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Connolly M, Hawkshaw MJ, Sataloff RT. Havana syndrome: Overview for otolaryngologists. Am J Otolaryngol 2024; 45:104332. [PMID: 38663328 DOI: 10.1016/j.amjoto.2024.104332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2024] [Accepted: 04/21/2024] [Indexed: 06/14/2024]
Abstract
Havana Syndrome is used to describe the array of deficits seen in diplomats stationed in Cuba from August 2016 to September 2017.1 Patients from this cohort were clinically studied, investigating their symptoms, audition and vestibular deficits, and imaging abnormalities seen on MRI.1-3 The primary studies were retrospective, looking at how these symptoms could be classified or fit into diagnostic criteria. The cohort had many similarities: a sound at the onset of symptoms, a mix of neurologic and otologic symptoms, and persistent symptoms that lasted for months.1-3 Theories of the cause of Havana Syndrome have led to no conclusive answer. Potential viral etiologies, mass psychogenic illness, and head trauma were examined as causes.1-5 Diseases with established diagnostic criteria were used to compare the patients' symptoms to try to find a disease that fits Havana Syndrome.3 Recent information from the Office of the Director of National Intelligence suggested the most likely cause to be mass psychogenic illness. With the cause of Havana Syndrome still unknown, a review of reported cases and reports helps otolaryngologists understand Havana Syndrome so they diagnose it only when appropriate and do not miss other conditions that may present with similar symptoms and that might respond well to targeted treatment.
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Affiliation(s)
| | - Mary J Hawkshaw
- Research Professor and Vice Chair for Research Initiatives, Department of Otolaryngology - Head and Neck Surgery, Drexel University College of Medicine, United States of America
| | - Robert T Sataloff
- Professor and Chair, Department of Otolaryngology - Head and Neck Surgery, Senior Associate Dean for Clinical Academic Specialties, Drexel University College of Medicine, United States of America.
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Bartholomew RE, Baloh RW. "Havana Syndrome": A post mortem. Int J Soc Psychiatry 2024; 70:402-405. [PMID: 38146090 PMCID: PMC10913303 DOI: 10.1177/00207640231208374] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/27/2023]
Abstract
BACKGROUND Since 2016, an array of claims and public discourse have circulated in the medical community over the origin and nature of a mysterious condition dubbed "Havana Syndrome," so named as it was first identified in Cuba. In March 2023, the United States intelligence community concluded that the condition was a socially constructed catch-all category for an array of health conditions and stress reactions that were lumped under a single label. AIMS To examine the history of "Havana Syndrome" and the many factors that led to its erroneous categorization as a novel clinical entity. METHOD A review of the literature. RESULTS/CONCLUSIONS Several factors led to the erroneous classification of "Havana Syndrome" as a novel entity including the failure to stay within the limitations of the data; the withholding of information by intelligence agencies, the prevalence of popular misconceptions about psychogenic illness, the inability to identify historical parallels; the role of the media, and the mixing of politics with science.
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Affiliation(s)
- Robert E Bartholomew
- Faculty of Medical and Health Sciences, The University of Auckland, Auckland, New Zealand
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Hoppes CW, Lambert KH, Whitney SL, Erbele ID, Esquivel CR, Yuan TT. Leveraging Technology for Vestibular Assessment and Rehabilitation in the Operational Environment: A Scoping Review. Bioengineering (Basel) 2024; 11:117. [PMID: 38391603 PMCID: PMC10886105 DOI: 10.3390/bioengineering11020117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Revised: 01/12/2024] [Accepted: 01/18/2024] [Indexed: 02/24/2024] Open
Abstract
INTRODUCTION The vestibular system, essential for gaze and postural stability, can be damaged by threats on the battlefield. Technology can aid in vestibular assessment and rehabilitation; however, not all devices are conducive to the delivery of healthcare in an austere setting. This scoping review aimed to examine the literature for technologies that can be utilized for vestibular assessment and rehabilitation in operational environments. MATERIALS AND METHODS A comprehensive search of PubMed was performed. Articles were included if they related to central or peripheral vestibular disorders, addressed assessment or rehabilitation, leveraged technology, and were written in English. Articles were excluded if they discussed health conditions other than vestibular disorders, focused on devices or techniques not conducive to the operational environment, or were written in a language other than English. RESULTS Our search strategy yielded 32 articles: 8 articles met our inclusion and exclusion criteria whereas the other 24 articles were rejected. DISCUSSION There is untapped potential for leveraging technology for vestibular assessment and rehabilitation in the operational environment. Few studies were found in the peer-reviewed literature that described the application of technology to improve the identification of central and/or peripheral vestibular system impairments; triage of acutely injured patients; diagnosis; delivery and monitoring of rehabilitation; and determination of readiness for return to duty. CONCLUSIONS This scoping review highlighted technology for vestibular assessment and rehabilitation feasible for use in an austere setting. Such technology may be leveraged for prevention; monitoring exposure to mechanisms of injury; vestibular-ocular motor evaluation; assessment, treatment, and monitoring of rehabilitation progress; and return-to-duty determination after vestibular injury. FUTURE DIRECTIONS The future of vestibular assessment and rehabilitation may be shaped by austere manufacturing and 3D printing; artificial intelligence; drug delivery in combination with vestibular implantation; organ-on-chip and organoids; cell and gene therapy; and bioprinting.
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Affiliation(s)
- Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, 3630 Stanley Road, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA
| | - Karen H Lambert
- Hearing Center of Excellence, 2200 Bergquist Drive, Lackland Air Force Base, TX 78236, USA
| | - Susan L Whitney
- Department of Physical Therapy, School of Health and Rehabilitation Sciences, University of Pittsburgh, Bridgeside Point 1, 100 Technology Drive, Pittsburgh, PA 15219, USA
| | - Isaac D Erbele
- Department of Otolaryngology-Head and Neck Surgery, San Antonio Uniformed Services Health Education Consortium, Brooke Army Medical Center, 3551 Roger Brooke Drive, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA
- Department of Surgery, School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
| | - Carlos R Esquivel
- Wilford Hall Ambulatory Surgical Center, 2200 Bergquist Drive, Lackland Air Force Base, TX 78236, USA
| | - Tony T Yuan
- Department of Radiology and Radiological Sciences, School of Medicine, Uniformed Services University of the Health Sciences, 4301 Jones Bridge Road, Bethesda, MD 20814, USA
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Asadi-Pooya AA. Havana syndrome: a scoping review of the existing literature. REVIEWS ON ENVIRONMENTAL HEALTH 2023; 38:655-661. [PMID: 35962646 DOI: 10.1515/reveh-2021-0182] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/30/2021] [Accepted: 07/22/2022] [Indexed: 06/15/2023]
Abstract
Since 2016, numerous American and Canadian diplomats and secret (intelligence) agents in Cuba, China, and other places in the world have experienced an abrupt onset of unusual clinical symptoms including, tinnitus, visual problems, vertigo, and cognitive difficulties, after they encountered strange sounds; this has been called "Havana syndrome" (HS). MEDLINE, Scopus, and Ovid databases from 2016 until 24 September 2021 were systematically searched for the related published manuscripts. The following search strategy was implemented: "Havana syndrome" OR "Neurological Symptoms and US Diplomats". The primary search yielded 120 publications. Only five original studies and 18 non-original articles were considered to be relevant. While these studies provided a constellation of signs and symptoms for HS, none provided a good level of evidence. In conclusion, Havana syndrome is a nonspecific neurological illness with an unidentified causative factor(s), an acute phase of auditory-vestibular symptoms and a chronic phase of nonspecific neurobehavioral symptoms. This syndrome should be considered and investigated as a health concern, and not as a political issue.
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Affiliation(s)
- Ali A Asadi-Pooya
- Department of Neurology, Jefferson Comprehensive Epilepsy Centre, Thomas Jefferson University, Philadelphia, PA, USA
- Epilepsy Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
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Della Sala S. Politics dictating on science is like a gunshot in a concert. Int J Soc Psychiatry 2023:207640231208373. [PMID: 37886800 DOI: 10.1177/00207640231208373] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/28/2023]
Affiliation(s)
- Sergio Della Sala
- Human Cognitive Neuroscience, Psychology, University of Edinburgh, Edinburgh, UK
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Whitney SL, Ou V, Hovareshti P, Costa CM, Cassidy AR, Dunlap PM, Roeder S, Holt L, Tolani D, Klatt BN, Hoppes CW. Utility of VestAid to Detect Eye-Gaze Accuracy in a Participant Exposed to Directed Energy. Mil Med 2023; 188:e1795-e1801. [PMID: 36208334 DOI: 10.1093/milmed/usac294] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2022] [Revised: 08/24/2022] [Accepted: 09/19/2022] [Indexed: 11/13/2022] Open
Abstract
INTRODUCTION The VestAid is a tablet-based application that provides feedback about a patient's eye/head movements during exercise after concussion. The goal of this case series was to determine if VestAid could be used to detect eye-gaze accuracy in a participant exposed to directed energy (DE). MATERIALS AND METHODS The VestAid results of a participant with DE were compared to an age- and gender-matched healthy control, a participant post-concussion, and a participant with vestibular neuritis. A tablet with VestAid software was utilized to record eye-gaze accuracy and head speed during VORx1 exercises using eye and facial recognition as participants were exposed to 12 visual scenes. RESULTS The participant with DE consistently had difficulty with eye-gaze accuracy when the head was rotated towards the right for all trials. The participant with DE had poor eye-gaze accuracy during all phases of the head turn cycle compared to the control participant (mean 47.91%, [SD = 7.32%] for the DE participant versus mean 94.28%, [SD = 5.87%] for the control participant). Post-exercise dizziness and perceived difficulty in the 12 exercises completed by the participant with DE were strongly related (Spearman's rho = 0.7372, P = .0062). The participant with DE had the lowest scores on 10 of the 12 head movement trials. CONCLUSIONS VestAid provided unique information about eye-gaze accuracy that detected eye movement abnormalities in the participants with DE exposure, concussion, and vestibular neuritis. The objective metrics of eye-gaze stability correlate with participants' symptoms and perceived difficulty of the eye/head movements.
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Affiliation(s)
- Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Victoria Ou
- Intelligent Automation dba BlueHalo, Rockville, MD 20855, USA
| | | | | | - Amy R Cassidy
- UPMC Centers for Rehab Services, Pittsburgh, PA 15213, USA
| | - Pamela M Dunlap
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Shamus Roeder
- Intelligent Automation dba BlueHalo, Rockville, MD 20855, USA
| | - Lisa Holt
- Intelligent Automation dba BlueHalo, Rockville, MD 20855, USA
| | - Devendra Tolani
- Intelligent Automation dba BlueHalo, Rockville, MD 20855, USA
| | - Brooke N Klatt
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Carrie W Hoppes
- Army-Baylor University Doctoral Program in Physical Therapy, Joint Base San Antonio-Fort Sam Houston, TX 78234, USA
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Hoppes CW, Lambert KH, Klatt BN, Harvard OD, Whitney SL. Vestibular Physical Therapy Treatment of Individuals Exposed to Directed Energy. Mil Med 2023; 188:e198-e204. [PMID: 34027970 DOI: 10.1093/milmed/usab202] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2021] [Revised: 05/06/2021] [Accepted: 05/10/2021] [Indexed: 01/11/2023] Open
Abstract
INTRODUCTION Following suspected sonic attacks on U.S. Embassies, a subset of individuals presented with a unique cluster of symptoms believed to have resulted from exposure to directed energy. Directed energy has been described as exposure to a unique sound/pressure phenomenon such as infrasonic or ultrasonic acoustic or electromagnetic energy. The Joint Force does not have an established protocol to guide vestibular physical therapy for individuals exposed to directed energy. Therefore, we have provided evidence-based guidance for the treatment of oculomotor- and vestibular-related impairments from similar populations. MATERIALS AND METHODS Published evidence was used to inform suggestions for clinical best practice. We offer resources for the management of non-oculomotor- and non-vestibular-related impairments, before discussing physical therapy interventions for dizziness and imbalance. RESULTS The physical therapist should design a treatment program that addresses the individual's health condition(s), body structure and function impairments, activity limitations, and participation restrictions after suspected directed energy exposure. This treatment program may include static standing, compliant surface standing, weight shifting, modified center of gravity, gait, and gaze stabilization or vestibular-ocular reflex training. Habituation may also be prescribed. Interventions were selected that require little to no specialized equipment, as such equipment may not be available in all settings (i.e., operational environments). CONCLUSIONS Evidence-based guidance for prescribing a comprehensive vestibular physical therapy regimen for individuals exposed to directed energy may aid in their rehabilitation and return to duty. This standardized approach can help physical therapists to treat complaints that do not match any previously known medical conditions but resemble brain injury or vestibular pathology.
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Affiliation(s)
- Carrie W Hoppes
- U.S. Army Medical Center of Excellence, Army-Baylor University Doctoral Program in Physical Therapy, Fort Sam Houston, TX 78234, USA
| | | | - Brooke N Klatt
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Orlando D Harvard
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15219, USA
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Aristi G, Kamintsky L, Ross M, Bowen C, Calkin C, Friedman A, Hashmi JA. Symptoms reported by Canadians posted in Havana are linked with reduced white matter fibre density. Brain Commun 2022; 4:fcac053. [PMID: 35505689 PMCID: PMC9050567 DOI: 10.1093/braincomms/fcac053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 12/09/2021] [Accepted: 03/03/2022] [Indexed: 11/24/2022] Open
Abstract
Diplomats representing the USA have reported with unusual neurologic symptoms and MRI changes after being posted in Havana, Cuba between late 2016 and 2018. Here, we examined white matter microstructure and network connectivity of individuals stationed in Havana, using diffusion-weighted MRI, fixel-based analysis and structural connectomics as implemented in MRtrix3. MRI data acquisition and clinical assessments were done in a total of 24 diplomats and their family members and 40 healthy controls. The diplomat data were grouped into an exposed cohort (n = 16) and an unexposed cohort (n = 10), and among these, two individuals were assessed before and after potential exposure. Fixel-based analysis revealed a reduction in fibre density in two specific regions: the fornix and the splenium, in exposed individuals, relative to unexposed individuals and healthy controls. Post hoc analyses showed the effect remained present (P < 0.05) in both regions when comparing exposed and unexposed diplomats; and reduced fibre density was correlated with longer time period stationed in Cuba after age correction. Reduction of fibre density was also found to be linked with clinical symptoms of persistent migraine, tinnitus, sound sensitivity and fatigue. Network statistical comparisons revealed decreased structural connectivity in two distinct networks, comprising subcortical and cortical systems in exposed individuals, relative to unexposed and normative data. While the cause for the differences between the groups remains unknown, our results reveal region-specific white matter injury, that is, significantly correlated with clinical symptoms.
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Affiliation(s)
- Guillermo Aristi
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Nova Scotia Health Authority, Halifax, Canada, B3H 1V7
| | - Lyna Kamintsky
- Department of Medical Neuroscience, Dalhousie University, NSHA, Halifax, Canada, B3H 1V7
| | - Margaux Ross
- Department of Psychiatry, Dalhousie University, NSHA, Halifax, Canada, B3H 1V7
| | - Chris Bowen
- Department of Diagnostic Radiology, Dalhousie University, NSHA, Halifax, Canada, B3H 1V7
| | - Cynthia Calkin
- Department of Psychiatry, Dalhousie University, NSHA, Halifax, Canada, B3H 1V7
| | - Alon Friedman
- Department of Medical Neuroscience, Dalhousie University, NSHA, Halifax, Canada, B3H 1V7
| | - Javeria A. Hashmi
- Department of Anesthesia, Pain Management & Perioperative Medicine, Dalhousie University, Nova Scotia Health Authority, Halifax, Canada, B3H 1V7
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Green-McKenzie J, Shofer FS, Matthei J, Biester R, Deibler M. Clinical and Psychological Factors Associated With Return to Work Among United States Diplomats Who Sustained a Work-Related Injury While on Assignment in Havana, Cuba. J Occup Environ Med 2022; 64:212-217. [PMID: 34873135 PMCID: PMC8887843 DOI: 10.1097/jom.0000000000002450] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To determine factors associated with return to work in US diplomats injured during a work assignment in Cuba. METHODS In this case series work ability was determined at each visit. Questionnaires used included the Symptom Score Questionnaire, Beck Anxiety Inventory, Beck Depression Inventory, Quality-of-Life Inventory, and Patient Health Questionnaire. RESULTS Of the 45 employees referred to Occupational Medicine, the mean age was 42.5 years, 60% were men, 68% were never out of work, 22% were out of work for some period, and 15% remain out of work. Vestibular, cognitive, hearing, sleep, and visual symptoms, and a higher initial symptom score were significantly associated with work inability while psychiatric symptoms were not. CONCLUSIONS This exposure resulted in prolonged illness with cognitive impairment and other clinical manifestations associated with work inability.
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Affiliation(s)
- Judith Green-McKenzie
- Division of Occupational Medicine, Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine; Center of Excellence in Environmental Toxicology, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania; Leonard Davis Institute of Health Economics, Philadelphia, Pennsylvania (Dr Green-McKenzie); Department of Emergency Medicine, University of Pennsylvania Perelman School of Medicine (Dr Shofer); SHARP Rees-Stealy Medical Group, San Diego, California (Dr Matthei);University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (Dr Matthei); Department of Physical Medicine and Rehabilitation, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pennsylvania (Dr Biester); Rehabilitation Medicine Service, Corporal Michael Crescenz Veterans Affairs Medical Center, Philadelphia, Pennsylvania (Dr Biester); The Center or Emotional Health of Greater Philadelphia, Philadelphia, Pennsylvania (Dr Deibler)
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Kullmann A, Ashmore RC, Braverman A, Mazur C, Snapp H, Williams E, Szczupak M, Murphy S, Marshall K, Crawford J, Balaban CD, Hoffer M, Kiderman A. Portable eye-tracking as a reliable assessment of oculomotor, cognitive and reaction time function: Normative data for 18-45 year old. PLoS One 2021; 16:e0260351. [PMID: 34807938 PMCID: PMC8608311 DOI: 10.1371/journal.pone.0260351] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2021] [Accepted: 11/08/2021] [Indexed: 01/29/2023] Open
Abstract
Eye movements measured by high precision eye-tracking technology represent a sensitive, objective, and non-invasive method to probe functional neural pathways. Oculomotor tests (e.g., saccades and smooth pursuit), tests that involve cognitive processing (e.g., antisaccade and predictive saccade), and reaction time tests have increasingly been showing utility in the diagnosis and monitoring of mild traumatic brain injury (mTBI) in research settings. Currently, the adoption of these tests into clinical practice is hampered by a lack of a normative data set. The goal of this study was to construct a normative database to be used as a reference for comparing patients' results. Oculomotor, cognitive, and reaction time tests were administered to male and female volunteers, aged 18-45, who were free of any neurological, vestibular disorders, or other head injuries. Tests were delivered using either a rotatory chair equipped with video-oculography goggles (VOG) or a portable virtual reality-like VOG goggle device with incorporated infrared eye-tracking technology. Statistical analysis revealed no effects of age on test metrics when participant data were divided into pediatric (i.e.,18-21 years, following FDA criteria) and adult (i.e., 21-45 years) groups. Gender (self-reported) had an effect on auditory reaction time, with males being faster than females. Pooled data were used to construct a normative database using 95% reference intervals (RI) with 90% confidence intervals on the upper and lower limits of the RI. The availability of these RIs readily allows clinicians to identify specific metrics that are deficient, therefore aiding in rapid triage, informing and monitoring treatment and/or rehabilitation protocols, and aiding in the return to duty/activity decision. This database is FDA cleared for use in clinical practice (K192186).
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Affiliation(s)
- Aura Kullmann
- Neurolign USA LLC, a Subsidiary of Neurolign Technologies Inc. (formerly Neuro Kinetics, Inc.), Pittsburgh, Pennsylvania, United States of America
| | - Robin C. Ashmore
- Neurolign USA LLC, a Subsidiary of Neurolign Technologies Inc. (formerly Neuro Kinetics, Inc.), Pittsburgh, Pennsylvania, United States of America
| | - Alexandr Braverman
- Department of Statistics and Data Science, The Hebrew University of Jerusalem, Jerusalem, Israel
| | - Christian Mazur
- Neurolign USA LLC, a Subsidiary of Neurolign Technologies Inc. (formerly Neuro Kinetics, Inc.), Pittsburgh, Pennsylvania, United States of America
| | - Hillary Snapp
- Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Erin Williams
- Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Mikhaylo Szczupak
- Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Sara Murphy
- Naval Medical Center, San Diego, California, United States of America
- Department of Defense, Hearing Center of Excellence, San Antonio, Texas, United States of America
| | - Kathryn Marshall
- Department of Defense, Hearing Center of Excellence, San Antonio, Texas, United States of America
- Madigan Army Medical Center, Tacoma, Washington, United States of America
| | - James Crawford
- Madigan Army Medical Center, Tacoma, Washington, United States of America
| | - Carey D. Balaban
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, Pennsylvania, United States of America
| | - Michael Hoffer
- Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Alexander Kiderman
- Neurolign USA LLC, a Subsidiary of Neurolign Technologies Inc. (formerly Neuro Kinetics, Inc.), Pittsburgh, Pennsylvania, United States of America
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Kullmann A, Ashmore RC, Braverman A, Mazur C, Snapp H, Williams E, Szczupak M, Murphy S, Marshall K, Crawford J, Balaban CD, Hoffer M, Kiderman A. Normative data for ages 18-45 for ocular motor and vestibular testing using eye tracking. Laryngoscope Investig Otolaryngol 2021; 6:1116-1127. [PMID: 34667856 PMCID: PMC8513422 DOI: 10.1002/lio2.632] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2021] [Revised: 06/26/2021] [Accepted: 07/29/2021] [Indexed: 01/31/2023] Open
Abstract
OBJECTIVE Eye tracking technology has been employed in assessing ocular motor and vestibular function following vestibular and neurologic conditions, including traumatic brain injury (TBI). Assessments include tests that provide visual and motion (rotation) stimuli while recording horizontal, vertical, and torsional eye movements. While some of these tests have shown diagnostic promise in previous studies, their use in clinical practice is limited by the lack of normative data. The goal of this study was to construct normative reference ranges to be used when comparing patients' results. METHODS Optokinetic response, subjective visual horizontal and vertical, and rotation tests were administered to male and female volunteers, ages 18-45, who were free from neurological, vestibular disorders, or other head injuries. Tests were administered using either a rotatory chair or a portable virtual reality-like goggle equipped with video-oculography. RESULTS Reference values for eye movements in response to different patterns of stimuli were analyzed from 290 to 449 participants. Analysis of gender (self-reported) or age when grouped as pediatric (late adolescent; 18-21 years of age) and adult (21-45 years of age) revealed no effects on the test metrics. Data were pooled and presented for each test metric as the 95% reference interval (RI) with 90% confidence intervals (CI) on upper and lower limits of the RI. CONCLUSIONS This normative database can serve as a tool to aid in diagnosis, treatment, and/or rehabilitation protocols for vestibular and neurological conditions, including mild TBI (mTBI). This database has been cleared by the FDA for use in clinical practice (K192186). LEVEL OF EVIDENCE 2b.
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Affiliation(s)
- Aura Kullmann
- Neurolign USA LLC, A Subsidiary of Neurolign Technologies Inc. (formerly Neuro Kinetics, Inc.)PittsburghPennsylvaniaUSA
| | - Robin C. Ashmore
- Neurolign USA LLC, A Subsidiary of Neurolign Technologies Inc. (formerly Neuro Kinetics, Inc.)PittsburghPennsylvaniaUSA
| | | | - Christian Mazur
- Neurolign USA LLC, A Subsidiary of Neurolign Technologies Inc. (formerly Neuro Kinetics, Inc.)PittsburghPennsylvaniaUSA
| | - Hillary Snapp
- Department of OtolaryngologyMiller School of Medicine, University of MiamiMiamiFloridaUSA
| | - Erin Williams
- Department of OtolaryngologyMiller School of Medicine, University of MiamiMiamiFloridaUSA
| | - Mikhaylo Szczupak
- Department of OtolaryngologyMiller School of Medicine, University of MiamiMiamiFloridaUSA
| | - Sara Murphy
- Naval Medical CenterSan DiegoCaliforniaUSA
- Department of DefenseHearing Center of ExcellenceSan AntonioTexasUSA
| | - Kathryn Marshall
- Department of DefenseHearing Center of ExcellenceSan AntonioTexasUSA
- Madigan Army Medical CenterTacomaWashingtonUSA
| | | | - Carey D. Balaban
- Department of OtolaryngologyUniversity of PittsburghPittsburghPennsylvaniaUSA
| | - Michael Hoffer
- Department of OtolaryngologyMiller School of Medicine, University of MiamiMiamiFloridaUSA
- Department of Neurological SurgeryMiller School of Medicine, University of MiamiMiamiFloridaUSA
| | - Alexander Kiderman
- Neurolign USA LLC, A Subsidiary of Neurolign Technologies Inc. (formerly Neuro Kinetics, Inc.)PittsburghPennsylvaniaUSA
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de Deus JL, Amorim MR, Ribeiro AB, Barcellos-Filho PCG, Ceballos CC, Branco LGS, Cunha AOS, Leão RM. Loss of Brain-Derived Neurotrophic Factor Mediates Inhibition of Hippocampal Long-Term Potentiation by High-Intensity Sound. Cell Mol Neurobiol 2021; 41:751-763. [PMID: 32445041 DOI: 10.1007/s10571-020-00881-8] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/09/2019] [Accepted: 05/16/2020] [Indexed: 01/15/2023]
Abstract
Exposure to noise produces cognitive and emotional disorders, and recent studies have shown that auditory stimulation or deprivation affects hippocampal function. Previously, we showed that exposure to high-intensity sound (110 dB, 1 min) strongly inhibits Schaffer-CA1 long-term potentiation (LTP). Here we investigated possible mechanisms involved in this effect. We found that exposure to 110 dB sound activates c-fos expression in hippocampal CA1 and CA3 neurons. Although sound stimulation did not affect glutamatergic or GABAergic neurotransmission in CA1, it did depress the level of brain-derived neurotrophic factor (BDNF), which is involved in promoting hippocampal synaptic plasticity. Moreover, perfusion of slices with BDNF rescued LTP in animals exposed to sound stimulation, whereas BDNF did not affect LTP in sham-stimulated rats. Furthermore, LM22A4, a TrkB receptor agonist, also rescued LTP from sound-stimulated animals. Our results indicate that depression of hippocampal BDNF mediates the inhibition of LTP produced by high-intensity sound stimulation.
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Affiliation(s)
- Júnia L de Deus
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14049-900, Brazil
- Department of Basic and Oral Biology, Dental School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-904, Brazil
| | - Mateus R Amorim
- Department of Basic and Oral Biology, Dental School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-904, Brazil
| | - Aline B Ribeiro
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14049-900, Brazil
| | - Procópio C G Barcellos-Filho
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14049-900, Brazil
| | - César C Ceballos
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14049-900, Brazil
| | - Luiz Guilherme S Branco
- Department of Basic and Oral Biology, Dental School of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14040-904, Brazil
| | - Alexandra O S Cunha
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14049-900, Brazil
| | - Ricardo M Leão
- Department of Physiology, School of Medicine of Ribeirão Preto, University of São Paulo, Ribeirão Preto, SP, 14049-900, Brazil.
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13
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Hoppes CW, Lambert KH, Harvard OD, Whitney SL. Vestibular Physical Therapy Evaluation of Individuals Exposed to Directed Energy. Mil Med 2020; 187:e122-e129. [PMID: 33367739 DOI: 10.1093/milmed/usaa562] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 11/19/2020] [Accepted: 12/11/2020] [Indexed: 02/01/2023] Open
Abstract
INTRODUCTION Directed energy has been described as exposure to a unique sound/pressure phenomenon such as infrasonic or ultrasonic acoustic or electromagnetic energy. Following suspected sonic attacks on U.S. Embassies, a subset of individuals presented with a unique cluster of symptoms believed to have resulted from exposure to directed energy. The Joint Force does not have an established protocol to guide the vestibular physical therapy evaluation of individuals exposed to directed energy. Therefore, we sought to provide evidence-based guidance for conducting a comprehensive vestibular physical therapy evaluation in persons exposed to directed energy. MATERIALS AND METHODS A comprehensive search of relevant databases was performed from 2018 to the present. Four seminal articles were used to inform suggestions for clinical best practice. RESULTS The physical therapist should ask open-ended questions to understand what the individual is experiencing and use key questions to focus attention on the mechanism of injury, symptom report, and symptom timeline. The physical therapist should perform an evaluation to determine if the peripheral vestibular apparatus (semicircular canals and otoliths), vestibular nerve, and/or central pathways have been affected by directed energy exposure. Components of the quantitative examination were selected because they provide information on health condition(s), body structure and function impairments, and activity limitations but require little to no specialized equipment. CONCLUSIONS Evidence-based guidance for conducting a comprehensive vestibular physical therapy evaluation in individuals exposed to directed energy may aid in the identification and diagnosis of unconventional brain injury. This standardized approach can help physical therapists to evaluate complaints that do not match any previously known medical conditions but resemble brain injury or vestibular pathology.
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Affiliation(s)
- Carrie W Hoppes
- U.S. Army Medical Center of Excellence, Army-Baylor University Doctoral Program in Physical Therapy, San Antonio, TX 78234, USA
| | | | - Orlando D Harvard
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15219, USA
| | - Susan L Whitney
- Department of Physical Therapy, University of Pittsburgh, Pittsburgh, PA 15219, USA
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14
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Hubler GK, Hoffman SW, Andreadis TD, DePalma RG. Pulsed Microwave Energy Transduction of Acoustic Phonon Related Brain Injury. Front Neurol 2020; 11:753. [PMID: 32849213 PMCID: PMC7417645 DOI: 10.3389/fneur.2020.00753] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2020] [Accepted: 06/18/2020] [Indexed: 01/31/2023] Open
Abstract
Pulsed microwaves above specific energy thresholds have been reported to cause brain injury in animal models. The actual physical mechanism causing brain damage is unexplained while the clinical reality of these injuries remains controversial. Here we propose mechanisms by which pulsed microwaves may injure brain tissue by transduction of microwave energy into damaging acoustic phonons in brain water. We have shown that low intensity explosive blast waves likely initiate phonon excitations in brain tissues. Brain injury in this instance occurs at nanoscale subcellular levels as predicted by physical consideration of phonon interactions in brain water content. The phonon mechanism may also explain similarities between primary non-impact blast-induced mild Traumatic Brain Injury (mTBI) and recent clinical and imaging findings of unexplained brain injuries observed in US embassy personnel possibly due to directed radiofrequency radiation. We describe experiments to elucidate mechanisms, RF frequencies and power levels by which pulsed microwaves potentially injure brain tissue. Pathological documentation of nanoscale brain blast injury has been supported experimentally using transmission electron microscopy (TEM) demonstrating nanoscale cellular damage in the absence of gross or light microscopic findings. Similar studies are required to better define pulsed microwave brain injury. Based upon existing findings, clinical diagnosis of both low intensity blast and microwave-induced brain injury likely will require diffusion tensor imaging (DTI), a specialized water based magnetic resonance imaging (MRI) technique.
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Affiliation(s)
- Graham K Hubler
- The School of Medicine, University of Missouri, Columbia, MO, United States
| | - Stuart W Hoffman
- US Department of Veterans Affairs, Rehabilitation Research and Development Service, Office of Research and Development, Veterans Health Administration, Washington, DC, United States
| | - Tim D Andreadis
- U.S. Naval Research Laboratory, Tactical Electronic Warfare Division, Washington, DC, United States
| | - Ralph G DePalma
- US Department of Veterans Affairs, Office of Research and Development, Veterans Health Administration, Washington, DC, United States.,Department of Surgery, Uniformed University of the Health Sciences, Bethesda, MD, United States
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15
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Balaban CD, Szczupak M, Kiderman A, Levin BE, Hoffer ME. Distinctive Convergence Eye Movements in an Acquired Neurosensory Dysfunction. Front Neurol 2020; 11:469. [PMID: 32655474 PMCID: PMC7325881 DOI: 10.3389/fneur.2020.00469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2019] [Accepted: 04/29/2020] [Indexed: 11/23/2022] Open
Abstract
In late 2016, diplomats in Havana, Cuba, began presenting with a unique symptom complex after perceiving a strange noise and/or feeling a pressure field in their domicile. This report is a retrospective, quantitative analysis of video-oculography data of pupillary light reflex performance and binocular disparity-driven eye and pupil movements during the acute time period after the reported exposure. The patterns of response in these 19 individuals are markedly different than those seen in a group of individuals with the usual acute mild traumatic brain injury (17 subjects) and from 62 control subjects (21-60 years old) with no injury. Non-linear least squares regression was used to estimate the model parameters from the eye movement and the pupil measurements (1). Linear discriminant analysis was then used to identify a classifier for an objective discrimination of the groups with >91% accuracy and no confusion between the acute neurosensory findings among the members of the Havana diplomatic community and the subjects with acute mild traumatic brain injury. This pattern difference in eye and pupil behavior may be a useful screen to help objectively distinguish blunt trauma from Havana-type effects in the future and to guide the affected individuals to appropriate care.
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Affiliation(s)
- Carey D. Balaban
- Department of Otolaryngology, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Neurobiology, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Communication Sciences & Disorders, University of Pittsburgh, Pittsburgh, PA, United States
- Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, United States
| | - Mikhaylo Szczupak
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States
| | - Alexander Kiderman
- Neurolign USA LLC, a subsidiary of Neurolign Technologies Inc. (formerly Neuro Kinetics, Inc.), Pittsburgh, PA, United States
| | - Bonnie E. Levin
- Department of Neurology University of Miami Miller School of Medicine, Miami, FL, United States
| | - Michael E. Hoffer
- Department of Otolaryngology, University of Miami Miller School of Medicine, Miami, FL, United States
- Department of Neurological Surgery, University of Miami Miller School of Medicine, Miami, FL, United States
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Lubner RJ, Kondamuri NS, Knoll RM, Ward BK, Littlefield PD, Rodgers D, Abdullah KG, Remenschneider AK, Kozin ED. Review of Audiovestibular Symptoms Following Exposure to Acoustic and Electromagnetic Energy Outside Conventional Human Hearing. Front Neurol 2020; 11:234. [PMID: 32411067 PMCID: PMC7199630 DOI: 10.3389/fneur.2020.00234] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2019] [Accepted: 03/11/2020] [Indexed: 12/14/2022] Open
Abstract
Objective: We aim to examine the existing literature on, and identify knowledge gaps in, the study of adverse animal and human audiovestibular effects from exposure to acoustic or electromagnetic waves that are outside of conventional human hearing. Design/Setting/Participants: A review was performed, which included searches of relevant MeSH terms using PubMed, Embase, and Scopus. Primary outcomes included documented auditory and/or vestibular signs or symptoms in animals or humans exposed to infrasound, ultrasound, radiofrequency, and magnetic resonance imaging. The references of these articles were then reviewed in order to identify primary sources and literature not captured by electronic search databases. Results: Infrasound and ultrasound acoustic waves have been described in the literature to result in audiovestibular symptomology following exposure. Technology emitting infrasound such as wind turbines and rocket engines have produced isolated reports of vestibular symptoms, including dizziness and nausea and auditory complaints, such as tinnitus following exposure. Occupational exposure to both low frequency and high frequency ultrasound has resulted in reports of wide-ranging audiovestibular symptoms, with less robust evidence of symptomology following modern-day exposure via new technology such as remote controls, automated door openers, and wireless phone chargers. Radiofrequency exposure has been linked to both auditory and vestibular dysfunction in animal models, with additional historical evidence of human audiovestibular disturbance following unquantifiable exposure. While several theories, such as the cavitation theory, have been postulated as a cause for symptomology, there is extremely limited knowledge of the pathophysiology behind the adverse effects that particular exposure frequencies, intensities, and durations have on animals and humans. This has created a knowledge gap in which much of our understanding is derived from retrospective examination of patients who develop symptoms after postulated exposures. Conclusion and Relevance: Evidence for adverse human audiovestibular symptomology following exposure to acoustic waves and electromagnetic energy outside the spectrum of human hearing is largely rooted in case series or small cohort studies. Further research on the pathogenesis of audiovestibular dysfunction following acoustic exposure to these frequencies is critical to understand reported symptoms.
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Affiliation(s)
- Rory J. Lubner
- Warren Alpert Medical School of Brown University, Providence, RI, United States
- Department of Otolaryngology, Harvard Medical School, Boston, MA, United States
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, United States
| | - Neil S. Kondamuri
- Warren Alpert Medical School of Brown University, Providence, RI, United States
- Department of Otolaryngology, Harvard Medical School, Boston, MA, United States
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, United States
| | - Renata M. Knoll
- Department of Otolaryngology, Harvard Medical School, Boston, MA, United States
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, United States
| | - Bryan K. Ward
- Department of Otolaryngology, Johns Hopkins University School of Medicine, Baltimore, MD, United States
| | | | - Derek Rodgers
- Madigan Army Medical Center, Tacoma, WA, United States
| | - Kalil G. Abdullah
- Department of Neurosurgery, UT Southwestern Medical Center, Dallas, TX, United States
| | - Aaron K. Remenschneider
- Department of Otolaryngology, Harvard Medical School, Boston, MA, United States
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, United States
- Department of Otolaryngology, University of Massachusetts Medical Center, Worcester, MA, United States
| | - Elliott D. Kozin
- Department of Otolaryngology, Harvard Medical School, Boston, MA, United States
- Department of Otolaryngology, Massachusetts Eye and Ear Infirmary, Boston, MA, United States
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17
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Wackym PA, Balaban CD, Zhang P, Siker DA, Hundal JS. Third Window Syndrome: Surgical Management of Cochlea-Facial Nerve Dehiscence. Front Neurol 2019; 10:1281. [PMID: 31920911 PMCID: PMC6923767 DOI: 10.3389/fneur.2019.01281] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2019] [Accepted: 11/19/2019] [Indexed: 12/22/2022] Open
Abstract
Objective: This communication is the first assessment of outcomes after surgical repair of cochlea-facial nerve dehiscence (CFD) in a series of patients. Pre- and post-operative quantitative measurement of validated survey instruments, symptoms, diagnostic findings and anonymous video descriptions of symptoms in a cohort of 16 patients with CFD and third window syndrome (TWS) symptoms were systematically studied. Study design: Observational analytic case-control study. Setting: Quaternary referral center. Patients: Group 1 had 8 patients (5 children and 3 adults) with CFD and TWS who underwent surgical management using a previously described round window reinforcement technique. Group 2 had 8 patients (2 children and 6 adults) with CFD who did not have surgical intervention. Interventions: The Dizziness Handicap Inventory (DHI) and Headache Impact Test (HIT-6) were administered pre-operatively and post-operatively. In addition, diagnostic findings of comprehensive audiometry, cervical vestibular evoked myogenic potential (cVEMP) thresholds and electrocochleography (ECoG) were studied. Symptoms before and after surgical intervention were compared. Main outcome measures: Pre- vs. post-operative DHI, HIT-6, and audiometric data were compared statistically. The thresholds and amplitudes for cVEMP in symptomatic ears, ears with cochlea-facial nerve dehiscence and ears without CFD were compared statistically. Results: There was a highly significant improvement in DHI and HIT-6 at pre- vs. post-operative (p < 0.0001 and p < 0.001, respectively). The age range was 12.8–52.9 years at the time of surgery (mean = 24.7 years). There were 6 females and 2 males. All 8 had a history of trauma before the onset of their symptoms. The mean cVEMP threshold was 75 dB nHL (SD 3.8) for the operated ear and 85.7 dB (SD 10.6) for the unoperated ear. In contrast to superior semicircular canal dehiscence, where most ears have abnormal ECoG findings suggestive of endolymphatic hydrops, only 1 of 8 operated CFD ears (1 of 16 ears) had an abnormal ECoG study. Conclusions: Overall there was a marked improvement in DHI, HIT-6 and symptoms post-operatively. Statistically significant reduction in cVEMP thresholds was observed in patients with radiographic evidence of CFD. Surgical management with round window reinforcement in patients with CFD was associated with improved symptoms and outcomes measures.
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Affiliation(s)
- P Ashley Wackym
- Department of Otolaryngology-Head and Neck Surgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - Carey D Balaban
- Departments of Otolaryngology, Neurobiology, Communication Sciences & Disorders, and Bioengineering, University of Pittsburgh School of Medicine, Pittsburgh, PA, United States
| | - Pengfei Zhang
- Department of Neurology, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
| | - David A Siker
- Siker Medical Imaging and Intervention, Portland, OR, United States
| | - Jasdeep S Hundal
- Department of Neurosurgery, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ, United States
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18
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Abouzari M, Goshtasbi K, Sarna B, Lin HW, Djalilian HR. Proposal for a new diagnosis for U.S. diplomats in Havana, Cuba, experiencing vestibular and neurological symptoms. Med Hypotheses 2019; 136:109499. [PMID: 31770686 DOI: 10.1016/j.mehy.2019.109499] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2019] [Revised: 11/12/2019] [Accepted: 11/16/2019] [Indexed: 01/03/2023]
Abstract
Between 2016 and 2017, several U.S. Diplomats in Havana, Cuba, experienced perplexing vestibular and neurological symptoms attributed to an unknown source. They presented with significant vestibular and headache symptoms similar to individuals who experience vestibular migraine (VM). As such, we hypothesize that VM may be a possible explanation for the Havana cohort's presenting symptoms. To evaluate this hypothesis, we compared symptoms reported by the affected individuals in Havana, Cuba, to symptoms reported by corresponding patients from a tertiary academic neurotology clinic with a chief complaint of vertigo or disequilibrium, who met the International Classification of Headache Disorders criteria for VM. The prevalence of the Havana subjects experiencing various symptomatic domains was compared with the VM cohort, leading to 26 unique domains and statistical comparisons between the cohorts. Of the 26 domains compared between the two cohorts, 18 were not significantly different. This included the two most important components of meeting criteria for VM, namely the co-existence of headache and vestibular symptoms. On regression analysis, the only feature which kept its significant difference between the two cohorts was acute intense head pressure (P = 0.007). The domains with similar occurrence ratios included dizziness, headache, light sensitivity, hearing reduction, and tinnitus. In other words, multiple headache and vestibular symptoms, consistent with VM criteria, were similar between the two cohorts. The considerable similarities across various domains between VM patients and Havana subjects could be due to migraine as a possible common etiology for both groups. We propose VM as a potential etiology for the symptomatology in the U.S. diplomats in Cuba.
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Affiliation(s)
- Mehdi Abouzari
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, USA; Division of Pediatric Otolaryngology, Children's Hospital of Orange County, Orange, USA
| | - Khodayar Goshtasbi
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, USA
| | - Brooke Sarna
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, USA
| | - Harrison W Lin
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, USA
| | - Hamid R Djalilian
- Department of Otolaryngology-Head and Neck Surgery, University of California, Irvine, USA; Department of Biomedical Engineering, University of California, Irvine, USA.
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Cunha AOS, de Deus JL, Ceballos CC, Leão RM. Increased hippocampal GABAergic inhibition after long-term high-intensity sound exposure. PLoS One 2019; 14:e0210451. [PMID: 31067215 PMCID: PMC6505933 DOI: 10.1371/journal.pone.0210451] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2018] [Accepted: 04/24/2019] [Indexed: 12/17/2022] Open
Abstract
Exposure to loud sounds is related to harmful mental and systemic effects. The hippocampal function can be affected to either high-intensity sound exposure or long-term sound deprivation. We previously showed that hippocampal long-term potentiation (LTP) is inhibited after ten days of daily exposure to 2 minutes of high-intensity noise (110 dB), in the hippocampi of Wistar rats. Here we investigated how the glutamatergic and GABAergic neurotransmission mediated by ionotropic receptors is affected by the same protocol of high-intensity sound exposure. We found that while the glutamatergic transmission both by AMPA/kainate and NMDA receptors in the Schaffer-CA1 synapses is unaffected by long-term exposure to high-intensity sound, the amplitude of the inhibitory GABAergic currents is potentiated, but not the frequency of both spontaneous and miniature currents. We conclude that after prolonged exposure to short periods of high-intensity sound, GABAergic transmission is potentiated in the hippocampal CA1 pyramidal neurons. This effect could be an essential factor for the reduced LTP in the hippocampi of these animals after high-intensity sound exposure. We conclude that prolonged exposure to high- intensity sound could affect hippocampal inhibitory transmission and consequently, its function.
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Affiliation(s)
| | - Junia L. de Deus
- Department of Physiology, FMRP, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Cesar C. Ceballos
- Department of Physiology, FMRP, University of São Paulo, Ribeirão Preto, SP, Brazil
| | - Ricardo M. Leão
- Department of Physiology, FMRP, University of São Paulo, Ribeirão Preto, SP, Brazil
- * E-mail:
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