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At least 631 records · Page 35Linked to original sources
PubMed2004

Electronystagmographic findings in benign paroxysmal positional vertigo.

The aim of this study was to investigate the electronystagmographic findings in patients with benign paroxysmal positional vertigo. A retrospective review of the records of 168 patients with this disease during the past 3 years was performed. Epidemiological data and results from the audiological and neuro-otologic workup, including electronystagmography, were recorded. One hundred fifty-one patients had involvement of the posterior canal, 14 of the horizontal canal, and 3 of the anterior canal. Seventy-two patients (42.8%) had abnormal findings on the caloric tests. Thirty-seven of them (22%) had canal paresis and 23 (13.7%) had directional preponderance, whereas in 12 patients (7.1%) both unilateral weakness and directional preponderance were found. Finally, 21 patients (12.5%) had spontaneous nystagmus. It may be thus concluded that electronystagmographic abnormalities are quite common in patients with benign paroxysmal positional vertigo. Their presence may be explained according to several mechanisms, which are further discussed herein.

Audiometry, Pure-Tone↗
PubMed1985

[Treatment of Meniere disease with betahistine dimesilate (Aequamen)--double-blind study versus placebo (crossover)].

The efficacy of treatment of Menière's disease was investigated in 2 double blind study versus placebo. Forty patients were given 36 mg betahistine dimesilate daily for at least six weeks. The course of disease and findings one year before and one year after the treatment were noted and compared for assessing the therapeutic success. The findings on threshold audiograms, spontaneous and provoked nystagmus and caloric tests did not show any significant changes. A slight improvement was noted in the low frequency range of threshold audiograms. Dizziness, tinnitus and disturbances of walking were significantly improved. The incidence of vertigo attacks was reduced to 64%. In 89% of the patients no further vertigo attacks were seen after the treatment. The best results of betahistine dimesilate treatment were observed in the early stages of Menière's disease.

Adult↗
PubMedDate not supplied

Bilateral Mondini dysplasia with normal hearing.

A 37-year-old man with both Mondini dysplasia and normal hearing is reported. The patient visited our clinic with a complaint of unsteadiness. Pure-tone audiometry showed a normal hearing level in both ears. Polytomography and computed tomography (CT) revealed enlargement of the vestibules and lateral semicircular canals in both ears but a normal shape of the cochlea and other semicircular canals. The caloric test indicated severe canal paresis (CP) in the left ear and moderate CP in the right ear, whereas the active head rotation test demonstrated that head-eye coordination was preserved at frequencies of 0.33 and 0.67 Hz but slightly deteriorated at 1.0 Hz. The patient's unsteadiness seemed to be attributable to a hypofunction of the bilateral semicircular canals, which may be due to insidious, repeated cerebrospinal fluid otorrhea caused by judo wrestling. Although Mondini dysplasia with normal hearing has been believed to be rare, phylogenetic consideration suggests that more such patients exist than has been assumed.

Adult↗
PubMed2003

Vestibular-evoked myogenic potential in patients with unilateral vestibular neuritis: abnormal VEMP and its recovery.

The incidence of inferior vestibular nerve disorders in patients suffering from unilateral vestibular neuritis and the recovery of these disorders were evaluated by monitoring the vestibular-evoked myogenic potential (VEMP). Eight patients ranged from 21 to 73 years that suffered from unilateral vestibular neuritis underwent VEMP and caloric testing. Abnormal VEMP was observed in two of the eight patients with unilateral vestibular neuritis. Two patients were diagnosed as having an inferior vestibular nerve disorder. One of these patients showed recovery of the inferior vestibular nerve function as assessed by the VEMP. Disorders of the inferior vestibular nerve function and their recovery was confirmed by our current results. The time course of recoveries of the superior and inferior vestibular nerve systems were similar in the two patients.

Adult↗
PubMed1997

[Intravenous gentamicin therapy in bilateral Menière disease].

BACKGROUND: The treatment of severe forms of bilateral Menière's disease remains an especially challenging task. Similar problems also occur in debilitating Menière's disease in the only hearing ear. The intramuscular titration therapy with streptomycin has been the means of choice since 1984 to minimize the risk of total hearing loss in cases of severe bilateral disease. METHOD: Since 1989 we have treated six out of 21 cases of bilateral Menière's disease by intravenous application of 2 x 120 mg gentamicin in Ringer's solution for several days. Additionally we reported on two cases in 1988. Only minor amounts of gentamicin were applied to sedate the function of both vestibular organs while avoiding damage to the cochlea. RESULTS: In two cases hearing approved approximately about 10 dB, in two cases hearing remained stable, and in two cases hearing worsened about 10 dB. Five of six patients showed minor excitability in caloric tests on both sides, they did not complain of vertigo attacks one to five years after therapy. CONCLUSION: Given that only very small amounts of gentamicin are applied to sedate the function of the vestibular organ while causing almost no damage to the cochlea, this method seems to be an excellent means for treatment of bilateral Menière's disease. Patients do not experience severe problems with equilibrium afterwards, and the treatment can be repeated as often as necessary.

Anti-Bacterial Agents↗
PubMed2002

[Bilateral vestibular areflexia: quantification is required].

Bilateral vestibular loss, that should be more precisely qualified as "horizontal semicircular canal bilateral loss", is a concept usually defined by the following characteristics: - no response to caloric tests, - no response to pendular test with a 20-second period, - increasing gain of the cervico-ocular reflex. We present five cases. We increased the stimulation frequency to a level higher than usually, employed and observed that: - at a given frequency threshold a certain amount of reactivity may be observed, - above that threshold the reactivity increases in proportion with stimulation frequency. The apparent vestibular loss is actually related to stimulation frequency. This phenomenon could be explained by considering the physiology of phasic and tonic cells.

Aged↗
PubMedDate not supplied

Monocular nystagmic responses to caloric stimulation.

Twenty-five normal subjects and 173 clinical patients received standard bithermal caloric testing. Vestibular nystagmus was evaluated for cumulative slow phase velocity from the summated horizontal eye recording and independent recording of the left and right eye. These data revealed that cold water stimulation produced more intense activation of the ipsilateral eye. Simultaneous closed-circuit video and D.C. electro-oculographic recordings from eight normal rhesus monkeys in response to cold water irrigations confirmed the fact that this stimulus leads to differential activation of the extraocular muscles. A possible explanation for this finding is discussed.

Adult↗
PubMed1996

[Follow-up study of vestibular neuronitis].

A follow-up study of 26 patients with vestibular neuronitis is reported. The disease is characterized by an acute attack of severe vertigo with complete loss of unilateral caloric response. The following results were obtained: 1) The average period of spontaneous nystagmus was 136 days and the standard error was 39 days. 2) No correlation could be found between age and the period of spontaneous nystagmus. 3) Six patients showed direction reversal in their spontaneous nystagmus (recovery nystagmus), and their outcome was good. 4) On the most recent caloric test, 42% of the patients had bilateral normal responses, 27% displayed partial improvement on the affected side, and no reaction was observed in 31% of patients. We suggest that three types of clinical courses may occur in vestibular neuronitis: i) complete recovery of the function of the affected vestibular nerve, ii) partial recovery of vestibular function, and iii) no recovery of the affected vestibular nerve, but central nervous system compensates for the vestibular imbalance.

Adolescent↗
PubMed1994

Postcaloric nystagmus by positional change. 1. Study in normal subjects.

We investigated the postcaloric nystagmus related to positional change. Twenty-two healthy subjects were examined (experiment 1). A caloric test was carried out in the supine position. Following the cessation of the primary phase, the subject was reoriented to the upright position. An additional 10 subjects were also examined with other positional changes (experiment 2): following the cessation of the primary phase, the subject was reoriented to the lateral positions, irrigated-ear-up and irrigated-ear-down positions. As a control study, 6 subjects were examined without positional change (experiment 3). In 37 (84%) ears, postcaloric nystagmus was observed in the upright position. Furthermore, in 12 of 20 (60%) ears in the irrigated-ear-up position and in 13 of 20 (65%) ears in the irrigated-ear-down position, the horizontal component of postcaloric nystagmus was observed. Without positional change, no postcaloric nystagmus was observed. These findings indicate that caloric nystagmus is modified by an adaptive process and that postcaloric nystagmus as it relates to positional change might be attributed mainly to the vestibular adaptation.

Adolescent↗
PubMed1994

Sudden deafness in vestibular schwannoma.

Twelve per cent of a series of 284 patients with vestibular schwannoma presented with sudden deafness. If sudden sensorineural hearing loss is present then it is very likely to be the main presenting symptom. The mean length of patients' history is eight months shorter in this group than in the non-sudden deafness group. Sixteen per cent of vestibular schwannoma patients without sudden deafness present with a 'dead' ear whereas 29.5 per cent of those presenting with sudden deafness have total hearing loss. There was no significant difference between the sudden deafness group and the 'all others' group with regard to tumour size, audiogram shape, caloric test, imbalance, and facial numbness. Although the numbers of patients with sudden deafness in this series were too small to reach significance, on the basis of the clinical correlation of vestibular schwannoma morphology it is possible to postulate that compression of the vasculature within the bony internal auditory canal by a laterally arising tumour may be the aetiological factor and may be more likely to occur than in more medially arising tumours.

Adult↗
PubMed1995

The risk of vestibular function loss after intracochlear implantation.

Sixty patients were selected for cochlear implantation and 50 of them received an intracochlear implant (Nucleus). Vestibular function was evaluated before and after surgery using a caloric test and a velocity step test. Sixteen patients had normal or residual vestibular function before surgery, 11 bilateral and 5 unilateral; in 3 of the latter patients, the ear with vestibular areflexia was elected for implantation, which reduced the number of patients at risk for vestibular dysfunction to 13. Vestibular function was preserved in all of these patients except for 4; the risk of vestibular function loss can therefore be rated at about 31%.

Adolescent↗
PubMed1983

Electronystagmography outside the hospital using a pocket-sized electrocardiograph.

It is the desire of the neurotologic clinician to record routinely the nystagmus of patients with vestibular disorders but it is troublesome to have it done frequently. We tried to have patients record their own nystagmus using a portable electrocardiograph. It is pocket-sized and can be operated easily at any time and any place by laymen and often provides beneficial information. When we performed the caloric test on nine patients, we recorded the nystagmus with an ordinary electronystagmograph and with this equipment simultaneously. It has been recognized that the records with a portable electrocardiograph bear close resemblance to the records obtained with an ordinary electronystagmograph. According to the experience in twenty cases of dizzy patients using this recording system, it was concluded that the equipment is useful not only for the diagnosis of dizzy patients, but also for evaluating the effect of drugs and for recommending changes in the mode of living for some patients.

Adult↗
PubMed1986

[Bárány's discovery and its reception by his contemporaries].

Bárány's main achievement is that he unified known, but apparently contradictory facts into one perspective. The concept of a method for examining each ear individually by means of the caloric test fundamentally advanced diagnostics. In 1914 he was honoured with the Nobel Prize, but in his home town of Vienna he was denied the title of professor. Many debates took place about this. In 1917 he moved to Uppsala where he eventually became head of the laryngology department. Two reasons justify the fact that we may call Bárány an Austrian Nobel Prize Winner, firstly that he kept his loyalty to Vienna, his birth place and, secondly, that all his work for which he was awarded the Nobel Prize was done in the Vienna General Hospital.

Austria↗
PubMed1988

A screening protocol used for the detection of acoustic neuromas: a clinical evaluation.

Screening for acoustic neuromas in large numbers of patients in whom the possibility exists should effectively select out the small proportion who have a tumour, prior to more definitive but costly radiological scanning techniques. A suitable screening protocol has been suggested using a combination of caloric testing, tomography of the internal auditory meati and evoked response audiometry. The protocol was applied retrospectively from the records of 64 patients with proven acoustic neuromas and found to predict correctly the presence of a tumour in 97% of cases. It is concluded that this combination of investigations constitutes an effective method of screening patients in whom an acoustic neuroma confined to the 8th nerve is suspected. The great importance of early diagnosis is that the operative mortality and morbidity is much less when the tumour removed is small.

Audiometry, Evoked Response↗
PubMed1987

The influence of temporal bone anatomical variation upon the caloric stimulus.

This study involved a comparison of temperature changes occurring in isolated cadaveric temporal bones as a result of caloric stimulation, with information gained from radiological examination of the bones by means of high resolution computed tomographic scanning. This was performed in order to investigate the complex nature of heat transfer within the temporal bone and the influence which anatomical variations may have upon the accuracy of evaluation of vestibular function by means of the caloric test. No significant correlation could be found between the maximum temperature change occurring across the lateral semicircular canal and any of the parameters obtained from radiological assessment except for the diameter of the internal auditory meatus. It was deduced that an intra-subject difference in the diameters of the internal auditory meatus of 0.5 mm would introduce an absolute error in the evaluation of percentage canal paresis of 10%. Since normal intra-subject differences in internal meatus diameter can exceed 0.5 mm, this finding was considered to be highly significant.

Caloric Tests↗
PubMed2000

Intratympanic gentamicin for the treatment of unilateral Meniere's disease.

OBJECTIVE: To determine the efficacy of intratympanic gentamicin instillation as treatment of incapacitating unilateral Meniere's disease, using a predetermined regimen with a fixed dose. STUDY DESIGN: A prospective study from a single institution between 1988 and 1998. METHODS: One hundred fourteen patients were enrolled in this study. Gentamicin (26.7 mg/mL) was administered three times daily for 4 consecutive days. The Committee on Hearing and Equilibrium Guidelines for Reporting Treatment Results in Meniere's Disease of the American Academy of Otolaryngology and Head and Neck Surgery (1985) were used. RESULTS: Comprehensive data were available for 90 individuals. Complete control of vertigo was achieved in 76 (84.4%), substantial control in 8 (9.0%), limited control in 2 (2.2%), and insignificant control in 4 (4.4%) patients. Disability scores at the end of 2 years were as follows: 76 patients (84.4%) had no disability, 5 (5.6%) had mild disability, 2 (22%) had moderate disability, and 7(7.8%) had severe disability. Caloric testing responses, as determined using electronystagmography, were as follows: 71% of the patients had an absent ice-water response, 16% had a positive ice-water response, and in 13% there continued to be present a bithermal response. Hearing was worse in 22 patients (25.6%), unchanged in 41 (48.2%), and improved in 22 (25.6%). CONCLUSIONS: Intratympanic gentamicin administration using this particular protocol is an effective treatment option for patients with disabling unilateral Meniere's disease. Hearing loss is a distinct possibility, and patients should be advised accordingly.

Adult↗
PubMed1990

[Selective injury of the vestibular and facial nerves following microvascular decompression procedures for hemifacial spasm: A case report].

Microvascular decompression procedures were carried out to relieve right hemifacial spasm in a 54-year-old man. His facial spasm was satisfactorily cured but he complained of severe vertigo, and slight facial palsy was also shown after the operation. Electronystagmograph disclosed spontaneous horizontal and rotatory nystagmus toward the non-operated (left) side. The postoperative caloric test showed profound dysfunction on the operated side. His hearing was well maintained postoperatively. These findings indicated, in addition to facial nerve injury, that the peripheral portion of the vestibular nerve was selectively damaged by the operative manipulations. It was shown that both the facial and vestibular nerves tended to be injured when the nerve trunk was shifted caudal-to-rostrally due to manipulations in the CP angle. It was stressed that caution should be paid to preserve not only the cochlear but also the vestibular nerve function in cerebellopontine angle manipulations.

Arteries↗
PubMed1982

[How spontaneous nystagmus modifies nystagmus induced by caloric vestibular stimulation, studied in 34 patients with vestibular neuritis].

Spontaneous nystagmus modifies the degree of rotatory pendular and caloric vestibular nystagmic responses, provoking directional preponderance towards the same side. Until now, no true correlation has been able to be established between directional preponderance intensity and that of spontaneous nystagmus, correlation between these two parameters depending, in fact, on a third factor; vestibular reflectivity. Spontaneous nystagmus can apparently be defined as a directional preponderance inversely proportional in degree to vestibular reflectivity (the reflectivity of a vestibule being the sum of the hot and cold stimulation response indices). This phenomenon produces a thermal preponderance during the caloric test, and "vestibular recrutment" during the rotatory pendulum test. These findings are the result of 56 measurements conducted in 34 patients with vestibular neuritis. There was also a significant increase in vestibular reflectivity on the healthy side in these patients, suggesting both central and peripheral lesions. Because of the difficulty sometimes encountered when attempting to relaste the different concepts of overall vestibular responses, a new clinical unit of measure is proposed: the number of nystagmic jerks in 30 s. Hinchcliffe has previously employed this unit for the vestibular response, but it is now proposed for more general application to measurement of reflectivity, mean directional preponderance, unilateral directional preponderance, and mean thermal preponderance.

Caloric Tests↗