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PubMed1982

Bobbing oscillopsia from gentamicin toxicity.

A series of 15 patients had been studied, all of whom suffered severe labyrinthine damage from gentamicin. All subjects were patients in a renal unit and had been in renal failure. The antibiotic was administered, either intramuscularly, intravenously or into the dialysate. In most of the patients there was a history of previous or simultaneous administration of another ototoxic agent, either another aminoglycoside, or a loop diuretic. None of the patients developed severe vertigo. They consistently complained, when they eventually were able to get out of bed, a vertical bouncing of their surroundings, when they walked, coinciding with each step. This sensation is made worse if the patient runs, or drives on a bumpy road, and stops as soon as the patient stands still. Caloric tests revealed non-functioning labyrinths on both sides. Gradual improvement in the symptom occurred over a period of months. No cochleotoxic effect was observed. The probable mechanism of this phenomenon is discussed.

Gentamicins↗

PubMed1997

[A long-term follow-up of patients with Meniere's disease--comparative study of unilateral and bilateral Mènière's disease].

A retrospective study was carried out on 46 patients with Meniere's disease (MD). Twenty of them were followed up for 20-40 years (long-term follow-up cases), and 26 of them for 5-12 years (middle-term follow-up cases). Thirteen of the patients suffered from fluctuating sensorineural hearing loss in one ear (unilateral MD), and 33 of them suffered from it in both ears (bilateral MD). Comparing the results of repeated audio-vestibular examinations of patients with unilateral MD with those of patients with bilateral MD revealed the following differences between them: 1) The range of fluctuation of the hearing level of the patients with unilateral MD was greater than that of the patients with bilateral MD. 2) Most patients with unilateral MD showed three audiometric configurations, but most patients with bilateral MD showed two audiometric configurations during the first 5 years of the follow-up period. 3) The patients with unilateral MD showed unilateral weakness on the caloric test more often than the patients with bilateral MD. But other clinical features in the patients with unilateral MD and those with bilateral MD were similar. We confirmed that there was an increase in bilaterality with time, but it is impossible to speculate whether the patients with unilateral MD will also suffer it in the contralateral ear or not. Therefore, it is possible that in all patients who have suffered from unilateral MD for a long time the disease may become bilateral in the future. Clinical observation of patients with MD as long as possible is the only way to clarify the relationship between unilateral and bilateral MD. It is stressed that to gain the patient's confidence is not only the basis of long-term follow-up of the patient, but also of effective treatment of MD.

Aged↗

PubMed2001

[Effects of steroid therapy on long-term canal prognosis and activity in the daily life of vestibular neuronitis patients].

We studied 28 patients with vestibular neuronitis treated at our hospital between 1997 and 1999. To determine the effects of steroid therapy on long-term canal prognosis and daily activity, we examined caloric tests and gave questionnaires to 12 steroid-treated and 16 nonsteroid-treated patients 2 years after onset. We found that canal improvement was 50% in the nonsteroid-treated group and 75% in the steroid-treated one. In cases with severe canal paresis (CP > or = 60%), canal improvement was 33% in the nonsteroid-treated group and 67% in the steroid-treated one. Steroid therapy at the acute stage of this disease significantly reduced the duration of spontaneous nystagmus and handicap in daily life due to dizziness induced by head and body movement, decreasing mood disturbance.

Activities of Daily Living↗

PubMed2002

[Navigation-aided surgery for congenital cholesteatoma at the petrous apex].

Computer-aided navigation in otolaryngology has been used mainly for nasal operation and rarely for ear surgery. The reason for its limited use in ear surgery appears to be that microscopic observation may be sufficient in most cases of ear surgery. We report a case of congenital cholesteatoma at the petrous apex operated on using navigation. A 65-year-old man with facial palsy, deafness, and canal paresis in caloric test on the left ear was found in preoperative computed tomograph (CT) showed a large mass at the apex with an expansively eroded skull base and inner ear. Navigation used for the operation was magnetic (Insta Trak). A probe 3.2 mm in diameter was moved in the operative field and 3 axial CTs were simultaneously monitored on a workstation to show the tip location. With this image-guided system, cholesteatoma was thoroughly and safely removed. We concluded that navigation should be used for safe surgery, especially in ear surgery at the petrous apex, because anatomical identification is very easy and damage to vital areas around the inner ear, nerve, brain, and internal carotid artery could be avoided.

Aged↗

PubMed1998

[Study on the effects of hyaluronic acid-streptomycin perfusion through the round window on the function and morphology in guinea pig inner ears].

To investigate the effects of the hyaluronic acid-streptomycin (HA-SM) perfusion through round window on the function and morphology of the inner ear in guinea pig, membrous labyrinth mapping, temporal bone section after celloidin embedding, transmission electron microscopy, electrocochlegraphy (ECochG) and electronystagmography (ENG) were examined. The nystagmus duration induced by caloric test was obviously reduced in comparison with that of the preoperation (P< 0.01), while the action potential(AP) by ECochG was not obviously changed. The sensory cells of estibular organs were severely damaged, while the morphology of corti's organs were significantly damaged after HA-SM perfusion. The results suggest that the HA-SM perfusion through the round window may selectively destroy the vestibular function, whereas the auditory function is not obviously damaged.

Animals↗

PubMed1997

[Effect of hyaluronan perfusion through the round window on the function and morphology of the inner ear in guinea pigs].

UNLABELLED: In order to study the effect of the hyaluronan (HA) on the inner ear, twenty-six guinea pigs were divided into experimental and control groups, the experimental group were perfused with 2% HA 0.2 ml through the left round window. Auditory and vestibular function were investigated before and 5, 14, 28 days after perfusion. The threshold of action potential (AP) response to filtered clicks (0.25-10 kHz) were elevated at 5 days and were improved (at 1-4 kHz) at 14 days after perfusion (P < 0.05). At 28 days all AP response thresholds had returned to normal (P > 0.05). The nystagmus duration induced by caloric test (ENG) had no obviously change comparing with that of preoperation (P > 0.05). All guinea pigs were sacrificed 28 days after operation. The histology of inner ear were examined by means of membranous labyrinth mapping and temporal bone section after celloidin embedding. The morphology of Corti's and vestibular organs were not significantly damaged after perfusion. IN CONCLUSION: 1) 2%HA caused reversible and temporary changes in auditory function of inner ear; 2) 2%HA lacked ototoxic adverse effects, whereas exerted considerable osmotic effects and a slow dehydration of inner ears.

Action Potentials↗

PubMed1999

Changes in blood serotonin in patients with tinnitus and other vestibular disturbances.

The role of serotonin as a mediator and stress hormone and its function in vessel tonus regulation is proved. The aim of the work is to study the concentration of serotonin in blood in patients with vestibular disturbances before and after vestibular provocation and in patients with tinnitus. The study was performed on 134 persons distributed among three groups: group I, 35 patients with vestibular disturbances; group II, 75 healthy persons; group III, 24 patients with tinnitus. Serotonin was examined twice in patients with vestibular disturbances (group I) and in healthy persons (group II), before and 15 minutes after vestibular provocation realized by a cold caloric test, and once in patients with tinnitus (group III). Vestibular loading provokes changes in blood serotonin: In vestibularly stable persons, serotonin decreases and comparatively weaker vestibular vegetative reactions develop. The role of serotonin in the compensatory mechanisms of the organism related to vestibular crisis is discussed. We recommend its inclusion with routine neurootological examinations for selecting candidates for work in conditions that overload the vestibular analyzer. Patients with tinnitus have serotonin blood values that significantly exceed the referent ones.

Cold Temperature↗

PubMed1975

[The influence of age on vestibular function].

Regular changes in vestibular responsitivity as a function of age are demonstrated with the maximum speed of the slow phase of caloric nystagmus. The clinical implication of this is that, when doing caloric tests, one should not switch for no reason from a once accepted temperature sequence, otherwise comparison with other tests becomes impossible. It rotation tests the best reactions are found in young people. The amplitude is a good parameter to detect age-factors in rotatory nystagmus.

Adolescent↗

PubMed1975

[Models and experimentation. Vestibular adaptation].

In 1961, we have given the experimental proof that, in the frog, the excited or inhited electrical activity of the ampullar nerve produced by a copular deflection of long duration, showed a decline which was attributed to an "adaptation" of peripheral origin. We suggested that the "inverse phase" was due to this adaptation. Since then, many workers have showed that such an adaptation was to be found in the induced nystagmus by prolonged angular acceleration. The mathematical models constructed to explain the vestibular function have to take in account this response decline to coincide with the evolution of the slow phase velocity of the nystagmus, during the prolonged deflexions of the cupula produced by the clinical vestibular rotatory and caloric tests.

Adaptation, Physiological↗

PubMed2000

[Central or vestibular vertigo? Diagnostic look through Frenzel glasses].

Vertigo is not a uniform symptom. The basis for a differentiated diagnosis is the history, which should record the frequency and duration of attacks. Further diagnostic investigations serve to differentiate between non-vestibular and vestibular (peripheral) forms of vertigo. Of essential importance is the determination of nystagmus with the aid of Frenzel lenses, with distinction being made between voluntary nystagmus and provoked nystagmus. These orientating examinations, which can be carried out by the family doctor, set the points for the further course. On account of the need for special equipment, such studies as the caloric tests, the swivel chair test, optokinetic tests or the tilting stage test, remain the domain of the specialist. They enable a definitive differentiation of an ENT illness from a neurological disorder.

Brain Diseases↗

PubMed1998

[Thermal influence on intracellular calcium concentration of isolated vestibular hair cells in guinea pig].

OBJECTIVE: To further understand the mechanism of caloric test. METHODS: Vestibular hair cells(VHC) were isolated from guinea pig crista ampullaris by enzymatic and mechanical methods and the variations of intracellular free calcium ion concentration ([Ca2+]i) with changes of the extracellular medium temperature were observed. The [Ca2+]i of VHC was examined using laser scanning confocal microscopy (LSCM) and the Ca2+ sensitive dye Fluo-3. RESULTS: Were as follows: 1. There was an increase in [Ca2+]i of 81.8% (18/22) type I VHC and 7/12 type II VHC with the heat stimulation and a decrease in [Ca2+]i with temperature decrease. The magnitude of variation in [Ca2+] i in type I VHC was larger than that in type II VHC. 2. There was no significant change in [Ca2+]i of outer hair cells (OHC) with the heat stimulation. CONCLUSION: There is a direct thermal influence on vestibular sensory cells and this influence accompany with the variation of [Ca2+]i in VHC.

Animals↗

PubMed2002

Two easy-to-perform diagnostic tests for Gilbert's syndrome.

Gilbert's syndrome is a benign, often familial condition characterized by asymptomatic jaundice. A patient suffering from Gilbert's syndrome may have hepatic activity of bilirubin-UDP-glucuronosyltransferase decreasing to levels around 30% of the normal. A clinical diagnosis of Gilbert's syndrome is usually followed in case of mild hyperbilirubinemia with a high fraction of unconjugated bilirubin, normal values of liver enzymes, and no overt signs of hemolysis. This article reported a 17-year-old male with only partial indication of indirect hyperbilirubinemia. Rifampicin test and caloric restriction test were applied to assure the patient had Gilbert's syndrome. These two non-invasive diagnostic means, with the benefit of avoiding hazardous liver biopsy, are gaining popularity in our routine Gilbert's syndrome examination.

Adolescent↗

PubMed1975

[Investigations on the vestibular recruitment (author's transl)].

Searching for some kind of vestibular recruitment that might be similar to the audiological recruitment as defined by Fowler, a caloric test was done at 44 degrees, 33 degrees, 30 degrees, 26 degrees, 17 degrees. The parameter of vestibular response was the maximum slow component speed, In total 36 Menière-patients were electronystagmographically examined. Out of the 36 only 16 were analyzed further for the question of vestibular recruitmen, who showed strictly unilateral lesions, who were attack-free since some months and who showed clear audiological recruitment at four different recruitment tests. The following results were obtained: 1. The values obtained for the sound side of Menière-patients correspond to values described as normal in literature. 2. The affected side showed less reaction at all temperatures, in no case there was a tendency to recruitment. 3. With considerable loss of excitability, a "flat curve" was resulting, indicating decruitment.

Audiometry↗

PubMed1976

[ENG in infants - a contribution on examination problems (author's transl)].

60 young children (3-6 years old) without any history of ear diseases were tested by caloric stimulation (30 degrees C and 44 degrees C). Distribution into the groups "with sedation" and "without sedation" was done following a statistical key. Sedation was achieved by intramusculair injection of Valium, considering age and weight of the subjects. Nystagmus registration was done by ENG. The following quantitative reductions in the observed nystagmus parameters could be shown: number of beats: 19% +/- 5%, maximal angular velocity of the slow phase: 24% +/- 11%, total amplitude: 24% +/- 11%. This experiment shows that Valium can be very well used in the sedation of young children for caloric vestibular testing, a quantitative variation of the response has to be considered.

Child↗

PubMedDate not supplied

Recovery trajectories of vestibulopathic subjects after perturbations during locomotion.

We compared the mediolateral (M/L) responses to perturbations during locomotion of vestibulopathic (VP) subjects to those of controls. Eight subjects with unilateral vestibular loss (100% Reduced Vestibular Response from the caloric test) resulting from surgery for vestibular schwannoma and 11 controls were selected for this study. Despite their known vestibulopathy, all VP subjects scored within the normal range on computerized dynamic posturography Sensory Organization Tests. During gait, subjects were given surface perturbations of the right support-phase foot in two possible directions (forward-right and backward-left) at two possible magnitudes (5 and 10 cm) that were randomly mixed with trials having no perturbations. M/L stability was quantified by estimating the length of the M/L moment arm between the support foot and the trunk, and the M/L accelerations of the sternum and the head. The VP group had greater changes (p < 0.05) in their moment arm responses compared to controls. The number of steps that it took for the moment arm oscillations to return to normal and the variability in the moment arms were greater for the VP group. Differences in the sternum and head accelerations between VP and control groups were not as consistent, but there was a trend toward greater response deviations in the VP group for all 4 perturbation types. Increased response magnitude and variability of the VP group is consistent with an increase in their sensory noise of vestibular inputs due to the surgical lesion. Another possibility is a reduced sensitivity to motion inputs. This perturbation approach may prove useful for characterizing subtle vestibulopathies and similar changes in the human orientation mechanism after exposure to microgravity.

Acceleration↗

PubMed2003

[Role of electrocochleography in identification of labyrinthine hydrops].

We studied potentialities of extratympanic electrocochleography (ETECG) in detection of labyrinthine hydrops (LH) in 50 patients who had an audiological picture of unilateral neurosensory hypoacusis. The patients were divided into two groups: group 1 patients suffered from attacks of systemic vertigo typical for Meniere's disease; group 2 patients had no vestibular complaints. ETECG results were compared to the dynamic range, results of otoacoustic emission and brain stem response, vestibulometry with electronystagmography (data of bithermal caloric test as most informative). The comparison indicated advantages of ETECG used alone and in combination with other tests.

Audiometry, Evoked Response↗

PubMed2003

[Cochlear implantation and vestibular function].

To determine the risk of injuring a peripheral part of the vestibular analyzer in usage of an intracochlear implant in patients with varying deafness, the author compared her data and data from other clinics making examinations according to similar methods: implantation was conducted using multichannel intracochlear electrode, the program of otoneurological examination employed the caloric test, the patients were examined before and after the operation.

Cochlear Implantation↗

PubMed2004

Preservation of tap vestibular evoked myogenic potentials despite resection of the inferior vestibular nerve.

Sound and skull-tap induced vestibular evoked myogenic potentials (VEMP) were studied in a 43-year-old man following inferior vestibular neurectomy. Surgery was performed because of a small acoustic neuroma. Postoperative caloric testing suggested sparing of superior vestibular nerve function on the operated side. In response to sound stimulation there were no VEMP on the operated side, irrespective of whether sounds were presented by air- or bone-conduction. This suggests sound-induced VEMP to be critically dependent on inferior vestibular nerve function and this is in agreement with present knowledge. However, VEMP were obtained in response to forehead skull taps, i.e. positive-negative VEMP not only on the healthy side but also on the operated side. This suggests remnant vestibular function on the operated side of importance for forehead skull tap VEMP, because with complete unilateral vestibular loss there are no (positive-negative) VEMP on the lesioned side. Thus, forehead skull-tap VEMP depend, at least partly, on the superior vestibular nerve function.

Acoustic Stimulation↗