Role of ocular VEMP test in assessing the occurrence of vertigo in otosclerosis patients

Association Between Postoperative Vertigo and Hearing Outcomes After Stapes Surgery for Otosclerosis

OBJECTIVE

During the postoperative period, most patients with otosclerosis report vertigo and/or nausea caused by interventions within the inner ear. The aim of this study was to evaluate both early and late vertigo associated with hearing improvement after stapes surgery for otosclerosis.

METHODS

The analysis included 170 patients admitted to the hospital undergoing their first surgery for otosclerosis. Audiological diagnostics, surgical techniques, and symptoms reported by the patients were all analyzed.

RESULTS

A statistical correlation and an unfavorable influence of late, undesired symptoms, such as vertigo, nausea/vomiting, and nystagmus, on final hearing improvement after surgical treatment of otosclerosis were found. Prostheses that were too long or placed too deep within the inner ear space were the most frequent cause of both vertigo and lack of hearing improvement observed after stapedotomy.

CONCLUSIONS

A significant negative influence on bone conduction thresholds, particularly at 2000 Hz, was associated with vestibular symptoms persisting for 7 days after the surgery. Symptoms of impaired bony labyrinth function after stapedotomy, persisting for more than 1 year, were associated with insufficient reduction of the air-bone gap and worse improvement in bone conduction thresholds at 1000 and 2000 Hz. The cause of both problems was related to a prosthesis that was too long or placed too deep in the inner ear during stapedotomy.

Brazilian Society of Otology task force - Otosclerosis: evaluation and treatment

OBJECTIVES

To review and provide evidence-based recommendations for the diagnosis and treatment of otosclerosis.

METHODS

Task force members were educated on knowledge synthesis methods, including electronic database search, review and selection of relevant citations, and critical appraisal of selected studies. Articles written in English or Portuguese on otosclerosis were eligible for inclusion. The American College of Physicians' guideline grading system and the American Thyroid Association's guideline criteria were used for critical appraisal of evidence and recommendations for therapeutic interventions.

RESULTS

The topics were divided into 2 parts: 1) Diagnosis - audiologic and radiologic; 2) Treatment - hearing AIDS, pharmacological therapy, stapes surgery, and implantable devices - bone-anchored devices, active middle ear implants, and Cochlear Implants (CI).

CONCLUSIONS

The pathophysiology of otosclerosis has not yet been fully elucidated, but environmental factors and unidentified genes are likely to play a significant role in it. Women with otosclerosis are not at increased risk of worsening clinical condition due to the use of contraceptives or during pregnancy. Drug treatment has shown little benefit. If the patient does not want to undergo stapedotomy, the use of hearing aids is well indicated. Implantable systems should be indicated only in rare cases, and the CI should be indicated in cases of profound deafness.

Vertigo Associated with Otosclerosis and Stapes Surgery-A Narrative Review

Otosclerosis is a pathological condition affecting the temporal bone, and is characterized by remodelling of the labyrinthine bone tissue through a dynamic process of osteolysis and osteogenesis. This condition progressively leads to hearing loss, tinnitus, and vertigo. Stapedotomy, a surgical procedure involving the removal of the stapes superstructure and its replacement with a prosthesis, is the treatment of choice to improve hearing in individuals with otosclerosis. However, vestibular dysfunction is a significant complication associated with this procedure, which can occur intraoperatively or postoperatively, ranging from the immediate postoperative period to weeks, months, or even years after surgery. This paper aims to provide a comprehensive review of the most important causes of vertigo associated with otosclerosis and stapes surgery with the goal of minimizing the incidence of this complication. Understanding the underlying factors contributing to vertigo in this context is crucial for the prevention and effective management of vertigo in patients undergoing stapedotomy.

Comprehensive vestibular evaluation in patients with Otosclerosis: a case control study

Aim

Otosclerosis is one of the common otologic diseases. The mechanism and the probable site of vestibular involvement are not yet fully understood. The present study aimed to perform a comprehensive vestibular evaluation in patients with otosclerosis, compared to the cases without otosclerosis.

Materials and methods

patients underwent a comprehensive cochleovestibular evaluation, including audiometry, ocular and cervical vestibular evoked myogenic potential (o-VEMP and c-VEMP), video head impulse (vHIT) and caloric tests. The results were compared with those obtained from the non-otosclerosis control group.

Results

A total of 61 individuals were included in the study who were divided into two groups of the case (50.82%) and control (49.18%). The results showed that there was a significant difference in the mean vHIT gain between the case and control groups (P < 0.05). However, the mean gain was still within the normal range. Besides, the patients with otosclerosis had significant bilateral or unilateral weaknesses according to caloric test results. Moreover, their o-VEMP and c-VEMP results were significantly abnormal as well (P < 0.05).

Conclusion

Based on the results of the present study, the vestibular system even in asymptomatic cases, is affected by otosclerosis. Furthermore, it seems that the otolithic system has a higher chance of involvement, compared to the semicircular canals.

Supplementary Information

The online version contains supplementary material available at 10.1007/s12070-022-03147-5.

Decision Making in Patients With Concomitant Otosclerosis and Superior Semicircular Canal Dehiscence: A Systematic Review of the Literature

OBJECTIVE

Concomitant otosclerosis (OTS) and superior semicircular canal dehiscence (SSCD) is a rare, but difficult-to-identify and treat diagnosis. A systematic review of the literature was performed to analyze the diagnostic and therapeutic approaches of concurrent OTS and SSCD cases and to identify possible factors that may help in predicting the surgical outcome.

DATA SOURCES

PubMed, Scopus, Medscape, Ovid databases.

STUDY SELECTION

Studies showing diagnosis of OTS documented by audiometric test with or without associated radiological signs (computed tomography), and concomitant diagnosis of SSCD, documented at least by high-resolution computed tomography (and possibly supported by neurophysiological testing) were included. Both surgically treated and untreated patients were considered for data analysis.

DATA EXTRACTION

The general characteristics of each study were recorded, when available. Clinical, audiological, vestibular testing, surgical, and radiological data were extracted from the published case reports and series, and recorded on a database. For each case, the diagnostic steps that confirmed OTS and concomitant SSCD in the same ear were extracted.

DATA SYNTHESIS

Twelve studies were included in the review and 18 cases affected simultaneously by the 2 conditions were extracted and analyzed. Seven of 12 ears (58.3%) undergoing stapes surgery experienced a hearing improvement. In four (33.3%) cases, vestibular symptoms (with or without associated acoustic symptoms) of SSCD were unmasked or worsened by stapes surgery.

CONCLUSIONS

A reliable preoperative diagnosis of the two concomitant conditions is possible with a proper interpretation of clinical signs, audiometric, and vestibular testing, in association with the radiologic assessment. Despite that the length and the location of the dehiscence may guide the surgical decision, definitive conclusions regarding the appropriate indications for surgical treatment cannot be drawn due to the limited number of cases with adequate data reported in the literature.

A model study of resonance effect on ocular vestibular-evoked myogenic potential

BACKGROUND/PURPOSE

This study measured the acceleration magnitude using a dummy model filled with various air-material ratios to elucidate the mechanism of resonance effect on ocular vestibular-evoked myogenic potential (oVEMP).

METHODS

With the percentages of air volume altered by filling various materials (water, glycerol, or ethanol) in an acrylic-made hollow spherical model, a minishaker was utilized to deliver vibration stimuli to the model. Then, acceleration magnitude of each model was measured.

RESULTS

Since the air was most occupied at the upper part of the model (z-axis), acceleration magnitude along the z-axis was selected for comparison. An increasing trend of the z-axis acceleration magnitude ranging 0.110-0.759 g was identified in air-water model with air volume percentage ranged 40-100%. On the other hand, a significant increasing trend of acceleration magnitude along the z-axis (0.157-0.759 g) was noted in air-glycerol model with 80-100% of air volume. While in air-ethanol model, a significant increasing trend in acceleration magnitude along the z-axis ranged 0.121-0.759 g correlating with 40-100% of air volume.

CONCLUSION

The mechanism for eliciting oVEMP is via the first-order bone vibration coupled with the second-order resonance effect. Both percentage of air volume (i.e. frontal sinus) and density of filling media (i.e. skull property) may contribute to the resonance effect, which then increases the acceleration magnitude so as to enhance the elicitation of oVEMP.

Vestibular evoked myogenic potentials (VEMP) captured in the forearm flexor muscles: a study of its feasibility and reference ranges

OBJECTIVE

To determine the central tendency measures and variability of vestibular evoked myogenic potential (VEMP) with regard to the latency and wave amplitude when potentials are captured from the flexor muscles of the forearm.

METHODS

Ten adult volunteers with normal hearing underwent examination of their forearm flexor muscles (right and left sides; 20 samples in total) for VEMP acquisition. To this end, 200 tone burst stimuli at a 500 Hz frequency and 95 dBnHL intensity were promediated.

RESULTS

No statistical differences were observed in VEMP responses acquired from the right and left forearm flexor muscles concerning P34 and N44 latencies (p=0.32 and 0.90, respectively). The mean latency obtained for the P34 wave component was 34.9 ms (±2.6), with a lower limit equal to 29.3 and an upper limit equal to 40.4 ms. The average latency of the N44 wave component was 43.6 ms (±2.1), with a lower limit of 39.1 ms and an upper limit of 48.1 ms. The results were consistent and had low variability, and showed an average asymmetry index of 15.4 (±10.7). These findings indicate that potentials may be investigated in different age groups and in specific clinical populations, such as pathologies that may alter the neuronal transmission of the inferior vestibular pathway, especially when a longer portion is observed.

CONCLUSIONS

VEMP recording from forearm flexors is both feasible and stable, with latency reference ranges between 29.3 and 40.4 ms for P34, and 39.1 and 48.1 ms for N44.

Surgical treatment of otosclerosis leading to changes in postural control and quality of life

OBJECTIVE

Evaluating postural function in patients with otosclerosis by assessing otoneurological function and balance-related quality of life before and 6 weeks after surgical treatment. Correlations between and clinical features were investigated.

METHODS

Thirty-three patients affected by otosclerosis underwent otoneurological examination, video Head Impulse Test (vHIT), and static posturography before and after stapedotomy. Quality of life and dizziness-related handicap were screened by means of validated questionnaires. Correlation analysis was performed in order to discover possible relations with audiological pre- and postoperative parameters.

RESULTS

A significant improvement in posturographic parameters was found. Correlation analysis yielded a negative correlation between preoperative bone conduction auditory threshold and both vHIT scores and postural performance improvement, evaluated by spectral analysis. Moreover, a positive correlation was also found between improvements in posturographic scores and quality-of-life questionnaires.

CONCLUSION

The study results demonstrated an improvement in postural function and self-reported measures in a cohort of patients with otosclerosis 6 weeks after stapedotomy. The inverse correlation with preoperative auditory levels may reflect lesser chance for balance restoration in cases with worse sensorineural function. Possible implications for daily activities and overall quality of life were suggested by improved self-report questionnaire results.

LEVEL OF EVIDENCE

4 Laryngoscope, 130:2448-2454, 2020.

Quantitative assessment of vestibular otopathology in otosclerosis: A temporal bone study

OBJECTIVES/HYPOTHESIS

To determine if peripheral vestibular otopathology is present in human temporal bones with otosclerosis.

STUDY DESIGN

Comparative human temporal bone study.

METHODS

Seventy-four human temporal bones from 46 subjects with otosclerosis (mean age of 61 ± 18 years) and 20 within histologically normal limits from 17 subjects (mean age of 59 ± 14 years) were included in this study. Temporal bones with otosclerosis were divided into those with and without endosteal involvement. Using differential interference contrast microscopy at 1008× magnification, type I and type II vestibular hair cell counts were performed on each vestibular sense organ in which the neuroepithelia was oriented perpendicular to the plane of section. The organ-specific cell densities (cells/0.01 mm(2) surface area) were compared between the groups with and without endosteal involvement, and also compared to counts in the nonotosclerosis control group using Student's t-test.

RESULTS

Mean type I and type II hair cell densities of all vestibular structures in the group with endosteal involvement were significantly lower compared to the group without endosteal involvement. Mean type I and type II hair cell densities of all vestibular structures in the group with endosteal involvement were also significantly lower compared to the control group, but they were not in the group without endosteal involvement compared to the control group.

CONCLUSION

Endosteal involvement of otosclerotic foci is associated with vestibular hair cell loss that may contribute to the vestibular symptoms in otosclerosis.

LEVEL OF EVIDENCE

N/A. Laryngoscope, 126:E118-E122, 2016.