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Individual semicircular canal function in superior and inferior vestibular neuritis.

OBJECTIVE: To examine the concept of selective superior and inferior vestibular nerve involvement in vestibular neuritis by studying the distribution of semicircular canal (SCC) involvement in such patients. BACKGROUND: Vestibular neuritis was traditionally thought to involve the superior and inferior vestibular nerves. Recent work suggests that in some patients, only the superior nerve is involved. So far there are no reported cases of selective involvement of the inferior vestibular nerve. METHODS: The authors measured the vestibuloocular reflex from individual SCC at natural head accelerations using the head impulse test. The authors studied 33 patients with acute unilateral peripheral vestibulopathy, including 29 with classic vestibular neuritis and 4 with simultaneous ipsilateral hearing loss, 18 healthy subjects and 15 surgical unilateral vestibular deafferented patients. RESULTS: In patients with preserved hearing, eight had deficits in all three SCC, suggesting involvement of the superior and inferior vestibular nerves. Twenty-one had a lateral SCC deficit or a combined lateral and anterior SCC deficit consistent with selective involvement of the superior vestibular nerve. Two patients with ipsilateral hearing loss had normal caloric responses and an isolated posterior SCC deficit on impulsive testing. The authors propose that these two patients had a selective loss of inferior vestibular nerve function. CONCLUSION: Vestibular neuritis can affect the superior and inferior vestibular nerves together or can selectively affect the superior vestibular nerve.

Adult↗

Relevance of plasma D-dimer measurement in patients with acute peripheral vertigo.

The aetiopathogenesis of acute unilateral peripheral vestibular dysfunction (APV), also known as vestibular neuritis, is still debated: the principal cause is viral infection with vascular factors second in importance. Plasmatic D-dimer, considered a plasmatic index of hypercoagulation, was measured in a group of 45 APV patients and in a group of 25 patients suffering from Ménière's disease. Measurements were taken both during the acute stage and after a four to six week period of pharmacological washout. The mean D-dimer levels were significantly higher than those measured in the controls both during the acute phase (301 SD161 vs 202 SD113 ng/mL) and after follow up (304 SD211 vs 192 SD111 ng/mL) (p = 0.008). Moreover, during the acute stage 23 of the APV patients (51.1 per cent) had plasmatic D-dimer levels above the upper normal limit (i.e.: <300 ng/mL), compared to four of those with Ménière's disease (16 per cent). Our results lead us to postulate an involvement of the haemostatic system in APV.

Adult↗

Vestibular-evoked myogenic potential in patients with unilateral vestibular neuritis: abnormal VEMP and its recovery.

The incidence of inferior vestibular nerve disorders in patients suffering from unilateral vestibular neuritis and the recovery of these disorders were evaluated by monitoring the vestibular-evoked myogenic potential (VEMP). Eight patients ranged from 21 to 73 years that suffered from unilateral vestibular neuritis underwent VEMP and caloric testing. Abnormal VEMP was observed in two of the eight patients with unilateral vestibular neuritis. Two patients were diagnosed as having an inferior vestibular nerve disorder. One of these patients showed recovery of the inferior vestibular nerve function as assessed by the VEMP. Disorders of the inferior vestibular nerve function and their recovery was confirmed by our current results. The time course of recoveries of the superior and inferior vestibular nerve systems were similar in the two patients.

Adult↗

[Specific vestibular exercises in the treatment of vestibular neuritis].

INTRODUCTION: Vestibular neuritis rapidly damages unilateral vestibular periphery, inducing severe balance disorders. In most cases, such vestibular imbalance is gradually restored to within the normal level after clinical therapies. This successive clinical recovery occurs due to regeneration of vestibular periphery and/or accomplishment of central vestibular compensation. REHABILITATION: The program of vestibular rehabilitation presents a major achievement in the field of treatment of balance disorders. Vestibular compensation is associated with central sensory reintegration and bilaterally equalizes the vestibular tonus over a period of time. MATERIAL AND METHODS: In this retrospective study of a series of cases authors present their results in 58 patients undergoing a program of vestibular rehabilitation. Patients were divided into two groups. Thirty patients were in group I, and 28 in group II. Specific vestibular exercises were conducted in group I, and non-specific exercises in group II. Analysis of effects of vestibular compensation was made due electronystagmography. RESULTS: Results were satisfactory in both groups of patients. Absence of spontaneous nystagmus was detected in 83.3% of patients in group I (specific vestibular exercises) and in 53.5% of patients in group II (non-specific exercises), with an average treatment time of up to 2 months. Harmonization of pendular stimulation was detected in 83.3% and 60.7% of patients in groups I and II, respectively. CONCLUSION: Early physiotherapeutic vestibular rehabilitation supports the vestibular compensation mechanism. At the same time vestibular rehabilitation may prevent panic disorder caused by hyperventilation syndrome.

Adult↗

Voluntary control of the human vestibulo-ocular reflex.

The ability of normal subjects to increase their vestibulo-ocular reflex (VOR) gain with an imagined stationary frame of reference was dependent on their strategy and the test conditions. With large amplitude sinusoidal rotation (greater than 50 degrees) subjects could not increase their VOR gain regardless of the strategy used. With small amplitude excursions (less than 50 degrees) they could significantly increase their VOR gain if they used a 'single stripe' strategy. Accompanying this increase in VOR gain was an increase in the phase lead of VOR slow phase velocity relative to head velocity. Apparently the signal used to augment the VOR gain with an imagined stationary surround had phase characteristics similar to those of primary vestibular afferent neurons.

Eye Movements↗

Differential effect of ischemia on spontaneous and sinusoidal-evoked activity in semicircular canal afferents in the bullfrog.

Spontaneous and sinusoidal-evoked nerve activity in semicircular canal afferent fibers of the bullfrog was evaluated prior to and following the production of ischemia of the labyrinthine arterial supply by mechanical occlusion of the vestibular artery. Neuronal spontaneous firing rates were observed to diminish by up to 100% within 10 min following the onset of ischemia. In most neurons there was a substantial increase in firing rate during the first few minutes. The sensitivity of the fibers to natural stimulation as determined by the gain in their responses to sinusoidal motion also diminished by as much as 75% over the same period. No detectable changes in the membrane potentials of the neurons were observed. The changes in excitability were closely correlated with the changes in spontaneous firing rate, but not all the neurons whose responses changed showed changes in spontaneous activity. Likewise, the relative magnitude of change varied from neuron to neuron.

Action Potentials↗

Simultaneous acute superior nerve neurolabyrinthitis and benign paroxysmal positional vertigo.

An acutely vertiginous 47-year-old woman presented to the emergency department with simultaneous acute left neurolabyrinthitis and left posterior canal benign paroxysmal positional vertigo (BPPV). Gaze nystagmus from the neurolabyrinthitis hampered diagnosis of the BPPV. However, once the BPPV was identified and treated, the patient's subjective vertigo improved rapidly. Concomitant BPPV should not be overlooked when a diagnosis of acute neurolabyrinthitis is made in the emergency department.

Ear, Middle↗

[Study on 242 inpatients reporting vertigo and dizziness].

We studied 242 inpatients--men (34%) and women (66%) reporting vertigo and dizziness while hospitalized at Hakodate Municipal Hospital from July 1999 to June 2002. Adults over 65 years old accounted for 47.3% of all subjects. Reports of symptoms tended to increase in March, August, and December. Cases were classified into 4 groups: 1) peripheral disorders (35.7%), 2) central disorders (7.9%), 3) disorders of other origins (8.3%), and 4) disorders of unknown origin (47.1%). Group 1) involved vestibular neuritis (10.1% of all cases), Meniere diseases (12.4%), benign paroxysmal positional vertigo (BPPV) (5.8%), and sudden deafness with vertigo (5.8%). Patients with vestibular neuritis--25 subjects including men (68%) and women (32%)--tended to be admitted mainly in July. Vestibular compensation in 15 patients with vestibular neuritis was studied using the platform stabilometry. The total length of a locus and the area of surroundings with open eyes decreased significantly (p < 0.05) as the condition of patients improved. In conclusion, many subjects reporting vertigo and dizziness had vestibular neuritis and few had BPPV. We found platform stabilometry to be useful in estimation of improvement in patients with vestibular neuritis.

Adult↗

[Factors influencing long-term progress in patients with vestibular neuritis].

We previously reported that platform stabilometry was effective in evaluating the condition of patients with vestibular neuritis. In the present study, we increased the patient population (n = 31) and followed them up for long-term (253.5 +/- 36.5 days after admission) to determine factors influencing prognosis. We examined the stability of patients with vestibular neuritis using platform stabilometry at 5 time points: P1, (5.3 +/- 0.7 days after admission); P2, (22.2 +/- 1.2 days); P3, (73.2 +/- 2.5 days); P4, (159.2 +/- 9.2 days); and P5, (258.3 +/- 23.5 days). For some elements--the total length of locus and the area of surroundings with open or closed eyes--the total length of locus with open eyes decreased significantly (P<0.05) following disease amelioration. Important factors for improving elements of platform stabilometry in patients with vestibular neuritis were age, presence of upper respiratory infection, and the duration of nystagmus.

Adult↗

[Recording of vestibular myogenic evoked potentials in patients with disturbed inner function].

In this study, we measured VEMP in patients with disturbed function of inner ear. We studied 4 patients with unilateral sensorineural deafness and normal excitability of vestibular organs; 6 persons with unilateral weakness of vestibular function and 10 healthy subjects. We found that in patients with unilateral weakness of vestibular function VEMPs had short latencies and diminished amplitudes whereas in patients with unilateral deafness VEMPs were unchanged. These data strongly suggested that VEMPs were generated by stimulation of vestibular and not cochlear part of inner ear-sacculus. Our data confirm that VEMPs are a highly objective technique, simple, secure and comfortable for patients to assess the vestibulo-spinal connections.

Adult↗

[Cochlear hypoxia and mtDNA deletion: possible correlated factors to cause presbycusis].

OBJECTIVE: To find the relationship among the most common mitochondrial DNA (mtDNA) 4,977 bp deletion, aging and deterioration of acoustic organ and determine the pathologic factors causing mtDNA 4,977 bp deletion. METHODS: Sixty-seven temporal bones from a presbycusis group, an age-matched control group and a young control group were evaluated. The nested PCR and tri-nested PCR techniques were used to test the presence of mtDNA 4,977 deletion. Computer imaging processing was used to measure the parameters of blood vessels in the internal acoustic meatus. RESULTS: Temporal bones from patients aged 50 years or over frequently showed mtDNA 4,977 deletions. In presbycusis patients, 17 of 34 ears showed mtDNA 4,977 deletion, whereas only 4 of 19 ears from the age-matched control group showed mtDNA 4,977 deletions. mtDNA 4,977 deletions were often seen in the spiral ganglion and vestibular ganglion neurons. In the presbycusis group, the lumen of the vasa nervosum of the internal auditory meatus showed a more severe reduction in patients with mtDNA 4,977 deletion than in those without deletion. CONCLUSION: There is a strong correlation between presbycusis and mtDNA 4,977 deletion. We hypothesize that cochlear hypoxia may cause mtDNA 4,977 deletions and other mtDNA mutants which in turn may cause a reduction of mitochondrial oxidative phosphorylation and decreased auditory nerve function. The symptoms of neural presbycusis, however, may appear only after mtDNA metabolism decreases below a specific threshold.

Aged↗

[Structure of the neurons of the spiral and vestibular ganglia and changes in them under conditions of adequate stimulation].

The ganglionic cells of the eighth nerve ganglia were studied. The cells of the vestibular and spiral ganglion were similar in structure. Changes in the ultrastructure involving the mitochondrial apparatus, and squamous endoplasmic reticulum and the nucleus took place in the ganglionic cells under effects of stimulation (sound, angular accelerations, vibration). These shifts appear to be morphological manifestations of the ganglionic cell metabolism under the influence of a specific stimulus.

Acoustic Stimulation↗