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Joel A Goebel

Publications and source records attributed to Joel A Goebel.

6 recordsLinked to original sources
PubMed2007

Gaze stabilization test: a new clinical test of unilateral vestibular dysfunction.

OBJECTIVE: Evaluate the sensitivity, specificity, and reliability of the Gaze Stabilization Test (GST) for detection of unilateral vestibular dysfunction. STUDY DESIGN: Prospective controlled clinical trial. SETTING: Tertiary academic referral laboratory. PATIENTS: Fourteen patients (mean age, 63.8 yr; range, 43-77 yr) with history of vertigo and greater than 50% bithermal caloric asymmetry; 14 control subjects (mean age, 45.8 yr; range, 23-78 yr). INTERVENTION(S): Diagnostic test protocol with computerized system of target presentation and head velocity monitoring. MAIN OUTCOME MEASURE(S): Comparison of peak head velocity with ipsilesional and contralesional head movement-allowing gaze stability by randomly presenting transient (75 ms) targets of three optotypes above static acuity in patients and healthy subjects during self-generated headshake movements. RESULTS: GST demonstrated 93% specificity, 64% sensitivity, and a reliability index of 0.91 for the detection of unilateral dysfunction with ipsilesional movement. Peak head velocity in healthy subjects averaged 147 degrees per second, whereas ipsilesional velocities dropped significantly to an average of 84 degrees per second. Surprisingly, peak velocities were also significantly reduced to an average of 112 degrees per second with contralesional movements. CONCLUSION: GST is a reliable specific test of gaze stability which has diagnostic and rehabilitative applications in patients with vestibular dysfunction. Reduced contralesional velocities may help explain oscillopsia in patients with unilateral dysfunction.

Adult↗
PubMed2005

Use of Mimix hydroxyapatite bone cement for difficult ossicular reconstruction.

OBJECTIVE: To describe the advantages of using Mimix hydroxyapatite (HA) bone cement in reconstructing a variety of ossicular chain abnormalities. STUDY DESIGN AND SETTING: Case series at a tertiary medical center. RESULTS: Twenty-five cases of HA reconstruction are included in this series (ages 23-74; mean, 47 years). The examples presented include (1) HA as the sole reconstructive material for incus erosion, (2) HA for securing a total or partial ossicular replacement prosthesis, (3) incus augmentation after crimping for revision stapedotomy with incus erosion, (4) HA in primary stapedotomy to fix the crimped prosthesis to an intact incus, and (5) other unique situations. Preoperative and postoperative audiograms were evaluated for 4-tone pure tone average (PTA), speech reception thresholds, word recognition scores, and air-bone gaps (AB gaps). Mean follow-up was 11 months (range 2 to 22 months). The mean PTA improved from 57 dB to 37 dB, whereas the mean AB gaps decreased from 33 dB to 16 dB. There were no cases of infection or extrusion. CONCLUSIONS: Hydroxyapatite bone cement is an excellent adjunct or alternative to ossiculoplasty with preformed prostheses. Easily malleable, rapidly setting, and rapidly hardening, Mimix is particularly well suited for middle ear work. SIGNIFICANCE: Definitive fixation with bone cements during difficult ossicular chain reconstruction may ensure a more enduring successful outcome.

Adult↗
PubMed2003

Vestibular dysfunction after cochlear implantation.

OBJECTIVE: To determine the prevalence, symptom characteristics, and potential risk factors for vestibular symptoms after cochlear implantation. STUDY DESIGN: Case-control study design embedded within an ongoing cohort of patients undergoing implantation. SETTING: Academic medical center cochlear implant research program funded by the National Institutes of Health. PATIENTS: Seventy five eligible consecutive patients undergoing cochlear implantation. INTERVENTION: Medical record review. MAIN OUTCOME MEASURE: Recorded symptoms of vestibular symptoms after cochlear implantation. Subjects with vestibular symptoms were considered case subjects; those without vestibular symptoms were considered control subjects. RESULTS: Twenty-nine of 75 (39%) patients experienced dizziness postoperatively. Four patients experienced a single, transient acute vertigo attack occurring less than 24 hours after surgery. The majority, 25 patients, experienced delayed, episodic onset of vertigo. The median (interquartile range) time of delayed onset was 74 (26-377) days after implantation. Delayed dizziness manifested as spontaneous episodic or positional vertigo. Preoperative dizziness, age at implantation, and age at onset of hearing loss were significantly greater in the dizzy group. Preoperative electronystagmography did not differentiate between groups. CONCLUSIONS: Thirty-nine percent (29/75) of subjects with implants were dizzy after implantation. The majority of subjects experienced dizziness in a delayed episodic fashion. Dizziness was not related to implant activation. It seemed that delayed dizziness was not related to immediate surgical intervention but could result from chronic changes occurring in the inner ear; there was some suggestion this could take the form of endolymphatic hydrops.

Acute Disease↗
PubMed2002

Migraine-associated dizziness: patient characteristics and management options.

OBJECTIVE: To determine patient characteristics and effectiveness of therapy for migraine-associated dizziness. STUDY DESIGN: Retrospective chart review. SETTING: Tertiary referral center. PATIENTS: Patients were identified through a code query of billing records for the diagnosis of migraine-associated vertigo or disequilibrium, based on the International Headache Society criteria. There were 81 patients (61 women, 20 men) with an average age of 36.6 years (range, 8-71 yr); all except four patients were evaluated between 1995 and 1999. Follow-up was obtained from chart review. Mean follow-up time was 54.5 weeks, with a range of 4 to 456 weeks. INTERVENTION: One or more treatment methods, including dietary manipulation, medication (tricyclic antidepressants, beta-blockers or calcium-channel blockers), and neurology consultation, were applied sequentially as necessary. MAIN OUTCOME MEASURE: Response to therapy was defined as greater than 75% reduction in symptom recurrence rate. RESULTS: Overall, 72% of patients experienced resolution or dramatic reduction of their attacks of vertigo or disequilibrium. Of the 13 patients treated with the introduction of dietary manipulation alone, 100% received significant relief. Of the 31 patients treated with dietary manipulation and the addition of a medication, 77% of these patients had significant relief. Of the final group of 37 patients treated with another medication or a neurology consultation, 57% received substantial relief. Of the responders, the majority (>95%) experienced an equal reduction in both vertigo or disequilibrium and headache symptoms. Interestingly, 100% of the patients in the migraine without active headache group received substantial relief of their vertigo or disequilibrium symptoms with migraine therapy. CONCLUSION: We conclude that there is effective therapy for the common problem of migraine-associated dizziness.

Adolescent↗
PubMed2002

Effects of lifetime ethanol consumption on postural control: a computerized dynamic posturography study.

The relationship between lifetime alcohol consumption and postural control was investigated in 35 subjects with no clinically-detectable neurologic abnormalities, using computerized dynamic posturography (CDP) procedures. The estimated total number of lifetime alcoholic drinks was positively correlated with anteroposterior sway spectral power within the 2-4 Hz and 4-6 Hz frequency bands, in three Sensory Organization Test (SOT) conditions: eyes closed with stable support surface (SOT 2), eyes open with sway-referenced support (SOT 4), and eyes closed with sway-referenced support (SOT 5). All correlations remained significant after controlling for subject age, and were increased after excluding nine drug-abusing subjects. In contrast to the strong findings for frequency-based measures, no correlation was observed using conventional amplitude-based sway measures. These results suggest that 1) alcohol consumption compromises postural control in an exposure-dependent manner, and 2) sway frequency analysis reveals pathological processes not manifested in conventional CDP measures of sway amplitude.

Adult↗