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At least 991 records · Page 55Linked to original sources
PubMed1995

Vestibular effects associated with implantation of a multiple channel cochlear prosthesis.

This study revealed that some patients with cochlear implants have symptoms of vertigo and imbalance following implant surgery. Although most experience a resolution of these symptoms, some patients have more persistent disturbances of balance. A total of 52 patients were implanted with a Nucleus 22 channel cochlear implant device between September 1988 and February 1994. Preoperatively, all but five of the patients received a vestibular evaluation. Twenty-two of the 52 patients received both pre- and postoperative vestibular evaluation. The cochlear implant was worn and activated during the postoperative vestibular assessment. The vestibular assessment included electronystagmography, computerized dynamic posturography, and harmonic acceleration testing. Five of the 22 patients demonstrated bilateral vestibular weakness preoperatively; that is, no response to caloric stimulation or a total of less than 30 degrees per second for the four irrigations. These patients were not included in the caloric analysis portion of the study. The remaining 17 were divided into groups under 60 years of age (7 patients) and over 60 years of age (10 patients). Analysis of the pre-and postoperative caloric response of the implanted ear showed a significant drop in output for the group over 60 years of age. The difference for the group under 60 years of age was not significant. Forty percent of the patients in the over 60 age group and 43% of those in the under 60 age group developed a peripheral vestibular weakness postoperatively. However, younger individuals in general did not seem to have balance complaints and did not require vestibular rehabilitation as frequently as the older group. Potential cochlear implant candidates should be advised of the possibility of postoperative vestibular effects following cochlear implantation. Most of the symptoms are transient; however, there may be persistent symptoms of imbalance that may be benefited by vestibular rehabilitation.

Adolescent↗
PubMed2005

Transtympanic gentamicin and fibrin tissue adhesive for treatment of unilateral Menière's disease: effects on vestibular function.

OBJECTIVE: To determine the effects of transtympanic injections, with a mixture composed of gentamicin and fibrin tissue adhesive (FTA), on vestibular function of patients with intractable unilateral Menière's disease. STUDY DESIGN: This was an open, prospective study. SETTING AND PATIENTS: The study was performed at 2 tertiary referral centers. Twenty-six patients affected by "definite" unilateral Menière's disease, unresponsive to medical therapy for at least 6 months, were enrolled. INTERVENTION: A buffered gentamicin solution mixed with FTA was injected in the middle ear until the development of bedside vestibular hypofunction signs and/or caloric weakness in the treated ear. MAIN OUTCOME MEASURE: Vestibular function was evaluated by 3 bedside vestibular tests (observation of spontaneous nystagmus, head shaking test, and head thrust test) and by a caloric test. Tests were performed on days 10 and 30 after completion of treatment. Tests were also performed 3, 6, and 12 months from completion of the gentamicin-FTA protocol. The effects of treatment were also assessed in terms of hearing levels, control of vertigo, and disability status. RESULTS: In 22 of the 26 patients, only 1 gentamicin-FTA injection was necessary to obtain 1 or more signs indicating a reduction of the vestibular function in the treated ear. Four patients needed another treatment because of the persistence of their incapacitating symptoms during the follow-up. Four patients needed more than 1 injection to obtain a vestibular hypofunction. None of the patients who received 1 or 2 injections presented hearing loss in direct temporal relationship to the treatment. CONCLUSIONS: A mixture of gentamicin and fibrin glue makes it possible to considerably reduce the number of administrations in patients with intractable unilateral Menière's disease. Spontaneous nystagmus, post head shaking nystagmus, and a head thrust sign are the clinical signs that indicate onset or progression of unilateral vestibular hypofunction. These signs were obtained with only 1 injection in 81% of patients.

Adult↗
PubMed1982

[Nystagmus and benign paroxysmal vertigo (author's transl)].

Audio-impedence, vestibular, caloric, and electronystagmograph tests were conducted in 22 patients with benign paroxysmal vertigo. The disorder is provoked by certain sudden head movements, a latency period of several seconds occurring between the end of the movement and the onset of vertigo. This markedly differentiates it from other types of vertigo. It is of brief duration and associated with autonomic nervous system signs. Nystagmus, usually rotatory, is provoked by the particular head movement involved or by Hallpike's manoeuver. Results of the majority of tests were normal, occasional slight anomalies being observed after calibrated caloric vetibular test. This benign affection appears to be due to a bilateral, or more frequently unilateral mechanical lesion of the posterior semicircular canal cupula. It runs a extremely variable course, usually not exceeding four months, and is an indication of choice for vestibular reeducation, for which new techniques have been developed.

Electronystagmography↗
PubMed2005

The effect of mental alerting on gaze-evoked nystagmus.

OBJECTIVES: To determine whether mental alerting (MA) makes a significant difference to nystagmus recorded during gaze testing using electronystagmography (ENG). DESIGN: A prospective study, blinded interpretation of test results, alternate order of testing sequence. SETTING: Vestibular assessment clinic in a tertiary referral centre. PARTICIPANTS: A total of 80 patients were seen by the authors (R.L.H., K.F.L.M.) for vestibular assessment, between August 2002 and February 2004. Patients cognitively unable to perform MA tasks or with limited English were omitted. Patients all underwent gaze-testing using ENG. Each patient was tested twice, once without MA and once with an MA task, in an alternate test order. MAIN OUTCOME MEASURES: Slow-phase velocity values of recorded nystagmus, number of patients with clinically significant nystagmus (slow-phase velocity > or = 6 deg/s). RESULTS: A total of eight patients had significant gaze-evoked nystagmus when tested without MA and a total of six patients when tested with MA. Only four of these patients were common to both groups. When all nystagmus values (regardless of significance) were considered, no statistically significant differences between nystagmus measured with and without alerting were found (Wilcoxon signed rank test, P > 0.05). CONCLUSIONS: Mental alerting during gaze testing did not result in a significant difference in nystagmus and is just as likely to result in an exacerbation as a reduction in slow-phase velocity. In addition, MA is likely to result in a noisy (and therefore difficult to interpret) recording and increases the impact of the test on the patient. In view of these findings, we propose that MA is contraindicated during the gaze-testing component of the vestibular test battery.

Caloric Tests↗
PubMed1993

A reevaluation of the vestibulo-ocular reflex: new ideas of its purpose, properties, neural substrate, and disorders.

Conventional views of the vestibulo-ocular reflex (VOR) have emphasized testing with caloric stimuli and by passively rotating patients at low frequencies in a chair. The properties of the VOR tested under these conditions differ from the performance of this reflex during the natural function for which it evolved--locomotion. Only the VOR (and not visually mediated eye movements) can cope with the high-frequency angular and linear perturbations of the head that occur during locomotion; this is achieved by generating eye movements at short latency (< 16 msec). Interpretation of vestibular testing is enhanced by the realization that, although the di- and trisynaptic components of the VOR are essential for this short-latency response, the overall accuracy and plasticity of the VOR depend upon a distributed, parallel network of neurons involving the vestibular nuclei. Neurons in this network variously upon a distributed, parallel network of neurons involving the vestibular nuclei. Neurons in this network variously encode inputs from the labyrinthine semicircular canals and otoliths, as well as from the visual and somatosensory systems. The central vestibular pathways branch to contact vestibular cortex (for perception) and the spinal cord (for control of posture). Thus, the vestibular nuclei basically coordinate the stabilization of gaze and posture, and contribute to the perception of verticality and self-motion. Consequently, brainstem disorders that disrupt the VOR cause not just only nystagmus, but also instability of posture (eg, increased fore-aft sway in patients with downbeat nystagmus) and disturbance of spatial orientation (eg, tilt of the subjective visual vertical in Wallenberg's syndrome).

Brain Diseases↗
PubMed1985

Vestibular evaluation of infants and preschool children.

This article presents an updated summary of vestibular test modifications employed at the Boys Town National Institute for Communication Disorders in Children. In addition, we report the results of vestibular evaluations of 104 full-term and premature children (47 male and 57 female) ranging in age from 3 months to 6 years, including a group of postmeningitic patients. The evaluations utilized harmonic acceleration (HA). No age-related maturational differences in HA gain, phase, or symmetry for an 0.08 Hz screening frequency were found when full-term and premature infants were compared. Infrared video technology was adapted to provide continuous visual monitoring of head and eye position in the totally darkened test enclosure.

Caloric Tests↗
PubMed1980

A review of vestibular test results in Meniere's disease.

It is our opinion that a great deal of prospective work must be done in order to sort out all the variables encountered in subjects with Meniere's disease. This goal will best be accomplished by first establishing a better understanding of the pathophysiology of Meniere's disease. Given a clearer understanding of the mechanisms of idiopathic hydrops and the changes that occur as the disease progresses, sensitive specific vestibular test methods can be developed to quantitatively define specific abnormalities. Techniques recently developed show a great deal of promise for meaningful quantitative testing in subjects with Meniere's disease.

Caloric Tests↗
PubMed1996

The ear in the acquired immunodeficiency syndrome: II. Clinical and audiologic investigation.

Patients with acquired immunodeficiency syndrome (AIDS) were investigated to determine the sites, nature, and severity of any otologic abnormalities. Tinnitus, "muffled" or "echoing" hearing, and vertigo were frequent complaints. Eight percent of the 155 patients studied showed evidence of chronic otitis media, usually with effusion. Mostly mild, but occasionally severe sensorineural hearing loss was found in many, affecting more severely the higher and lower frequencies than the middle range. Almost all patients showed diminished otoacoustic emissions, suggesting cochlear dysfunction resulting from infection or ototoxicity as the basis for the hearing loss. Impairment of the otoacoustic emissions by a subclinical otitis media with effusion cannot, however, be excluded. On the basis of this study it is suggested that the provision of otologic care to patients with AIDS may enhance their quality of life and, by the early detection and treatment of severe otitis media, may even prolong life.

Acoustic Impedance Tests↗
PubMed1997

Medicare program; revisions to payment policies under the physician fee for schedule, other Part B payment policies, and establishment of the clinical psychologist fee schedule for calendar year 1998--HCFA. Proposed rule.

This proposed rule discusses several policy changes affecting Medicare Part B payment. The changes related to physician services, including resource-based practice expense relative value units and geographic practice cost index changes, clinical psychologist services, supervision of diagnostic tests, the methodology used to develop reasonable compensation equivalent limits, payment to participating and nonparticipating suppliers, global surgical services, caloric vestibular testing, clinical consultations, and payments based on actual charges. Under the law, we are required to develop a resource-based system for determining practice expense relative value units effective January 1, 1998. In addition, since we established the physician fee schedule on January 1, 1992, our experience indicates that some of our Part B payment policies need to be reconsidered. This proposed rule is intended to correct inequities in physician payment and solicits public comments on specific proposed policy changes.

Centers for Medicare and Medicaid Services, U.S.↗
PubMed1994

Computer analysis for routine electronystagmography tests.

A computer program has been developed for on-line analysis of routine electronystagmography (ENG) tests. With this system, data acquisition of eye movements and stimulus signals obtained from ENG are accomplished at a rate of 200 Hz through a 12-bit analog-digital converter. A small spotlight for eye tracking tests is sinusoidally driven by a computer-generated analog signal. Six optokinetic stripes projected onto a screen are also controlled by the computer. Seven spots for saccade tests can be turned on or off based on digital signals produced through a digital output device. There are three types of eye movements in this series: nystagmus, pursuit eye movement and saccadic eye movement. An algorithm for the analysis of different eye movements is described in this paper. Recent significant advances in computer technology make it possible to perform such complicated tasks and to accomplish quantitative assessment of any type of eye movements in routine ENG tests. Consequently, computer analysis provides clues to the location of a disease and is very useful as a diagnostic tool in routine ENG testing.

Artifacts↗
PubMed1978

[Audiovestibular study in Friedreich's ataxia].

A preliminary report is presented of the audiovestibular findings in 16 cases of typical Friedreich ataxia. Many ENG abnormalities of the central type were found, the most frequent being square waves, ocular dysmetria, and disorganized pursuit of the pendulum. The other abnormal findings were less frequent or less specific. Peripheral vestibular and auditory impairment were not the rule. Eventually, the electronystagmogram could become an early paraclinical screening test of Friedreich's disease.

Adolescent↗
PubMed1991

Prediction of bithermal caloric response from monothermal stimulation.

The use of either cold or warm caloric stimulation alone as a screening tool for unilateral weakness has been suggested as a means of both shortening testing time and reducing patient discomfort. The validity of the monothermal caloric test must be well established before it can be routinely used in clinical situations. The purpose of this investigation was to re-evaluate the monothermal caloric test by examining the correlations between unilateral weakness derived from bithermal caloric stimulation compared to monothermal caloric results using either warm or cool stimulation alone. A retrospective analysis of 200 patients indicated significant correlations between bithermal and monothermal unilateral weakness for patients with unilateral weakness of less than 15% and greater than 30% for both warm and cool water stimulation. For patients with 15% to 30% unilateral weakness, the bithermal and monothermal calorics were significantly correlated for only the cool condition. When predicting normal or greater than 20% unilateral weakness, either of the monothermal calorics have greater than 85% efficiency, with specificity greater than 94% and sensitivity greater than 64%. However, the false-negative rate is 29% for warm and 36% for cool calorics. The high rate of false-negative findings indicates that screening tests have no place in a diagnostic battery, especially in view of the implications for missing significant pathology.

Adolescent↗
PubMed1997

Medicare program; revisions to payment policies and adjustments to the relative value units under the physician fee schedule, other Part B payment policies, and establishment of the clinical psychologist fee schedule for calendar year 1998--HCFA. Final rule with comment period.

This final rule makes several policy changes affecting Medicare Part B payment. The changes relate to physician services, including geographic practice cost index changes, clinical psychologist services, physician supervision of diagnostic tests, establishment of independent diagnostic testing facilities, the methodology used to develop reasonable compensation equivalent limits, payment to participating and nonparticipating suppliers, global surgical services, caloric vestibular testing, and clinical consultations. This rule also implements provisions in the Balanced Budget Act of 1997 relating to practice expense relative value units, screening mammography, colorectal cancer screening, screening pelvic examinations, and EKG transportation. In addition, we are finalizing the 1997 interim work relative value units and are issuing interim work relative value units for new and revised codes for 1998.

Aged↗