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PubMed1977

Comparative clinical studies of ototoxicity and nephrotoxicity of amikacin and gentamicin.

A comparative study of the oto- and nephrotoxicity of amikacin and gentamicin was carried out prospectively. Twenty-six gentamicin-treated patients and 27 amikacin-treated patients were monitored for changes in auditory and renal function during and after therapy. Thirteen of those treated with gentamicin and 20 of those treated with amikacin underwent vestibular caloric testing which could be evaluated for evidence of toxicity. In four (15.4%) of the gentamicin-treated patients, nephrotoxicity developed; no such toxicity was seen in the amikacin-treated patients. This difference may have been due to a fortuitously higher incidence of pretreatment renal impairment in the gentamicin-treated group. In two gentamicin-treated patients (7.7%), ototoxicity developed (one auditory, one vestibular), and in two amikacin-treated patients (7.4%), auditory toxicity developed. Statistical analysis of oto- and nephrotoxicity and their risk factors was not attempted because of the small numbers of patients who could be evaluated. Additional patients are being studied.

Adult↗
PubMed2006

Abnormal electronystagmography in rheumatoid arthritis.

OBJECTIVE: Although sensorineural hearing loss has been widely investigated in those with rheumatoid arthritis, studies assessing the vestibular system in patients with rheumatoid arthritis are limited. The aim of this study was to assess the vestibular system in patients with rheumatoid arthritis. METHODS: The study consisted of 43 patients with rheumatoid arthritis and 30 healthy controls. Otorhinolaryngologic and neurotologic examinations, pure-tone audiometry, impedancemetry, electronystagmography including smooth pursuit, saccade, positional, and caloric tests were performed in all patients with rheumatoid arthritis and in controls. The erythrocyte sedimentation rate, C-reactive protein level, and rheumatoid factor level were evaluated in all patients with rheumatoid arthritis. RESULTS: Audiograms revealed sensorineural hearing loss in 12 patients (27.9%) with rheumatoid arthritis and in two controls (6.6%); the difference was statistically significant (P=.033). In those with rheumatoid arthritis, the results of electronystagmography revealed central abnormalities in nine patients (20.9%), peripheral abnormalities in three (6.9%), and mixed abnormalities in three (6.9%). Smooth pursuit and saccade tracing impairments were significantly higher in patients with rheumatoid arthritis (P>.05). Canal paresis in patients with rheumatoid arthritis were significantly higher than those in the control group (P=.039). No association was found between electronystagmographic abnormalities in patients with rheumatoid arthritis and age, sex, duration of disease, the results of laboratory testing, sensorineural hearing loss, or medication use. CONCLUSION: Our results suggest an association of rheumatoid arthritis with vestibular system dysfunction as well as auditory impairment.

Acoustic Impedance Tests↗
PubMed2006

Embolic internal auditory artery infarction from vertebral artery dissection.

A 51-year-old man developed sudden vertigo, right hearing loss and dysphagia. Examination revealed right Horner syndrome, spontaneous torsional-horizontal nystagmus, right central type facial palsy, dysarthria, reduced soft palate elevation without gag reflex, left hypesthesia, right dysmetria and imbalance. Audiometry and bithermal caloric tests documented right sensorineural hearing loss and canal paresis. Brain MRI and cerebral angiography documented right lateral medullary infarction from vertebral artery dissection, without involvement of other parts of the brainstem supplied by the anterior inferior cerebellar artery (AICA). This case suggests artery-to-artery embolism as a possible mechanism of isolated vertigo or hearing loss from labyrinthine infarction.

Adult↗
PubMed2006

D-Methionine attenuated cisplatin-induced vestibulotoxicity through altering ATPase activities and oxidative stress in guinea pigs.

Cisplatin has been used as a chemotherapeutic agent to treat many kinds of malignancies. Its damage to the vestibulo-ocular reflex (VOR) system has been reported. However, the underlying biochemical change in the inner ear or central vestibular nervous system is not fully understood. In this study, we attempted to examine whether cisplatin-induced vestibulotoxicity and D-methionine protection were correlated with the changes of ATPase activities and oxidative stress of ampullary tissue of vestibules as well as cerebellar cortex (the inhibitory center of VOR system) of guinea pigs. By means of a caloric test coupled with electronystagmographic recordings, we found that cisplatin exposure caused a dose-dependent (1, 3, or 5 mg/kg) vestibular dysfunction as revealed by a decrease of slow phase velocity (SPV). In addition, cisplatin significantly inhibited the Na(+), K(+)-ATPase and Ca(2+)-ATPase activities in the ampullary tissue with a good dose-response relationship but not those of cerebellar cortex. Regression analysis indicated that a decrease of SPV was well correlated with the reduction of Na(+), K(+)-ATPase and Ca(2+)-ATPase activities of the ampullary tissue. D-Methionine (300 mg/kg) reduced both abnormalities of SPV and ATPase activities in a correlated manner. Moreover, cisplatin exposure led to a significant dose-dependent increase of lipid peroxidation and nitric oxide concentrations of the vestibules, which could be significantly suppressed by D-methionine. However, cisplatin did not alter the levels of lipid peroxidation and nitric oxide of the cerebellum. In conclusion, cisplatin inhibited ATPase activities and increased oxidative stress in guinea pig vestibular labyrinths. D-Methionine attenuated cisplatin-induced vestibulotoxicity associated with ionic disturbance through its antioxidative property.

Adenosine Triphosphatases↗
PubMedDate not supplied

[The role of video-nystagmography in the diagnosis of acoustic neuroma].

AIM: Schwannoma of the vestibular nerve represents 75% of all expansive processes affecting the pontocerebellosum angle. Hearing loss is the most frequent symptom at diagnosis (86%) with or without tinnitus, in the intracanalicular tumors. Vestibular symptoms are described in 60% of patients. MATERIAL AND METHOD: We study twenty cases of acoustic neuromas diagnosed between years 2000 and 2002 in both Otolaryngology and Neurosurgery Departments in our hospital. Videonystagmography (VNG) was performed in all of them. Videonystagmographic findings were analyzed statistically together with the tumoral size and hypoacusia level. DISCUSSION AND CONCLUSION: According to the medical literature reviewed for this paper, we conclude that caloric tests are the most frequently altered ones (77%), showing vestibular hyporreflexia or arreflexia.

Adolescent↗
PubMed1995

Approach to the evaluation of the dizzy patient.

Dizziness is a nonspecific symptom caused by many different pathophysiologic mechanisms. Vertigo, an illusion of movement, indicates a lesion within the vestibular system. The duration of attacks and associated symptoms helps to determine the site of lesion and likely diagnosis. Examination of the dizzy patient should include a careful assessment of gait and balance and a search for spontaneous and positional nystagmus. The vestibulo-ocular reflex can be evaluated qualitatively at the bedside with the doll's eye, dynamic visual acuity, and ice water caloric tests. Each test provides different information about vestibular function.

Dizziness↗
PubMedDate not supplied

Electronystagmographic findings in idiopathic sudden hearing loss.

The electronystagmographic findings for 116 patients with unilateral idiopathic sudden hearing loss (ISHL) were analyzed. For the purpose of the study, three groups were formed: patients with normal electronystagmographic (ENG) findings; patients with mild to moderate vestibular injuries consisting of spontaneous horizontal nystagmus or directional preponderance; and patients with severe vestibular injuries indicated by reduced vestibular responses, including paresis of the semicircular canal or lack of response to caloric testing. Clinical and audiologic findings were compared. High correlations were found between both subjective vertigo and abnormal ENG findings and the presence of profound hearing loss at the onset of ISHL. There was an inverse relationship between recovery from ISHL and the ENG findings, namely, as the severity of the vestibular injury increased, the percentage of patients who achieved recovery decreased. Patients with abnormal ENGs had a greater mean hearing loss at onset of ISHL and less mean recovery of hearing than did patients who had normal ENG findings. In addition, patients who had abnormal ENG findings recovered less fully from hearing loss in the high frequencies than from those in the low frequencies owing to the proximity of the basilar turn of the cochlea to the vestibular sense organ.

Adolescent↗
PubMed2001

Vestibular evoked myogenic potential (VEMP) in patients with acoustic neuromas.

OBJECTIVE: To study the utility of VEMP (vestibular-evoked myogenic potential) in the diagnosis of acoustic neuromas. METHODS: Eighteen patients with unilateral acoustic neuromas were subjected to this study. Myogenic potential responding to loud click stimuli was recorded at ipsilateral sternocleidomastoid muscle. A normal range of VEMP was obtained from 20 controls. VEMP responses were compared with both, clinical symptoms and results of caloric tests. RESULT: Thirteen out of 18 patients showed decreased responses of VEMP at the affected side. VEMP responses seemed to have little relation with dysequilibrium, spontaneous nystagmus, canal paresis and pure-tone hearing. CONCLUSION: VEMP is useful for detecting dysfunction of inferior vestibular nerve in patients with acoustic neuromas.

Adult↗
PubMed1984

[Therapy of tinnitus. Tympanic cavity infusion of lidocaine and steroid solution].

Tinnitus is an otological symptom which is often encountered and is yet difficult to treat. If tinnitus is of cochlear origin then it seems reasonable to assume that a total depression of the cochlear function will abolish cochlear tinnitus. To achieve this depression, transtympanic injections of a local anesthetic (4% Lidocaine) to anesthetize the inner ear and of Decadoron were conducted in a patient suffering from tinnitus. One hundred and sixty-eight patients (220 ears) who had suffered from relatively long-term tinnitus were included in this study. In almost all of the cases the clinical symptoms and the otological findings (i.e., the audiogram and caloric test) indicated that the probable lesion underlying the tinnitus was located within the end organ. In some cases this injection brought a transient (for few days), slight, neurosensorial deafness in the low-frequency range. This auditory disorder, however, was completely restored without sequelae. Our results are summarized as follows: in 76 ears, tinnitus was abolished completely, in 109 ears, tinnitus was considerably ameliorated, in 35 ears, tinnitus was slightly ameliorated or no effect. One hundred and nine patients (138 ears) who had suffered from tinnitus were included in this study. Decadoron was applied to the middle ear cavity by transtympanic injection. Our results are summarized as follows: in 87 ears, tinnitus was abolished, in 39 ears, tinnitus was considerably ameliorated, in 14 ears, tinnitus was slightly ameliorated or no effect.

Dexamethasone↗
PubMed1986

[Classification of optokinetic after-nystagmus and its topographical-diagnostic significance in man].

The existence of optokinetic after-nystagmus (OKAN) has long been known, as far back as the age of Bárány. The term OKAN means nystagmus appearing after first inducing optokinetic nystagmus, and then the optokinetic stimulation is removed. It appears easily with the eyes open in a dark place. There have been various theories about the mechanism of the onset of OKAN. Sakata et al. previously classified the types of OKAN into the following 7 types: 1) The normal type, (2) the directional preponderance type, (3) the disinhibitory type, (4) the inversive type, (5) the inhibitory type, (6) the dysmetric type, (7) the clonic type. In the present study, the authors performed a vestibular equilibrium function inspection, including an OKAN inspection, on about 10,000 patients who visited the Department of Neuro-Otology with complaints of vertigo and equilibrium disturbance. The results of the inspection were classified in accordance with Sakata's method, and the diagnostic contribution of the OKAN inspection was examined. The diagnostic significance of the OKAN inspection is considered as follows: (1) This inspection can detect a very small difference between the left and right of nystagmus in the vestibular-optokinetic system, which difference cannot be detected with OKP inspection giving a rather strong stimulation or with the caloric test giving a non-physiological strong stimulation. (2) This can be a focal localization diagnostic method by the classification by type.

Humans↗
PubMed1997

Ultrastructural analysis of the vestibular nerve in Ménière's disease.

Numerical analysis of the vestibular nerve in Méniè's disease was performed. Vestibular nerve specimens were obtained from three patients with classical clinical findings of Ménière's disease during retrosigmoid vestibular neurectomy. For each patient, an ultrathin section, including an entire cross-section of the nerve specimen, was examined. Fiber counts of nerve specimens with definite pathologic findings were compared with caloric testing results. A significant correlation was found between reduced vestibular response and the incidence of abnormal nerve fibers and also the density of the abnormal nerve fibers. However, the number of nerve fibers with pathologic findings was small. Results of the present study demonstrate no general degeneration of nerve fibers caused by the disease process of Ménière's disease.

Adult↗
PubMed1991

Prognostic significance of hearing loss as a lateralizing indicator in the surgical treatment of vertigo.

In patients with peripheral vertigo the presence of an asymmetrical hearing loss is an important lateralizing sign, having both diagnostic and prognostic significance. In a consecutive series of 83 patients undergoing retro-labyrinthine vestibular nerve section for uncontrolled vertigo, asymmetrical hearing loss was associated with an 83 per cent incidence of complete control of vertigo and a 49 per cent incidence of complete relief from dysequilibrium. In the absence of a lateralizing hearing loss, the figures were 50 per cent and 24 per cent respectively (p less than 0.01 and p less than 0.05). The explanation for this finding may be that the presence of a hearing loss is more often associated with an exclusively peripheral disorder (controllable by peripheral surgical ablation), whereas in patients with symmetrical hearing there may be an unrecognized central or contralateral pathology resulting in less effective results from a unilateral peripheral surgical approach. The bithermal caloric test did not give such useful diagnostic or prognostic information.

Evaluation Studies as Topic↗
PubMed1991

Gentamicin administration via peritoneal dialysis fluid: the risk of ototoxicity.

In a prospective study on 47 patients, 16 mg of gentamicin per two litres dialysate was administered intraperitoneally at every cycle of intermittent peritoneal dialysis, carried out over the course of several days. Serum gentamicin sampling, pure tone audiometry and caloric tests were performed before and during the treatment. The gentamicin levels reached at the end of the thirtieth cycle were observed to be low. In view of this, the risk of acute ototoxicity was considered to be minimal. This was confirmed by the absence of clinical audiometric or vestibulometric evidence of toxicity.

Audiometry, Pure-Tone↗
PubMed1995

Unilateral hearing loss due to a rhabdomyoma in a six-year-old child.

A case report of a six-year-old child is presented, who had had a unilateral sensorineural hearing loss for several years. Because of impairment in the ABR as well as in the caloric testing a MRI and CT scan were performed. A 17 mm tumour in the cerebellopontine angle (CPA) was detected, which after suboccipital surgery proved to be a rhabdomyoma. This tumour has not been described before in the CPA. Unilateral sensorineural hearing loss should, at all ages, be an indication for further (radiodiagnostic) investigations.

Cerebellar Neoplasms↗
PubMed1999

The effect of severity of unilateral vestibular dysfunction on symptoms, disabilities and handicap in vertiginous patients.

This study compares the symptoms, disabilities and handicap, as assessed by means of a questionnaire, in two groups of patients with a unilateral peripheral vestibular disorder: those with a total canal paresis and those with a partial canal paresis, as judged by the duration parameter using the Fitzgerald Hallpike caloric test in the absence of optic fixation. The results of the study indicate that the severity of dizziness, the Dizziness Index (severity x frequency) and the overall level of disabilities related to visual vertigo are less severe in unilateral profound or total loss of vestibular function than in unilateral mild vestibular loss.

Case-Control Studies↗
PubMed2002

Idiopathic paroxysmal kinesigenic choreoathetosis: precipitation of attacks by vestibular stimulation.

A 24-year-old woman presented with a 3.5-year history of paroxysmal dystonia that was precipitated by sudden movement, especially when she started to walk. It was characterised by shrugging of shoulders, flexion of the neck and thoracic spine, and stiffness of the right leg followed by falls. Each attack lasted for less than 5min. Inadequate sleep and stress were exacerbating factors. There was no similar family history. Physical examination and investigations were normal. The following manoeuvres that caused vestibular stimulation precipitated attacks: turning her head from side to side while standing still, sitting still on a rotating chair and an ice-water caloric test. She had partial responses to phenytoin and levodopa, and a good response to haloperidol. Vestibular stimulation as a precipitating factor in paroxysmal kinesigenic choreoathetosis has not been reported previously.

Adult↗
PubMed2006

[Lipoma of the cerebellopontine angle - a case report].

BACKGROUND: Lipomas of the cerebellopontine angle are rare. Until today in the english literature only isolated cases are described. The most frequent symptoms are: hearing loss (62,2 %), vertigo (43,3 %) and tinnitus (42,2 %). With the help of MRI intracranial lipomas can be diagnosed almost certainly. PATIENT: A 26 year old patient presented himself to our outpatient departement with recurrent vertigo and tinnitus since two months. Electronystagmography and caloric testing showed a unilateral weakness of the right vestibular organ. Audiometric examination revealed a Normacusis on the right side. BERA resulted in borderline prolonged interpeaklatency on the right side, wave I-V. MRI showed a ca. 5x8x11 mm Lipoma of the right cerebellopontine angel which surrounded the vestibulocochlear nerve. In contrast to schwannomas which are often described in this area the lesion did not enhance contrast medium. On the native T1 sequence the tumor was hyperintense and fat-supression images confirmed the tumor to be fat in origin. Because of the minor symptoms and the small size of the tumor we recommended a BERA after six months and an MRI every year. CONCLUSION: The therapeutic options of a lipoma of the cerebellopontine angel depend on the clinical symptoms and a radiologic confirmed progression of size. Because of the received data until today an operative therapy is only indicated when symptoms clinically can not be treated or the leason seems to be a well differentiated liposarcoma.

Adult↗
PubMed1989

[Long-term results of gentamycin therapy of Menière's disease].

During the years 1976 to 1987, 82 patients with Ménière's disease received a tympanoclysis with gentamicin on a daily basis. Dosage was titrated up to the initial symptoms of vestibular or cochlear intoxication. Sixty-four patients filed for a complete follow-up examination; it was possible to interview 15, while three patients were lost. Vertigo was eliminated in 70 (89%) cases. Nine patients (11%) remained disabled, while demonstrating typical paroxysmal positional vertigo in three cases. Speech discrimination improved in 13%, stabilized in 54%, and deteriorated in 33%. Hearing improved significantly better if, preoperatively, there had been low frequency loss rather than a flat audiogram. HALLPIKE's caloric test demonstrated residual vestibular activity in 72 percent. In the author's opinion, tympanoclysis with gentamicin offers a technically simple, riskless, and effective method to rehabilitate patients with disabling Ménière's disease.

Adolescent↗