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PubMed1982

Vestibular dysfunction in Parkinson disease.

Symptoms and signs of postural instability are often present in patients with Parkinson disease (PD). Because vestibular dysfunction might contribute to the postural instability, we carried out bithermal caloric tests and electronystagmography in 36 patients with PD and 316 controls. Significantly more PD patients had reduced and absent vestibular responses than controls. Decreased or absent vestibular responses in patients with PD were associated with postural instability and increasing severity of other symptoms. Vestibular dysfunction may contribute to the postural instability of PD.

Aged↗

PubMed1987

Benign positional vertigo: clinical and oculographic features in 240 cases.

We report the clinical and oculographic features in 240 patients with benign positional vertigo (BPV). In each case, after a rapid position change from the sitting to head-hanging position, a stereotyped torsional paroxysmal positional nystagmus was visually observed and recorded with electronystagmography (ENG). The mean age of onset was 54 years, with a range of 11 to 84 years. In slightly more than one-half of the cases (122/240) a likely diagnosis was determined. The most common identifiable causes were head trauma (17%) and viral neurolabyrinthitis (15%). Females outnumbered males approximately two to one in the idiopathic group. Abnormalities on bithermal caloric testing were found in 47% of patients. Only two patients, both with well-documented neurologic disorders, had central signs on ENG. Our data are consistent with a peripheral, posterior semicircular canal origin of BPV.

Adolescent↗

PubMed1995

Repetitive paroxysmal nystagmus and vertigo.

A 55-year-old woman had paroxysms of vertigo and visual blurring associated with complex combined torsional, horizontal, and vertical nystagmus. These episodes occurred regularly at 2-minute intervals, each attack lasting for 15 seconds. Between attacks, there was a much finer asymptomatic nystagmus whose components were in the opposite direction to those associated with the paroxysmal attacks. A brain MRI revealed an arteriovenous malformation in close proximity to the left vestibular nucleus, with evidence of previous bleeding. Caloric testing demonstrated a left-sided vestibular paresis. We suggest that neurons in this patient's damaged left vestibular nucleus are usually underactive but regularly produce pathologic brief bursts of hyperactivity causing episodic reversal and gross exacerbation of her resting nystagmus. Treatment with low-dose carbamazepine was successful in abolishing both the paroxysms of nystagmus and the symptoms of vertigo and visual disturbance.

Arteriovenous Malformations↗

PubMed1975

Vestibular involvement in Bell's palsy.

Vestibular involvement in the acute phase of idiopathic facial paralysis (Bell's palsy) was observed in 22 percent and 14 patients. These patients were evaluated by history, physical examination and caloric tests with electronystagmography (ENG) employing the Cawthorne-Hallpike technique. Bell's palsy has been considered a mononeuropathy limited to the facial nerve. Evidence of occasional involvement of other cranial nerves (Vth and/or VIIIth) suggests a polyneuropathy. Several theories have been advanced to explain the involvement of the vestibular nerve.

Facial Paralysis↗

PubMed1976

Microscopic characteristics of the acoustic tumor in relationship of its nerve of origin.

The microscopic characteristics of a 0.9 cm vestibular schwannoma en bloc resected with its nerve of origin which occurred in a 54-year-old white woman presenting with a two-year history of a unilateral progressive sensori-neural hearing loss is described. The tumor originated in the inferior vestibular portion of the vestibular division of the VIIIth cranial nerve just medial to the internal auditory canal meatus at approximately the level of the glial-non-glial junction. The tumor demonstrated two distinctly different, yet simultaneous, modes of involvement with its nerve of origin: 1. inseparable cellular continuity; and 2. peripheral compression of the remainder of the nerve within the tumor capsule. Despite only slight microscopic continuity of the nerve histologically, electronystagmography showed no unilateral weakness on bithermal caloric testing, and pure tone and speech audiometry was only moderately depressed.

Audiometry↗

PubMed1989

[Unilateral nerve deafness due to rupture of a right vertebral artery aneurysm. Case report].

A 49-year-old female with no history of hearing disturbance developed sudden onset of headache and was admitted with no neurological deficits other than mild nuchal rigidity. Computed tomography (CT) showed subarachnoid hemorrhage. Four-vessel cerebral angiography disclosed no aneurysm. A second angiogram obtained on the 14th day showed vasospasm of the bilateral posterior cerebral arteries and right anterior inferior cerebellar artery, but still failed to demonstrate an aneurysm. Following the second angiography, she developed mild disturbance of consciousness and cerebellar ataxia of the right limbs, and repeat CT showed an infarct in the right cerebellar hemisphere. When she regained consciousness a few days later, she was completely deaf on the right side. The third angiography revealed a right vertebral artery dissecting aneurysm. Following clipping of the proximal portion of the right vertebral artery, she did well and was discharged, although right cerebellar ataxia and deafness persisted. Neuro-otological evaluation, including pure-tone audiography, auditory brainstem responses, electrocochleography, and caloric testing, indicated that her deafness resulted from ischemia in the territory of the right internal auditory artery due to vasospasm.

Deafness↗

PubMed2003

Reversible bilateral vestibular impairment caused by fourth ventricle epidermoid tumor.

A 26-year-old man presented with an epidermoid tumor of the fourth ventricle manifesting as headache with nausea and vertigo. Neurological examination revealed no cerebellar signs, except nystagmus. Bilateral vestibular impairment was identified by the caloric test. The tumor was removed via the midline suboccipital approach. The bilateral peripheral vestibular function recovered remarkably postoperatively. This marked improvement suggests that the bilateral vestibular impairment was caused by compression of the vestibular nuclei by the tumor.

Adult↗

PubMedDate not supplied

[Audiologic diagnostics of vestibular schwannoma].

INTRODUCTION: Vestibular schwannoma (acoustic neuroma) is a rare, but important cause of sensorineural hearing loss. Patients with asymmetric hearing loss, or unilateral tinnitus should be evaluated expeditiously, to prevent further neurological damage. AUDIOLOGIC DIAGNOSTICS: Audiologic diagnostics represents the basic diagnosis for early detection of vestibular schwannoma. Patients with vestibular schwannomas may present with a variety of clinical features, including retrocochlear pattern of sensorineural hearing loss. Supraliminary audiometry, tympanometry, stapedius reflex and otoacoustic emissions as well as vestibular response to caloric testing are methods for selection of patients with suspicion of this tumor. CONCLUSION: The golden standard for audiologic diagnostics of vestibular schwannoma is BAEP (Brainstem Auditory Evoked Potentials). Patients with pathological findings of BAEP should undergo MRI of the posterior fossa. Gadolinium-enhanced magnetic resonance imaging is the best and final tool for making a diagnosis of vestibular schwannoma.

Audiometry↗

PubMed2002

A matched-pair comparison of two cochlear implant systems.

OBJECTIVES: To compare the overall performance of two implant systems based on audiologic outcome, tinnitus handicap, and quality of life using objective and subjective measures. DESIGN: Retrospective cohort study. SETTING: Sunnybrook & Women's College Health Science Centre. METHODS: Two matched groups, with 24 Nucleus 22 SPEAK (Advanced Bionics, Symlar, CA) and 24 Clarion CIS (Cochlear Corporation, Sydney, Australia), were selected. Patients were administered survey forms to evaluate subjective tinnitus and dizziness symptomatology, as well as a 27-item tinnitus handicap questionnaire. Both groups were administered survey forms to assess the frequency of implant use, the subjective benefit derived, and the perceived impact on quality of life. The 36-Item Short-Form (SF-36) Health Survey was administered as a measure of quality of life at 6 months postimplant. Standardized open-set speech recognition parameters were evaluated at 24 months postimplant. Vestibular function was determined by pre-and postimplant electronystagmography with caloric testing. The first author was blinded to implant type during data collection and analysis RESULTS: Cochlear implantation yielded a significant 22% reduction in overall tinnitus handicap (p < .05). There was a 27% reduction in vestibular function that failed to show statistical significance (p = .78). There was no significant reduction in vestibular function postimplant in either group. The average open-set speech perception responses at 24 months postimplant were monosyllabic word recognition 45%, phoneme recognition 65%, and sentence recognition 86.5%. There was no significant difference with respect to implant type. Overall, 76% of implantees reported satisfaction with the amount of subjective benefit they received from their implants. Furthermore, 96% reported an overall positive impact on quality of life. CONCLUSION: Overall, there was no significant difference between the two multichannel devices studied using the present software and hardware configurations.

Adult↗

PubMed1984

Harmonic acceleration as a measure of vestibular compensation.

The results of conventional electronystagmography (ENG) sometimes are confusing. The Hallpike alternate binaural bithermal (ABB) caloric test is helpful diagnostically except for the group of "sick patients that have a normal test". Conventional ENG tests also fall short in the area of objective confirmation of patient progress. What does each test tell us regarding site of lesion? Alternate binaural bithermal stimulation gives us information about the semicircular canals--particularly the horizontal semicircular canal--pickup head. Simultaneous binaural bithermal stimulation gives information about brain stem connections--switching and relay. Rotation testing gives information about the processing by the brain--central control.

Humans↗

PubMed1984

Influence of long-term repetitive rotatostimulations on lateral semicircular canals.

Sixty-five guinea pigs were used to investigate the influence of rotatostimulations on the lateral crista ampullaris. After repeated turning stimulations with the cupulometric mode (the terminal turning velocity: 180 degrees/sec) for 24-72 hours, the morphological changes in the crista ampullaris on the ampullopetal flow side were compared with those on the ampullofugal flow side by using scanning and transmission electron microscopy. Postrotatory nystagmus recorded by ENG during this experiment revealed the response decline phenomenon in all animals, and the caloric test performed after the rotatostimulation showed 'canal paresis' in the ear on the ampullopetal flow side. In a group stimulated for 24 hours, no particular damage on the crista ampullaris was noticed. However, in a group stimulated for 72 hours, local damage was dominant in the central part of the crista, which showed a tendency to extend towards the planum semilunatum according to an increment of changes. These findings were more remarkable on the ampullopetal flow side than on the ampullofugal flow side, suggesting the predominant effect of the ampullopetal endolymph flow in the lateral semicircular canal.

Animals↗

PubMed1988

Internal auditory canal vascular loops and sensorineural hearing loss.

The relationship between vascular loops in the internal auditory canal and VIII nerve disorders was examined by performing pneumatic computerized tomographic (CT) cisternography in patients with idiopathic sudden deafness, idiopathic sensorineural hearing loss, and Meniere's disease. The incidence of vascular loops was higher in the diseased group than in the control group, viz. 19 of 61 cases (30%) in the former, compared with only 6 of 88 cases (7%) in the latter. The loops were classified as of Types I-IV according to the proximity to the fundus of the internal auditory canal. A large proportion of the loops found in the diseased group were classified as Type II or III. In most of the patients with vascular loops, the hearing loss was of the cochlear type, and in most cases, normal responses were obtained by the caloric test. Therefore, we concluded that vascular loops may be a possible cause of VIII nerve disorders and that this mechanism may involve circulatory disorder.

Ear, Inner↗

PubMed1989

Retro-labyrinthine disorders detected by galvanic body sway responses in routine equilibrium examinations.

Galvanic stimulation applied to the head provides important information for differential diagnosis between inner ear and retro-labyrinthine disorders of the vestibular system. So far, galvanic stimulation has been difficult to introduce in routine practice because of side effects such as severe pain around the electrode area. We have developed a new method to record fine body sway elicited by low current stimulation of less than 0.4 mA and to quantitatively evaluate the responses by Fourier transform. During the past 5 years, 502 patients, showing uni- or bilateral canal paresis in the caloric test or findings of central disequilibrium, were tested by this method without producing any side effects. In 122 patients (24.8%), such as sudden deafness, acoustic tumour, vascular disorders of the CNS system and so on, findings of retro-labyrinthine disorders were detected. It has been concluded that this method was easy to perform and very useful for differential diagnosis of diseases of the vestibular system.

Aged↗

PubMed1989

Comparative study on computed tomography and neurotological findings in spinocerebellar degeneration.

The classification of SCD on the basis of the neurotological findings was with classification based on CT findings in 40 cass of SCD. The areas of pons, cerebellar hemisphere, vermis and posterior fossa on CT films were measured by craniometer, and were compared in order to estimate the degree of atrophy. From these assessments, patients were classified into 3 types as follows; (1) 14 cases of cerebellar type, (2) 9 cases of brain stem type and (3) 17 cases of combined type. The classification of SCD based on the neurotological findings including the findings of gaze test, positioning test, eye tracking test, OKN, and fixation suppression test of caloric nystagmus, was well correlated to the classification based on CT findings. From the results, neurotological examination was demonstrated to make a contribution to the estimation of lesions and types in SCD.

Caloric Tests↗

PubMed1991

Ablation of otolithic organs with argon laser.

Utricular maculae of guinea pigs were irradiated by argon laser through the oval window without touching the perilymph. The stapes was replaced in the oval window after irradiation. The inner ear was studied morphologically and physiologically. Argon laser beam caused detachment of the sensory epithelium from the basement membrane of the utricular macula. The lesion was round and localized at the site of irradiation. The epithelium changed to a layer of cuboidal cells after 2 to 3 weeks at the irradiated spot. Degeneration of the epithelium gradually spread to the periphery, and total loss of sensory epithelium was observed 10 weeks after irradiation. Hearing was preserved, and caloric test showed normal response.

Acoustic Maculae↗

PubMed1996

Diplopia from skew deviation in unilateral peripheral vestibular lesions.

Vertical diplopia from skew deviation is well described in brainstem lesions. The phenomenon can also result from peripheral vestibular lesions. During the past years, we have observed these ocular changes in the acute stage following unilateral vestibular neurectomy and labyrinthectomy (n = 13), as well as in series of patients suffering from idiopathic sudden unilateral peripheral vestibular or cochleo-vestibular deficit (n = 5). Diplopia from skew deviation was noted immediately following ablative vestibular procedures; in patients with idiopathic vestibular deficit, it was observed as an associated sign. In all patients, clinical evaluation revealed an acute unilateral peripheral vestibular loss, with spontaneous nystagmus toward the unaffected ear and absence of nystagmic response to caloric testing on the affected ear. Skew deviation was measured using the Hess-Weiss test, which is based on the haploscopic principle. Static visual vertical was evaluated with the original methods of vertical frame and Maddox rod techniques. Photographs were made of the ocular fundi, to measure the degree of cyclotorsion of both eyes. In our patients, we found skew deviation with hypotropia of the eye that was ipsilateral to the affected ear and conjugated cyclotorsion and tilt of the static visual vertical on the side of the affected ear. Skew deviation was the first sign to disappear within a few days; conjugated cyclotorsion and tilt of the static visual vertical persisted for weeks to months. The eye-head postural reaction, consisting of head tilt, conjugated eye cyclotorsion, skew deviation, and alteration of vertical perception directed toward the side of the lesion, is known as the Ocular Tilt Reaction (OTR). The mechanism is presumably related to a lesion of the otolithic organs and/or to changes in the afferent graviceptive pathways. In man, the OTR is often mild and unrecognized, masked by spontaneous nystagmus and marked neuro-vegetative symptoms. Our observations indicate that skew deviation, as a part of the OTR, occurs in patients with sudden peripheral vestibular lesions, whether surgical or non-surgical in origin.

Adult↗

PubMed1989

Electronystagmographic findings and recovery of cochlear and vestibular function in patients suffering from sudden deafness with a special reference to the effect of anticoagulation.

The study included 80 patients treated for sudden deafness over the last 5-7 years. Case history, laboratory findings, pure-tone audiogram and electronystagmography (ENG) findings were noted. If any abnormalities had been recorded in ENG studies, the studies were redone. ORL status was redefined and audiograms were obtained in all patients. When becoming ill, the 80 patients had not differed from the normal population in common cardiovascular risk factors. None of them had had signs of viral infection (paired serum samples had been taken at 2-week intervals; routine examinations had been done for common viral antigens). As many as 31 of the 80 patients with acute hearing loss had had abnormalities such as spontaneous nystagmus (PN), hypoexcitability (HE) and directional preponderance (DP) in the bithermal caloric tests (+44 degrees C, + 30 degrees C) of their ENG studies. Twenty of the 31 patients still had abnormal ENG studies after 5-7 years. Only 1 subject had positional nystagmus, and none had subjective vertigo. Patients with an abnormal ENG study showed a poor recovery of the speech reception threshold, whereas those with a normal ENG study showed slightly significant (p less than 0.05) recovery.

Administration, Oral↗

PubMed1988

Clinical application of brain-stem audiometry.

Based on the examination of 249 consecutive patients, the usefulness of brain-stem response audiometry in a major audiological clinic was evaluated. Auditory brain-stem responses were performed either for hearing threshold determination (67 patients) or for assessment of retrocochlear hearing loss (182 patients). The results demonstrate that ABR is a reliable method for the estimation of hearing thresholds in non-cooperative subjects. The rate of false positives was 5% and no false negatives were found. In combination with caloric testing, ABR is considered a valuable testing procedure in the audiological clinic and it may form the basis for submission to brain imaging examination when a suspicion of retrocochlear hearing disorder is raised. Concerning the diagnosis of retrocochlear hearing disorder, no false negatives have yet been found, while a rate of 13% of false positives has been indicated.

Adolescent↗