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At least 685 records · Page 38Linked to original sources
PubMed2003

Vestibular neuronitis in pilots: follow-up results and implications for flight safety.

OBJECTIVES To report our experience over the past 12 years with the evaluation and follow-up of pilots with vestibular neuronitis and to discuss points relevant to flight safety and the resumption of flying duties. STUDY DESIGN A retrospective, consecutive case series.METHODS Eighteen military pilots with vestibular neuronitis were examined and followed up. A complete otoneurological workup was performed, including both physical examination and laboratory evaluation. The latter included electro-oculography (EOG) and a rotatory chair test using the smooth harmonic acceleration protocol. RESULTS The mean patient age was 35 +/- 6 years (range, 23 to 42 y), and the average follow-up period was 20.5 +/- 12.8 months (mean +/- standard deviation [SD]; (range, 11 to 48 mo). Electro-oculography caloric test on presentation documented significant unilateral hypofunction in all patients. Thirteen of the 18 patients (72%) had abnormal smooth harmonic acceleration test results. None of the pilots reported any symptoms on follow-up. However, five (28%) had positive otoneurological examination findings, and eight (44%) still had significant caloric lateralization (>25%). The average caloric hypofunction was reduced from 67.8% +/- 29.3% at onset to 40% +/- 16% (mean +/- SD, <.05, paired test). Seven of the patients (39%) had additional electro-oculography findings beyond caloric hypofunction. These included spontaneous, positional, and positioning nystagmus. Smooth harmonic acceleration disease on follow-up was documented in eight patients (44%), five of whom had canal paresis. Eleven patients (61%) demonstrated residual vestibular damage on follow-up. In 6 of these 11 cases (55%), the laboratory evaluation revealed vestibular deficits otherwise undiagnosed by the bedside test battery. CONCLUSIONS The vestibular system plays a central role in orientation awareness and is often challenged by flying conditions. The finding that approximately 60% of pilots who have had vestibular neuronitis continue to show signs of vestibular malfunction, despite apparent clinical recovery, emphasizes the need for a complete vestibular evaluation, including specific bedside testing and laboratory examinations, before flying duties can be resumed.

Acute Disease↗
PubMed1982

[An interactive computer system for control, handling and recording of vestibular tests].

One processor controls and records the standard leakage of spontaneous nystagmus and the rotatory and caloric tests in three laboratories. It cyclicly scans the horizontal and vertical electronystagmographic leakage from all rooms and it stores the results of its measurement on to a magnetic disk. If these data are to be archived, the computer first calls for the patients's records and then it transfers the test data from the magnetic disk on to an analogous magnetic tape with a tenfold reduction of the time interval. A 3,600-feet-long magnetic tape contains the results of test measurements for a total of 256 h, corresponding to 800-1,000 vestibular tests. With the computer, it is possible to introduce modifications of all vestibular tests, to stop a test at any time, or to plot an electronystagmogram on a curve tracer.

Computers↗
PubMed2000

Computerized electronystagmography: normative data revisited.

This study provides normative data from computerized electronystagmography (ENG) testing of 40 healthy subjects with an average age of 45 years. The clinical test protocol comprises an extensive vestibular examination with oculomotor, positional, rotary chair and caloric tests. The results show that with a computerized ENG set-up considerable variabilities of 22% for rotary chair asymmetry and 19% for caloric labyrinth asymmetry remain.

Adult↗
PubMed2002

Nonsyndromic hearing loss caused by a mitochondrial T7511C mutation.

OBJECTIVES: The aims of the present study were to identify a mutation in a Japanese family showing nonsyndromic sensorineural hearing loss and to relate the mutation to characteristics of patients, including audiovestibular findings. STUDY DESIGN: Familial cohort study. METHODS: Mutation analysis was performed using genomic DNA extracted from blood samples. Subjects underwent audiovestibular examinations, including pure-tone audiograms, tympanometry, self-recording audiometry, acoustic reflex threshold, speech discrimination testing, evoked and distortion-product otoacoustic emissions, auditory brainstem responses, and caloric testing. RESULTS: We identified a T7511C mutation in the mitochondrial tRNA(Ser(UCN)) gene previously reported in one other family. The degree of heteroplasmy for the T7511C mutation ranged from 84% to 92%, and did not correlate with age at examination or severity of hearing loss. Extensive audiologic evaluation suggested both cochlear and retrocochlear involvement. CONCLUSION: Families with maternally transmitted nonsyndromic hearing loss should be investigated for mutations in the tRNA(Ser(UCN)) gene.

Adult↗
PubMed1993

Vestibular neuronitis in aged patients: results from an epidemiological survey by questionnaire in Japan.

An epidemiological survey of vestibular neuronitis in Japan was done using a questionnaire. Answer sheets were obtained from 619 patients with vestibular neuronitis. In order to evaluate data from aged patients, 74 cases were singled out. The following results were obtained: i) There was no sexual difference and no laterality of affected side; ii) There was no case of bilateral vestibular neuronitis; iii) Ten cases were reported as recurrent. Aged patients had a relatively high rate of recurrence; iv) About 10% of 74 cases had had an upper respiratory tract infection, and this rate was lower than that for patients under 65 years of age; v) Thirty-five cases had complications. Hypertension was the most common complication; vi) The caloric test was re-used in 28 cases. The continued existence of caloric CP was observed in 23 cases upon re-examination.

Aged↗
PubMed1998

Subjective Visual Horizontal Determination During Otolith Stimulation by Eccentric Rotation in Conservatively Treated Meniere's Disease.

Peripheral vestibular equilibrium disorders may originate in various parts of the labyrinth or of the vestibular nerve. Traditionally, the function of the lateral semicircular canals has been assessed by caloric irrigation and has been interpreted (sometimes falsely) as demonstrating a vestibular nerve lesion. The vertical semicircular canals are not assessed easily. Caloric testing with the head in various positions is not very helpful, but the canals may be tested in pairs using specific rotational techniques. Often, the otolith organs, detecting linear acceleration forces, are forgotten as a source of vertigo and dizziness. The extent of otolith involvement in Meniere's disease is not well understood. The tested subject is seated eccentrically in a rotatory chair and faces the direction of rotation. Thus, the otolith organs are stimulated in steady-state rotation. The subject experiences a lateral tilt and, in darkness, is instructed to point a short light bar in the position that he or she thinks a water surface would have (identical to the perceived tilt). Patients with conservatively treated unilateral Meniere's disease were tested. In the eccentric rotation test, the patients with unilateral Meniere's disease showed highly variable, sometimes even paradoxical, responses. No correlation was noted between the eccentric otolith test and pure-tone audiometry or the side difference of the caloric responses. Otolith and lateral semicircular canal functions may differ in patients with Meniere's disease, the nature of which remains to be elucidated in further studies.

Journal Article↗
PubMed2005

Drop attacks and vertical vertigo after transtympanic gentamicin: diagnosis and management.

Drop attacks represent a significant problem during the natural course of Meniere's disease. They are characterized by a sudden fall to the ground without loss of consciousness. Diagnosis is clinical and based on the typical description of the patient. Involvement of vertical canal is possible during Meniere's disease and also after gentamicin application. Treatment of drop attacks is still a matter of discussion; most cases have a benign course with spontaneous remission and no treatment is necessary. In severe cases, aggressive treatment (surgical or pharmacological) is necessary. A case of drop attack associated with vertical vertigo is presented. Vestibular tests were performed in order to assess the involvement of inner ear. Caloric test and ice water test reveal no response. Vestibular Evoked Myogenic Potentials are present even after high doses of gentamicin. Drop attacks and vertical vertigo can occur after transtympanic gentamicin and can be well managed with high doses of local gentamicin.

Administration, Topical↗
PubMed1998

[On the frequency of Meniere's disease occurrence].

The authors estimated the frequency of Ménière's disease occurrence among patients of Department of Otolaryngology, University School of Medicine in Lodz in years 1986-1995. The incidence of Ménière's disease was evaluated as 0.46% of all clinic patients and as 1.7% of cases which were treated for aural diseases. Diagnosis was made on the basis of clinical symptomatology, exact medical examination and audiologic tests. The function of vestibular organs was assessed with the help of caloric tests with ENG recordings. Ménière's disease incidence has been the subject of many epidemiological papers in literature but the exact values are different. Perhaps it can be attributed to a variety of criteria applied in defining Ménière's disease or to epidemiological differences.

Adult↗
PubMed2005

Acute vestibular neuritis: prognosis based upon bedside clinical tests (thrusts and heaves).

We compared bedside tests of vestibulo-ocular function (head thrust and head heave signs) with caloric testing results in 68 patients with acute vestibular neuritis seen at onset and in follow-up for one year. The head thrust and head heave signs each were strong predictors of a decreased probability of recovery, and if both were present, there was a trend for a slower recovery and a further decrease in the probability of recovery. If the head thrust sign was absent, recovery was assured. Our results suggest that careful bedside testing of semicircular canal (head thrust maneuver) and otolith (head heave maneuver) function provides useful information for predicting prognosis in patients with acute vestibular neuritis.

Acute Disease↗
PubMed1984

Diagnostic value of vestibular function tests: an analysis of 200 consecutive cases.

The contribution that vestibular function tests can make in achieving a topographic and etiologic diagnosis is being increasingly questioned. A greater reliance is therefore being placed on audiometeric tests including auditory brain stem tests. Our experience with vestibular testing has been most favorable, using photoelectric nystagmography and the Torok monothermal differential caloric test. This analysis of 200 consecutive cases shows that patients with normal vestibular function can be differentiated with certainty from those with organic disorders. In the latter group the site of lesion could be confirmed with greater than 90% accuracy. The reasons why vestibular tests in general are non-productive are discussed.

Allied Health Personnel↗
PubMed1977

Progress in vestibular analysis in Omagh.

To sum up, rotational testing forms a valuable role in our system of vestibular analysis. It does not replace history taking, clinical examination, and other vestibular tests, but it does supplement them and in particular it does supplement the caloric test which by itself has many limitations.

Aged↗
PubMed1993

Neurotological findings in patients with acute mumps deafness.

We report the neurotological findings in 4 cases of acute stage hearing loss due to mumps. In 2 of the cases, the less severe hearing loss which occurred in the opposite ear was shown to have improved after therapy. If patients with mumps suffer from a mild hearing loss which recovers quickly, the temporary auditory problem might go undiagnosed; thus the incidence of mumps deafness might well be higher than that reported in the literature. Two of our patients complained of dizziness. In the caloric test, a reduced response of the ear with poorer hearing was found in 3 cases, and a normal caloric response was revealed in the fourth. In the galvanic body sway test (GBST), 3 cases showed a normal response bilaterally and one case presented a normal response bilaterally in the first test, no response in the right side in the second test, and recovery of response in the third test. These findings suggest that an inner ear disorder might occur in combination with a retrolabyrinthine disorder in mumps deafness, with the former lasting longer and the latter improving earlier.

Adult↗
PubMedDate not supplied

[Vestibular function of middle-aged persons exposed to 30-day head-down tilt hypokinesia].

Vestibular responses of 15 men (aged 42-50) to 30-day head-down tilt (-8 degrees) were investigated. The test subjects showed atherosclerotic symptoms and neuro-circulatory dystonia of the hypertensive type. They were exposed to the Fitzgerald-Hallpike caloric test, indirect otolithometry (eye counter-rolling reflex according to the method of successively presented images), and motion sickness according to Bryanov. In the pretest period vestibular changes were seen at the level of labyrinths and central formations (change in the nystagmic pattern, dissociation of the components of the caloric reaction, vestibular asymmetry, negative counter-rolling). During head-down tilt cupular reflexes remained essentially unaltered, except for the asymmetry and enhancement of the sensory and autonomic components of the caloric reaction. The otolith function was modified in all the test subjects. After exposure tolerance to motion sickness was not deteriorated. The time-course variations of the vestibular reactions of the tilted subjects were similar to those seen in young and healthy test subjects. The results of this simulated study suggest that vestibular reactions of crewmembers of the above age group in real space flight should be close to those of the young and healthy crewmembers.

Adaptation, Physiological↗
PubMed2000

Vestibular neuritis: three-dimensional videonystagmography and vestibular evoked myogenic potential results.

Eight patients diagnosed with vestibular neuritis received the newly developed three-dimensional videonystagmography (3D VNG) and vestibular evoked myogenic potential (VEMP) examination in order to localize the lesion site. Two (25%) of the 8 patients exhibited spontaneous nystagmus with 3 components, indicating that both the horizontal semicircular canal (HSCC) and anterior semicircular canal (ASCC) were affected. The remaining 6 patients (75%) displayed only horizontal nystagmus, meaning that only the HSCC was involved. Seven (88%) of the 8 patients had bilateral normal VEMPs, revealing sparing of the posterior semicircular canal (PSCC). In a comparative study, another seven patients with vestibular neuritis 1 year post-treatment also received the caloric test, 3D VNG and VEMP examination. Only one patient exhibited spontaneous nystagmus. An absent caloric response of the lesioned side persisted in 5 (71%) of the 7 patients. However, all patients showed normal VEMPs bilaterally. 3D VNG and VEMP examination indicates that vestibular neuritis mainly affects the superior division of the vestibular nerve, which innervates the HSCC and ASCC. Meanwhile, the function of the PSCC and saccule, innervated by the inferior vestibular nerve, is preserved.

Adolescent↗
PubMed2004

Gamma knife radiosurgery for acoustic neuromas performed by a neurotologist: early experiences and outcomes.

OBJECTIVE: To assess early outcomes after Gamma knife radiosurgery of acoustic neuromas and other skull base tumors. BACKGROUND: Gamma knife radiosurgery is one of the available methods to treat acoustic neuromas, in addition to micro-surgical resection. Neuro-otologists have long been associated with microsurgical resection of these tumors; however, the application of Gamma knife radiosurgery to the treatment of these tumors by neuro-otologists has not been previously described. SETTING: Acoustic Neuroma and Skull Base Surgery Program / Tertiary Referral Center. STUDY DESIGN/PATIENTS/INTERVENTION: Prospective clinical study of all patients treated by the senior author and our gamma knife team beginning in June 2000. MAIN OUTCOME MEASURES: Preoperative MRI, audiometry, vestibular testing and facial nerve electromyography were completed. At six-month intervals postoperatively, audiometry, caloric testing and MRI were performed to determine thresholds and speech discrimination ability, vestibular function, and the size of the tumor. RESULTS: From June 2000 until March 2004, 38 patients were treated, and these included 33 acoustic neuromas, two meningiomas, one glomus jugulare tumor, and two facial neuromas. Greater than 36 month follow-up was available in 7 patients, > 24 months in 24, > 12 months in 31, and > 6 months in 34 patients. Statistically significant reduction in tumor size was seen over time, and tumor control was achieved in all but two patients. Various patterns of changes in auditory function, both in threshold and speech discrimination were observed in either positive or negative directions. CONCLUSIONS: Preliminary experience with Gamma knife radiosurgery indicates that this treatment method represents another option for neuro-otologists to use in managing patients with skull base tumors.

Follow-Up Studies↗
PubMed1991

Detection of the unilateral vestibular recruitment phenomenon using the rotation test.

The possibility of detecting unilateral vestibular recruitment using the rotation test was examined. According to the analogy model of cochlear recruitment, the directional difference of rotation nystagmus reaches its maximum at the threshold stimulus intensity of the affected ear when recruitment is present, and the predicted maximum directional difference remains within the normal variation range when the contribution from the spontaneous nystagmus is removed. Moreover, there was no difference in the positive ratio of recruitment in the rotation test between the two groups evaluated as having positive and negative recruitment on the caloric test. From these results, detection of the unilateral vestibular recruitment phenomenon, when similar to the cochlear recruitment, was concluded to be difficult using the rotation test.

Hot Temperature↗
PubMed1995

Vestibular function test anomalies in patients with chronic fatigue syndrome.

Chronic fatigue syndrome (CFS) is distinguished by the new onset of debilitating fatigue that lasts at least 6 months, concomitant with other symptoms to be described later. Many CFS patients complain of disequilibrium, yet the exact type of the balance dysfunction and its function and its location (peripheral vs. central) have not been described. Herein we report results of vestibular function testing performed on 11 CFS patients. These results revealed no predominant pattern of abnormalities. Patients typically performed below average in dynamic posturography testing, with a significant number of falls in the tests requiring subjects to depend heavily on the vestibular system. One patient had abnormal caloric testing, while 3 had abnormally low earth vertical axis rotation (EVA) gains at the higher frequencies tested. As a group, the average gain of EVA was significantly lower than normals in the 0.1 - 1.0 Hz range (p < 0.05). In earth horizontal axis rotation, the CFS group had a higher than normal bias value for the optokinetic (OKN) and eyes open in the dark conditions (p < 0.05), but had normal scores during visual vestibular reflex testing. Five of the 11 subjects had an abnormal OKN bias build up over the course of the run, equal to or actually exceeding the 60 degrees/s target velocity by as much as 14 degrees/s. Altogether, these results are more suggestive of central nervous system deficits than of peripheral vestibular disfunction.

Adult↗
PubMed2006

Clinical investigation on hypotensive patients with vertigo.

The aim of this study was to investigate the characteristic of hypotensive patients with vertigo. Twenty hypotensive patients with rotatory vertigo, 15 hypotensive subjects without vertigo, and 15 mitral valve prolapse subjects without vertigo underwent a battery of tests including audiometry, electronystagmography (ENG), and vestibular evoked myogenic potential (VEMP) test. The abnormal rates in terms of audiometry, eye tracking, optokinetic nystagmus, visual suppression, and caloric tests were 15, 35, 35, 10, and 42% for the first group; 13, 20, 33, 0, and 0% for the second group; and 7, 13, 60, 0, and 3% for the third group, respectively. Comparison of the first group with the other two control groups revealed that significant difference existed only in the abnormality of caloric responses. Fifteen (75%) of 20 hypotensive patients with vertigo having abnormal ENG results, asymmetric caloric responses, or delayed VEMPs were attributed to vertigo of central origin, possibly from ischemic disorder. In contrast, five patients (25%) had neither central signs in ENG nor abnormal VEMPs, but showing bilateral normal or hyperactive caloric responses were classified as autonomic dysfunction. After 3 months of medication, all patients with autonomic dysfunction had their vertigo and autonomic symptoms subsided, whereas 27% of the patients with ischemic disorder had vertigo persisted, showing a significant difference. In conclusion, hypotensive patients with vertigo could be due to either direct autonomic dysfunction or ischemic disorder mediated by autonomic deficits.

Adult↗