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Ionescu EC, Reynard P, Idriss SA, Ltaief-Boudriga A, Joly CA, Thai-Van H. The "Near"-Narrowed Internal Auditory Canal Syndrome in Adults: Clinical Aspects, Audio-Vestibular Findings, and Radiological Criteria for Diagnosis. J Clin Med 2023; 12:7580. [PMID: 38137649 PMCID: PMC10743808 DOI: 10.3390/jcm12247580] [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: 10/17/2023] [Revised: 11/28/2023] [Accepted: 12/06/2023] [Indexed: 12/24/2023] Open
Abstract
INTRODUCTION Vestibular Paroxysmia (VP) refers to short attacks of vertigo, spontaneous or triggered by head movements, and implies the presence of a compressive vascular loop in contact with the cochleovestibular nerve (CVN). Classically, a narrowed internal auditory canal (IAC) corresponds to a diameter of less than 2 mm on CT, usually associated with a hypoplastic CVN on MRI. The aim of this study was to discuss a distinct clinical entity mimicking VP in relation to a "near"-narrowed IAC (NNIAC) and to propose radiological criteria for its diagnosis. METHODS Radiological measurements of the IAC were compared between three groups: the study group (SG, subjects with a clinical presentation suggestive of VP, but whose MRI of the inner ear and pontocerebellar angle excluded a compressive vascular loop) and two control groups (adult and children) with normal vestibular evaluations and no history of vertigo. RESULTS 59 subjects (18 M and 41 F) were included in the SG. The main symptoms of NNIAC were positional vertigo, exercise- or rapid head movements-induced vertigo, and dizziness. The statistical analysis in the study group showed that the threshold values for diagnosis were 3.3 mm (in tomodensitometry) and 2.9 mm (in MRI) in coronal sections of IAC. Although a significantly lower mean value for axial IAC diameter was found in SG compared with controls, the statistics did not reveal a threshold due to the large inter-individual variations in IAC measurements in normal subjects. There was no significant difference in IAC diameter between the adult and pediatric controls. CONCLUSIONS In the present study, we report a new anatomopathological condition that appears to be responsible for a clinical picture very similar-but not identical-to VP in association with the presence of an NNIAC. The diagnosis requires a careful analysis of the IAC's shape and diameters in both axial and coronal planes.
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Affiliation(s)
- Eugen C. Ionescu
- Department of Audiology and Neurotology, Civil Hospitals of Lyon, 69003 Lyon, France; (P.R.); (C.-A.J.); (H.T.-V.)
- Team Clinical and Translational Exploration of Sensorineural Hearing Loss, Hearing Institute, Research Center of Pasteur Institute, Inserm U1120, 75015 Paris, France
| | - Pierre Reynard
- Department of Audiology and Neurotology, Civil Hospitals of Lyon, 69003 Lyon, France; (P.R.); (C.-A.J.); (H.T.-V.)
- Team Clinical and Translational Exploration of Sensorineural Hearing Loss, Hearing Institute, Research Center of Pasteur Institute, Inserm U1120, 75015 Paris, France
- Department of Physiology, Claude Bernard University, 69003 Lyon, France
| | - Samar A. Idriss
- Department of Audiology and Neurotology, Civil Hospitals of Lyon, 69003 Lyon, France; (P.R.); (C.-A.J.); (H.T.-V.)
- Department of Otolaryngology, Dar Al Shifa Hospital, Hawally 13034, Kuwait
- Department of Otolaryngology and Head and Neck Surgery, Eye and Ear Hospital, Holy Spirit University of Kaslik, Beirut 1201, Lebanon
| | | | - Charles-Alexandre Joly
- Department of Audiology and Neurotology, Civil Hospitals of Lyon, 69003 Lyon, France; (P.R.); (C.-A.J.); (H.T.-V.)
- Team Clinical and Translational Exploration of Sensorineural Hearing Loss, Hearing Institute, Research Center of Pasteur Institute, Inserm U1120, 75015 Paris, France
| | - Hung Thai-Van
- Department of Audiology and Neurotology, Civil Hospitals of Lyon, 69003 Lyon, France; (P.R.); (C.-A.J.); (H.T.-V.)
- Team Clinical and Translational Exploration of Sensorineural Hearing Loss, Hearing Institute, Research Center of Pasteur Institute, Inserm U1120, 75015 Paris, France
- Department of Physiology, Claude Bernard University, 69003 Lyon, France
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Oka M, Ichijo K, Koda K, Kamogashira T, Kinoshita M, Igarashi K, Kawahara T, Takashima I, Yamasoba T, Fujimoto C. Preceding Balance Disorders Affect Vestibular Function in Persistent Postural-Perceptual Dizziness. J Clin Med 2023; 12:2589. [PMID: 37048672 PMCID: PMC10095344 DOI: 10.3390/jcm12072589] [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: 02/01/2023] [Revised: 03/24/2023] [Accepted: 03/26/2023] [Indexed: 04/14/2023] Open
Abstract
Persistent postural-perceptual dizziness (PPPD) is induced by preceding conditions that cause balance disorders. To investigate the association between vestibular function and preceding balance disorders in PPPD patients, a retrospective chart review was performed. Vestibular function in 55 PPPD patients was measured using the caloric test, cervical vestibular evoked myogenic potential testing to air-conducted sound (ACS cVEMP), ocular vestibular evoked myogenic potential testing to bone-conducted vibration (BCV oVEMP), and video head impulse testing (vHIT). Patients were classified according to the type of preceding balance disorder. The age-stratified Cochran-Mantel-Haenszel (CMH) test and the exact test for the common odds ratio were conducted to evaluate the association between preceding n ≥ 4 balance disorders and present peripheral vestibular dysfunction. PPPD patients with preceding vestibular neuritis presented a significant positive association with abnormal caloric responses (p = 0.013), while those with preceding benign paroxysmal positional vertigo (BPPV) had significantly lower rates of abnormal BCV oVEMP (p = 0.003). Furthermore, patients with preceding vestibular neuritis showed lateral semicircular canal dysfunction, while those with preceding BPPV presented normal utricular functions. These results present the influence of preceding balance disorders on the vestibular function in PPPD.
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Affiliation(s)
- Mineko Oka
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Kentaro Ichijo
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Kento Koda
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Teru Kamogashira
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Makoto Kinoshita
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Kazunori Igarashi
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Takuya Kawahara
- Clinical Research Promotion Center, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Ikumi Takashima
- Clinical Research Promotion Center, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo 113-8655, Japan
| | - Chisato Fujimoto
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo Hospital, Tokyo 113-8655, Japan
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Murofushi T, Suh MW, Manzari L. Editorial: Isolated otolith dysfunction and vertigo. Front Neurol 2022; 13:1030513. [DOI: 10.3389/fneur.2022.1030513] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2022] [Accepted: 09/14/2022] [Indexed: 11/13/2022] Open
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Sozzi S, Do MC, Schieppati M. Vertical ground reaction force oscillation during standing on hard and compliant surfaces: The “postural rhythm”. Front Neurol 2022; 13:975752. [PMID: 36119676 PMCID: PMC9475112 DOI: 10.3389/fneur.2022.975752] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2022] [Accepted: 08/10/2022] [Indexed: 11/14/2022] Open
Abstract
When a person stands upright quietly, the position of the Centre of Mass (CoM), the vertical force acting on the ground and the geometrical configuration of body segments is accurately controlled around to the direction of gravity by multiple feedback mechanisms and by integrative brain centres that coordinate multi-joint movements. This is not always easy and the postural muscles continuously produce appropriate torques, recorded as ground reaction force by a force platform. We studied 23 young adults during a 90 s period, standing at ease on a hard (Solid) and on a compliant support (Foam) with eyes open (EO) and with eyes closed (EC), focusing on the vertical component of the ground reaction force (VGRF). Analysis of VGRF time series gave the amplitude of their rhythmic oscillations (the root mean square, RMS) and of their frequency spectrum. Sway Area and Path Length of the Centre of Pressure (CoP) were also calculated. VGRF RMS (as well as CoP sway measures) increased in the order EO Solid ≈ EC Solid < EO Foam < EC Foam. The VGRF frequency spectra featured prevailing frequencies around 4–5 Hz under all tested conditions, slightly higher on Solid than Foam support. Around that value, the VGRF frequencies varied in a larger range on hard than on compliant support. Sway Area and Path Length were inversely related to the prevailing VGRF frequency. Vision compared to no-vision decreased Sway Area and Path Length and VGRF RMS on Foam support. However, no significant effect of vision was found on VGRF mean frequency for either base of support condition. A description of the VGRF, at the interface between balance control mechanisms and sway of the CoP, can contribute information on how upright balance is maintained. Analysis of the frequency pattern of VGRF oscillations and its role in the maintenance of upright stance should complement the traditional measures of CoP excursions in the horizontal plane.
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Affiliation(s)
- Stefania Sozzi
- Istituti Clinici Scientifici Maugeri IRCCS, Centro Studi Attività Motorie (CSAM), Pavia, Italy
| | - Manh-Cuong Do
- Complexité, Innovation, Activités Motrices et Sportives (CIAMS), Université Paris-Saclay, Orsay, France
- Complexité, Innovation, Activités Motrices et Sportives (CIAMS), Université d'Orléans, Orléans, France
| | - Marco Schieppati
- Istituti Clinici Scientifici Maugeri IRCCS, Centro Studi Attività Motorie (CSAM), Pavia, Italy
- *Correspondence: Marco Schieppati ;
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Tian L, Chen Z, Wang J, Zhang L, Zhao H, Chi F, Wang J. High frequency hearing loss may act as a screening index evaluating otolith function in vertigo patients with normal semi-circular canal function. Front Neurol 2022; 13:978490. [PMID: 36062007 PMCID: PMC9437537 DOI: 10.3389/fneur.2022.978490] [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: 06/26/2022] [Accepted: 07/29/2022] [Indexed: 11/13/2022] Open
Abstract
ObjectiveTo investigate whether otolith dysfunction is related to hearing impairment in vertigo patients with normal semicircular canal function, and to clarify the types of hearing impairment that may be related to otolith organ damage.MethodsThe demographic data, pure tone threshold audiometry (PTA) results (air-conduction), data of bithermal and video-head impulse test (vHIT), and vestibular evoked myogenic potential (VEMP) results (reaction threshold, P1–N1 amplitude) of patients with vertigo in outpatient clinic from April 2017 to January 2020 were collected. The clinical records of 51 vertigo patients with normal semicircular canal function were included in this study. Low-frequency, speech-frequency, high-frequency, full-frequency PTA were defined as the average of PTA in different frequency bands, respectively (low: 0.125, 0.25, 0.5 kHz; speech: 0.5, 1, 2 kHz, high: 4, 8 kHz, full 0.125–8 kHz). The correlations between hearing impairment in different frequency bands and otolith function impairment were analyzed.ResultsThe mean thresholds of 51 patients (102 ears) in low-PTA, speech-PTA, high-PTA, full-PTA were 20.95 ± 6.01, 21.92 ± 6.90, 40.12 ± 17.47, 26.97 ± 8.53 dB nHL, respectively. Among 102 ears, 87 ears (85.3%) could elicit c-VEMP waveforms and 65 ears (63.7%) had o-VEMP waveforms. The mean threshold and P1–N1 amplitude of c-VEMP were 83.10 ± 6.96 dB nHL and 176.79 ± 103.10 uV, while those of o-VEMP were 87.92 ± 5.99 dB nHL and 21.45 ± 32.22 uV. The mean threshold in high-PTA was significantly linearly correlated with c-VEMP threshold (P = 0.01) and P1–N1 amplitude (P = 0.028). There were not significant linear correlations between the mean threshold in each frequency band of PTA and o-VEMP threshold (low-PTA: P = 0.266, speech-PTA: P = 0.33, high-PTA: P = 0.311) or P1–N1 amplitude (low-PTA: P = 0.414, speech-PTA: P = 0.069, high-PTA: P = 0.08).ConclusionsThere is a positive linear correlation between saccule dysfunction and high-frequency hearing impairment in vertigo patients with normal semi-circular canal function. High frequency hearing loss can be expected in patients who have saccular damage. It suggests that high frequency hearing loss in PTA may act as a screening index that otolith organ function should be comprehensively evaluated.
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Affiliation(s)
- Liang Tian
- Ear, Nose, Throat (ENT) Institute and Department of Otorhinolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
- National Health Council Key Laboratory of Hearing Medicine (Fudan University), Shanghai, China
| | - Zhongchun Chen
- Department of Otorhinolaryngology-Head and Neck Surgery, Huashan Hospital, Fudan University, Shanghai, China
| | - Jinyu Wang
- Ear, Nose, Throat (ENT) Institute and Department of Otorhinolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
- National Health Council Key Laboratory of Hearing Medicine (Fudan University), Shanghai, China
| | - Lei Zhang
- Ear, Nose, Throat (ENT) Institute and Department of Otorhinolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
- National Health Council Key Laboratory of Hearing Medicine (Fudan University), Shanghai, China
| | - Hao Zhao
- Department Nuclear Medicine, The Affiliated Tai'an City Central Hospital of Qingdao University, Tai'an, China
| | - Fanglu Chi
- Ear, Nose, Throat (ENT) Institute and Department of Otorhinolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
- National Health Council Key Laboratory of Hearing Medicine (Fudan University), Shanghai, China
| | - Jing Wang
- Ear, Nose, Throat (ENT) Institute and Department of Otorhinolaryngology, Eye and ENT Hospital, Fudan University, Shanghai, China
- National Health Council Key Laboratory of Hearing Medicine (Fudan University), Shanghai, China
- *Correspondence: Jing Wang
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The Narrowed Internal Auditory Canal: A Distinct Etiology of Pediatric Vestibular Paroxysmia. J Clin Med 2022; 11:jcm11154300. [PMID: 35893390 PMCID: PMC9332349 DOI: 10.3390/jcm11154300] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2022] [Revised: 07/15/2022] [Accepted: 07/22/2022] [Indexed: 12/10/2022] Open
Abstract
Vestibular paroxysmia (VP) is a disorder encountered in the pediatric population that etiology has been attributed to neurovascular cross-compression syndrome (NVCC). The purpose of this study was to report a new probable pathological condition, the narrowed internal auditory canal (IAC), which appears to be involved in the development of a clinical picture of VP in the pediatric population. A retrospective descriptive comparative study was conducted to compare clinical, electrophysiological, radiological, and therapeutic outcomes in both etiologies. Overall, 16 pediatric patients suffering from VP were included and divided into two groups: patients with narrowed internal auditory (Group 1) were compared to those with NVCC syndrome (Group 2). Patients in both groups were similar in terms of auditory complaints, as well as hearing, vestibular, and electrophysiological status. A narrowed IAC was encountered in the adolescent age category and females, especially those with rapid growth. The diagnosis requires a careful analysis of the shape and diameters of the IAC. Radiologic measurements in the axial plane do not seem to be sufficient to confirm the diagnosis, and, therefore, an analysis of diameters in the coronal plane is required. Treatment with sodium-channel blockers drugs showed promising results not only by relieving vertigo but also by normalizing the electrophysiological findings. In conclusion, a narrowed IAC can be considered in patients suffering from VP.
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Iwasaki S, Kamogashira T, Fujimoto C, Kabaya K, Kinoshita M, Yamasoba T. The Role of Neck Input in Producing Corrective Saccades in the Head Impulse Test. Front Neurol 2022; 13:881411. [PMID: 35655613 PMCID: PMC9152213 DOI: 10.3389/fneur.2022.881411] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2022] [Accepted: 05/03/2022] [Indexed: 12/21/2022] Open
Abstract
Background The head impulse test is a valuable clinical test that can help identify peripheral vestibular dysfunction by observing corrective saccades that return the eyes to the target of interest. Corrective saccades have been classified as covert if the onset occurs before the end of the head impulse and as overt if they occur afterwards. However, the mechanism that trigger these saccades remain unclear. Objective The objective of this study was to examine the role of neck input in generating overt as well as covert saccades. Methods Sixteen patients (9 males and 7 females: age 35-80 years, average 62.7 years old) who showed corrective saccades during the head impulse test were included. Twelve patients had unilateral vestibular dysfunction, and 4 patients had bilateral vestibular dysfunction. Patients underwent both the head impulse test (HIT) and the body impulse test (BIT) in a randomized order. While the head is rotated horizontally in HIT, the body is rotated horizontally in BIT. During BIT, the neck is fixed by a cervical collar (neck lock extrication collar) to reduce somatosensory input from the neck. The head movements and eye movements were recorded and analyzed by the video HIT recording system. Results In all 16 patients, corrective saccades were observed in HIT as well as in BIT. While there were no significant differences in peak head velocities between HIT and BIT (p = 0.33, paired t-test), the VOR gain in BIT was significantly smaller than that in HIT (p = 0.011, paired t-test). The number of overt saccades per trial in BIT was significantly decreased compared to that in HIT (p < 0.001, paired t-test) whereas there were no significant differences in the number of covert saccades between the two tests. The proportion of overt saccades among all corrective saccades in BIT was significantly lower than the proportion in HIT (p < 0.001, paired t-test). Conclusions Somatosensory input from the neck contributes to the generation of overt saccades and reinforces the vestibulo-ocular reflex complementing the retinal slip during high frequency head movements.
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Affiliation(s)
- Shinichi Iwasaki
- Department of Otolaryngology & Head and Neck Surgery, Nagoya City University Graduate School of Medicine, Nagoya, Japan
| | - Teru Kamogashira
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chisato Fujimoto
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Kayoko Kabaya
- Department of Otolaryngology & Head and Neck Surgery, Nagoya City University Graduate School of Medicine, Nagoya, Japan
| | - Makoto Kinoshita
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Faculty of Medicine, The University of Tokyo, Tokyo, Japan
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Chua KWD, Yuen HW, Low DYM, Kamath SH. The prevalence of isolated otolith dysfunction in a local tertiary hospital. J Otol 2022; 17:5-12. [PMID: 35140753 PMCID: PMC8811395 DOI: 10.1016/j.joto.2021.06.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2021] [Revised: 06/21/2021] [Accepted: 06/22/2021] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Patients with dizziness may present with symptoms of tilting, swaying, rocking, floating or with disequilibrium. This may be suggestive of an isolated otolithic dysfunction yet, there is little emphasis on this emerging clinical entity. To characterize and describe the prevalence of isolated otolith dysfunction in a local tertiary hospital and correlate them with clinical diagnosis. METHODOLOGY Retrospective medical chart review of patients who presented with dizziness to the specialist outpatient Otolaryngology clinic, who required vestibular laboratory investigation. RESULTS Of the 206 patients, more than half of them (52.4%) fulfilled the criteria for either probable or definite isolated otolith dysfunction. When there are clinical symptoms of otolith dysfunction reported, there is a 1.62 odds of a remarkable laboratory otolith finding. The most common clinical finding was "no clear diagnosis" (65.5%) followed by Vestibular Migraine (13.6%). CONCLUSION The prevalence of isolated otolith dysfunction is quite high. Laboratory tests of otolith function should be performed more routinely. This can be done in a sequential way to optimize cost effectiveness in countries with no insurance reimbursement. Prospective cohort studies on isolated otolith dysfunction, will lay the groundwork for achieving diagnostic consensus and formulating rehabilitation plans to aid this group of patients.
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Affiliation(s)
- Kenneth Wei De Chua
- Department of Otorhinolaryngology-Head and Neck Surgery, Changi General Hospital, Singapore
- The American Institute of Balance (AIB), Largo, FL, USA
| | - Heng Wai Yuen
- Department of Otorhinolaryngology-Head and Neck Surgery, Changi General Hospital, Singapore
| | - David Yong Ming Low
- Department of Otorhinolaryngology-Head and Neck Surgery, Changi General Hospital, Singapore
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Waissbluth S, Oyarzún J. Case Report: Isolated Idiopathic Saccular Dysfunction. Front Neurol 2021; 12:753433. [PMID: 34867738 PMCID: PMC8634261 DOI: 10.3389/fneur.2021.753433] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/04/2021] [Indexed: 11/13/2022] Open
Abstract
Advances in vestibular testing have now allowed us to test each semicircular canal as well as the utricle and saccule, independently. This has led to the discovery of new patterns of vestibular dysfunction that were once impossible to evaluate. This report describes the case of a 20-year-old woman with a 2-month history of recurrent dizziness. She had a complete audiovestibular assessment. The only abnormality observed was the absence of a cervical vestibular-evoked myogenic potential response for the right side, hence an isolated saccular dysfunction. In conclusion, isolated otolithic dysfunction is probably an overlooked and neglected clinical presentation. Its true incidence is unknown, and further research is needed to understand this clinical entity.
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Affiliation(s)
- Sofia Waissbluth
- Department of Otolaryngology, Pontificia Universidad Católica de Chile, Santiago, Chile
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Koyama H, Kashio A, Fujimoto C, Uranaka T, Matsumoto Y, Kamogashira T, Kinoshita M, Iwasaki S, Yamasoba T. Alteration of Vestibular Function in Pediatric Cochlear Implant Recipients. Front Neurol 2021; 12:661302. [PMID: 34122305 PMCID: PMC8193854 DOI: 10.3389/fneur.2021.661302] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/23/2021] [Indexed: 11/16/2022] Open
Abstract
Background: Vestibular dysfunction is a complication of cochlear implantation (CI). Reports on the evaluation of vestibular function before and after CI are limited, especially in children. We investigated the effect of CI on vestibular function in pediatric patients. Patients and Methods: We routinely evaluated vestibular function before but not immediately after CI. Therefore, patients who underwent sequential bilateral CI were enrolled in this study. Seventy-three children who underwent sequential CI from 2003 to 2020 at our hospital were included. Since the vestibular function of the first implanted ear was evaluated before the second surgery for the contralateral ear, post-CI evaluation timing differed among the cases. The evaluation included a caloric test, a cervical vestibular-evoked myogenic potential (cVEMP) test, and a damped rotation test. The objective variables included the results of these tests, and the explanatory variables included the age at surgery, cause of hearing loss, electrode type, and surgical approach used. The associations of these tests were analyzed. Results: cVEMP was the most affected after CI (36.1%), followed by the caloric test (23.6%), and damped rotation test (7.8%). Cochleostomy was significantly more harmful than a round window (RW) approach or an extended RW approach based on the results of the caloric test (p = 0.035) and damped rotation test (p = 0.029). Perimodiolar electrodes affected the caloric test results greater than straight electrodes (p = 0.041). There were no significant associations among these tests' results. Conclusions: Minimally invasive surgery in children using a round window approach or an extended round window approach with straight electrodes is desirable to preserve vestibular function after CI.
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Affiliation(s)
- Hajime Koyama
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Akinori Kashio
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Chisato Fujimoto
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Tsukasa Uranaka
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Yu Matsumoto
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Teru Kamogashira
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Makoto Kinoshita
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Shinichi Iwasaki
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medical Sciences and Medical School, Nagoya City University, Nagoya, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
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Predictive Value of Vestibular Evoked Myogenic Potentials in the Diagnosis of Menière's Disease and Vestibular Migraine. Otol Neurotol 2021; 41:828-835. [PMID: 32271263 DOI: 10.1097/mao.0000000000002636] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To explore the usefulness of vestibular evoked myogenic potentials (VEMPs) in the diagnosis of Menière's disease (MD) and vestibular migraine (VM). STUDY DESIGN Retrospective cohort. SETTING Multidisciplinary neurotology clinic. PATIENTS Definite MD and definite VM patients between January, 2015 and May, 2017, as well as healthy volunteers. INTERVENTIONS Cervical and ocular VEMP (cVEMP and oVEMP) testing. MAIN OUTCOME MEASURES VEMP response, amplitude, and latency. RESULTS Twenty five definite MD, 34 definite VM, and 13 control subjects were analyzed. MD affected ears had significantly lower cVEMP (p = 0.007) and oVEMP (p < 0.001) amplitudes than control ears. VM ears had significantly lower oVEMP (p = 0.001), but not cVEMP (p = 0.198) amplitudes than control ears. MD affected ears, but not VM ears, had significantly more absent cVEMP (25.9% versus 0%, p = 0.005) and oVEMP responses (40.7% versus 0%, p < 0.001) than control ears. oVEMP latency was significantly shorter for both MD affected (p < 0.001) and VM ears (p < 0.001) than control ears. Sensitivity, specificity, negative predictive value (NPV), and positive predictive value (PPV) were calculated using a neurotology clinic MD prevalence of 7.9% in dizzy patients. A present cVEMP or oVEMP both have more than 93% chance of ruling MD out in the tested ear, while a cVEMP amplitude more than 54.9 μV or oVEMP amplitude more than 5.1 μV both have more than 94% of ruling out MD in the tested ear. CONCLUSIONS Despite some overlap in VEMP results between MD and VM, when the diagnosis is uncertain between the two disorders due to symptomatic overlap and nonspecific audiometric data, VEMPs can be helpful in guiding treatment toward one disease entity or the other until more evidence points to a definitive diagnosis.
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12
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Dlugaiczyk J. Rare Disorders of the Vestibular Labyrinth: of Zebras, Chameleons and Wolves in Sheep's Clothing. Laryngorhinootologie 2021; 100:S1-S40. [PMID: 34352900 PMCID: PMC8363216 DOI: 10.1055/a-1349-7475] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The differential diagnosis of vertigo syndromes is a challenging issue, as many - and in particular - rare disorders of the vestibular labyrinth can hide behind the very common symptoms of "vertigo" and "dizziness". The following article presents an overview of those rare disorders of the balance organ that are of special interest for the otorhinolaryngologist dealing with vertigo disorders. For a better orientation, these disorders are categorized as acute (AVS), episodic (EVS) and chronic vestibular syndromes (CVS) according to their clinical presentation. The main focus lies on EVS sorted by their duration and the presence/absence of triggering factors (seconds, no triggers: vestibular paroxysmia, Tumarkin attacks; seconds, sound and pressure induced: "third window" syndromes; seconds to minutes, positional: rare variants and differential diagnoses of benign paroxysmal positional vertigo; hours to days, spontaneous: intralabyrinthine schwannomas, endolymphatic sac tumors, autoimmune disorders of the inner ear). Furthermore, rare causes of AVS (inferior vestibular neuritis, otolith organ specific dysfunction, vascular labyrinthine disorders, acute bilateral vestibulopathy) and CVS (chronic bilateral vestibulopathy) are covered. In each case, special emphasis is laid on the decisive diagnostic test for the identification of the rare disease and "red flags" for potentially dangerous disorders (e. g. labyrinthine infarction/hemorrhage). Thus, this chapter may serve as a clinical companion for the otorhinolaryngologist aiding in the efficient diagnosis and treatment of rare disorders of the vestibular labyrinth.
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Affiliation(s)
- Julia Dlugaiczyk
- Klinik für Ohren-, Nasen-, Hals- und Gesichtschirurgie
& Interdisziplinäres Zentrum für Schwindel und
neurologische Sehstörungen, Universitätsspital Zürich
(USZ), Universität Zürich (UZH), Zürich,
Schweiz
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13
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Wu P, Yang J, Huang X, Ma Z, Zhang T, Li H. Predictors of residual dizziness in patients with benign paroxysmal positional vertigo after successful repositioning: A multi-center prospective cohort study. J Vestib Res 2020; 31:119-129. [PMID: 33285662 DOI: 10.3233/ves-201535] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND While patients with benign paroxysmal positional vertigo (BPPV) commonly develop residual dizziness (RD) after successful repositioning, the factors predictive of RD remain controversial. OBJECTIVE To identify factors predictive of RD onset in patients with BPPV following successful repositioning. METHODS This multi-center prospective cohort study enrolled 243 patients with idiopathic BPPV. Vestibular functional and psychological wellbeing assessments administered before repositioning provided the data used to identify factors predictive of RD with a log-binomial model. The endpoint was RD at 1 week after successful repositioning. RESULTS Of the enrolled patients, 118 reported RD. After adjusting for cofounders, mild [risk ratio (RR), 2.06; 95% confidence interval (CI), 1.39-3.04] or severe (RR, 3.08; 95% CI, 2.17-4.38) anxiety and abnormal vestibular ratio of sensory organization test (RR, 2.68; 95% CI, 1.82-3.95) were identified as risk predictors. Presence of ocular vestibular evoked myogenic potentials responses, either unilateral (RR, 0.55; 95% CI, 0.44-0.69) or bilateral (RR, 0.49; 95% CI, 0.36-0.68), were protective factors. CONCLUSIONS Anxiety and abnormal balance are significant predictors of RD, while the presence of ocular vestibular evoked myogenic potentials responses predicts against it. These findings may help to improve BPPV outcomes by informing prognoses and guiding treatment strategies. TRIAL REGISTRATION ChiCTR1800018004 (date of registration: 26 August 2018).
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Affiliation(s)
- Peixia Wu
- Eye and ENT Hospital of Fudan University, Shanghai, China
| | - Jun Yang
- Xinhua Hospital of Shanghai Jiaotong University Medical School, Shanghai, China
| | | | | | | | - Huawei Li
- Eye and ENT Hospital of Fudan University, Shanghai, China
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14
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Fujimoto C, Kawahara T, Yagi M, Murofushi T. Association between vestibular dysfunction and findings of horizontal head-shaking and vibration-induced nystagmus. J Vestib Res 2020; 30:319-327. [PMID: 33164966 DOI: 10.3233/ves-200721] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND The association between vestibular function and findings of horizontal head-shaking nystagmus (HHSN) and vibration-induced nystagmus (VIN) tests is not well understood. OBJECTIVE To investigate the association between function in the five distinct vestibular end organs and findings of these nystagmus tests. METHODS We retrospectively reviewed the medical records of 50 patients with vestibular diseases who underwent HHSN testing, VIN testing, video head impulse testing (vHIT), cervical vestibular evoked myogenic potential testing to air-conducted sound (ACS cVEMP) and ocular VEMP testing to ACS (ACS oVEMP). We performed mixed-effects logistic regression analyses to see whether age, sex or the presence of nystagmus in HHSN or VIN have an association with the presence of peripheral vestibular dysfunction on the opposite side to the direction of nystagmus. RESULTS The presence of HHSN had a significant association with abnormal vHIT in the lateral semicircular canal (LSCC) on the opposite side to the direction of nystagmus. The presence of VIN had a significant association with abnormal vHIT in all the SCCs and abnormal ACS oVEMP on the opposite side to the direction of nystagmus. CONCLUSIONS HHSN had an association with LSCC dysfunction alone. VIN had an association with dysfunction in all the SCCs and the utricle.
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Affiliation(s)
- Chisato Fujimoto
- Department of Otolaryngology, Tokyo Teishin Hospital, Tokyo, Japan.,Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Takuya Kawahara
- Biostatistics Division, Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Masato Yagi
- Department of Otolaryngology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Toshihisa Murofushi
- Department of Otolaryngology, Tokyo Teishin Hospital, Tokyo, Japan.,Department of Otolaryngology, Teikyo University School of Medicine Mizonokuchi Hospital, Kawasaki, Japan
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15
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Choi JY, Park YM, Lee SH, Choi J, Hyun SW, Song JM, Kim HJ, Oh HJ, Kim JS. Linear Vertigo in Benign Paroxysmal Positional Vertigo: Prevalence and Mechanism. THE CEREBELLUM 2020; 20:160-168. [PMID: 33015731 DOI: 10.1007/s12311-020-01196-6] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 09/29/2020] [Indexed: 11/28/2022]
Abstract
This study aimed to determine the prevalence and mechanism of linear vertigo reported by the patients during the attacks of benign paroxysmal positional vertigo (BPPV). We prospectively evaluated the characteristics (rotational vs. linear) of positional vertigo in 70 patients with posterior and horizontal canal BPPV using a questionnaire allowing multiple choices. In patients with linear vertigo, we further assessed the directionality of linear vertigo. We adopted the velocity-storage model to explain the occurrence and direction of linear vertigo in these patients with BPPV. Patients reported only rotational vertigo in 46 (46/70, 65.7%), only linear vertigo in 10 (14.3%), and both rotational and linear vertigo in 14 (20%). The patients experienced fear from rotational vertigo in 54 (54/70, 77.1%) and from linear vertigo in 20 (20/70, 28.6%). The direction of linear vertigo was concordant with the direction of inertial acceleration predicted by the velocity-storage model. Patients with BPPV may experience linear as well as rotational vertigo during the attacks. This linear vertigo may be ascribed to centrally estimated inertial acceleration.
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Affiliation(s)
- Jeong-Yoon Choi
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea.,Department of Neurology, College of Medicine, Seoul National University, Seoul, South Korea
| | - Young-Min Park
- Department of Neurology, Korea University Anam Hospital, Seoul, South Korea
| | - Seung Hoon Lee
- Department of Pediatrics, College of Medicine, Seoul National University, Seoul, South Korea
| | - Jieun Choi
- College of Medicine, Seoul National University, Seoul, South Korea
| | - Seung Won Hyun
- College of Medicine, Seoul National University, Seoul, South Korea
| | - Jung-Mi Song
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hyo-Jung Kim
- Research Administration Team, Seoul National University Bundang Hospital, Seongnam, South Korea
| | - Hui Jong Oh
- The MTV (Migraine, Tinnitus, and Vertigo) Clinic, Oh Neurology Center, Daegu, South Korea
| | - Ji-Soo Kim
- Dizziness Center, Clinical Neuroscience Center, and Department of Neurology, Seoul National University Bundang Hospital, 173-82 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do, 13620, South Korea. .,Department of Neurology, College of Medicine, Seoul National University, Seoul, South Korea.
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16
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Abstract
BACKGROUND Vestibular evoked myogenic potentials (VEMPs) are increasingly being used for testing otolith organ function. OBJECTIVE This article provides an overview of the anatomical, biomechanical and neurophysiological principles underlying the evidence-based clinical application of ocular and cervical VEMPs (oVEMPs and cVEMPs). MATERIAL AND METHODS Systematic literature search in PubMed until April 2019. RESULTS Sound and vibration at a frequency of 500 Hz represent selective vestibular stimuli for the otolith organs. The predominant specificity of oVEMPs for contralateral utricular function and of cVEMPs for ipsilateral saccular function is defined by the different central projections of utricular and saccular afferents. VEMPs are particularly useful in the diagnosis of superior canal dehiscence and otolith organ specific vestibular dysfunction and as an alternative diagnostic approach in situations when video oculography is not possible or useful. CONCLUSION The use of VEMPs is a simple, safe, reliable and selective test of dynamic function of otolith organs.
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Affiliation(s)
- J Dlugaiczyk
- Deutsches Schwindel- und Gleichgewichtszentrum (DSGZ), Klinikum der Universität München, LMU München, Marchioninistraße 15, 81377, Munich, Germany.
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17
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Physiology, clinical evidence and diagnostic relevance of sound-induced and vibration-induced vestibular stimulation. Curr Opin Neurol 2020; 33:126-135. [DOI: 10.1097/wco.0000000000000770] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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18
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Wang Y, Gu ST, Bao XL, Guo JL. Clinical value of vestibular-evoked myogenic potential tests in patients with sudden sensorineural hearing loss. BMC Neurol 2019; 19:337. [PMID: 31864340 PMCID: PMC6925420 DOI: 10.1186/s12883-019-1576-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2019] [Accepted: 12/16/2019] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aims to investigate the clinical value of two kinds of vestibular-evoked myogenic potentials in patients with sudden sensorineural hearing loss (SSNHL). METHODS A total of 82 patients were divided into two groups: vertigo group and non-vertigo group. All patients underwent examinations for pure tone hearing thresholds, middle ear analysis, the videonystagmography, caloric tests, and vestibular-evoked myogenic potentials elicited from the sternocleidomastoid and extraocular muscle. In addition, 30 healthy subjects were selected as the control group. RESULTS For the 30 healthy subjects, the average latency of p13 and n23 of the cervical vestibular evoked myogenic potentials (cVEMPs) were 13.13 ± 2.89 ms and 23.51 ± 3.25 ms, respectively, and the bilateral amplitude asymmetry rate ranged within 0.05-0.31. The average latency of n10 of the ocular vestibular evoked myogenic potentials (oVEMPs) was 10.13 ± 0.48 ms. The average amplitude of the n10-p15-wave was 5.58 ± 0.65 μV. Among the 35 vertigo patients with SSNHL, 27 patients had normal cVEMP and oVEMP examination results, five patients had abnormal oVEMP examination results, and five patients had abnormal cVEMP examination results. The latency and amplifier of oVEMPs and cVEMPs were within the normal range in 47 SSNHL patients without vertigo. The chi-square value was 5.647, the P-value was equal to 0.017, and the difference was statistically significant at a confidence interval of 95%. CONCLUSIONS OVEMPs and cVEMPs can be used evaluate the vestibular nerve function of SSNHL patients with vertigo.
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Affiliation(s)
- Yuan Wang
- Department of Otolaryngology-Head & Neck Surgery, Tianjin TEDA Hospital, Tianjin, China
| | - Shun-Tong Gu
- Department of General Surgery, Tianjin Fifth Central Hospital, Tianjin, China
| | - Xiao-Lin Bao
- Department of Otolaryngology-Head & Neck Surgery, Tianjin TEDA Hospital, Tianjin, China
| | - Jia-Liang Guo
- Department of Otolaryngology-Head & Neck Surgery, Tianjin TEDA Hospital, Tianjin, China
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19
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Dlugaiczyk J. [Evidence-based diagnostic use of VEMPs : From neurophysiological principles to clinical application. German version]. HNO 2019; 68:324-335. [PMID: 31578599 DOI: 10.1007/s00106-019-00757-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022]
Abstract
BACKGROUND Vestibular evoked myogenic potentials (VEMPs) are increasingly being used for testing otolith organ function. OBJECTIVE This article provides an overview of the anatomical, biomechanical and neurophysiological principles of an evidence-based clinical application of ocular and cervical VEMPs (oVEMPs and cVEMPs). MATERIAL AND METHODS Systematic literature search in PubMed until April 2019. RESULTS Sound and vibration at a frequency of 500 Hz represent selective vestibular stimuli for the otolith organs. The predominant specificity of oVEMPs for contralateral utricular function and of cVEMPs for ipsilateral saccular function is defined by the different neuronal projections of the utricle and the saccule. VEMPs are particularly useful in the diagnosis of superior canal dehiscence and otolith organ-specific vestibular dysfunction and as an alternative diagnostic approach in situations when video oculography is not possible or useful. CONCLUSION The use of VEMPs is a simple, safe, reliable and selective test of dynamic function of otolith organs.
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Affiliation(s)
- J Dlugaiczyk
- Deutsches Schwindel- und Gleichgewichtszentrum (DSGZ), Klinikum der Universität München, LMU München, Marchioninistr. 15, 81377, München, Deutschland. .,Neurologische Klinik und Poliklinik, Klinikum der Universität München, LMU München, München, Deutschland.
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20
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Jung I, Ahn SH, Lee J, Lee SU, Oh HJ, Kim HJ, Choi JY, Kim JS. Age-related deterioration of saccule-related neural function is associated with decreased estimated glomerular filtration rate and increased free thyroxine. Clin Neurophysiol 2019; 130:795-801. [DOI: 10.1016/j.clinph.2019.02.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2018] [Revised: 12/31/2018] [Accepted: 02/03/2019] [Indexed: 01/30/2023]
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21
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Visscher RMS, Feddermann-Demont N, Romano F, Straumann D, Bertolini G. Artificial intelligence for understanding concussion: Retrospective cluster analysis on the balance and vestibular diagnostic data of concussion patients. PLoS One 2019; 14:e0214525. [PMID: 30939164 PMCID: PMC6445465 DOI: 10.1371/journal.pone.0214525] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2018] [Accepted: 03/14/2019] [Indexed: 12/26/2022] Open
Abstract
OBJECTIVES We propose a bottom-up, machine-learning approach, for the objective vestibular and balance diagnostic data of concussion patients, to provide insight into the differences in patients' phenotypes, independent of existing diagnoses (unsupervised learning). METHODS Diagnostic data from a battery of validated balance and vestibular assessments were extracted from the database of the Swiss Concussion Center. The desired number of clusters within the patient database was estimated using Calinski-Harabasz criteria. Complex (self-organizing map, SOM) and standard (k-means) clustering tools were used, and the formed clusters were compared. RESULTS A total of 96 patients (81.3% male, age (median [IQR]): 25.0[10.8]) who were expected to suffer from sports-related concussion or post-concussive syndrome (52[140] days between diagnostic testing and the concussive episode) were included. The cluster evaluation indicated dividing the data into two groups. Only the SOM gave a stable clustering outcome, dividing the patients in group-1 (n = 38) and group-2 (n = 58). A large significant difference was found for the caloric summary score for the maximal speed of the slow phase, where group-1 scored 30.7% lower than group-2 (27.6[18.2] vs. 51.0[31.0]). Group-1 also scored significantly lower on the sensory organisation test composite score (69.0[22.3] vs. 79.0[10.5]) and higher on the visual acuity (-0.03[0.33] vs. -0.14[0.12]) and dynamic visual acuity (0.38[0.84] vs. 0.20[0.20]) tests. The importance of caloric, SOT and DVA, was supported by the PCA outcomes. Group-1 tended to report headaches, blurred vision and balance problems more frequently than group-2 (>10% difference). CONCLUSION The SOM divided the data into one group with prominent vestibular disorders and another with no clear vestibular or balance problems, suggesting that artificial intelligence might help improve the diagnostic process.
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Affiliation(s)
- Rosa M. S. Visscher
- Institute for Biomechanics, ETH Zurich, Zurich, Switzerland
- Department of Neurology, Interdisciplinary Center for Vertigo and Neurological Visual Disorders, University Hospital Zurich, University of Zurich, Zurich, Switzerland
| | - Nina Feddermann-Demont
- Department of Neurology, Interdisciplinary Center for Vertigo and Neurological Visual Disorders, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
| | - Fausto Romano
- Department of Neurology, Interdisciplinary Center for Vertigo and Neurological Visual Disorders, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
| | - Dominik Straumann
- Department of Neurology, Interdisciplinary Center for Vertigo and Neurological Visual Disorders, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
| | - Giovanni Bertolini
- Department of Neurology, Interdisciplinary Center for Vertigo and Neurological Visual Disorders, University Hospital Zurich, University of Zurich, Zurich, Switzerland
- Swiss Concussion Center, Schulthess Clinic, Zurich, Switzerland
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22
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Park HG, Lee JH, Oh SH, Park MK, Suh MW. Proposal on the Diagnostic Criteria of Definite Isolated Otolith Dysfunction. J Audiol Otol 2018; 23:103-111. [PMID: 30562878 PMCID: PMC6468282 DOI: 10.7874/jao.2018.00374] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Accepted: 10/08/2018] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND AND OBJECTIVES Dizzy patients with abnormal otolith function tests, despite a normal caloric response, are defined as having specific (isolated) otolith organ dysfunction. This study was performed to compare the differences in clinical presentation between isolated otolith dysfunction (iOD) patients with lab- and Sx-based iOD group and lab-based iOD symptoms. SUBJECT AND METHODS The medical records of 23 iOD patients with normal caloric response but abnormal cervical vestibular evoked myogenic potential (VEMP), ocular VEMP, or subjective visual vertical were reviewed. Non-spinning vertigo was considered as otolith-related symptoms. The patients' age, onset of dizziness, Numeric Rating Scale on the severity of dizziness, and concomitant vestibular disorders were analyzed. RESULTS Patients in the lab-based iOD group were significantly older than those in the lab- and Sx-based iOD group. Known vestibular disorders were significantly more common in the lab-based iOD group (83.3%) compared to the lab- and Sx-based iOD group (18.2%). Despite the normal caloric response, catch-up saccade was found in the video head impulse test in more than half (54.5%) of the lab-based iOD group patients. There was no catch-up saccade in the lab- and Sx-based iOD group. There were no significant differences in gender ratio, frequency of dizziness attacks, and duration of illness. CONCLUSIONS We propose new definitions of definite iOD (lab- and Sx-based iOD) and probable iOD (lab- or Sx-based iOD). These new definitions may help researchers to identify patients who are more likely to have true iOD, and facilitate comparisons of results between different studies.
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Affiliation(s)
- Han Gyeol Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Jun Ho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Seung Ha Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Moo Kyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
| | - Myung-Whan Suh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University Hospital, Seoul, Korea
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23
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Fujimoto C, Kawahara T, Kinoshita M, Kikkawa YS, Sugasawa K, Yagi M, Yamasoba T, Iwasaki S, Murofushi T. Aging Is a Risk Factor for Utricular Dysfunction in Idiopathic Benign Paroxysmal Positional Vertigo. Front Neurol 2018; 9:1049. [PMID: 30559714 PMCID: PMC6287371 DOI: 10.3389/fneur.2018.01049] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2018] [Accepted: 11/19/2018] [Indexed: 11/13/2022] Open
Abstract
Benign paroxysmal positional vertigo (BPPV) is the most common cause of balance disorders in the elderly. Dislodgement of the otoconia in BPPV might have an association with damage to the otolith organs. The aim of this study was to investigate whether aging is a risk factor for otolith organ dysfunction in idiopathic BPPV. We retrospectively reviewed the medical records of 112 consecutive idiopathic BPPV patients who underwent cervical VEMP testing to air-conducted sound (ACS cVEMP), ocular VEMP testing to bone-conducted vibration (BCV oVEMP), and caloric testing. We performed binomial logistic regression analyses to see whether age, the side affected by BPPV or the canal affected by BPPV have an association with the presence of peripheral vestibular dysfunction in idiopathic BPPV patients. The elderly group (aged ≥65 years) had a significantly positive association with abnormalities in BCV oVEMPs (p = 0.0109), while the side affected by BPPV (p = 0.598) and the canal affected by BPPV (p = 0.576) did not. The odds ratio of the abnormal BCV oVEMPs for the elderly group compared with the non-elderly group (aged < 65 years) was 2.676 (95% confidence interval, 1.254–5.079). The elderly group had no significant association with the abnormalities in ACS cVEMPs (p = 0.0955) or caloric testing (p = 0.488). Dysfunction of the utricle, where the dislodgement of the otoconia mainly occurs, is affected by aging in idiopathic BPPV.
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Affiliation(s)
- Chisato Fujimoto
- Department of Otolaryngology, Tokyo Teishin Hospital, Tokyo, Japan.,Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Takuya Kawahara
- Biostatistics Division, Clinical Research Support Center, The University of Tokyo Hospital, Tokyo, Japan
| | - Makoto Kinoshita
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Yayoi S Kikkawa
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Keiko Sugasawa
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masato Yagi
- Department of Otolaryngology, Tokyo Teishin Hospital, Tokyo, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Shinichi Iwasaki
- Department of Otolaryngology and Head and Neck Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Toshihisa Murofushi
- Department of Otolaryngology, Tokyo Teishin Hospital, Tokyo, Japan.,Department of Otolaryngology, School of Medicine, Teikyo University Mizonokuchi Hospital, Kawasaki, Japan
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Iwasaki S, Fujimoto C, Egami N, Kinoshita M, Togo F, Yamamoto Y, Yamasoba T. Noisy vestibular stimulation increases gait speed in normals and in bilateral vestibulopathy. Brain Stimul 2018; 11:709-715. [PMID: 29563049 DOI: 10.1016/j.brs.2018.03.005] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2017] [Revised: 03/06/2018] [Accepted: 03/07/2018] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Galvanic vestibular stimulation delivered as zero-mean current noise (noisy GVS) has been shown to improve static and dynamic postural stability probably by enhancing vestibular information. OBJECTIVE /Hypothesis: To examine the effect of an imperceptible level of noisy GVS on dynamic locomotion in normal subjects as well as in patients with bilateral vestibulopathy. METHODS Walking performance of 19 healthy subjects and 12 patients with bilateral vestibulopathy at their preferred speed was examined during application of noisy GVS with an amplitude ranging from 0 to 1000 μA. The gait velocity, stride length and stride time were analyzed. RESULTS Noisy GVS had significant effects on gait velocity, stride length and stride time in healthy subjects as well as in patients with bilateral vestibulopathy (p < 0.05). The optimal amplitude of noisy GVS improved gait velocity by 10.9 ± 1.2%, stride length by 5.7 ± 1.2% and stride time by 4.6 ± 7% (p < 0.0001) compared to the control session in healthy subjects. The optimal stimulus improved gait velocity by 12.8 ± 1.3%, stride length by 8.3 ± 1.1% and stride time by 3.7 ± 7% (p < 0.0001) in patients with bilateral vestibulopathy. The improved values of these parameters of locomotion by noisy GVS in the patients were not significantly different from those in healthy subjects in the control condition (p > 0.4). CONCLUSION Noisy GVS is effective in improving gait performance in healthy subjects as well as in patients with bilateral vestibulopathy.
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Affiliation(s)
- Shinichi Iwasaki
- Department of Otolaryngology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
| | - Chisato Fujimoto
- Department of Otolaryngology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Naoya Egami
- Department of Otolaryngology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Makoto Kinoshita
- Department of Otolaryngology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Fumiharu Togo
- Educational Physiological Laboratory, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Yoshiharu Yamamoto
- Educational Physiological Laboratory, Graduate School of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
| | - Tatsuya Yamasoba
- Department of Otolaryngology, Faculty of Medicine, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan
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