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PubMed1991

Reduction and recovery of neuronal size in the cochlear nucleus of the chicken following aminoglycoside intoxication.

The effect of aminoglycoside intoxication on the cross-sectional area of neurons in nucleus magnocellularis (NM) was studied in neonatal chickens. Birds received daily injections of 100 mg/kg body weight of gentamicin for 10 consecutive days. Cell area was measured at five different tonotopic regions along the posterior-to-anterior dimension of NM (low-to-high frequency) after post-treatment survival times of 8, 23 and 40 days. Gentamicin caused a reversible reduction of cell area that varied as a function of location and survival time. Significant decreases of cell area occurred only in the rostral half of the nucleus. Cell area was reduced at 8 and 23 days survival and recovered to near control values by 40 days post-treatment. Body weight, brain weight and the cross-sectional area of cerebellar Purkinje neurons were also reduced but did not recover. The present results show that aminoglycoside toxicity can affect auditory neurons in the brain. It is suggested that two factors contributed to the changes in NM neuron size: (1) Processes specifically related to the loss and regeneration of cochlear hair cells, most likely changes in afferent activity. (2) A general retardation in growth.

Animals↗
PubMed2006

A child with vestibular neuritis. is adenovirus implicated?

Vertigo in children is relatively under examined in the literature. Among its causes, vestibular neuritis (VN) represents only 2% of cases, with its etiology remaining unknown. We report for the first time a 4-year-old boy with vestibular neuritis and serological results compatible with adenoviral infection. Serological diagnosis was performed on the basis of a rise and consequent normalization of complement fixation (CF) titers of the plasma antibodies. Although we were not able to detect exactly when the infection started, we were able to detect an increased level of adenovirus antibodies by CF titers, followed by a decrease (i.e. 1/16, then 1/8, then <1/4) during the recovery. This is typical of a resolving infection. Furthermore, that this increase in antibodies was specific to an adenovirus infection was suggested by the observation that we did not detect increases in antibodies to other common viruses (i.e. herpes simplex and zoster viruses, Epstein-Barr virus, cytomegalovirus, influenza and parainfluenza viruses). This allows us to exclude the chance of nonspecific antibody activation. We concluded that, although our data do not formally demonstrate an involvement of adenovirus in VN, they suggest such an involvement. This may be of interest, given that a viral etiology for VN has been proposed but not definitively proven.

Adenoviridae↗
PubMed2004

Stem/progenitor cells in the postnatal inner ear of the GFP-nestin transgenic mouse.

Nestin promoter-GFP (green fluorescent protein) transgenic mice were used to determine the presence of stem/progenitor cells in the mouse inner ear. We examined the inner ear of mice at the following postnatal days (P): P0, P4, P5, P15 and P60. Hair cells stereocilia were identified with the use of the histochemical marker phalloidin. Whole endorgans or cryosections were analyzed under epi-fluorescent or confocal microscopy. From P0 to P5, GFP expressing cells were found in the vestibular sensory epithelia of the macula utricle, but not in the crista ampullaris. Cells within the stroma (tissue underneath the sensory epithelia), utricle, and crista were also GFP-positive. Satellite cells in the vestibular ganglia were GFP-positive, while vestibular ganglia neurons were not. In the organ of Corti, GFP signal was found in inner border and inner phalangeal cells that surround the inner hair cells (GFP-negative), Dieters cells and cells in the great epithelial ridge. Outer hair cells were mildly positive for GFP. Satellite cells in the spiral ganglia were GFP-positive, while spiral ganglia neurons were not. Similar GFP expression was found in the vestibule and cochlea of animals at P15, however, outer hair cells showed no GFP expression. The inner ear of P60 animals contained moderate GFP expression in the stroma of the crista ampullaris and utricle, but not within the sensory epithelia. In the organ of Corti, moderate GFP expression was found in a few Deiters cells. The present data indicates that the expression of nestin in the mouse inner ear is developmentally regulated; yet in the adult inner ear there are some nestin expressing cells, suggesting an intrinsic repair potential, although to a more limited extent than during early post-natal life.

Age Factors↗
PubMed2004

Vestibular neuritis in a child with otitis media with effusion; clinical application of vestibular evoked myogenic potential by bone-conducted sound.

Vestibular evoked myogenic potential (VEMP) has been applied for patients with vestibulo-cochlear disorders. The impairment of the sound transmission due to middle ear pathology affects VEMP results. In children, otitis media with effusion (OME) is well documented and it is difficult to apply conventional VEMP in such cases. To overcome the attenuation of stimulation due to middle ear pathology, VEMP by bone-conducted sound has been developed. We report a 3-year-old girl with vestibular neuritis and OME as a representative case of clinical application of VEMP by bone-conducted sound. VEMP by bone-conducted sound can be an alternative method to elicit vestibular-dependent potential.

Bone Conduction↗
PubMed2005

What accounts for vertigo one year after neuritis vestibularis - anxiety or a dysfunctional vestibular organ?

One year after neuritis vestibularis, 29% from a sample of 75 patients still complained of vertigo. The objective of this investigation was to study why patients suffer from persisting vertigo. The alternative hypotheses were that the vertigo experienced could be explained either by a persisting vestibular dysfunction or by psychopathological changes. To elucidate this question, patients were examined with dynamic posturography, the symptom check list (SCL 90 R), the state-trait anxiety inventory (STAI), the agoraphobic cognitions questionnaire (ALQ) and the body sensations questionnaire (BSQ). After one year, only two patients had overall pathological results in the posturography. Following the assumption that sub-clinical dysfunction of the organs of balance can also lead to an altered body perception in combination with anxiety, the pathological results of posturographic sub-tests were related to experiences of vertigo. Here also there were no significant associations. However, vertigo correlated highly significantly with body-related anxiety and anxiety-related apprehension. In conclusion, chronic vertigo after an acute vestibular disorder could be regarded as a somatopsychic process. Persisting experience of vertigo is not explained by sub-clinical organic changes. Anxiety seems to be the crucial factor in persisting vertigo.

Anxiety↗
PubMed2007

Audiovestibular disturbance in patients with systemic lupus erythematosus.

OBJECTIVE: The aim of this study was to evaluate the audiovestibular disturbance in patients with systemic lupus erythematosus (SLE). STUDY DESIGN AND SETTING: Twenty-eight patients with SLE and 28 healthy control subjects were included. Pure-tone audiometry, impedance audiometry, and electronystagmography (ENG) were used for baseline evaluation. Laboratory tests were carried out. Cranial and brain stem magnetic resonance imagings (MRI) were undertaken. RESULTS: Nineteen (67%) patients reported audiovestibular symptoms. Sensorineural hearing loss was found in 6 (21%) patients. Abnormal results on ENG were significantly higher (50%) (P < 0.01). Abnormal laboratory data were available from 26 patients (P < 0.05). MRI did not show any pathosis. CONCLUSION: The audiovestibular disturbances in SLE are more prevalent than previously recognized. Although no cause and effect relationship can be established by this type of study, it appears that a relationship exists. SIGNIFICANCE: Audiologic research should be directed toward routine, pure tone audiometry, and ENG assessment for patients with SLE to enable crucial treatment.

Adolescent↗
PubMed2006

Vestibular neuritis caused by enteroviral infection.

Vestibular neuritis is characterized by the sudden onset of nausea, vomiting, and spontaneous horizontal or horizonto-rotatory nystagmus. The etiology of the disease is multifactorial. Mumps, rubella, herpes simplex virus type 1, cytomegalovirus, and Epstein-Barr virus may have a role in the disease. Enteroviruses are among the other rare causes. This report presents a 7-year-old male admitted with nausea, vomiting, rotatory vertigo, horizonto-rotatory nystagmus with positive Romberg's sign and positive head-thrust test. Cranial magnetic resonance imaging and audiometry of the patient were normal. He was diagnosed with vestibular neuritis, and steroid therapy was initiated. At the second month of follow-up, all symptoms had regressed. To the best of our knowledge, this case report describes the first pediatric patient in whom enteroviral ribonucleic acid is documented both in cerebrospinal fluid and in nasopharyngeal material in active disease. This finding supports the possible role of enteroviruses in the etiology of vestibular neuritis.

Anti-Inflammatory Agents↗
PubMed2002

Endoscopy in neuro-otologic surgery.

Endoscopy offers several distinct advantages over the operating microscope during neuro-otologic surgery that make it an excellent adjunctive tool to the microscope or independent modality during cranial base surgery. The high magnification gives excellent definition of perforating blood vessels, cranial nerves, and neural structures, which in many cases is superior to that achieved with the microscope. Furthermore, the use of angled or flexible endoscopes allows one to look around corners and behind anatomic structures blocking the view seen via a 0 degree microscope. Endoscopy also has the theoretical advantage that a less invasive operative procedure is required, which should reduce the operative morbidity. Several notable disadvantages of endoscopy include the problems associated with blood soiling the endoscope, making visualization difficult or impossible, the lack of readily available instrumentation designed specifically for endoscopic neuro-otology, and the poor overview of the operative field. This last point is an important one because the endoscope is placed adjacent to the lesion and does not allow one to look backward to prevent [figure: see text] injury to structures next to the shaft of the telescope. Furthermore, the surgeon must be cognizant of potential thermal injury to structures caused by the heat generated by the light source. The present endoscopic technology limits the image that the surgeon sees to two dimensions, which results in certain unique problems when operating in a three-dimensional milieu. Because of this, there is a steep learning curve to acquire endoscopic dexterity and three-dimensional orientation. Finally, bimanual operation requires the use of an articulated endoscope holder or the commitment of the co-surgeon to hold the endoscope. One of the limitations of the operative microscope is that the angle of view is determined by the distance of the lens to the skull, retractor, or obstructing tissue, which is a function of the lens focal length; the longer the focal length, the narrower the viewing angle. During most microsurgical procedures, the focal distance varies between 200 and 400 mm. Using a previous analogy, if one looks through a door's keyhole at close range, nearly the entire room on the opposite side of the door can be seen, although nothing can be seen when the hole is viewed from a long distance. This is similar to what happens when using the endoscope with focal lengths ranging from 5 to 20 mm: a wider angle of view can be achieved. Based on their, experience the authors believe that endoscopes can be used safely during neuro-otologic surgery. As an adjunct to or substitution for the operative microscope, this modality does improve visualization of bony, neural, and vascular structures while minimizing cerebellar retraction.

Decompression, Surgical↗
PubMed2002

Evaluation of vestibular function in young children.

Together, these tests provide a full evaluation of vestibular function in infants and small children. If attention is paid to creating the appropriate testing environment, and interpretation of the tests takes into account the unique properties of the responses of infants and young children, this testing can provide a useful adjunct to audiometric evaluation in young children.

Caloric Tests↗
PubMed2000

Diagnosis and initiating treatment for peripheral system disorders: imbalance and dizziness with normal hearing.

Disorders affecting the peripheral vestibular system commonly involve the peripheral auditory system causing hearing loss. There are a number of disorders, however, that selectively involve the peripheral vestibular system causing dizziness without hearing loss. These disorders include benign paroxysmal positional vertigo, vestibular neuritis, recurrent vestibulopathy, familial vestibulopathy, and bilateral idiopathic vestibulopathy. This article reviews these disorders and their diagnosis and management.

Diagnosis, Differential↗
PubMed2000

Distinguishing and treating causes of central vertigo.

A patient's dizziness can be caused by a peripheral vestibular disorder, VIIIth nerve compression, brain stem ischemia, or cerebellar stroke. Clues from the history and physical examination are mentioned, and diagnostic entities, such as demyelination, cerebrovascular disease, migraine, Arnold-Chiari malformation, cerebellar degeneration, and neoplastic disease are discussed. Treatment options are outlined so that therapeutic and diagnostic trials can be initiated. Guidelines are offered for when to image the brain or posterior circulation vasculature and when a patient with acute vertigo should be admitted for observation.

Brain Diseases↗
PubMed2003

Various causes and clinical characteristics in vertigo in children with normal eardrums.

OBJECTIVE: The differential diagnosis of vertigo in children is extensive. Otitis media and middle ear effusion could be the most common causes of vertigo in children, but there are some problems in detecting the other causes for vertigo because they are one of most frequent diseases of childhood. The purpose of this study is to review the clinical characteristics and both the audiological and vestibular findings of vertigo in children with normal eardrums, who do not show otitis media or middle ear effusion, and to assist in making a differential diagnosis of vertigo. METHODS: The fifty five children (< 16 years old) with vertigo, who visited the Department of Otolaryngology, Ajou University Hospital, Suwon, South Korea between January 1995 and December 2001 were selected for this study. These excluded the patients with abnormal eardrums/tympanograms or those that did not perform questionnaires, audiological, or vestibular evaluations. They were retrospectively analyzed for clinical symptoms, vestibular functions, and differential diagnosis. RESULTS: The most common causes for vertigo in children were migraine in 17 (30.9%) and benign paroxysmal vertigo of childhood (BPVC) in 14 (25.5%). Other less frequent causes included four cases of trauma, two cases each of Meniere's disease, delayed endolymphatic hydrops, benign positional vertigo, and one case only for cerebellopontine angle tumor, seizure, acute vestibular neuritis, juvenile rheumatoid arthritis, leaving ten cases (18.2%) as unclassified. Abnormal findings were noted in 13 (23.6%) in pure tone audiogram, 3 (5.5%) in positioning test, 6 (10.9%) in bithermal caloric test, and 36 (65.5%) in rotation chair test. CONCLUSIONS: The vertigo in children with normal eardrums, who did not show otitis media or middle ear effusion, was most commonly caused by migraine and BPVC. These findings have shown to be very different from those with adult vertigo. The evaluation of vertigo in children requires a questionnaire for extensive and complete history taking, audiograms and vestibular function tests. And in selected cases, electroencephalography, hematological evaluation, imaging of the brain or temporal bone should be performed.

Adolescent↗
PubMed1999

Compared study of optokinetic and caloric nystagmus in children with unilateral hyporeflexia and other vestibular disorders.

The authors compare the nystagmus evoked by the caloric test and by two slow and fast optokinetic 'look' stimulations performed in 78 subjects subdivided into two groups and recorded by ENG: group 1 composed of 22 subjects with 'significative' unilateral hyporeflexia and group 2 composed of 56 subjects with important anomalies at the vestibular caloric test. The results can be summarized as follows: 1. the presence of unilateral vestibular hyporeflexia is not exceptional in the child: 22 over 140 cases (15.7%); 2. the comparison between the caloric test and the OKN test in the 22 subjects with significant unilateral hyporeflexia shows: slow and fast TAP homolateral to the side with labyrinthine deficit prevails in ten subjects (45.4%); TAP is inconsistency with respect to the hyporeflexic side (i.e. homolateral in one test and contralateral in the other) in seven cases (31.8%); TAP is contralateral in five cases (22.7%). Within the same group, STAP varies according to cases. 3. In group II, TAP values at the OKN test overlap considerably with respect to the caloric test (18 cases with a total TAP prevailing on the right side, 32.2%; 19 cases with divergent TAP, 33.9%; 19 cases with total TAP prevailing on the left side, 33.9%). 4. The data shown in group 1 with significant vestibular hyporeflexia can be correlated to the time elapsed between the last electronystagmography and that performed soon after disease onset. Since for ENG performed some days after vertigo onset (even though clinical examination is negative) shows a concordance of OKN TAP and the hyporeflexic side (as the mechanisms of central compensation are still being developed) and then when these mechanisms improve with time, an inconsistency of OKN TAP and hyporeflexic side and finally a contralaterality. We might rely on the comparison between OKN TAP and caloric test as a finding of the time distance from the vertigo onset (when unknown) and a rough prognostic sign. The only case of vestibular neuritis by us followed in time seems to confirm our assumption.

Adolescent↗
PubMedDate not supplied

Vestibular function interferes in cardiovascular reflexes [corrected].

BACKGROUND: Experimental work indicates that the vestibular system participates in autonomic reflexes during body movement and postural changes. However, there are no studies of cardiovascular reflexes during vertigo due to human acute vestibular lesions. METHODS: We assessed the response to active change of posture and hand immersion in cold water in seven patients with unilateral peripheral vestibular failure (vestibular neuritis) and seven age/sex-matched healthy subjects in acute phase (72 h from vertigo onset) and at 2 weeks of follow-up. RESULTS: During acute phase, patients showed decreased blood pressure response during cold hand test (p < 0.05). Upright stance induced deficient decrease of the respiratory component of heart rate variability (p < 0.05) with lack of increase in low frequency/high frequency (LF/HF) ratio. At 2 weeks of follow-up, these abnormalities improved. CONCLUSIONS: Results suggest that acute vestibular lesions can interfere with cardiovascular autonomic responses in humans. This may reflect disruption of normal vestibulo-autonomic reflexes.

Adult↗
PubMed2001

Developmental expression of monocarboxylate transporter in the gerbil inner ear.

The expression of H+-monocarboxylate cotransporters (MCTs) that facilitate cell uptake of lactate, pyruvate and other monocarboxylates was investigated in the adult and postnatally developing gerbil inner ear. In the mature cochlea, immunoreactive MCT1 was present in marginal cells of the stria vascularis and in type II, suprastrial and limbal fibrocytes. In the adult vestibular system, dark cells and a subpopulation of fibrocytes immediately underlying maculae and cristae stained strongly for MCT1. Satellite cells surrounding mature spiral and vestibular ganglia neurons also expressed MCT1. MCT1 immunoreactivity was present at birth in marginal and dark cells, at 8 days after birth in fibrocytes and at 12 days after birth in satellite cells, and coincided precisely with the developmental expression of Na,K-ATPase in these sites. The coexpression of MCT1 and Na,K-ATPase in these cell types points to MCT1 as an important source of energy to drive inner ear Na,K-ATPase activity. In the adult inner ear, MCT2 was detectable only in tectal cells of the cochlea and supporting cells of the crista ampullaris. Immunostaining was first observed at 16 days after birth in tectal and at 20 days after birth in supporting cells, and at the same time immunoreactive aquaporin 4 appeared in these cells. The coexpression of MCT2 and aquaporin 4 suggests a possible role for MCT2 in regulating transcellular water movement. Because MCT2 facilitates the transport of acidic intermediates, its biological significance also could relate to modulation of cell pH and volume. Maintenance of the inner ear's unique ion and fluid gradients is essential to normal hearing and balance and requires the expenditure of large amounts of energy. The cellular distribution of MCT1 and MCT2 points to their participation in generating these electrochemical gradients and their potential involvement in sensory deficits associated with various inner ear disorders.

Aging↗
PubMed1993

The neurons of the human magnocellular septal nuclei: a Golgi study.

The morphology of neurons in the magnocellular septal nuclei (medial septal and diagonal band nucleus) were studied in frontal sections of 15 human brains by means of the Golgi method. We classified neurons in the diagonal band nucleus according to their size and morphology into four types: type I--multipolar neurons, type II--fusiform neurons, type III--triangular neurons and type IV--fusiform multipolar neurons. The neurons of the medial septal nucleus we classified into two types: type I--multipolar neurons and type II--fusiform neurons. Our results indicated greater morphological variability of neurons in the human diagonal band nucleus than in the medial septal nucleus.

Adult↗