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[Frequent errors in neuro-otologic diagnosis].

A number of characteristic sources of error during the testing of vestibular function, originating from anamnesis, equipment and examination, are described. It is stressed that false-positive findings are often due to the influence of alcohol and that false-negative findings may be the result of tiredness or sedative drugs. With regard to the caloric test, it is recommended that water provides a better stimulus than air, and that the warm caloric stimulus is more valid than the cold caloric stimulus. Attention should be paid to the ENG-recorders, particularly to an adequate writing breadth, and to time constants. Different parameters in use for quantitative analysis of the intensity of vestibular reactions are discussed. If the findings are vague, repeated examination will often help to clarify matters. The regular use of Frenzel glasses is of great importance, since otherwise examination of the vestibular organs must be considered incomplete.

Alcohol Drinking↗

Comparative oto-vestibular effects in the pigmented guinea pig after dibekacin and netilmicin treatment.

We treated groups of pigmented guinea pigs with either intramuscular netilmicin or dibekacin at 100 and 150 mg/kg per day for 3 weeks. Saline was used as the control solution. All animals were tested weekly for both vestibular and auditory functions. The vestibular function was evaluated by the duration of post-rotatory nystagmus (PRN) elicited by interrupting the rotation of the animal around the vertical axis; auditory function was evaluated by the threshold response for the Preyer's pinna reflex (PPR). All animals were then sacrificed and either their labyrinths or Corti organs were processed for further investigations using the scanning electron microscope (SEM). The duration of PRN decreased over the treatment period in all of the groups as a result of adaptation. However, 150 mg/kg dibekacin produced a significant decrease of the PRN responses as compared to the control and other groups. This effect also continued during the recovery period. Likewise, the PPR threshold of the animals receiving 150 mg/kg dibekacin showed a significant increase at the end of the treatments and during the recovery period, while the other dibekacin group had no significant auditory impairment. Netilmicin at both doses did not significantly affect responses following either vestibular or auditory stimulations. SEM observations demonstrated that the sensory epithelia of the labyrinths and Corti organs affected by 150 mg/kg dibekacin had great losses of stereocilia, while comparable doses of netilmicin (150 mg/kg) had only very moderate losses of stereocilia in the labyrinths but not in the Corti organs.

Animals↗

An assessment of gait and balance deficits after traumatic brain injury.

OBJECTIVE: To assess the sensations of instability that many patients report after traumatic brain injury (TBI). DESIGN: A controlled study. SETTING: A motion analysis and vestibular and balance laboratory. PARTICIPANTS: Twenty subjects, 10 with TBI and complaints of instability, and 10 without TBI. INTERVENTIONS: Balance and gait analysis. MAIN OUTCOME MEASURES: Dizziness Handicap Inventory (DHI), caloric irrigation, optokinetic testing, Dix-Hallpike Test, posturography, and center of mass (COM) movement. RESULTS: Subjects were well matched in terms of age, height, weight, and gender. DHI scores of those with and without TBI differed significantly (32.2+/-23.0 vs 0.2+/-0.63, P<.001). Caloric and optokinetic circularvection testing were abnormal only in subjects with TBI (8/10 and 4/10, respectively). Benign paroxysmal positioning vertigo was present in only 3 subjects with TBI, and this either resolved spontaneously (n=1) or was successfully treated (n=2). Composite posturography scores of those with and without TBI differed significantly (69.6+/-35.8 vs 79.5+/-40.5, P=.02). Gait parameters also differed significantly between the groups (P=.05), with the subjects with TBI having lower anterior and posterior and higher medial and lateral COM displacements and velocities. CONCLUSIONS: Patients' complaints of instability after TBI may have objective correlates and may be rectifiable. Balance and gait testing in these patients is warranted.

Adolescent↗

Caloric nystagmus: ENG in comparison with observation by Frenzel's glasses.

After caloric stimulation with water at 30 degrees C for 30 sec an electronystagmogram (ENG) was registered. Simultaneously with the ENG the test person's nystagmus was observed by Frenzel's glasses. If the evaluation is limited to the frequency of the nystagmus and if it is possible to neglect the velocity of the slow phase, the simple observation through Frenzel's glasses and its plotting on a time chart recorder is no less effective than an ENG for measuring the difference between the right and left labyrinth.

Adult↗

The vestibulo-ocular (caloric) reflex in the diagnosis of cerebral death.

Correlation between vestibulo-ocular (caloric) reflex and the electroencephalogram was examined in 25 apparently brain-dead and 17 severely brain-injured patients. Among the apparently cerebrally dead, 3 patients still had some EEG activity and in 2, there was some response to caloric testing. In the control group of patients some EEG activity was present in all, and the caloric response was absent in 1. It is concluded that absence of caloric response has similar power to the electroencephalogram in confirming cerebral death. The diagnosis, however, must be made on the total information available, including history and examination of the patient. The policy of the Intensive Care Unit of Prince Henry Hospital in this regard is outlined.

Brain Death↗

[Cupulometry].

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Humans↗