Vestibular neuronitis: epidemiological survey by questionnaire in Japan

Current treatment of vestibular, ocular motor disorders and nystagmus

Vertigo and dizziness are among the most common complaints with a lifetime prevalence of about 30%. The various forms of vestibular disorders can be treated with pharmacological therapy, physical therapy, psychotherapeutic measures or, rarely, surgery. In this review, the current pharmacological treatment options for peripheral and central vestibular, cerebellar and ocular motor disorders will be described. They are as follows for peripheral vestibular disorders. In vestibular neuritis recovery of the peripheral vestibular function can be improved by treatment with oral corticosteroids. In Menière's disease a recent study showed long-term high-dose treatment with betahistine has a significant effect on the frequency of the attacks. The use of aminopyridines introduced a new therapeutic principle in the treatment of downbeat and upbeat nystagmus and episodic ataxia type 2 (EA 2). These potassium channel blockers presumably increase the activity and excitability of cerebellar Purkinje cells, thereby augmenting the inhibitory influence of these cells on vestibular and cerebellar nuclei. A few studies showed that baclofen improves periodic alternating nystagmus, and gabapentin and memantine, pendular nystagmus. However, many other eye movement disorders such as ocular flutter opsoclonus, central positioning, or see-saw nystagmus are still difficult to treat. Although progress has been made in the treatment of vestibular neuritis, downbeat and upbeat nystagmus, as well as EA 2, state-of-the-art trials must still be performed on many vestibular and ocular motor disorders, namely Menière's disease, bilateral vestibular failure, vestibular paroxysmia, vestibular migraine, and many forms of central eye movement disorders.

Pharmacotherapy of vestibular and ocular motor disorders, including nystagmus

We review current pharmacological treatments for peripheral and central vestibular disorders, and ocular motor disorders that impair vision, especially pathological nystagmus. The prerequisites for successful pharmacotherapy of vertigo, dizziness, and abnormal eye movements are the "4 D's": correct diagnosis, correct drug, appropriate dosage, and sufficient duration. There are seven groups of drugs (the "7 A's") that can be used: antiemetics; anti-inflammatory, anti-Ménière's, and anti-migrainous medications; anti-depressants, anti-convulsants, and aminopyridines. A recovery from acute vestibular neuritis can be promoted by treatment with oral corticosteroids. Betahistine may reduce the frequency of attacks of Ménière's disease. The aminopyridines constitute a novel treatment approach for downbeat and upbeat nystagmus, as well as episodic ataxia type 2 (EA 2); these drugs may restore normal "pacemaker" activity to the Purkinje cells that govern vestibular and cerebellar nuclei. A limited number of trials indicate that baclofen improves periodic alternating nystagmus, and that gabapentin and memantine improve acquired pendular and infantile (congenital) nystagmus. Preliminary reports suggest suppression of square-wave saccadic intrusions by memantine, and ocular flutter by beta-blockers. Thus, although progress has been made in the treatment of vestibular neuritis, some forms of pathological nystagmus, and EA 2, controlled, masked trials are still needed to evaluate treatments for many vestibular and ocular motor disorders, including betahistine for Ménière's disease, oxcarbazepine for vestibular paroxysmia, or metoprolol for vestibular migraine.

Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis)

BACKGROUND

Idiopathic acute vestibular dysfunction (vestibular neuritis) is the second most common cause of peripheral vertigo after benign paroxysmal positional vertigo (BPPV) and accounts for 7% of the patients who present at outpatient clinics specialising in the treatment of dizziness. The exact aetiology of the condition is unknown and the effects of corticosteroids on the condition and its recovery are uncertain.

OBJECTIVES

To assess the effectiveness of corticosteroids in the management of patients with idiopathic acute vestibular dysfunction (vestibular neuritis).

SEARCH STRATEGY

We searched the Cochrane ENT Group Trials Register; CENTRAL; PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 28 December 2010.

SELECTION CRITERIA

Randomised controlled trials comparing corticosteroids with placebo, no treatment or other active treatments, for adults diagnosed with idiopathic acute vestibular dysfunction.

DATA COLLECTION AND ANALYSIS

Two authors independently selected studies from the search results and extracted data. Three authors independently assessed risk of bias.

MAIN RESULTS

Four trials, involving a total of 149 participants, compared the effectiveness of oral corticosteroids against placebo. All the trials were small and of low methodological quality. Although there was an overall significant effect of corticosteroids compared with placebo medication on complete caloric recovery at one month (risk ratio (RR) of 2.81; 95% confidence interval (CI) 1.32 to 6.00, P = 0.007), no significant effect was seen on complete caloric recovery at 12 months (RR 1.58; 95% CI 0.45 to 5.62, P = 0.48), or on the extent of caloric recovery at either one month (mean difference (MD) 9.60%; 95% CI -20.66 to 39.86, P = 0.53) or at 12 months (MD 6.83%; 95% CI -27.69 to 41.36, P = 0.70). In addition, there was no significant difference between corticosteroids and placebo medication in the symptomatic recovery of vestibular function following idiopathic acute vestibular dysfunction with respect to vertigo at 24 hours (RR 0.39; 95% CI 0.04 to 3.57, P = 0.40) and use of the Dizziness Handicap Inventory score at one, three, six and 12 months.

AUTHORS' CONCLUSIONS

Overall, there is currently insufficient evidence from these trials to support the administration of corticosteroids to patients with idiopathic acute vestibular dysfunction. We found no trials with a low risk of methodological bias that used the highest level of diagnostic criteria and outcome measures. We recommend that future studies should include health-related quality of life and symptom-based outcome measures, in addition to objective measures of vestibular improvement, such as caloric testing and electronystagmography.

Which medication do I need to manage dizzy patients?

Vertigo and dizziness are not independent disease entities, but instead symptoms of various diseases. Accordingly, a variety of treatment approaches are required. Here we review the most relevant drugs for managing dizziness, vertigo, and nystagmus syndromes. It is important to differentiate symptomatic treatment of nausea and vomiting with, for example, dimenhydrinate and benzodiazepines, and prophylactic treatment of motion sickness with scopolamine from a causal therapy of the underlying disorders. Examples of such causal therapy include aminopyridines for downbeat nystagmus and episodic ataxia type 2; carbamazepine for vestibular paroxysmia, paroxsymal dysarthria and ataxia in multiple sclerosis, and superior oblique myokymia; betahistine, dexamethasone, and gentamicin for Menière's disease; gabapentin and memantine for different forms of acquired and congenital nystagmus; corticosteroids for acute vestibular neuritis and Cogan's syndrome; metoprolol and topiramate for vestibular migraine; and selective serotonin reuptake inhibitors such as paroxetine for phobic postural vertigo. The clinical entities are briefly described, the various medications are discussed in alphabetical order, and dosage, major side effects, contraindications, and alternative medications of each drug are displayed in boxes for easy reference.

Acute vestibulopathy

The presentation of acute vertigo may represent both a common benign disorder or a life threatening but rare one. Familiarity with the common peripheral vestibular disorders will allow the clinician to rapidly "rule-in" a benign disorder and recognize when further testing is required. Key features of vertigo required to make an accurate diagnosis are duration, chronicity, associated symptoms, and triggers. Bedside tests that are critical to the diagnosis of acute vertigo include the Dix-Hallpike maneuver and canalith repositioning manuever, occlusive ophthalmoscopy, and the head impulse test. The goal of this review is to provide the clinician with the clinical and pathophysiologic background of the most common disorders that present with vertigo to develop a logical differential diagnosis and management plan.

Vestibular neuritis: recurrence and incidence of secondary benign paroxysmal positional vertigo

CONCLUSIONS

Recurrence of vestibular neuritis (VN) is a rare event in long-term follow-up. The incidence of benign paroxysmal positional vertigo (BPPV) in VN patients represents a quite common outcome. To our knowledge, this study represents the only long-term longitudinal study on recurrence of VN and incidence of secondary BPPV in VN.

OBJECTIVES

To study a large number of VN patients longitudinally to identify the recurrence rate of VN and incidence of BPPV, other peripheral vestibular disorders, sudden hearing loss or Bell's palsy.

METHODS

This prospective cohort study assessed a VN patient-based clinic population. All patients received a complete bedside clinical examination and caloric irrigation.

RESULTS

Long-term (range 4-6 years, mean 4.9 years) longitudinal follow-up examination of 51 VN patients demonstrated a low recurrence rate (1/51 patients, 2.0%). With recurrence, VN affected the same ear after 6 months and caused less severe symptoms. BPPV appears to be more frequent (5/51 patients, 9.8%) in VN patients than in the general population, consistently affecting the posterior canal of the same ear. BPPV occurrence after VN predominantly affects VN patients who did not fully recover from the disease. Moreover, BPPV after VN appears to be more difficult to treat than idiopathic BPPV.

Corticosteroids in the treatment of vestibular neuritis: a systematic review and meta-analysis

OBJECTIVE

To systematically review and meta-analyze the results of all randomized controlled trials comparing corticosteroids with placebo for the treatment of patients with vestibular neuritis.

DATA SOURCES

An electronic search was performed in MEDLINE, EMBASE, Cochrane Library, and CENTRAL databases, and then extensive hand-searching was performed for the identification of relevant studies. No time and language limitations were applied.

STUDY SELECTION

Prospective randomized controlled trials comparing corticosteroids with placebo for the treatment of patients with vestibular neuritis.

DATA EXTRACTION

Odds ratios (ORs), weighted mean differences (WMD), 95% confidence intervals (CIs), and tests for heterogeneity were reported.

DATA SYNTHESIS

Four studies were eventually identified and systematically reviewed. Meta-analysis was feasible for 3 studies. Regarding the recovery of clinical symptoms, the proportion of patients with clinical recovery at 1 month after the initiation of therapy did not differ significantly between the corticosteroids and placebo groups (OR, 1.45; 95% CI, 0.26-8.01; p = 0.67). The proportion of patients with caloric complete recovery was significantly different between the corticosteroids and placebo groups both at 1 (OR, 12.64; 95% CI, 2.6-61.52; p = 0.002; heterogeneity, p = 0.53; fixed effects model) and 12 months (OR, 3.35; 95% CI, 1.45-7.76; p = 0.005; heterogeneity, p = 0.03; random effects model) after the initiation of therapy. The caloric extent of canal paresis at 12 months after the initiation of therapy seemed to differ significantly between patients who received corticosteroids and those who received placebo (WMD, -12.15; 95% CI, -19.85 to -4.46; p < 0.05; heterogeneity, p < 0.05; random effects model).

CONCLUSION

The present systematic review and meta-analysis, based on the currently available evidence, suggests that corticosteroids improve only the caloric extent and recovery of canal paresis of patients with vestibular neuritis. At present, clinical recovery does not seem be better in patients receiving corticosteroids.

Medical treatment of vestibular disorders

BACKGROUND

The lifelong prevalence of rotatory vertigo is 30%. Despite this high figure, patients with vertigo generally receive either inappropriate or inadequate treatment. However, the majority of vestibular disorders have a benign cause, take a favorable natural course, and respond positively to therapy.

OBJECTIVE

This review puts special emphasis on the medical rather than the physical, operative, or psychotherapeutic treatments available.

METHODS

A selected review of recent reports and studies on the medical treatment of peripheral and central vestibular disorders.

RESULTS/CONCLUSIONS

In vestibular neuritis, recovery of the peripheral vestibular function can be improved by oral corticosteroids; in Menière's disease, there is first evidence that high-dose, long-term administration of betahistine reduces attack frequency; carbamazepine or oxcarbamazepine is the treatment of first choice in vestibular paroxysmia, a disorder mainly caused by neurovascular cross-compression; the potassium channel blocker aminopyridine provides a new therapeutic principle for treatment of downbeat nystagmus, upbeat nystagmus, and episodic ataxia type 2.

The inner ear and the neurologist

Inner ear disorders are common and patients with vestibular failure often present to a neurology clinic because of their dizziness, gait unsteadiness and oscillopsia. Vestibular disorders can be divided into peripheral and central vestibular disorders. Most of the peripheral vestibular disorders have a clinical diagnosis, and a thorough history and examination will often provide a clear direction as to the diagnosis. Correct diagnosis allows treatment for many of the peripheral and central vestibular disorders. As inner ear damage is generally irreversible, early diagnosis allowing prompt treatment is important. The aim of this review is to discuss some audiovestibular conditions that may well appear in a neurology clinic, and to discuss some recent advances within the audiovestibular field that may be of interest to neurologists. Some of the most common audiovestibular conditions will be discussed along side more uncommon conditions.

Epidemiology of vertigo

PURPOSE OF REVIEW

Epidemiological findings on the distribution, determinants and outcome of vertigo can be used for clinical decision making and can help understand the underlying causes of vestibular diseases. This article gives an overview of the epidemiology of the vestibular symptom vertigo and of four specific vestibular disorders: benign paroxysmal positional vertigo, migrainous vertigo, Menière's disease and vestibular neuritis.

RECENT FINDINGS

Based on a neurotologic survey of the general population, 1-year prevalence estimates for vertigo were 4.9%, for migrainous vertigo 0.89% and for benign paroxysmal positional vertigo 1.6%. Diagnostic positional manoeuvres and treatments for benign paroxysmal positional vertigo, however, are still not being done by most doctors. The female preponderance among patients with benign paroxysmal positional vertigo and migrainous vertigo may be linked to migraine but is not fully understood. A recently reported prevalence of Menière's disease of 0.51% is much higher than previous estimates. Follow-up studies have shown benign paroxysmal positional vertigo recurrence rates of 50% at 5 years and a persistence of dizziness related to anxiety in almost a third of patients 1 year after vestibular neuritis.

SUMMARY

The epidemiology of vertigo and vestibular disorders is still an underdeveloped field. Recent studies have underscored the impact of vertigo at the population level, but its determinants and outcome are not well known yet.

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.

Pharmacological advances in the treatment of neuro-otological and eye movement disorders

PURPOSE OF REVIEW

First, to describe the current pharmacological treatment options for peripheral and central vestibular, cerebellar, and ocular motor disorders. Second, to identify vestibular and ocular motor disorders in which treatment trials are warranted.

RECENT FINDINGS

Peripheral vestibular disorders: In vestibular neuritis recovery of the peripheral vestibular function can be improved by treatment with oral corticosteroids. In Ménière's disease treatment strategies range from low-salt diet, diuretics, and betahistine, to intratympanic injection of corticosteroids or gentamicin. Unfortunately most of the trials on Ménière's disease do not have an up-to-date design. In bilateral vestibulopathy steroids do not seem to improve vestibular function.Central vestibular, cerebellar, and ocular motor disorders: The use of aminopyridines introduced a new therapeutic principle in the treatment of downbeat and upbeat nystagmus and episodic ataxia type 2 (EA2). These potassium channel blockers presumably increase the activity and excitability of cerebellar Purkinje cells, thereby augmenting the inhibitory influence of these cells on vestibular and cerebellar nuclei. A few studies showed that baclofen improves periodic alternating nystagmus, and gabapentin and memantine, pendular nystagmus. Many other eye movement disorders, however, such as ocular flutter, opsoclonus, central positioning, or see-saw nystagmus are still difficult to treat.

SUMMARY

Although progress has been made in the treatment of vestibular neuritis, downbeat and upbeat nystagmus, as well as EA2, state-of-the-art trials must still be performed on many vestibular and ocular motor disorders, namely Ménière's disease, bilateral vestibulopathy, vestibular paroxysmia, vestibular migraine, and many forms of central eye movement disorders.

[Distribution of neurotological findings in patients with cochleovestibular dysfunction]

The relationship between spatial body positioning and environment comes from perfect corporal balance. The three most important systems responsible for this relationship are: the optic system (sight), the proprioceptive system, and the labyrinthine system.

STUDY DESIGN

Retrospective clinical. A retrospective study conducted on 3,701 patients of a private otolaryngologic clinic, in Jundiaí - São Paulo - Brazil, who underwent vestibular and cochlear labyrinthine function testing, from 1979 to 2004.

AIM

To determinate the syndromic distribution occurred at that population and to correlate its relationship with sex, age, symptomatology, as well as otological, clinical and electronystagmographic findings and which were the most frequent medical specialties who asked for this investigation.

RESULTS

There was found in the studied population a major prevalence on females (1.75:1). Seventy-nine percent of the patients were from 20 to 59 years old, therefore including people in labor age, with a major prevalence of peripheral syndromes, but there was no a preferential age or sex group among the different syndromes. This study also demonstrated that some otoneurological symptoms were common to all kind of otoneurological syndromes, in opposition to the data found in the world literature. Tinnitus, hearing loss, nausea and vomit as well as harmonic alterations on clinical examination were found with more frequency on peripheral syndrome and no harmonic on central syndromes, according to the reviewed literature.

CONCLUSIONS

The study conclusions were able to show that the majority of the patients started their investigation with either otolaryngologists or neurologists and 36% of the patients had peripheral syndrome with almost 25% that had normal evaluation.

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.

Methylprednisolone, valacyclovir, or the combination for vestibular neuritis

BACKGROUND

Vestibular neuritis is the second most common cause of peripheral vestibular vertigo. Its assumed cause is a reactivation of herpes simplex virus type 1 infection. Therefore, corticosteroids, antiviral agents, or a combination of the two might improve the outcome in patients with vestibular neuritis.

METHODS

We performed a prospective, randomized, double-blind, two-by-two factorial trial in which patients with acute vestibular neuritis were randomly assigned to treatment with placebo, methylprednisolone, valacyclovir, or methylprednisolone plus valacyclovir. Vestibular function was determined by caloric irrigation, with the use of the vestibular paresis formula (to measure the extent of unilateral caloric paresis) within 3 days after the onset of symptoms and 12 months afterward.

RESULTS

Of a total of 141 patients who underwent randomization, 38 received placebo, 35 methylprednisolone, 33 valacyclovir, and 35 methylprednisolone plus valacyclovir. At the onset of symptoms there was no difference among the groups in the severity of vestibular paresis. The mean (+/-SD) improvement in peripheral vestibular function at the 12-month follow-up was 39.6+/-28.1 percentage points in the placebo group, 62.4+/-16.9 percentage points in the methylprednisolone group, 36.0+/-26.7 percentage points in the valacyclovir group, and 59.2+/-24.1 percentage points in the methylprednisolone-plus-valacyclovir group. Analysis of variance showed a significant effect of methylprednisolone (P<0.001) but not of valacyclovir (P=0.43). The combination of methylprednisolone and valacyclovir was not superior to corticosteroid monotherapy.

CONCLUSIONS

Methylprednisolone significantly improves the recovery of peripheral vestibular function in patients with vestibular neuritis, whereas valacyclovir does not.

Pediatric neurotology

Pediatric neurotology is a subspecialty encompassing the medical and surgical treatment of conditions involving the middle ear, inner ear and lateral skull base. Multiple otologic and neurotologic diseases exist. In the pediatric patient the most common neurotologic conditions are vertigo, complications of otitis media, cholesteatoma, hearing loss and facial paralysis. Vertigo is differentiated into peripheral and central vestibular abnormalities. Peripheral vestibular causes include Meniere's disease, benign paroxysmal positional vertigo, vestibular neuronitis, otitis media and labyrinthitis. The predominant lesions in our field causing central vestibular disorders are brainstem and posterior fossa tumors. Mastoiditis, meningitis, petrositis, sigmoid sinus thrombosis, extradural abscess, brain abscess, otitic hydrocephalus, cholesteatoma and cholesterol granuloma are complications of otitis media and middle ear disease. Sensorineural hearing loss is now readily treated with cochlear implantation. Facial nerve paralysis may result from infectious and other etiologies.

Dizziness

There are several causes of dizziness, each of which requires a different form of management. Virtually all causes of dizziness can be treated with medication, diet, or physical therapy. This article discusses the most common causes of dizziness and management. Case examples are used extensively.

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.

Exercise and drug therapy alter recovery from labyrinth lesion in humans

Acute unilateral vestibular failure is characterized by rotatory vertigo, horizontal-rotatory nystagmus, and postural imbalance, all of which last from days to weeks. These signs and symptoms are caused by a vestibular tone imbalance between the two labyrinths. Recovery results from a combination of peripheral restoration of labyrinthine function (usually incomplete) and central vestibular compensation (CVC) of the vestibular tone imbalance. Acute unilateral failure is most often caused by vestibular neuritis, which is most likely due to the reactivation of a latent HSV-1 infection. Therefore, therapeutic strategies to improve the outcome of VN are theoretically based on two principles: (a) vestibular exercises and drugs to improve CVC and (b) drug treatment of the assumed viral inflammation. The following conclusions can be drawn from studies in animals and/or humans: (1) There is strong evidence that vestibular exercises may improve vestibulo-spinal compensation. These exercises should begin as early as possible after symptom onset. Moreover, slower exercises are likely to be more effective than faster exercises because slower ones seem to depend more on the vestibular system. (2) Despite extensive data from animal experiments indicating that drugs have a favorable effect on CVC, this has not been clinically proven and thus cannot be recommended yet. (3) Preliminary results of an interim analysis from an ongoing randomized, prospective study showed that methylprednisolone (plus an antiviral agent?) may be useful for improving peripheral vestibular function in vestibular neuritis.

Vertigo

Vertigo is a common symptom among outpatients. There are several causes for vertigo, and each cause requires a specific treatment. Depending on the cause, treatment includes change in drugs, physical therapy, bedside maneuvers, life style, and diet. All forms of treatment can be done by neurologists in an outpatient setting.

Distribution of herpes simplex virus type 1 in human geniculate and vestibular ganglia: implications for vestibular neuritis

Vestibular neuritis is a common cause of partial unilateral vestibular paralysis, which usually spares posterior semicircular canal function. The cause is assumed to be a viral reactivation of latent herpes simplex virus type 1 (HSV-1) in human vestibular ganglia. The existence of an anastomosis between the intermediate nerve and the superior vestibular nerve suggests the question of whether selective affliction of the superior vestibular nerve is the result of migration of HSV-1 from the geniculate ganglion along this faciovestibular anastomosis. We determined the distribution of HSV-1 among geniculate ganglia, vestibular ganglia, and within Scarpa's ganglion by examining 35 human temporal bones by polymerase chain reaction. HSV-1 was found in 66% of geniculate ganglia and 60% of vestibular ganglia; all examined parts of vestibular ganglia were almost equally HSV-1 infected. Our data provided no support for viral migration along this anastomosis or for a preferential latency of HSV-1 in the superior vestibular nerve. We suggest that the common double innervation of the posterior ampulla by two nerves running in two separate bony canals could offer an alternative explanation for the regular sparing of posterior canal function in vestibular neuritis.

Risk factors for sudden deafness: a case-control study

In order to investigate risk factors for idiopathic sudden sensorineural hearing loss (sudden deafness), a case-control study was done in 109 patients with sudden deafness who visited our hospital between 1992 and 1994, with 109 controls matched to each patient by gender and age. Odds ratio (OR) and 95% confidence interval (CI) for smoking habits, drinking habits, dietary habits, environmental noise, past history of disease, sleeping hours, appetite, fatigue, incidence of common cold were obtained. Fatigue (OR: 3.28; 95% CI: 1.36-7.90) and loss of appetite (OR: 8:00; 95% CI: 1.00-64.0) elevated the risk for sudden deafness. Those who ate many fresh vegetables were at a decreased risk (OR: 0.48; 95% CI: 0.24-0.96 for light-colored vegetables, OR: 0.55; 95% CI: 0.30-1.02 for green-yellow vegetables). Personal histories of hypertension and thyroid disease, and susceptibility to colds appeared to be positively associated with the risk (0.05 < P < 0.10). Smoking habits, drinking habits and environmental noise had no significant association with sudden deafness. These results suggested that environmental factors, including diet, may be importantly involved in the genesis of sudden deafness.

Histopathology of idiopathic chronic recurrent vertigo

Vestibular neuritis is a degenerative neuropathy of the peripheral vestibular system. The etiology of this condition is uncertain, although it is generally believed to be viral. A small percentage of patients with vestibular neuritis have chronic recurrent episodes of vertigo. Detailed cytologic descriptions of acute or chronic vestibular neuritis are lacking, and no previous studies have reported evidence of chronic inflammation in human temporal bone specimens. The authors of this study examined temporal bone specimens from three patients with a history of chronic recurrent vertigo of unknown cause. Varying degrees of inflammation and destruction were seen in the vestibular system, and mild involvement of the cochlear system was noted. These findings are consistent with postinfectious inflammatory changes of the cochlear-vestibular system analogous to a postinfectious syndrome involving the central nervous system.

Dizziness in childhood

There is a scant literature regarding vestibular evaluation of children with complaints of dizziness or vertigo. Considerable time and effort are expended on the problem and prevention of hearing loss in children, yet we often ignore concurrent or subsequent vestibular disorders. This neglect could be due to several factors, perhaps the most common being the fact that vertiginous crises in childhood are often attributed to problems of behavior or incoordination. In this article, we offer an approach to the dizzy child based on presenting symptoms. We discuss features of the history, examination, and laboratory evaluation key to determining the cause of dizziness. Finally, we discuss management, which varies according to the diagnosis.