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PubMed1983

Physical and behavioral aspects of middle ear disease in school children.

Middle ear disease is today's primary aural health problem in school-age children. Until recently, pediatric health researchers were aware only of the medical consequences that middle ear disease had no children. Except in a few cases of chronic otitis media, the effects of middle ear disease were considered transitory. However, current research on middle ear disease suggests permanent changes in hearing sensitivity, reduced development of the auditory neural network and developmental delays in speech, language and cognitive skills dependent on hearing. This article presents a review of recent studies on the physical and behavioral aspects of middle ear disease and its sequelae in school children.

Auditory Pathways↗
PubMed1999

The interaction of otolith and proprioceptive information in the perception of verticality. The effects of labyrinthine and CNS disease.

A review of recent experiments in patients with labyrinthine and neurological disorders assessing the subjective postural vertical (SPV) and the subjective visual vertical (SVV) is presented. The SPV was measured with subjects (Ss) seated in a motorized flight simulator tilting at 1.5 deg/s in roll and pitch; the Ss' task was to indicate when they entered and left self-verticality. The SVV was measured by Ss adjusting a straight line to what they perceived as gravitational upright. Clear dissociations between the SVV and SPV were found, for example, patients with acute unilateral vestibular disorders had marked tilts of the SVV toward the side of the lesion but a "lean" (bias, tilt) of the SPV was never found. Dissociations of the SPV and SVV could also be induced in normal subjects by roll-plane visual motion stimuli: the SVV was tilted in the direction of motion, but the SPV was not. Prolonged lateral body tilt did, however, bias the SVV (the "A" effect) and the SPV, but these effects are likely to be mediated by somatosensory rather than otolithic input. Evidence for the latter came from (i) findings in patients with absent vestibular function, who showed an enhanced "A" effect, and (ii) from a patient with a thalamic infarction, who showed absence of the "A" effect when leaning on the hemihypesthetic side. In separate experiments where normal Ss indicated space-vertical and space-horizontal with saccadic eye movements, we found differences between these percepts, that is, subjective external space lost orthogonality. The findings in these various experiments can be interpreted if we abandon the idea of a single, "internal representation" of verticality. Different sensory modalities convey different and sometimes conflicting messages about verticality. Otolithic and somatosensory signals can have opposite sign effects during verticality estimates while tilted. In man, somatosensory cues have a prominent role in verticality perception.

Body Image↗
PubMed1987

Visual postural performance after loss of somatosensory and vestibular function.

Visual stabilisation of body sway in a patient with severe deficits of the vestibular system (due to gentamicin treatment) and the somatosensory system (due to polyneuropathy) was studied. With eyes open the patient was able to stand and walk slowly. With eyes closed he lost balance within one second. In order to optimise visual stabilisation he intuitively searched for nearby visual targets. His postural sway was recorded using posturography. His balance performance deteriorated significantly beyond a distance of 1 m between the eyes and the surrounding objects and with visual acuity below 0.3 (experimentally achieved with semitransparent plastic foils). With flicker illumination of decreasing frequencies of the visual surround he needed at least a visual input rate of 17 Hz in order to maintain an upright body position. The data provide clinical evidence for rapid visuo-spinal control of posture.

Adult↗
PubMed1978

Flunarizine and cinnarizine as vestibular depressants. A statistical study.

The authors analysed the vestibular depressant activity of flunarizine and cinnarizine, as compared to a placebo, in 58 patients with peripheral labyrinthine disorders. The activity of the medications was judged by the reduction of the average velocity of the slow phase of the post-caloric nystagmus, before and after treatment. In spite of being administered in a smaller dosis, flunarizine appeared to have a more intense vestibular supressant activity, as judged by different statistical tests.

Caloric Tests↗
PubMed1982

Oculomotor abnormalities after labyrinthine and cerebellar lesion. A case report.

A subject presenting a rare association of left labyrinthine and left hemispheric cerebellar lesion was examined, with recording and analysis of eye movements at different intervals. A complete compensation of the vestibular deficit and recovery of cerebellar postural ataxia, with persistence of limb incoordination and oculomotor abnormalities, were observed. The saccadic, smooth pursuit and optokinetic nystagmus systems were impaired. Ocular signs, in combination, may suggest a cerebellar dysfunction but they do not supply sufficient diagnostic criteria for localizing the cerebellar damage. Only the direction-specific impairment of smooth pursuit and optokinetic nystagmus is indicative of the side of the lesion.

Ataxia↗
PubMed1984

Management of the labyrinthine fistula in cholesteatoma surgery.

The presence of a labyrinthine fistula has remained one of the major problems in cholesteatoma surgery. Confronted with this problem, the surgeon may ultimately base his choice of procedure on four basic conditions: the size of the fistula, its location in the ear, the condition of the other ear, and the cochlear function. Our attitude has been changing, and currently we prefer to perform a staged closed tympanoplasty. When a closed technique is performed, we either remove the cholesteatoma matrix and then cover the fistula immediately or we leave the matrix in situ and re-explore the mastoid process 5 or 6 months later. The series consists of 88 cases out of a total of 701 patients with cholesteatoma operated on between January 1971 and June 1982. In 20 patients the matrix was left over the fistula at the first stage. The results suggest that a staged operation, i.e. closed tympanoplasty, is to be preferred even in cases with an extensive labyrinthine fistula.

Cholesteatoma↗
PubMed1987

Vestibular habituation training and posturography in benign paroxysmal positioning vertigo.

A number of cases with typical positioning vertigo (BPPV) show a unilateral vestibular hypofunction (UVH) by caloric testing. However, treatment by habituation exercises (VHT) improves vertigo independently of the presence of UVH. Moreover, VHT has no influence upon the results of caloric and rotation tests. These findings prove the independence of the pathogenetic mechanisms of the peripheral vestibular disturbances UVH and BPPV.

Caloric Tests↗
PubMedDate not supplied

The pharmacology of auditory and vestibular systems.

Pharmacologists are among the most recent basic medical scientists to apply themselves to the auditory and vestibular systems. They bring to the subject a fresh perspective and, uniquely, the ability to control biological processes through drugs. Interest in the auditory and vestibular systems among pharmacologists has focussed on: the drug-sensitive processes (primarily but not exclusively neuro-transmission); toxicology, and pharmacotherapy. Pharmacology holds the promise of shedding further light on auditory and vestibular function and ameliorating auditory and vestibular dysfunction.

Auditory Cortex↗
PubMed2003

Benign paroxysmal positional vertigo in older women may be related to osteoporosis and osteopenia.

Benign paroxysmal positional vertigo (BPPV), so-called canalolithiasis and cupulolithiasis, usually occurs after head trauma or viral vestibular neuritis. In many cases, the cause remains obscure, and it often affects women more than 50 years old. The goal of this work was to study a possible relationship between BPPV and osteopenia or osteoporosis. Thirty-two women, whose ages ranged from 50 to 85 years (median age, 69 years), who had BPPV and were free of any other otoneurologic history, were selected. The diagnosis of osteopenia or osteoporosis was confirmed by a bone mineral density measurement made with dual x-ray absorptiometry of spine and hip (T-score). The BPPV was unilateral in 26 patients and bilateral in 6 patients. Our results showed osteopenia or osteoporosis in 24 of the 32 patients (75%) with BPPV. The T-scores were compared in 3 age groups to those of 83 healthy women. The patients with BPPV had a significantly lower (p < .026) T-score in all groups. Possible pathophysiological mechanisms are discussed to explain the apparent correlation between BPPV and osteopenia or osteoporosis.

Aged↗
PubMed2006

Prospective study of positional nystagmus in 100 consecutive patients.

OBJECTIVES: The purpose of this study was to investigate the various diagnoses of patients who present with positional nystagmus. METHODS: Positional maneuvers were systematically performed in the plane of the posterior canal (PC; Dix-Hallpike maneuver) and the horizontal canal (HC; patients were rolled to either side in a supine position) on 490 consecutive patients essentially referred for vertigo and/or gait unsteadiness. RESULTS: One hundred patients (20%) presented positional nystagmus. This nystagmus had a peripheral origin in 83 patients, including 80 patients with benign paroxysmal positional vertigo (BPPV). In BPPV, the PC was involved in 61 patients, the HC in 18 patients (geotropic horizontal nystagmus in 11 and ageotropic in 7; changing from geotropic to ageotropic or the reverse in 4 patients), and both the PC and HC in 1 patient. There was evidence of central positional nystagmus in 12 patients, including positional downbeat nystagmus during the Dix-Hallpike maneuver in 7 patients with various neurologic disorders, and ageotropic horizontal nystagmus during the HC maneuver in 2 patients with, respectively, cerebellar ischemia and definite migrainous vertigo. The peripheral or central origin of the positional nystagmus could not be ascertained in 5 patients, including 1 patient with probable migrainous vertigo and another with possible anterior canal BPPV. CONCLUSIONS: A rotatory-upbeat nystagmus in the context of PC BPPV, a horizontal nystagmus, whether geotropic or ageotropic, due to HC BPPV, and a positional downbeat nystagmus related to various central disorders are the 3 most common types of positional nystagmus. Geotropic horizontal positional nystagmus and, most certainly, horizontal positional nystagmus changing from geotropic to ageotropic or the reverse point to HC BPPV. In contrast, an ageotropic horizontal positional nystagmus that is not changing (from ageotropic to geotropic) may indicate a central lesion.

Adult↗
PubMedDate not supplied

Natural history of sudden sensorineural hearing loss.

This is a prospective in-depth study of patients with sudden idiopathic sensorineural hearing loss. We found that 65% recover completely to functional hearing levels spontaneously and independent of any type of medical treatment. The majority do so within 14 days and many within the first few days. Prognosis can be predicted according to the slope of the initial audiogram (low-frequency losses do better than high-frequency losses), hearing at 8 kHz, erythrocyte sedimentation rates, in some select instances spatial disorientation symptoms, and speech discrimination scores. There was a very poor correlation between hearing and vestibular test abnormalities, except hypoactive calories. There were no correlations with age (excepting the very elderly), with antecedent respiratory infections, hypertension, diabetes, or other chronic diseases. We conclude that there is a fundamental difference in the behavior of apical and basal cochlea losses, that hearing recovery is always better at low than at high frequencies, that because of the high spontaneous recovery rates, tympanotomies seeking peri-lymph fistulas should be delayed ten days unless there is a progressive hearing loss, and that none of the current recommended treatments, especially histamine, have any effect on the outcome.

Adolescent↗
PubMedDate not supplied

Screening procedure for detection of middle ear and cochlear disease.

Experiences from a six-year study in which 11,772 seven-year-olds have been tested with a combination of the pure tone sweep check test and impedance audiometry (tympanometry and stapedius reflex test) are presented. During the study there has been a gradual change in the screening level. The goal has been to find an ideal screening level in which the results from the screening procedure correspond as much as possible to the findings of the otologist. Analysis of the results from the stapedius reflex test demonstrated that in ears in which the middle ear pressure was within +/- 50 mm H2O the stapedius reflex test could not be elicited in 1.9% of the ears when the maximum output of the audiometer was used (110 dB SPL ipsilateral stimulation); in the ears with middle ear pressure within +/- 150 mm H2O the stapedius reflex could not be elicited in 6.1% using the maximum output of the audiometer. Based on the experiences from our studies it is therefore recommended that the stapedius reflex test be excluded from the test battery and that pure tone screening supplemented by tympanometry be used. A middle ear pressure of less than or equal to -150 mm H2O or a flat tympanogram and/or tone screening levels > 20 dB HTL at 0.5 kHz and/or 4 kHz are considered as indicative of ear pathology.

Acoustic Impedance Tests↗
PubMedDate not supplied

The optokinetic test and the ENG test battery.

The importance of including optokinetic nystagmus as part of a more comprehensive visual test battery in ENG testing is discussed. Useful clinical information may be obtained which not only may confirm the presence of peripheral disease, but also may reveal evidence of disturbed central vestibular function. The technique and some of the diagnostic possibilities are described.

Brain Diseases↗
PubMedDate not supplied

Hearing impairments and vestibular abnormalities among children with subclinical cytomegalovirus.

This paper strengthens the importance of neonatal screening in the early identification and etiological specification of hearing loss by demonstrating that subclinical cytomegalovirus (CMV) is the most common viral agent causing sensorineural hearing loss (SNHL) among pediatric patients. Consequently, if hearing impairment is found on neonatal screening, viral studies should be done at once. In addition to a survey of previous literature, these points are presented from a retrospective study of 14 children with SNHL caused by focal CMV. Moreover, vestibular studies are presented which suggest that hearing and vestibular impairments may operate independently of one another or conjointly in patients infected with CMV.

Adolescent↗