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PubMed1976

[Pseudocaloric nystagmus (author's transl)].

A pseudocaloric nystagmus is, in its strict sense, a spontaneous nystagmus activated by the unspecific stimulus of syringing the auditory canal. 40 patients with a unilateral, peripheral-vestibular defect were examined electronystagmographically. With most patients the 30 degrees caloric stimulation gave an incorrect result of the degree of hypoexcitability with all parameters (duration, maximum frequency and maximum intensity). This incorrect result was most pronounced with patients after neurectomy of the vestibular nerve, who frequently had a heavily reduced reaction of the healthy ear. For quantitative measurement of genuine pseudocaloric effects, by a special method of examination (as for instance by consideration of the "maximum spontaneous nystagmus"), the "real" vestibular excitability was calculated. Data exceeding this value were regarded as genuine pseudocaloric nystagmus. At stimulation temperatures of 44 degrees to 17 degrees C they were so low as to be negligible. They were only found with 5 of the 40 patients and amounted to only 10-20% of the reaction of the healthy ear. However, with ice water there frequently were considerable pseudocaloric reactions. So testing with ice water is not appropriate.

Caloric Tests↗
PubMed1991

The acute effects of unilateral vestibular neurectomy on sensory and motor tests of human otolithic function.

Patients were tested 1 day before and 1 week after therapeutic unilateral vestibular neurectomy (UVN) on vestibular tests which are likely determined primarily by otolithic function. UVN causes a maintained ocular torsion: fundus photographs showed that both eyes of every patients were rolled such that the upper pole of both eyes was tonically deviated towards the operated side, and there is a corresponding change in the perceived gravitational horizontal: patients set a small bar of LEDs bar down on the same side as their operation. One week after UVN, patients showed an asymmetrical sensitivity to linear acceleration vectors directed along their interaural axis in comparison to their preoperative settings for the same stimuli.

Acceleration↗
PubMed1999

Bacterial meningitis in adults: demonstration of inner ear involvement using high-resolution MRI.

OBJECTIVE: To visualize the sites involved in audiovestibular dysfunction during bacterial meningitis in adults and to relate these findings to the extent of hearing impairment and vestibular dysfunction. BACKGROUND: Hearing impairment is among the most frequent complications of bacterial meningitis. METHODS: High-resolution MRI (HR-MRI) of the inner ear was performed in seven adult patients with hearing loss as a complication of bacterial meningitis. RESULTS: Five patients had unilateral (n = 1) or bilateral (n = 4) contrast enhancement of vestibulocochlear structures. The structures most frequently involved were the cochlear nerve (n = 9), the first cochlear turn (n = 9), the vestibulum (n = 9), and the semicircular canals (n = 7). There was a significant correlation between clinical and MRI findings: all nine ears with cochlear enhancement were deaf (hearing loss >90 dB), whereas none of the five ears with normal MRI findings had hearing losses of more than 90 dB (range, 30 to 70 dB; p = 0.0005). Vestibular dysfunction as revealed clinically and by quantitative vestibular function testing was found in six of seven patients (11 of 14 ears). Five of these patients (nine ears) also demonstrated enhancement of the vestibular organ on high-resolution MRI of the inner ear. CONCLUSIONS: High-resolution MRI can visualize the involvement of vestibulocochlear structures in bacterial meningitis in both cooperative and consciously impaired patients. These findings suggest a correlation between abnormalities on MRI and the extent of cochlear dysfunction.

Adolescent↗
PubMed1976

Computer processing of audiological and vestibular data. II. A further note.

This paper provides an addendum to an earlier paper describing the development of a computer record system for patient data. The specific problems addressed pertain to the storage and retrieval of historical information, physical signs and diagnosis. Some preliminary comparisons of audiological and vestibular test results are given for groups of patients with diagnoses of acoustic neuroma, Ménière's disease, temporal bone fracture and vestibular neuronitis.

Diagnosis, Computer-Assisted↗
PubMed1979

The accuracy of the simultaneous binaural bithermal test in the diagnosis of acoustic neuroma.

Forty-three patients with a surgically confirmed unilateral acoustic neuroma were studied preoperatively with both alternate and simultaneous binaural bithermal caloric tests using horizontal lead electronystagmography. Twenty-four patients had a significant reduced vestibular response on the side of the tumor utilizing the alternate binaural bithermal calorization of Fitzgerald-Hallpike. The addition of the simultaneous binaural bithermal stimulus improved the diagnostic accuracy of caloric testing from 56% to 86%. The simultaneous test was of particular accuracy in diagnosing the inferior vestibular nerve neuroma. The simultaneous stimulus, which adds only six and one-half minutes to overall testing time, is felt to be a valuable adjunct to the alternate test of Fitzgerald-Hallpike.

Adult↗
PubMed1995

Vestibular evoked myogenic potentials in the sternomastoid muscle are not of lateral canal origin.

We studied vestibular evoked myogenic potentials in 6 patients after unilateral vestibular neurectomy and in 22 patients after unilateral vestibular neuritis and unilateral absent caloric responses. We found that the ipsilesional vestibular evoked potentials were abolished in every patient after unilateral vestibular neurectomy. In vestibular neuritis patients we found that the ipsilesional vestibular evoked potentials were absent in some but not in all cases. These findings confirm that the p13-n23 potential is of vestibular origin and also show that it is not of lateral canal origin.

Acoustic Stimulation↗
PubMed1978

Tobramycin in patients with various infections: a clinical evaluation.

22 patients with various gram-negative infections were treated with tobramycin at a dose of approximately 3 mh/kg body weight/24 h for 7 to 53 (mean 16) days. Therapy was monitored with determinations of drug serum concentrations and renal and audio-vestibular function tests. In 16 patients either cure of clinical improvement were achieved. Two patients did not improve. In another 4 patients the effect of tobramycin therapy could nto be evaluated. One patient exhibited a subclinical vestibular dysfunction and one patient experienced transient tinnitus. In one patient, slight but clinically significant renal impairment occurred.

Adolescent↗
PubMed1992

Patterns of vestibular function following vestibular nerve section.

Bithermal caloric irrigations, low-frequency rotational chair stimulation, and posturography were performed on 20 patients before and after vestibular nerve section. Twelve patients demonstrated acute postoperative spontaneous nystagmus and rotational vestibulo-ocular reflex (VOR) asymmetry. Eight patients demonstrated minimal acute postoperative spontaneous nystagmus and VOR asymmetry. Four patients had suppression of all vestibular function characterized by an absent contralateral caloric response, low VOR gain, and falls on posturography when required to rely solely on vestibular input to maintain posture. Four patients had a severe preoperative vestibular loss and no acute change in vestibular function following surgery. Over time, 5 patients continued to manifest elevated spontaneous nystagmus, 2 patients manifested a persistent rotational VOR asymmetry, and 5 patients exhibited a return of caloric function in the operated ear. It is suggested that multiple clinical factors contributed to the variable vestibular responses demonstrated in this study.

Adult↗
PubMed2003

Various causes and clinical characteristics in vertigo in children with normal eardrums.

OBJECTIVE: The differential diagnosis of vertigo in children is extensive. Otitis media and middle ear effusion could be the most common causes of vertigo in children, but there are some problems in detecting the other causes for vertigo because they are one of most frequent diseases of childhood. The purpose of this study is to review the clinical characteristics and both the audiological and vestibular findings of vertigo in children with normal eardrums, who do not show otitis media or middle ear effusion, and to assist in making a differential diagnosis of vertigo. METHODS: The fifty five children (< 16 years old) with vertigo, who visited the Department of Otolaryngology, Ajou University Hospital, Suwon, South Korea between January 1995 and December 2001 were selected for this study. These excluded the patients with abnormal eardrums/tympanograms or those that did not perform questionnaires, audiological, or vestibular evaluations. They were retrospectively analyzed for clinical symptoms, vestibular functions, and differential diagnosis. RESULTS: The most common causes for vertigo in children were migraine in 17 (30.9%) and benign paroxysmal vertigo of childhood (BPVC) in 14 (25.5%). Other less frequent causes included four cases of trauma, two cases each of Meniere's disease, delayed endolymphatic hydrops, benign positional vertigo, and one case only for cerebellopontine angle tumor, seizure, acute vestibular neuritis, juvenile rheumatoid arthritis, leaving ten cases (18.2%) as unclassified. Abnormal findings were noted in 13 (23.6%) in pure tone audiogram, 3 (5.5%) in positioning test, 6 (10.9%) in bithermal caloric test, and 36 (65.5%) in rotation chair test. CONCLUSIONS: The vertigo in children with normal eardrums, who did not show otitis media or middle ear effusion, was most commonly caused by migraine and BPVC. These findings have shown to be very different from those with adult vertigo. The evaluation of vertigo in children requires a questionnaire for extensive and complete history taking, audiograms and vestibular function tests. And in selected cases, electroencephalography, hematological evaluation, imaging of the brain or temporal bone should be performed.

Adolescent↗
PubMed1989

Evaluation of the monothermal caloric test.

In 1970, Torok reported that patients with labyrinthine disease showed vestibular recruitment and that patients with retrolabyrinthine disease showed vestibular decruitment on the monothermal caloric test. Other investigators have failed to confirm these findings; however, their studies did not precisely replicate Torok's test procedure. Following Torok's procedure exactly, the monothermal caloric test was administered to normal individuals and to patients with well-documented vestibular lesions. Nine of ten normal persons showed normal responses and one person showed borderline decruitment. Six of eight patients who had lesions of the vestibular nerve or central vestibular pathways showed decruitment. Two patients with active Meniere's disease showed recruitment and one showed asymmetry. Two patients with Meniere's disease who had undergone endolymphatic sac operations showed normal responses. These findings support Torok's claim that the monothermal caloric test discriminates between labyrinthine and retrolabyrinthine vestibular pathology.

Adult↗
PubMed1993

Vestibular nerve disorder in patients suffering from sudden deafness with vertigo and/or vestibular dysfunction.

Vestibular nerve disorder (VND) in cases suffering from sudden deafness with vertigo was studied. Between 1987 and 1991, we observed 46 patients suffering from sudden deafness with or without vertigo, who had undergone the caloric test and galvanic body sway test (GBST). Twenty-seven patients had vertigo and canal paresis (CP) upon the caloric test, 6 vertigo without CP and 13 CP without vertigo. VND was detected in 12 of the 46 patients. All those with VND had vertigo and CP upon the caloric test, 12/27 (44%). The degree of hearing loss in those with VND was significantly (p < 0.05) more severe and their recovery of hearing loss was poorer than in patients without VND. These results indicate that VND is a common finding in cases of sudden deafness with vertigo especially in those with severe hearing loss.

Caloric Tests↗
PubMed2001

Behavioural disturbances and sensory pathology following allylnitrile exposure in rats.

Animals exposed to allylnitrile develop permanent abnormalities in motor behaviour, similar to those caused by 3,3'-iminodipropionitrile (IDPN) and crotononitrile. IDPN and crotononitrile effects have been attributed to vestibular hair cell degeneration, but allylnitrile has been suggested to modify behaviour through neuronal degeneration in the CNS. Adult male Long-Evans rats were exposed to allylnitrile (0, 20, 40, 60 mg/kg per day, for 3 days) and the changes in rearing activity and rating scores in tests of vestibular function were assessed. Surface preparations of the vestibular sensory epithelia and the organ of Corti were observed for hair cell loss by scanning electron microscopy. Corneal transparency and concentrations in retina and olfactory bulbs of glial fibrillary acidic protein (GFAP), a marker for reactive gliosis, were also determined, as they are known targets of IDPN toxicity. In a dose-dependent manner, allylnitrile caused corneal opacity and gliosis in the retina and olfactory bulbs, decreased rearing activity and increased the rating scores in tests of vestibular dysfunction, and induced hair cell loss in both the vestibular sensory epithelia and the organ of Corti. The behavioural deficits correlated well with the loss of vestibular hair cells. We conclude that allylnitrile causes permanent modifications in behaviour by loss of vestibular function as IDPN and crotononitrile do and that all these chemicals share other toxic targets, such as the cornea, the retina, and the olfactory system. Data reported here and elsewhere indicate that a number of nitriles show similar neurotoxic properties.

Animals↗
PubMed2005

[Study on the causes and risk factors on vertigo and balance disorders in 118 elderly patients].

OBJECTIVE: To understand the various factors causing vertigo and balance disorders in the elderly. METHODS: 118 elderly patients (aged equal or older than 60 years of age) with vertigo or balance disorders were retrospectively analyzed through clinical symptoms, audio-vestibular function tests, X-ray, CT scan or MRI in cervical vertebras, brain and inner ears, ultrasonography, transcranial doppler (TCD) or magnetic resonance angiography (MRA) in blood vessels on head and neck. RESULTS: Of 118 patients, 70 (23%) of them suffered perip heral vestibular disorders while 29 (58%) having cerebral vertigo or dizzness, leaving 19 cases (16%) as unclassified. CONCLUSION: For elderly patients, vertigo and balance disorders were commonly caused by many kinds of peripheral and cerebral vestibular pathological disfunctions while the functional weakness of vestibular organs and systems affected by the physiological process of ageing and different concommitant diseases as well as environmental, psychogenic factors should also be considered.

Aged↗