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At least 649 records · Page 36Linked to original sources
PubMed2005

Click-evoked myogenic potentials recorded on alert guinea pigs.

The aim of this study was to establish an animal model of acoustically evoked vestibulo-collic reflex using guinea pigs. A special clamp was applied to restrain the head and body of the guinea pigs, but leaving its four legs free. Each animal underwent vestibular evoked myogenic potential (VEMP) and caloric tests using clip electrode method without general anesthesia or decerebrate surgery. The response rates for the myogenic potentials on the neck of guinea pigs using 100, 90, 80 and 70 dB monaural acoustic stimulation with unilateral recording were 100%, 62%, 50% and 0%, respectively. The mean latencies of the positive and negative peaks for the myogenic potentials were 7.24+/-0.49 and 9.15+/-0.47 ms, 7.09+/-0.43 and 9.28+/-0.42 ms, as well as 7.03+/-0.59 and 9.14+/-0.56 ms, when elicited by 100, 90 and 80 dB acoustic stimulation, respectively. The median (minimum-maximum) peak-to-peak amplitudes were 11.93 (6.14-16.86), 10.99 (5.28-19.40), and 11.17 (5.02-20.72) microV, when elicited by 100, 90 and 80 dB acoustic stimulation, respectively. We found no significant relationship between the stimulus intensity and the mean latencies or peak-to-peak amplitude of the myogenic potentials in guinea pigs. For those treated with gentamicin unilaterally, all guinea pigs showed absent caloric responses on the lesion side, and absent myogenic potentials on the neck when using ipsi-lesional acoustic stimulation, while the hearing was preserved. Hence, the use of gentamicin-treated animals, along with normal controls and auditory brainstem responses, results in convincing results that the recorded myogenic potentials are in fact of vestibular origin.

Acoustic Stimulation↗
PubMedDate not supplied

Why does vertigo become chronic after neuropathia vestibularis?

OBJECTIVE: Vertigo is one of the most frequent complaints in general medical practice and is often linked to psychiatric disorders. A longitudinal study of 67 patients with an acute vestibular disorder was undertaken to clarify if, after experiencing acute vestibular vertigo, certain patients have a higher likelihood of developing chronic, debilitating dizziness despite no evidence of a damaged peripheral vestibular system. METHOD: The severity of dizziness was determined in 67 patients with vestibular neuronitis, 6 months after their release from hospital, using the Vertigo Symptom Scale from Yardley et al. The intensity of anxiety directly after vertigo was experienced, body-related cognitions, illness coping, personality structure, and the recovery of the organ of equilibrium were recorded in order to explain the severity of vertigo that occurred after 6 months. The function of the organ of equilibrium was assessed by using a caloric test. RESULTS: Over a period of 6 months, 13 of the 67 patients (19.4%) reported continuing dizziness after neuropathia vestibularis. Eleven of the 13 patients showed high scores on a scale for measuring vertigo-related symptoms, which can be interpreted as being equivalent to anxiety. The variables of gender, catastrophic thoughts and a dependent personality accounted for 35% of why vertigo became chronic. CONCLUSION: Neuropathia vestibularis represents a risk factor for the development of chronic vertigo. Chronic vertigo after neuropathia vestibularis appears to be equivalent to anxiety and is partly conditional on catastrophic thoughts at the beginning.

Anxiety Disorders↗
PubMed1996

Optokinetic after-nystagmus in the human: a comparative study between normals and patients with peripheral vestibular and central disorders.

The purpose of this study was to classify various patterns of optokinetic after-nystagmus (OKAN) appearing in normal subjects, and to investigate the difference of OKAN between 147 normal subjects and 55 patients suffering from central nervous system (CNS) or peripheral vestibular disorders, in which 18 CNS disorders and 37 peripheral vestibular diseases were included. Data was divided into three categories by duration of the 1st phase of OKAN, i.e. hypo-response below 10 sec, middle response between 10 and 60 sec and hyper-response above 60 sec. The patterns of OKAN were then classified into six types with nine subtypes according to the following classification. All combinations of duration times of the 1st phase of OKAN toward both directions were then classified into six types, i.e. type 1, bilateral middle responses; type 2, bilateral hyper-responses; type 3, bilateral hypo-responses; type 4, unilateral hypo-response with contralateral middle response; type 5, unilateral hypo-response with contralateral hyper-response; and type 6, unilateral middle response with contralateral hyper-response. Moreover, subtypes "a" and "b" indicated symmetric and asymmetric in both types 1 and 2. Namely, if a relative value of the difference between bilateral responses against the sum of those was less than 20%, it was called "symmetric", otherwise, "asymmetric". Type 3 was divided into two subtypes: no response (3a) and hypo-response (3b). Results were summarized as follows. All combinations of horizontal OKAN toward both sides appeared in the 147 normal subjects. The incidence of each type, i.e. 1a, 1b, 2a, 2b, 3a plus 3b, 4, 5 and 6, was 10.9, 15.0, 2.7%, 1.4%, 25.2%, 31.3%, 4.1% and 9.5%, respectively. The incidence of type 3, type 3a in particular, was higher in patients than in the normals (p < 0.001). Also, the incidence of type 4 in normals was significantly higher than that of the patients (p < 0.01). Caloric tests revealed unilateral and bilateral canal pareses (CP) in 44 of 52 patients. The incidence of type 3 in the group of patients with CNS disorders was higher than those with peripheral vestibular disorders (p < 0.01). The 2nd phase of OKAN appeared in only nine of the 147 normals and in nine of the 55 patients. However, the 3rd phase of OKAN was observed in only one patient, the duration of which was 80 sec. The appearance rate of the 2nd phase of OKAN in patients was significantly higher than in the normal subjects (p < 0.05).

Adult↗
PubMed2002

The Chiari I malformation and the neurotologist.

OBJECTIVE: The first objective of this paper is to report the clinical symptoms of 77 patients and the results of their neurologic, vestibular, and audiological evaluations done with magnetic resonance imaging, which confirmed Chiari I malformations. The second objective is to report how the results of a vestibular evaluation can help neurosurgeons decide on the need for surgical treatment. STUDY DESIGN: Retrospective chart review of 77 patients seen between 1988 and 2000. SETTING: Tertiary care center. PATIENTS: The clinical data of patients under diagnoses of Chiari I malformation, which was filed in the vestibular laboratory computer, was analyzed. INTERVENTION: The cases included in this study were derived from a population of patients who were evaluated for dizziness, hearing loss, and tinnitus in the Torok Vestibular Laboratory. MAIN OUTCOME MEASURE: Occurrence of central vestibular findings in the patients with Chiari I malformation. RESULTS: In this group of 77 patients, 10 had bilateral sensorineural hearing loss and 22 had unilateral sensorineural hearing loss of varying severities. Horizontal spontaneous nystagmus was noted in 27 patients, vertical upbeat nystagmus in 3, and downbeat nystagmus in 4 others. Saccadic dysmetria was noted in 4 patients, optokinetic nystagmus was impaired in 3, and smooth-pursuit impairment was noted in 12 of the group. Positional nystagmus was noted in 9 patients. The Torok monothermal caloric test showed normal responses in 19 patients, hyperactive responses in 43, decruitment in 45, and rebound caloric nystagmus in 20. Surgical decompression of the Chiari I malformation was completed in 33 patients. CONCLUSION: From this study it is clear that the results of the basic vestibular function-test battery reflect the functional deficit in the vestibulocerebellum that is presumed by its ectopic position. These tests results have given our neurosurgeons a stronger foundation on which to base surgical decisions for this disease.

Adolescent↗
PubMed2001

[Use of intratympanic gentamycin for the treatment of Meniere's disease].

The ablation treatment of Meniere's disease by intratympanic streptomycin applications was first reported by Schuknecht in 1957. Streptomycin and gentamycin are the most frequent aminoglycosides used for the Meniere's disease treatment. Gentamycin is responsible for the damage of vestibular dark cells causing the impairment of endolymph production. This method gives the possibility for the control of the vertigo with a potential hearing preservation. Fifteen patients with unilateral Meniere's disease who had not responded to conventional therapy, were treated by intratympanic gentamycin injections. The hearing status and the caloric test were staged before and after treatment according to the AAO-HNS guidelines. Overall results after minimum 1 year follow-up in this group were as shown below: complete vertigo control--5 patients, substantial vertigo control--8 patients, complete relief of tinnitus--10, relief of aural fullness--12 patients, hearing loss--none. According to presented results, intratympanic injections of gentamycin is the useful alternative to the surgery. This method should be consider in every patient with the unilateral Meniere's disease, who had not responded to the conventional treatment.

Aged↗
PubMed1995

Minimum amount of calories needed to elicit the vestibulo-ocular reflex in normal human subjects.

Calorie as a unit of heat quantity is considered more appropriate than temperatures and seconds as in conventional caloric testing. In an attempt to determine the minimum amount of calories needed to elicit the vestibulo-ocular reflex, we modified free-flowing irrigation into a closed irrigation of the external meatus. Using this method, we studied 61 ears in 34 normal healthy subjects, revealing the threshold to be 310.26 +/- 151.19 calories. Concern about the excessive heat used in conventional stimuli, which is believed to be the cause of unwanted autonomic responses, has been answered by this finding. Conventional irrigation with water at 44 degrees C is about 5-fold stronger than that minimum. With the closed irrigation technique, the autonomic responses have been reduced relatively.

Adult↗
PubMed2004

Delayed vertigo after stapes surgery.

OBJECTIVES: Stapes surgery restores partial or total hearing in almost 95% of cases, and in case of failure, revision surgery may often resolve the problem. Delayed vertigo is commonly related to perilymphatic fistula. The aim of this study is to report experience gained in revision stapes surgery in cases of delayed vertigo. STUDY DESIGN: This is an intervention study, before-after trial; it includes follow-up between 12 and 84 months that was based on clinical history and audiometric evaluations. METHODS: The work was carried out in the otologic surgery referral center of Piemonte in outpatient surgery. Nine patients (4 males and 5 females, between 43 and 60 years of age) who presented with delayed vertigo after stapes surgery were retrospectively reviewed. All nine underwent clinical history evaluation, pure tone audiogram, investigation of the vestibular system with a bithermal binaural caloric test, and fistula test. Vestibular tests were performed with electronystagmography recording. In all nine subjects, functional middle ear exploration was carried out by way of a transmeatal approach using local anesthesia. The demonstration of a perilymphatic leak was positive in only three (33%) cases, but the oval window region was filled with fibrin glue in all nine cases. RESULTS: At follow-up, vertigo was resolved in all cases with revision surgery, even though perilymph leak was positive only in three cases. CONCLUSION: From the results obtained, we feel that exploration of the middle ear should be always carried out in cases of delayed vertigo after stapes surgery with suspected perilymphatic fistula.

Adult↗
PubMedDate not supplied

[Vestibular disorders in contusions of the temporal lobe of the brain].

An analysis of the caloric test results in 30 victims of a severe contusion-crush of the temporal lobe of the brain showed that to this type of pathology the common significant changes in the vestibular-oculomotor reflex which, more often than not, found their expression in the prevalence of an experimental nystagmus in the direction toward the affected hemisphere. The victims, in whom contusions of the temporal lobe were attended by lesions of the brain stem of the primary or dislocation genesis, demonstrated the presence of vestibular areflexia or dissociaton of the quick nystagmus phase. Against the background of a continual tonic component there would become evident gross functional disruptions of the oculomotor elements which in a number of cases proved unrecognizable with an ordinary clinical observation.

Adult↗
PubMed1996

The subjective horizontal in eccentric rotation influenced by peripheral vestibular lesion.

Peripheral vestibular equilibrium disorders may originate in various parts of the labyrinth or the vestibular nerve. Traditionally, the function of the lateral semicircular canals has been assessed with caloric irrigation, and sometimes falsely been interpreted as a vestibular nerve lesion. The vertical semicircular canals are not easily assessed. Caloric testing with the head in different positions is not very helpful, but the canals may pairwise be tested using specific rotational techniques. Often the otolithic organs, capable of detecting linear acceleration forces, are forgotten as a source of vertigo and dizziness. We have implemented horizontal rotatory testing with the subject seated eccentrically facing the direction of rotation as a means of assessing otolithic function. The subject experiences a lateral tilt and is instructed in darkness to put a short light bar in the position he thinks a water surface would have, which is identical to his perceived tilt. In 39 normal subjects, a theoretical tilt of 24 degrees was estimated as approximately 19.5 degrees, and the standard deviation was 6 degrees. A side difference index was proposed to be normal if below 25%. The preliminary findings in a few patients with known labyrinthine lesions are presented. We propose that otolithic as well as lateral semicircular canal functions are useful to monitor in patients with suspected peripheral equilibrium disorders.

Adult↗
PubMed1990

A modified screening protocol for the diagnosis of acoustic neuromas.

In many centres the diagnosis of acoustic neuromas relies on a preliminary screening protocol. The current method is a combination of caloric tests, tomography of the internal auditory meati and brain stem evoked response audiometry (BSERA) with 2 positive results indicating the need for further investigation. This protocol, although sensitive lacks specificity and results in a high incidence of normal CT air meatograms. As this procedure is associated with a significant morbidity, we have devised a 'weighted' system of scoring to avoid subjecting large numbers of normal patients to CT air meatography. The proposed system has been derived from screening 61 patients with unilateral sensorineural hearing loss, 24 of whom had an acoustic neuroma. This method reduced the false positive rate of CT air meatography from 68%, using the 2 out of 3 criteria, to 18%, whilst the false negative incidence remained at 8%.

Audiometry, Evoked Response↗
PubMed2003

Steroid effects on vestibular compensation in human.

Vestibular neuritis (VN) rapidly damages unilateral vestibular periphery, inducing severe balance disorders. In most cases, such vestibular imbalance is gradually restored to within the normal level after clinical therapies. This successive clinical recovery occurs due to regeneration of vestibular periphery and/or accomplishment of central vestibular compensation. We experienced 36 patients with VN treated at our hospital, including cases in our previous preliminary report. To elucidate effects of steroid therapy both on the recovery of peripheral function and on the adaptation of central vestibular compensation, we examined caloric test and several questionnaires with two randomly divided groups, 18 steroid-treated and 18 nonsteroid-treated patients, over two years after the onset. These examinations revealed that steroid-treated patients had a tendency of better canal improvements (13/18, 72%) than nonsteroid-treated ones (10/18, 55.6%). However, there was no significant difference between these two groups. In cases with persistent canal paresis, steroid-treated patients (n = 5) reduced handicaps in their everyday life due to the dizziness induced by head and/or body movements and the disturbance of their mood, more effectively than those with nonsteroid therapy (n = 8). These findings suggest that steroid therapy with VN could be effective on not only vestibular periphery but central vestibular system, to restore the balance.

Activities of Daily Living↗
PubMed2006

Lateralised vestibular hypofunction: canal paresis and handedness.

In this retrospective study it was found that 549 out of 1175 patients seen for vestibular assessment within an 8-year period within a district hospital service showed lateralised canal paresis as determined by caloric testing. It was found that there was a tendency for canal paresis, indicative of vestibular hypofunction, to be on the side of handedness. This bias showed statistical significance, (chi-squared, p < .005), for the patients overall, as well as for the 65 left-handers considered separately, (p < .05). Surprisingly, this form of bias does not appear to have been reported previously. The bias was shown most clearly in the largest of the groups defined by sex and handedness, namely that of female right-handers. In this group the prevalence of associated hearing loss was similar for canal paresis on either side. This allowed speculation as to the particular type of disorder to which those cases of canal paresis that were associated with the bias might be due, from which it seemed that migraine, rather than Menière's disease or vestibular neuronitis, was likely.

Aged↗
PubMed2005

Prognosis of inner ear periphery and central vestibular plasticity in sudden deafness with vertigo.

OBJECTIVES: We sought to elucidate the clinical problems and otopathology of patients with sudden deafness with vertigo (SDV). METHODS: In 24 patients with SDV who had significant canal paresis (CP) at their first visit to our hospital between 1997 and 2001, we examined pure tone audiograms, caloric tests, and several questionnaires twice, at the first visit within 5 days after the onset and around 2 years after steroid therapy. RESULTS: These examinations revealed that improvements of auditory and vestibular function in patients with SDV tended to be correlated with one another. Sixteen of the 24 patients (66.7%) still had CP. This rate in SDV was significantly worse than that reported previously for vestibular neuritis (VN). On the other hand, patients with SDV with long-lasting CP had a faster reduction of head-shaking afternystagmus and of handicaps in their everyday life due to dizziness than did patients with VN and CP. CONCLUSIONS: These findings suggest that SDV may deteriorate the inner ear function more severely but accelerate the central vestibular compensation more effectively than VN after the lesion. It is well known that vestibular neurectomy causes much more severe motion-induced dizziness after surgery than does labyrinthectomy. Taken together, these findings suggest different regions of damage in SDV (mainly the labyrinth, as in labyrinthectomy) and VN (mainly the ganglion, as in vestibular neurectomy).

Adult↗
PubMed2004

Clinical experience with the vestibular evoked myogenic potential.

The vestibular evoked myogenic potential (VEMP) is a promising test of the descending vestibulocollic system. Our aim was to determine whether the VEMP can be applied to an older patient population and can detect lesions in descending vestibulospinal pathways. We also compared VEMP clinical performance with that of the standard caloric test. VEMP test performance was retrospectively analyzed in relation to clinical diagnosis and other vestibular test performance in 62 patients (age, 30-85 years) referred for vestibular testing to Mayo Clinic, Jacksonville, Florida. The VEMP was evoked using a 250 Hz tone burst. Results suggest age-related changes in VEMP amplitude and latency in this patient population. VEMP tests were sensitive to lesions not detected by electronystagmography. VEMP and caloric sensitivity and specificity were essentially equal (d' = 1). Combining both tests improved sensitivity. However, VEMP false-positive rates hampered specificity. VEMP testing may be refined to improve false-positive rates and clinical utility.

Adult↗
PubMed2002

Efficacy of increased gentamicin concentration for intratympanic injection therapy in Ménière's disease.

OBJECTIVES: Update of ongoing case series of intratympanic gentamicin use in intractable Ménière's disease. Comparison of the treatment results of two gentamicin concentrations: 30 mg/ml and 40 mg/ml. STUDY DESIGN: Retrospective case-matched review of an ongoing protocol. SETTING: Ambulatory visits in an office setting. PATIENTS: Eighty-seven patients were included in this study according to the 1995 guidelines of the American Academy of Otolaryngology-Head and Neck Surgery (AAO-HNS) for reporting treatment results of Ménière's disease. INTERVENTION: Intratympanic injection of a buffered gentamicin solution (30 mg/ml) was used in 44 patients (Group 1) in years 1992 to 1995. Stock gentamicin solution (40 mg/ml) was used in 43 patients (Group 2) in years 1996 to 1999. Treatment was titrated for each patient, and the hearing was strictly monitored. The endpoint of treatment was the complete cessation of vertigo spells. MAIN OUTCOME MEASURES: Hearing results, vertigo control scores, and ice water caloric testing responses were analyzed after 24 months of follow-up. Thirty-two patients from each group were selected for case-matched statistical analysis. RESULTS: Four or fewer gentamicin injections were used in 70% of Group 1 patients and 96% of Group 2 patients. In Group 1, vertigo control was achieved in 81% of patients, and the hearing remained the same or was improved in 68% of patients. In Group 2, vertigo control was achieved in 72% of patients, and the hearing remained the same or was improved in 81% of patients. Treatment was aborted in four patients of Group 2 for early reversible hearing loss, and 31 of 39 patients (79%) who completed the protocol experienced lasting vertigo control. There was a trend for longer-lasting vertigo control in the Group 2 patients. CONCLUSION: It was concluded that increasing the gentamicin concentration to 40 mg/ml probably produces similar rates of vertigo control as those of the lower dose, at least initially, but requires fewer injections. The higher dose did not increase the risk of hearing loss if treatment was stopped at the first indication of injury. A larger study is needed to confirm the trend of improved long-term hearing results in patients treated with the 40 mg/ml solution.

Caloric Tests↗
PubMed1988

Alternobaric vertigo in professional divers.

The present investigation was part of a project performed to detect possible effects of diving on the cochleovestibular system. A group of 194 professional divers were interviewed, examined otologically, and their hearing was tested audiometrically. Caloric vestibular tests were performed in 48 subjects. The interview reviewed age, diving experience, previous ear disease or injury, head trauma, noise exposure during diving and during spare-time activities, eye color, tobacco habits, and the occurrence of vertigo during diving. Useful information regarding vertigo was obtained from 193. Of the 76 (39%) who had experienced vertigo, 64 (33%) were classified as alternobaric vertigo (AV), a type of vertigo caused by asymmetric middle ear pressure. A stepwise multiple logistic regression analysis was performed to detect variables contributing to the presence of AV. Variables having a statistically significant association with AV were previous barotrauma of the ear (P less than 0.05) and noise exposure during diving (less than 0.05). AV was most frequently encountered when diving during a common cold. In this sample of divers, AV did not lead to any serious or critical situations.

Adult↗
PubMed1999

Poststeroid balance disorder--a case report in a body builder.

The authors describe a case of poststeroid balance disorder in a 20-year-old athlete. Previous information of such a doping pathology among sportsmen taking anabolics was not found. That anabolic steroids had a harm to central activities and could be suspected especially on the basis of reported psychiatric sequels and cerebrovascular disorders. The case described is of a patient who had been given metandienone, oxymetholone, and nandrolone phenyloproprionate in two courses. Vertigo appeared twice just after introducing doping and persisted in spite of a 1.5 year break in taking anabolics. In the electronystagmography a positional nystagmus was detected, the eye-tracking test was distempered, and abnormal responses in the caloric tests were obtained. In the computed dynamic posturography the number and length of body sway were increased and, consequently, the field of the outspread area was enlarged. The moment of appearance and long-lasting vertigo as well as the results of laboratory examinations indicate a poststeroid permanent disorder of the central part of the equilibrium organ. Such a diagnosis seems to be most probable here.

Adult↗
PubMed1982

Unilateral cystic inner ear anomalies in siblings.

Unilateral cystic inner ear anomalies were diagnosed in two siblings, a 9 year old boy and a 6 year old girl. X-ray examination of the temporal bone was performed, together with audiological examinations and vestibular function tests. The common tomographic X-ray findings consisted of an enlarged solitary sac type deformity of the vestibule with narrowing of the internal auditory canal, severe hypoplasia of the anterior semicircular canal and no visualized cochlea. Pure-tone audiometry revealed severe mixed type of hearing loss in the right ear in both children. The test for vestibular function showed no response to caloric testing.

Child↗