Vestibular Migraine and Tinnitus: A Challenging Narrative

Beyond Vertigo: Vestibular, Aural, and Perceptual Symptoms in Vestibular Migraine

PURPOSE

To review the vestibular, aural, and perceptual symptoms of vestibular migraine (VM) that may present alongside vertigo.

RECENT FINDINGS

Increased research attention to the wide spectrum of symptoms presenting in VM patients has improved understanding of this disorder, with recent identification of five different VM phenotypes. Research into the clinical overlap between VM and other chronic vestibular syndromes such as persistent postural-perceptual dizziness and mal-de-debarquement syndrome reveals a range of vestibular symptoms and hints at pathophysiological connections between migraine and vestibular dysfunction. Studies of migraine treatment for hearing loss suggest patients presenting with aural symptoms may have an underlying diagnosis of migraine and deserve a trial of migraine preventives. Research into the neurologic basis of the perceptual disorder Alice in Wonderland syndrome has revealed brain areas that are likely involved and may help explain its prevalence in VM patients. VM is a sensory processing disorder that presents with more than just vertigo. Understanding the range of potential symptoms improves diagnosis and treatment for migraine patients whose diagnosis may be missed when only the symptoms identified in the diagnostic criteria are considered.

Temporomandibular joint dysfunction in relation to tinnitus in Peruvian patients: A cross-sectional study

Background

To determine the relationship between temporomandibular joint dysfunction (TMJD) and tinnitus in Peruvian adult patients.

Material and Methods

This observational and cross-sectional study was conducted between April and May 2023, including 76 adult patients from the Otorhinolaryngology Service of Víctor Lazarte Echegaray Essalud Hospital in Trujillo (Peru). The intra- and inter-rater reliability was determined for the clinical measurement of TMJD, obtaining Kappa values above 0.995. To diagnose tinnitus, we worked with a doctor specializing in otolaryngology. Chi-square test and logistic regression were used to analyze results, considering a significance level of p<0.05.

Results

A relationship was found between TMJD and tinnitus (p=0.022), increasing the frequency of this disorder as temporomandibular involvement was higher (p=0.043). There was no relation between these disorders according to gender and age, nor in hypertensive patients (p=0.131) or patients suffering from migraine (p=0.147); however, a relationship was found between TMJD and tinnitus in patients with hearing loss (p=0.046).

Conclusions

TMJD is associated with tinnitus in otorhinolaryngological and hypoacusis patients. However, in hypertensive and migraine patients, and according to gender and age, no relation was found between those disorders. Key words:Tinnitus, Temporomandibular Joint Disorders, Hearing Loss, Sensorineural, Audiometry, Migraine, Hypertension, Headache.

Cognition in vestibular disorders: state of the field, challenges, and priorities for the future

Vestibular disorders are prevalent and debilitating conditions of the inner ear and brain which affect balance, coordination, and the integration of multisensory inputs. A growing body of research has linked vestibular disorders to cognitive problems, most notably attention, visuospatial perception, spatial memory, and executive function. However, the mechanistic bases of these cognitive sequelae remain poorly defined, and there is a gap between our theoretical understanding of vestibular cognitive dysfunction, and how best to identify and manage this within clinical practice. This article takes stock of these shortcomings and provides recommendations and priorities for healthcare professionals who assess and treat vestibular disorders, and for researchers developing cognitive models and rehabilitation interventions. We highlight the importance of multidisciplinary collaboration for developing and evaluating clinically relevant theoretical models of vestibular cognition, to advance research and treatment.

Investigation of hearing loss in elderly vertigo and dizziness patients in the past 10 years

Background

Vertigo and hearing loss are both prevalent in the elderly. This study retrospectively analyzed hearing test results from elderly patients experiencing vertigo and dizziness at ENT outpatient over a 10-year period, in order to study the patterns of hearing loss in this patient population.

Methods

Nine thousand three hundred eighty four patients over 50 years old underwent retrospective collection and screening of outpatient diagnosis, pure tone audiometry, acoustic immittance measurement (tympanogram) and auditory brainstem response (ABR) test. The patient's audiograms are divided into 7 subtypes according to a set of fixed criteria. Meanwhile, K-Means clustering analysis method was used to classify the audiogram.

Results

The Jerger classification of tympanogram in elderly patients with vertigo and dizziness showed the majority falling under type A. The leading audiogram shapes were flat (27.81% in right ear and 26.89% in left ear), high-frequency gently sloping (25.97% in right ear and 27.34% in left ear), and high-frequency steeply sloping (21.60% in right ear and 22.53% in left ear). Meniere's disease (MD; 30.87%), benign recurrent vertigo (BRV; 19.07%), and benign paroxysmal positional vertigo (BPPV; 15.66%) were the most common etiologies in elderly vestibular diseases. We observed statistically significant differences in hearing thresholds among these vestibular diseases (P < 0.001). K-Means clustering analysis suggested that the optimal number of clusters was three, with sample sizes for the three clusters being 2,747, 2,413, and 4,139, respectively. The ANOVA statistical results of each characteristic value showed P < 0.001.

Conclusion

The elderly patients often have mild to moderate hearing loss as a concomitant symptom with vertigo. Female patients have better hearing thresholds than males. The dominant audiometric shapes in this patient population were flat, high-frequency gently sloping, and high-frequency steeply sloping according to a set of fixed criteria. This study highlights the need for tailored strategies in managing hearing loss in elderly patients with vertigo and dizziness.

Severe tinnitus and migraine headache in a 37-year-old woman treated with trastuzumab for breast cancer: A case report

BACKGROUND

Trastuzumab is a generally safe agent prescribed in the systemic treatment of breast cancer. Tinnitus is not a currently known adverse event related to trastuzumab. Here, we describe a rare case of severe tinnitus and a migraine headache induced by trastuzumab used for adjuvant therapy.

CASE SUMMARY

A 37-year-old woman was diagnosed with hormone receptor-positive and human epidermal growth factor receptor 2-positive breast cancer. After surgery, she was treated with four cycles of epirubicin and cyclophosphamide; she then received docetaxel and a loading dose of trastuzumab plus pertuzumab. Less than half an hour after trastuzumab infusion, the patient complained of severe tinnitus and left-sided migraine headache. Trastuzumab monotherapy was discontinued immediately, and symptoms disappeared after 10 min. Trastuzumab was readministered, and severe tinnitus and migraine headache recurred. Trastuzumab was stopped, and severe tinnitus diminished after 10 min. Pertuzumab and docetaxel therapy was then administered, and no adverse events were observed. Subsequent infusions of trastuzumab every three weeks did not show the same symptoms.

CONCLUSION

Although trastuzumab is well-tolerated in most patients, we should pay attention to the risk of severe tinnitus and migraine.