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PubMed1982

Adaptation to altered support and visual conditions during stance: patients with vestibular deficits.

Patients whose deficits were limited to clinically well qualified vestibular disorders have been exposed to a number of altered support surface and visual environments while standing unsupported. A six-degrees-of-freedom platform employing movable support surfaces for each foot and a movable visual surround deprived patients of normal inputs derived from a fixed level support surface and from an immobile surround. Various tests employing EMG, force, and body movement recording identified quantitative changes in the patients' strategy for the relative weighting of proprioceptive, vestibular, and visual inputs. The most dramatic performance deficit of patients was their inability to suppress the influence of visual and proprioceptive inputs appropriately whenever motions of external surface disturbed the orientation information provided by these inputs. Thus, the more mildly afflicted patients experienced instability not so much because of the loss of vestibular inputs directly to posture but because of their inappropriate responses to proprioceptive inputs and vision. Discussion is centered on the role of vestibular input as an internal reference system for orientation about which adaptive changes in proprioceptive and visual inputs are made.

Humans↗
PubMed1995

CT of postmeningitic deafness: observations and predictive value for cochlear implants in children.

PURPOSE: To demonstrate CT abnormalities encountered in children with postmeningitic deafness and to assess the value of CT in the prediction of cochlear implantation difficulties. METHODS: Thirteen children with postmeningitic deafness were evaluated with high-resolution, thin-section CT. CT findings were correlated with surgical anatomy at the time of cochlear implantation, with particular regard to the prediction of implant success. RESULTS: CT findings included normal scans (3 of 13, 23.1%), cochlear stenosis (5 of 13, 37.7%), cochlear fibroossific change (1 of 13, 7.7%), cochlear ossification (4 of 13, 30.8%), and osseous hypertrophy at the round window niche (4 of 13, 30.8%). Nine of 10 patients with abnormal findings had incomplete or difficult implantations (90%); 7 (88.8%) of these 9 received limited electrode insertions. CONCLUSION: Attention to subtle otological abnormalities on thin-section CT is helpful in the prediction of early success or failure of implantation in children with postmeningitic deafness. Those with CT abnormalities had a 90% risk of incomplete or difficult insertions with a 70% chance of limited electrode insertion.

Adolescent↗
PubMed1984

[Cholesteatoma of the petrous bone with major expansion. Apropos of 17 cases].

Cholesteatomas with major extension correspond to lesions invading beyond the classical limits of middle ear affections. Pathogenicity, and clinical and therapeutic aspects of the disorder are discussed in relation to 17 cases where the affection appeared to be secondary to initial otitic lesions. The diagnostic difficulty in patients with open tympanic membranes is the evaluation of the degree of extension of the lesion, while it has to be considered in patients with closed membranes, particularly in the presence of facial paralysis and internal ear deafness. Radiographic examinations, even when of high quality, may fail to detect cholesteatomas with major extension, and these may be a surprising finding on operation. Treatment is uniquely surgical and requires experience in otoneurosurgical techniques. Total excision is essential in order to avoid rare but serious complications of the affection.

Bone Diseases↗
PubMed2001

Vestibular end-organ impairment in an animal model of type 2 diabetes mellitus.

OBJECTIVES/HYPOTHESIS: To define and assess the functional impairment of the vestibular part of the inner ear in a diabetic state, using a direct and objective test for evaluating the vestibular end-organ and an animal model for diet-induced type 2 diabetes mellitus. STUDY DESIGN: Prospective controlled animal study. METHODS: Two groups of sand rats (Psammomys obesus) were maintained on two different diets. The experimental group received a specially designed high-energy diet known to induce a diabetic state, and the control group a low-energy diet maintaining these animals in a normal metabolic state. After 1 month of documented hyperglycemia in the experimental group, recordings of vestibular evoked potentials (VsEPs) and recordings of auditory brainstem response (ABR) were conducted in all animals. The latency and the amplitude of the first wave of both responses, shown to reflect end-organ activity, were compared between the two groups. RESULTS: The mean latency of the first wave of the VsEPs was significantly (P = .002) prolonged and the amplitude was significantly (P = .005) decreased in the diabetic group in comparison to the control group. The latency of the first wave of ABR was significantly (P = .02) prolonged, the amplitude was not significantly decreased, and threshold was significantly elevated (P = .01) in the diabetic group. CONCLUSION: For the first time, using an objective assessment test, functional impairment of the vestibular part of the inner ear has been demonstrated in the diabetic metabolic state. Despite this being an animal study, these findings would seem to indicate that the vestibular-end-organ should be added to the long list of organs and tissues adversely affected by diabetes.

Animals↗
PubMed1984

An algorithm for neurotologic disorders.

In the evaluation of patients with complaints of dizziness, hearing loss, and/or tinnitus, the primary objective is to determine the site of the lesion. An accurate localization of the lesion is important for selecting the most appropriate radiologic study. The information obtained from the vestibular and audiometeric evaluations identifies the site of the lesion accurately. For the vestibular evaluation we use photoelectric nystagmography (PENG) and the Torok monothermal differential caloric test. The initial audiometeric evaluation consists of a pure-tone audiogram and speech discrimination scores. Additional audiometric site-of-lesion tests and ABR are used selectively as the diagnostic yield of these tests does not significantly add to the information already obtained from the vestibular evaluation. If the lesion is suspected to lie in the middle ear or internal auditory canals, we use pluridirectional tomography. For further delineation of lesions confined to the internal auditory canal we use pneumo-CT. For suspected morphologic lesions of the posterior fossa we use thin-section CT with enhancement. Review has proved useful in defining petrous apex and skull base lesions. CT-rBBC studies have proved valuable in objectively demonstrating a deficient perfusion of the brain. The vascularity of certain lesions such as glomus tumors can be satisfactorily confirmed by this technique.

Adult↗
PubMed1983

Circling syndrome and inner ear disease in mice infected intraperitoneally or intravenously with Coccidioides immitis spherule-endospore phase cultures.

Infection was studied in mice with varying doses of spherule-endospore phase cultures of Coccidioides immitis, administered intraperitoneally, intravenously and intranasally. Stain 46 was compared with strain Silveira. The first of these is relatively avirulent in the mycelial phase, the second, rather virulent. Animals were observed for acute death and for circling. Gross and microscopic pathology was studied in mice sacrificed at appropriate intervals after infection. Numbers of fungi were assayed in spleen, lung, kidney, liver, blood, brain, and ear tissue. Strain 46 endospores administered intraperitoneally in doses from 9 X 10(6) to 2.5 X 10(7) produced a high incidence of 'circling syndrome' ataxia attributable to inner ear disease.

Animals↗
PubMedDate not supplied

Quantitative study of Scarpa's ganglion and vestibular sense organs in endolymphatic hydrops.

The density of vestibular hair cells and the number of neurons in Scarpa's ganglion were estimated for 11 temporal bones with endolymphatic hydrops. The ten subjects from which these bones were taken all exhibited decreased caloric response (when tested), fluctuating hearing loss, and episodic vertigo. The degeneration of vestibular sense organs was found within the "normal" range for all except one case, which showed total degeneration of the posterior crista ampullaris. Ganglion cell counts in all cases were low. In three of the ten subjects, counts fell below the lowest values seen in a sample of "normal" ears. These three subjects exhibited fluctuating hearing loss and episodic vertigo for more than six years prior to death. In cases of unilateral endolymphatic hydrops there was no significant difference between counts in the affected and unaffected ear. Thus, the apparent ganglion cell degeneration may be due to ear disease other than endolymphatic hydrops.

Aged↗