paroxysmal positional vertigo secondary to vestibular neuritis.

The aim of this study was to present the demographic, pathogenetic and clinical features of benign paroxysmal positional vertigo (BPPV) secondary to vestibular neuritis (VN). The medical records of 22 patients, who presented with BPPV within 12 weeks after the onset of VN, were reviewed. Data of a complete otolaryngological, audiological, neurotologic and imaging evaluation were available for all patients. Two hundred and eighty-four patients with idiopathic BPPV were used as a control group. The patients with BPPV secondary to VN presented the following features, in which they differed from the patients with idiopathic BPPV: (1) a lower mean age; (2) involvement of the posterior semicircular canal; (3) presence of canal weakness; (4) more therapeutic sessions needed for cure and a higher rate of recurrence. It may be, thus, concluded that BPPV associated with VN differs from idiopathic BPPV in regard to several epidemiological and clinical features, it responds less effectively to treatment and may follow a protracted course, having a tendency for recurrence.

Pathological and non-pathological irregularities of nystagmus.

Irregularities of nystagmus can be found almost in every electronystagmographic record, but only a few are pathological. In this investigation, the authors try to define the border line between pathological and nonpathological irregularities of nystagmus and according to this measure the diagnostic use of findings of irregularities of nystagmus.