[Semicircular canal occlusion]

Semicircular canal occlusion（SCO） is a surgical technique widely used for treating vertigo symptoms. It is primarily aimed at treating benign paroxysmal positional vertigo（BPPV）, Ménière's disease（MD）, labyrinthine fistula, and superior semicircular canal dehiscence syndrome, among others. This review aims to comprehensively summarize the development, evolution, relevant basic research, and clinical applications of semicircular canal occlusion, especially the application of endoscopic technology in recent years, and explore its practical value in the field of surgical treatment for vertigo.

Physiologic Effects of Microneedle-Mediated Intracochlear Dexamethasone Injection in the Guinea Pig

OBJECTIVES

Oral or intratympanic corticosteroids are commonly used to treat sudden sensorineural hearing loss (SSHL), tinnitus, and Meniere disease. Direct intracochlear delivery has been proposed to overcome the variability in bioavailability and efficacy of systemic or middle ear delivery. In this study, we aim to characterize the physiologic consequences of microneedle-mediated direct intracochlear injection of dexamethasone through the round window membrane (RWM).

METHODS

In Hartley guinea pigs (n = 5), a post-auricular incision followed by bullostomy was made to access the round window membrane. Using 100 μm diameter hollow microneedles, 1.0 μl of 10 mg/ml dexamethasone was injected through the RWM over 1 min. Compound action potential (CAP) and distortion product otoacoustic action emissions (DPOAE) were measured before perforation, at 1 h, and at 5 h following injection. CAP hearing thresholds were measured from 0.5 to 40 kHz, and DPOAE f2 frequencies ranged from 1.0 and 32 kHz. Repeated measures ANOVA followed by pairwise t-tests were used for statistical analysis.

RESULTS

ANOVA identified significant CAP threshold shifts at four frequencies (4, 16, 36, and 40 kHz) and differences in DPOAE at 1 frequency (6 kHz). Paired t-tests revealed differences between the pre-perforation and 1 h time point. By 5 h post injection, both CAP hearing thresholds and DPOAE recover and are not significantly different from baseline thresholds.

CONCLUSION

Direct intracochlear delivery of dexamethasone via microneedles results in temporary shifts in hearing thresholds that resolve by 5 hours, thus supporting microneedle technology for the treatment of inner ear disorders.

LEVEL OF EVIDENCE

NA Laryngoscope, 134:388-392, 2024.

Noise-induced hearing loss in the contralateral ear during otologic and neurotologic surgeries

OBJECTIVE

Noise-induced hearing loss in the non-surgical ear during otologic/neurotologic surgery has not been well studied. The purpose of this study was to evaluate changes in hearing that may occur in the contralateral (i.e., non-surgical) ear after various otologic/neurotologic surgeries due to noise generated by drills. We hypothesized that otologic/neurotologic surgeries, longer in duration, would suggest longer drilling times and result in decreased hearing in the contralateral ear as evidenced by a change post-operative pure tone air conduction thresholds when compared to pre-operative thresholds.

METHODS

A retrospective chart review at a tertiary referral center. Adult patients (18-75 years old) who underwent otologic/neurotologic surgeries from May 1, 2016 through May 1, 2021 were considered for inclusion. Surgeries included vestibular schwannoma resection (translabyrinthine, middle cranial fossa, or retrosigmoid approaches), endolymphatic sac/shunt and labyrinthectomy for Meniere's disease, and tympanomastoid surgery for middle ear pathology (e.g., cholesteatoma). Patient characteristics obtained through record review included age, sex, surgical procedure, pre-operative and post-operative audiometric thresholds and word recognition scores (WRS) for the contralateral ear, and duration of surgery.

RESULTS

No significant differences were observed for change in audiometric thresholds in the contralateral ear for any surgery when considering individual frequencies. Additionally, no significant change in WRS was observed for any surgical approach.

CONCLUSIONS

The risk of hearing loss in the non-surgical ear during various otologic/neurotologic surgeries appears to be minimal when measured via routine clinical tests.

Prognosis of Acute Low-Tone Hearing Loss Without Vertigo: A Scoping Review

OBJECTIVE

Despite its relatively high prevalence, our understanding of the natural clinical course of acute low-tone hearing loss (ALHL) without vertigo remains incomplete. The purpose of this study is to summarize the findings of studies that evaluated recovery from hearing loss (HL), recurrence and/or fluctuation of HL, and progression to Meniere's Disease (MD) of patients presenting with ALHL without vertigo.

METHODS

A scoping review of the English literature was performed. On May 14, 2020 and July 6, 2022, MEDLINE, Embase, and Scopus were searched to identify articles related to the prognosis of ALHL. To be included, articles had to present outcomes that were clearly distinguishable for patients with ALHL without vertigo. Two reviewers evaluated articles for inclusion and extracted data. Disagreements were adjudicated by a third reviewer.

RESULTS

Forty-one studies were included. There was extensive heterogeneity between studies in regard to defining ALHL, treatment methods, and time of follow-up. Most of the cohorts (39 out of 40) reported partial or complete recovery of hearing in the majority (>50%) of patients, although reports of recurrence were relatively common. Progression to MD was infrequently reported. Shorter time from onset of symptoms to treatment predicted better hearing outcomes in 6 of 8 studies.

CONCLUSION

The literature suggests that although the majority of patients with ALHL experience hearing improvement, recurrence and/or fluctuation are common, and progression to MD occurs in a minority of patients. Additional trials utilizing standardized inclusion and outcome criteria are needed to determine the ideal treatment for ALHL.

LEVEL OF EVIDENCE

NA Laryngoscope, 133:2457-2469, 2023.

[The role of TLR4/NF-κB signaling pathway in sleep deprivation induced Meniere's disease]

Objective:By detecting the levels of proteins in the Toll-like receptor-4/nuclear factor-κB （TLR4/NF-κB） signaling pathway and downstream proinflammatory cytokines in peripheral blood of patients with Meniere's disease （MD）, Pittsburgh Sleep Quality Index （PSQI） scores were collected to investigate the correlation between sleep disorders and MD and the role of TLR4/NF-κB signaling pathway in mediating sleep disorders inducing MD. Methods:Thirty-two MD patients and 20 family members of patients without middle ear and inner ear related diseases were selected. Basic data, PSQI and fasting peripheral blood of all subjects were collected. Enzyme linked immunosorbent assay.The levels of interleukin-1β（IL-1β）, tumor necrosis factor-α（TNF-α）, monocyte chemokine-1（MCP-1）, Toll-like receptor 4（TLR4） and nuclear factor-κB（NF-κB） in peripheral blood were detected by ELISA, and the data were statistically analyzed. Results:①PSQI score of MD group was higher than that of normal control group, and the difference was statistically significant（P<0.01）; The scores of every factors of PSQI in MD group were higher than those in normal control group, and the scores of factors 2, 4 and 6 were significantly different from those in normal control group. ②In the MD group, there were 18 patients with sleep disorders, with a prevalence rate of 56.25%, including 6 males with a prevalence rate of 50.00% and 12 females with a prevalence rate of 60.00%. ③The levels of five test indexes in MD group, sleep disorder group and non-sleep disorder group were higher than those in control group, and the levels of TLR4 and NF-κB in MD group were significantly different from those in control group（P<0.05）. The levels of IL-1β, TNF-α, TLR4 and NF-κB in sleep disorder group were significantly different from those in control group（P<0.05）. The levels of five test indexes in non-sleep disorder group were not statistically significant compared with those in control group. The levels of five test indexes in the MD sleep disorder group were higher than those in the MD group and the non-sleep disorder group, with no statistical significance. The levels of five test indexes in MD group were higher than those in non-sleep disorder group, with no statistical significance（P>0.05）. Conclusion:①Sleep disorders may be one of the important predisposing factors of some MD, and the effects of sleep disorders on MD are different between the sexes. ②Sleep disorders may activate TLR4/NF-κB signaling pathway to induce MD. The selection of TLR4/NF-κB signaling pathway related proteins and downstream pro-inflammatory factor inhibitors to intervene MD may provide a new idea for protecting the hearing balance function of MD.

Live Imaging of the Dehydration Effect of Isosorbide on the Normal and Hydropic Guinea Pig Cochleae Using Optical Coherence Tomography

OBJECTIVE

To investigate the isosorbide-induced dehydration effect on the endolymphatic space by intratympanic administration of isosorbide.

BACKGROUND

Isosorbide, an osmotic diuretic, is used orally as a typical conservative therapy for Menière's disease (MD) in Japan. The dehydration effect occurs 6 hours after isosorbide ingestion. Intratympanic administration of isosorbide resolves endolymphatic hydrops faster than oral ingestion. In addition, the dehydration effect has never been shown directly. Therefore, we investigated the dehydration effect of intratympanic administration of isosorbide on endolymphatic hydrops using optical coherence tomography.

METHODS

We used eight Hartley guinea pigs, divided into normal and hydrops groups. In the hydrops group, the animals underwent endolymphatic sac obliteration to create endolymphatic hydrops. We obtained midmodiolar section images of the cochleae using optical coherence tomography. Then, 50 to 70% isosorbide was sequentially administered intratympanically for 5 minutes, and the apical turn of the cochlea was observed. The relative midmodiolar cross-sectional area of the scala media was calculated for quantitative assessment of the endolymphatic space.

RESULTS

In the normal group, 50% isosorbide had a slight but significant dehydration effect on the scala media; at 55 to 70%, Reissner's membrane became flat. In the hydrops group, 50% isosorbide slightly reduced endolymphatic hydrops; 65% flattened Reissner's membrane, and 70% slightly concaved it toward the basilar membrane.

CONCLUSION

The results suggest that we could select the concentration of isosorbide according to the stage or severity of MD and relief from acute attack. Intratympanic administration of isosorbide may be a promising treatment for patients with MD.

The effect of vestibular rehabilitation in Meniere's disease: a systematic review and meta-analysis of clinical trials

BACKGROUND

Meniere's disease (MD) is a complex disease that can severely affect the quality of life. In this systematic review and meta-analysis, we aimed to investigate the effect of vestibular rehabilitation (VR) versus control/other interventions on the quality of life in patients with MD.

METHODS

We searched six electronic databases (PubMed/MEDLINE, Web of Science, EMBASE, Scopus, ProQuest, CENTRAL) from inception to September 30, 2022 with no language restriction for publications comparing the effect of VR with control/ other interventions in patients with MD. The primary outcome was quality of life assessed by dizziness handicap inventory (DHI).

RESULTS

Overall, three studies with a total of 465 patients were included in the meta-analysis. All the included studies reported immediate-term DHI scores. A medium effect (standardized mean difference [SMD] = - 0.58, 95% confidence interval [CI] - 1.12; - 0.05) was observed favoring the use of VR to improve DHI scores in patients with MD in the immediate term. Moreover, there was severe heterogeneity in immediate DHI scores among the included studies (χ2 = 22.33, P = 0.00, I2 = 82.1%).

CONCLUSIONS

VR rehabilitation can improve the quality of life in patients with MD immediately after treatment. Since all the included studies had a high risk of bias and none had long-term follow-ups, further high-quality research is required to determine the short-, intermediate-, and long-term effects of VR compared to control/other interventions.

Potential biomarkers in peripheral blood mononuclear cells of patients with sporadic Ménière's disease based on proteomics

BACKGROUND

Ménière's disease (MD) mainly refers to the endolymphatic hydrops in membranous labyrinth of the inner ear. Application of the mass spectrometry-based proteomics techniques has not been applied in the field of MD.

OBJECTIVES

To search for potential differential proteins to identify the disease biomarkers and reveal disease bioinformatics-related mechanisms through applying protein technology to analyze the expression changes of peripheral blood mononuclear cells (PBMCs) in sporadic MD patients.

MATERIAL AND METHODS

15 MD patients and 15 healthy individuals were enrolled. PBMCs from them were extracted, and their protein expression was identified and compared by LC-MS/MS and spectra analysis.

RESULTS

There was significant difference in protein expression between MD patients and the control group. GO and KEGG analysis showed that endocytosis was involved in MD patients. Western blot results of CHMP1A and MMP9 protein showed that the expression of CHMP1A was higher in the MD group than that in the control group, while MMP9 was down-regulated. Immunohistochemistry confirmed that CHMP1A and MMP9 were expressed in the endolymphatic sacs of MD patients and in the inner ear of adult mice.

CONCLUSIONS AND SIGNIFICANCE

Endocytosis may be involved in the pathogenesis of sporadic MD, furthermore CHMP1A, VPS4A, FCN3 and MMP9 could be considered as potential biomarkers.

Differential Expression of Na/K-ATPase in the Human Saccule of Patients With and Without Otologic Disease

HYPOTHESIS

Na + , K + -ATPase (Na/K-ATPase) α1 subunit expression in the saccule of patients diagnosed with otologic disease is different compared with normal controls.

BACKGROUND

We have recently characterized changes in the expression of Na/K-ATPase α1 subunit in the normal and pathological cochlea; however, no studies have determined the distribution Na/K-ATPase α1 subunit in the human saccule. The present study uses archival temporal bones to study the expression Na/K-ATPase α1 subunit in the human saccule.

METHODS

Archival celloidin formalin fixed 20-micron thick sections of the vestibule from patients diagnosed with Menière's disease (n = 5), otosclerosis (n = 5), sensorineural hearing loss, and normal hearing and balance (n = 5) were analyzed. Sections containing the saccular macula were immunoreacted with mouse monoclonal antibodies against Na/K-ATPase α1 subunit. Micrographs were acquired using a high-resolution digital camera coupled to a light inverted microscope.

RESULTS

In the normal human saccule vestibular sensory epithelium, Na/K-ATPase α1 immunoreactivity (IR) was present in nerve fibers and calyces that surround type I vestibular hair cells and nerve terminals. The transition epithelium cells were also Na/K-ATPase α1 immunoreactive. Comparison between normal and pathological specimens showed that there was a significant reduction of Na/K-ATPase α1 IR in the saccule vestibular sensory epithelium from patients with Menière's disease, otosclerosis, and sensorineural hearing loss.

CONCLUSIONS

The decrease of Na/K-ATPase-IR α1 in the saccule vestibular sensory epithelium from patients with otopathologies suggests its critical role in inner ear homeostasis and pathology.

Rare Coding Variants in Patients with Non-Syndromic Vestibular Dysfunction

Vertigo due to vestibular dysfunction is rare in children. The elucidation of its etiology will improve clinical management and the quality of life of patients. Genes for vestibular dysfunction were previously identified in patients with both hearing loss and vertigo. This study aimed to identify rare, coding variants in children with peripheral vertigo but no hearing loss, and in patients with potentially overlapping phenotypes, namely, Meniere's disease or idiopathic scoliosis. Rare variants were selected from the exome sequence data of 5 American children with vertigo, 226 Spanish patients with Meniere's disease, and 38 European-American probands with scoliosis. In children with vertigo, 17 variants were found in 15 genes involved in migraine, musculoskeletal phenotypes, and vestibular development. Three genes, OTOP1, HMX3, and LAMA2, have knockout mouse models for vestibular dysfunction. Moreover, HMX3 and LAMA2 were expressed in human vestibular tissues. Rare variants within ECM1, OTOP1, and OTOP2 were each identified in three adult patients with Meniere's disease. Additionally, an OTOP1 variant was identified in 11 adolescents with lateral semicircular canal asymmetry, 10 of whom have scoliosis. We hypothesize that peripheral vestibular dysfunction in children may be due to multiple rare variants within genes that are involved in the inner ear structure, migraine, and musculoskeletal disease.

Lifestyle and dietary interventions for Ménière's disease

BACKGROUND

Ménière's disease is a condition that causes recurrent episodes of vertigo, associated with hearing loss and tinnitus. Lifestyle or dietary modifications (including reducing the amount of salt or caffeine in the diet) are sometimes suggested to be of benefit for this condition. The underlying cause of Ménière's disease is unknown, as is the way in which these interventions may work. The efficacy of these different interventions at preventing vertigo attacks, and their associated symptoms, is currently unclear.

OBJECTIVES

To evaluate the benefits and harms of lifestyle and dietary interventions versus placebo or no treatment in people with Ménière's disease.

SEARCH METHODS

The Cochrane ENT Information Specialist searched the Cochrane ENT Register; Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE; Ovid Embase; Web of Science; ClinicalTrials.gov; ICTRP and additional sources for published and unpublished trials. The date of the search was 14 September 2022.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) and quasi-RCTs in adults with Ménière's disease comparing any lifestyle or dietary intervention with either placebo or no treatment. We excluded studies with follow-up of less than three months, or with a cross-over design (unless data from the first phase of the study could be identified).  DATA COLLECTION AND ANALYSIS: We used standard Cochrane methods. Our primary outcomes were: 1) improvement in vertigo (assessed as a dichotomous outcome - improved or not improved), 2) change in vertigo (assessed as a continuous outcome, with a score on a numerical scale) and 3) serious adverse events. Our secondary outcomes were: 4) disease-specific health-related quality of life, 5) change in hearing, 6) change in tinnitus and 7) other adverse effects. We considered outcomes reported at three time points: 3 to < 6 months, 6 to ≤ 12 months and > 12 months. We used GRADE to assess the certainty of evidence for each outcome.  MAIN RESULTS: We included two RCTs, one related to diet, and the other related to fluid intake and sleep. In a Swedish study, 51 participants were randomised to receive 'specially processed cereals' or standard cereals. The specially processed cereals are thought to stimulate the production of anti-secretory factor - a protein that reduces inflammation and fluid secretion. Participants received the cereals for three months. The only outcome reported by this study was disease-specific health-related quality of life.  The second study was conducted in Japan. The participants (223) were randomised to receive abundant water intake (35 mL/kg/day), or to sleep in darkness (in an unlit room for six to seven hours per night), or to receive no intervention. The duration of follow-up was two years. The outcomes assessed were 'improvement in vertigo' and hearing.  As these studies considered different interventions we were unable to carry out any meta-analysis, and for almost all outcomes the certainty of the evidence was very low. We are unable to draw meaningful conclusions from the numerical results.

AUTHORS' CONCLUSIONS

The evidence for lifestyle or dietary interventions for Ménière's disease is very uncertain. We did not identify any placebo-controlled RCTs for interventions that are frequently recommended for those with Ménière's disease, such as salt restriction or caffeine restriction. We identified only two RCTs that compared a lifestyle or dietary intervention to placebo or no treatment, and the evidence that is currently available from these studies is of low or very low certainty. This means that we have very low confidence that the effects reported are accurate estimates of the true effect of these interventions. Consensus on the appropriate outcomes to measure in studies of Ménière's disease is needed (i.e. a core outcome set) in order to guide future studies in this area and enable meta-analyses of the results. This must include appropriate consideration of the potential harms of treatment, as well as the benefits.

Otolith Membrane Herniation, not Semicircular Canal Duct Dilation, Is Associated with Decreased Caloric Responses in Ménière's Disease

Ménière's disease (MD) is a debilitating disorder with unclear pathophysiology whose diagnosis often relies on clinical judgment rather than objective testing. To complicate matters further, a dissociation has emerged between two vestibular function tests commonly used in patients with MD to examine the same end-organ (the semicircular canals): the caloric test and video head impulse testing (vHIT). Caloric responses are often abnormal, while vHIT results remain normal. Explaining this dissociation could reveal novel insights into MD pathophysiology. Here, we conduct a histopathological study using temporal bone specimens (N = 58, 21 MD-affected ears and 37 age-matched controls) and their clinical testing data to examine current hypotheses aimed at this dissociation. We find otolith membrane herniation into the horizontal semicircular canal in 69% of MD ears, with 90% of these ears demonstrating a diminished caloric response. No ears with a normal response had this herniation. Moreover, we evaluated the semicircular canals for endolymphatic hydrops, which had been hypothesized to contribute to the dissociation, and found no evidence of duct dilation/hydrops. We did, however, note a potentially novel morphologic finding-smaller bony labyrinth cross-sectional diameters/areas in some MD ear canals compared to controls, suggesting relative size of the membranous duct to the bony canal rather than absolute size may be of importance. Taken together, this study refines hypotheses on the vestibular test dissociation in MD, holding diagnostic implications and expanding our understanding of the mechanisms underlying this enigmatic disease.

[The characteristics of vestibular-evoked myogenic potentials in unilateral Meniere's disease patients at different clinical stages]

Objective:This study was to retrospectively analyze the results of vestibular-evoked myogenic potentials（VEMP） in unilateral Meniere's disease（MD） patients. Methods:The clinical assessment results of MD patients who visited the department between January 2016 to February 2022 were reviewed. Unilateral MD patients who met the inclusion and exclusion criteria were divided into three groups according to clinical stages, namely, group 1（stage Ⅰ+ stage Ⅱ）, group 2（stage Ⅲ） and group 3（stage Ⅳ）. The normal value data were used to investigate the incidence of abnormal P1 and N1 latencies, abnormal P1-N1 interwave latency, and abnormal interaural amplitude asymmetry ratio（IAR）. Afterwards, considering all the above mentioned parameters, the VEMP result of each patient was graded into four levels（grade 1 means VEMP result is normal, grade 2, 3 and 4 means the VEMP result is abnormal in different degrees）. The correlation between VEMP result level and pure tone average（PTA） of MD patients in different clinical stages was examined. Results:The prevalence of cVEMP in three groups was 84.2%, 70.0% and 33.3%, respectively（P<0.05）. The prevalence of oVEMP in three groups was 63.2%, 34.0% and 16.7%, respectively（P<0.05）. The incidence of abnormal P1 latency, N1 letancy and P1-N1 interwave latency of cVEMP was 21.1%, 26.3% and 24.6%, respectively. The incidence of abnormal P1 latency, N1 latency and interwave latency of oVEMP was 15.6%, 43.8% and 3.1%, respectively. The incidence of abnormal cVEMP IAR in group 1, group 2 and group 3 was 6.7%, 21.2% and 33.3%, respectively（P>0.05）. The incidence of abnormal IAR of oVEMP in group 1, group 2 and group 3 was 16.7%, 23.1% and 0, respectively（P>0.05）. cVEMP and oVEMP result levels were significantly correlated with PTA（r=0.339, P<0.01; r=0.362, P<0.01 ）, respectively. Conclusion:With the progression of MD, the function of saccule-vestibular inferior nerve pathway and utricle-vestibular superior nerve pathway would deteriorate in the same way as hearing.

Vestibular syncope: clinical characteristics and mechanism

Background and Objectives

Vestibular syncope is a condition in which vertigo‐induced hemodynamic changes cause syncope. This study investigated the clinical and laboratory findings of vestibular syncope and tried to refine our knowledge of the mechanism underlying this newly recognized entity.

Methods

This study retrospectively analyzed 53 patients (33 women, median age = 63 years [interquartile range = 54–71 years]) with vestibular syncope from January 2017 to December 2021. To explain the mechanism of vestibular syncope, we incorporated a velocity‐storage model into the dual reflex pathways comprising the vestibulo‐sympathetic reflex and baroreflex and predicted the cardiovascular responses.

Results

Twenty (37.7%) patients had multiple episodes of vestibular syncope, and seven (13.2%) had potentially life‐threatening injuries. Meniere's disease (20.8%) and benign paroxysmal positional vertigo (9.4%) were the most common underlying vestibular disorders. Abnormal vestibular function tests included impaired cervical vestibular‐evoked myogenic potentials (57.5%) and positive head impulse tests (31.0%). Orthostatic hypotension was found in 19.5% of patients. Dyslipidemia (30.2%) and hypertension (28.3%) were common medical comorbidities. The dual reflex pathways incorporating the function of the velocity‐storage circuit in the brainstem and cerebellum suggest that vestibular syncope is a neurally mediated reflex syncope associated with a sudden hemodynamic change during vertigo. This change can be arterial hypertension triggered by a false downward inertial cue, as suggested previously, or hypotension driven by a false upward inertial cue.

Conclusions

Vestibular syncope is associated with various vestibular disorders and requires careful evaluation and intervention to prevent recurrent falls and significant injuries.

[The effectiveness of vestibular rehabilitation in Ménière's disease patients with chronic imbalance]

Objective:To observe the effectiveness of vestibular rehabilitation in Ménière's disease patients with chronic imbalance. Methods:Forty-five Ménière's disease patients with chronic imbalance treated in vertigo specialist clinic of Eye and ENT Hospital of Fudan University from December 2020 to December 2021 were enrolled. Patients were divided randomly into two groups, 23 patients in experimental group and 22 patients in control group. Both groups received routine outpatient treatment, and the experimental group received an additional vestibular rehabilitation for 8 weeks. All patients were evaluated with dizziness handicap inventory （DHI） at baseline and 8-week follow-up, and the incidence of fall was calculated. The occurrence of adverse events during the study was also recorded. Results:There was no significant difference in baseline data between the two groups （P>0.05）. During the study, 1 patient were lost to follow-up and 2 patients dropped out. A total of 42 patients completed the study. Intentionality analysis was performed on lost follow-up patients. After 8 weeks of the treatment, there were significant statistically differences in difference values of DHI and DHI-F scores（d₁=-30.22±3.78, d₂=-13.09±4.85, t=-2.799, P<0.05; d₁=-12.43±1.46, d₂=-4.55±2.17, t=-3.043, P<0.05）, while no significant difference was showed in the difference values of DHI-P and DHI-E scores（P>0.05）. There was no significant difference in incidence of fall between two groups（P>0.05）, but the incidence of experimental group decreased significantly compared with that before treatment（4.35% vs 34.78%, χ²=4.973, P<0.05）. No serious adverse event was reported in the two groups. Conclusion:Vestibular rehabilitation can improve the balance function and reduce risk of fall in Ménière's disease patients with chronic imbalance. Therefore, it is worthy of clinical application.

[Characteristics of wideband tympanometry in patients with Ménière's disease based on neutral network]

Objective:To construct a prediction model for Ménière's disease based on neural network and evaluate its prediction ability. Methods:Sixty-four patients with Ménière's disease underwent gadolinium enhanced magnetic resonance imaging of inner ear which showed endolymphatic hydrops. Meanwhile, 40 healthy adults were enrolled as controls. The database of wideband tympanometry of patients and control subjects was analyzed, and the neural network model was established by MATLAB 2021a software. The prediction ability of the model was evaluated by accuracy, positive predictive value, negative predictive value, the Youden index, sensitivity, specificity, receiver operating characteristic curve and area under curve （AUC）. Results:A feedforward network model was built with a single hidden layer to predict Ménière's disease with wideband tympanometry. There were 104 features in the input layer, 13 neuron nodes in the hidden layer and 1 output neuron in the output layer. The accuracy of the model was 83.2%, the positive predictive value was 80.7%, the negative predictive value was 84.3%, the sensitivity was 76.5%, the specificity was 83.7%, the Youden index was 0.602, and the AUC was 0.855. Conclusion:Based on neural network, the prediction model of Ménière's disease with high accuracy was constructed according to the results of wideband tympanometry, which provided reference for the diagnose of Ménière's disease.

The Effect of Collagen Viscoelastoplasiticty on Reissner’s Membrane Displacement: A Graphic Analysis

Background: The aim of this study is to analyze the effect of collagen viscoelastoplasticity on the bulge displacement of Reissner’s membrane that is observed in endolymphatic hydrops and Meniere’s disease.

Methods: Viscoelastoplastic load–deformation characteristics for Reissner’s membrane were based on a reported collagen polymer model of the cochleo-saccular membranes. The projected bulge displacements of Reissner’s model membrane at key distention points were quantified trigonometrically and plotted graphically.

Results: Initial deformation is characterized by a membrane laxity with substantial stretch at low tension with projected bulge displacement of Reissner’s membrane approaching 30%. Intermediate deformation is characterized by a linear membrane stiffness with projected bulge displacement of Reissner’s membrane in the range of 30-40%. Terminal deformation is characterized by reduced stiffness with a disproportionate increase in membrane stretch with projected bulge displacement of Reissner’s membrane reaching a critical value of 50%, indicating a hemi-circular profile with imminent risk of rupture.

Conclusion: This collagen model of membrane viscoelastoplasticity demonstrates that at low pressure significant degrees of bulge displacement up to 30% can occur that may be reversible. The narrower 30-40% range of membrane displacement is one of the increasing deformity but without risk of rupture. Greater displacements approaching 50% indicate that the membrane is reaching a critical hemi-circular configuration with impending rupture.

Vestibular and auditory manifestations of migraine

PURPOSE OF REVIEW

The purpose of this narrative review is to discuss current literature about vestibular migraine and other cochleovestibular symptoms related to migraine.

RECENT FINDINGS

Vestibular migraine affects 2.7% of the US population. Misdiagnosis is common. The pathophysiology is currently unknown but new research shows that calcitonin gene-related peptide, which is implicated in migraine headaches, is expressed in the audiovestibular periphery. A recent large-scale placebo-controlled trial looking at metoprolol for vestibular migraine was terminated early due to poor recruitment; however, at study completion, no differences were seen between treatment arms. Many other audiovestibular symptoms have been shown to be associated with migraine, including tinnitus, hearing loss, aural fullness, otalgia, and sinus symptoms. Migraine is also associated with risk for developing numerous otologic conditions, including Meniere's disease, vestibular loss, Benign Paroxysmal Positional Vertigo, and sudden sensorineural hearing loss. There is now some evidence that patients may experience fluctuating hearing loss and aural fullness without vertigo in association with migraine, which is called cochlear migraine.

SUMMARY

Migraine can cause a variety of audiologic and vestibular symptoms, and further research is required to understand how migraine affects the inner ear.

Influence of sex hormones on vestibular disorders

PURPOSE OF REVIEW

Vestibular disorders are gender distributed with a higher prevalence in women. Although research has increased in this field, the mechanisms underlying this unbalance is unclear. This review summarises recent advances in this research sphere, and briefly discusses sex hormone effects on various vestibular conditions and highlights some recent theories.

RECENT FINDINGS

Recent work has identified a direct link between aberrant gonadal hormone levels and vestibular dysfunction. Benign paroxysmal positional vertigo research suggests that the disorder may be linked to the rapid decrease in oestrogen, observed in menopausal women, which disrupts otoconial metabolism within the inner ear. A successful hormonal therapeutic intervention study has advanced our knowledge of hormonal influences in the inner ear in Ménière's disease. Also, several studies have focused on potential mechanisms involved in the interaction between Vestibular Migraine, Mal de Debarquement Syndrome, and gonadal hormones.

SUMMARY

In females, gonadal hormones and sex-specific synaptic plasticity may play a significant role in the underlying pathophysiology of peripheral and central vestibular disorders. Overall, this review concludes that clinical assessment of female vestibular patients requires a multifaceted approach which includes auditory and vestibular medicine physicians, gynaecologists and/or endocrinologists, in conjunction with hormonal profile evaluations.

[A preliminary study on characteristics of wideband acoustic immittance in patients with Meniere's disease]

Objective:To explore the wideband absorbance characteristics of patients with Meniere's disease（MD）. Methods:Wideband acoustic immittance was performed in 52 patients with unilateral Meniere's disease（UMD） and 30 control subjects with normal hearing. All UMD patients underwent pure tone audiometry, 226 Hz acoustic immittance, wideband acoustic immittance, and gadolinium contrast MRI. Sixteen frequency points were chosen to analyze the wideband absorbance at ambient and peak pressure, and the subjects were grouped as UMD group vs. control group and asymptomatic group. The student's t-test was used to compare the absorbance difference between them. Results:Both at peak and ambient pressure, there was a significant difference between the MD group and control group at 1587 Hz, 2000 Hz, 2519 Hz, 3174 Hz, and 4000 Hz; the MD group was lower than the control group（P<0.05）; there were no differences between the asymptomatic group and the symptomatic group, there also was a significant difference between the asymptomatic group and control group at 1587-4000 Hz（P<0.05）. Conclusion:The wideband absorbance in MD patients was significantly reduced within the frequency range of 1587-4000 Hz, and wideband acoustic immittance seems to be cost-effective in predicting MD.

Allergy, Immunotherapy, and Alternative Treatments for Dizziness

Allergic reactions may result in central symptoms of dizziness, including nonspecific chronic imbalance, Meniere's disease, and autoimmune inner ear disease. Excepting first-generation antihistamines, and short-term use of steroids, most pharmacotherapies used to treat allergic rhinitis have limited benefit in treating allergically induced or related dizziness. Allergy immunotherapy and/or an elimination diet for diagnosed food allergies have been found to be effective treatments. Individuals diagnosed with autoimmune inner ear disease remain challenging to treat and may require high-dose, long-term steroid treatment, biologics, or immunomodulators for symptom control.

1D Convolutional Neural Networks for Detecting Nystagmus

Vertigo is a type of dizziness characterised by the subjective feeling of movement despite being stationary. One in four individuals in the community experience symptoms of dizziness at any given time, and it can be challenging for clinicians to diagnose the underlying cause. When dizziness is the result of a malfunction in the inner-ear, the eyes flicker and this is called nystagmus. In this article we describe the first use of Deep Neural Network architectures applied to detecting nystagmus. The data used in these experiments was gathered during a clinical investigation of a novel medical device for recording head and eye movements. We describe methods for training networks using very limited amounts of training data, with an average of 11 mins of nystagmus across four subjects, and less than 24 hours of data in total, per subject. Our methods work by replicating and modifying existing samples to generate new data. In a cross-fold validation experiment, we achieve an average F1 score of 0.59 (SD = 0.24) across all four folds, showing that the methods employed are capable of identifying periods of nystagmus with a modest degree of accuracy. Notably, we were also able to identify periods of pathological nystagmus produced by a patient during an acute attack of Ménière's Disease, despite training the network on nystagmus that was induced by different means.

Does Cognitive Dysfunction Correlate With Dizziness Severity in Meniére's Disease Patients

OBJECTIVE

Characterize the relationship between cognitive dysfunction and the dizziness severity in Meniére's disease (MD) patients.

STUDY DESIGN

Retrospective review.

SETTING

University-based tertiary medical center.

PATIENTS

Three hundred patients were evaluated for MD from 2015 to 2019. Excluding comorbid or alternative vestibular disorders, 29 patients with definite MD and available pre- and postintervention data were included for analysis.

INTERVENTIONS

A progressive protocol of salt restriction, diuretics, steroid and/or gentamycin injection, and endolymphatic sac decompression for those refractory to medical therapy.

MAIN OUTCOME MEASURES

Quality of life measured with the Dizziness Handicap Inventory (DHI) and cognitive function measured with the Cognitive Failures Questionnaire (CFQ). Pre- and posttreatment DHI and DHI subscale scores and change in these scores were correlated with pre- and posttreatment CFQ scores and change in CFQ with therapy.

RESULTS

Analysis showed a number of limited associations between improvement in DHI and improvement in CFQ. Total DHI scores failed to correlate scores or variation in scores with change in CFQ (p = 0.091 and p = 0.085, respectively). Improvement in the CFQ false-triggering domain was significantly associated with improvement in the DHI physical subscale (r = 0.491, p = 0.007) and was nonsignificantly associated with improvement in total DHI and DHI emotional subscale scores (r = 0.422, p = 0.016 and r = 0.399, p = 0.032).

CONCLUSIONS

The DHI correlates with several pre- and posttreatment measures of cognitive dysfunction (CFQ) in MD patients. However, change in DHI and CFQ with therapy correlate poorly. Overall, the commonly used DHI may fail to adequately assess cognitive dysfunction in MD patients possibly due to factors not directly implicated by measures of vestibular dysfunction, such as central nervous system or cognitive dysfunction; however, the specific physical and emotional subscales may offer helpful insight into cognitive dysfunction change/improvement with treatment.

[Characteristics of endolymphatic hydrops in low frequency descent sudden hearing loss]

Objective: To investigate the correlation between the clinical features of low-frequency sudden deafness and endolymphatic hydrops on gadolinium contrast in the inner ear. Methods: From July 2019 to January 2020, adult patients with unilateral low-frequency sudden deafness who were hospitalized in the outpatient clinic or ward of the Department of Otorhinolaryngology, Eye and ENT Hospital of Fudan University were selected and examined by audiology and gadolinium magnetic resonance (MR) angiography of inner ear. The same treatment plan was given, and the curative effect was recorded and followed up for more than 3 months. SPSS 20.0 software was used to analyze the correlation between the accompanying symptoms, deafness, and endolymphatic hydrops. Results: A total of 48 patients were included in the study, including 18 males and 30 females. The age ranged from 21 to 52 (37.3±10.0) years. All of them were unilateral, including 28 cases of left ear and 20 cases of right ear. The course of the disease was less than 2 weeks in all cases. The endolymphatic hydrops group included 14 cases, including vestibular hydrocele (6 cases), cochlear hydrops (2 cases), and cochlear and vestibular hydrops (6 cases). The incidence of dizziness in the endolymphatic hydrops group was higher than that in the non-hydrops group (6/14 vs 0/34, P<0.001). There was no significant difference in hearing values between the two groups at 125, 250, 500, 4 000 and 8 000 Hz (all P>0.05). The hearing in the endolymphatic hydrops group was worse than that in the non-hydrops group at 1 000 and 2 000 Hz. Conclusion: Compared with those without endolymphatic hydrops, patients with hydrops tend to have a higher incidence of dizziness, worse hearing at 1 000 and 2 000 Hz, and a worse prognosis.

[Etiological analysis of 1027 patients with vertigo in Xinjiang Autonomous Region]

Objective:To analysis the etiological characteristics of patients with vertigo in Xinjiang Uygur Autonomous Region. Method:The data of 1027 patients with vertigo and dizziness were collected and the etiology was analyzed. Result:The patients aged 51-60 years accounted for 27.95% of the total, followed by those aged 61-70 years accounted for 20.16% and those aged 41-50 years accounted for 17.33% s. There were 363 males and 664 females with a ratio of 1∶1.8. Benign paroxysmal positional vertigo （BPPV） was the most common cause in 233 cases （22.69%）, followed by vestibular migraine （VM） in 184 cases （17.92%）, Meniere's disease （MD） in 139 cases （13.53%）, sudden deafness with vertigo in 132 cases （12.85%）, and unknown cause in 114 cases （11.10%）. Conclusion:Among vertigo patients, women are significantly more than men. BPPV, VM, MD, and SHL are the most common vertigo causes. There are still some patients haven't received definite diagnosis.

[The serivation and establishment of the new disease name "Otogenic Vertigo" of integration of Chinese and Western medicine]

"Otogenic vertigo()" is a new disease name of modern traditional Chinese medicine(TCM), which is equivalent to otogenic vertigo of modern medicine.TCM has observed vertigo symptoms very early, and otogenic vertigo is included in many diseases recorded in ancient Chinese medicine, such as "xuanmao ()" , "diaoxuan()" , "vertigo()" , "wind vertigo()" , "true vertigo()" , etc. "True vertigo" is closer to the current otogenic vertigo than others. "Otogenic vertigo" is a new disease name created by experts of TCM otorhinolaryngology in the context of integrated Chinese and Western medicine.It was born in the 4th and 5th edition of Otorhinolaryngology of Traditional Chinese Medicine which is national unified textbooks of TCM. "Otogenic vertigo" has become a standard term , and it has been almost uniform definition, as its corresponding modern medicine diseases. The definition of vertigo in modern TCM internal medicine is broad, and otogenic vertigois also included.

[Analysis of clinical features of vestibular migraine]

Objective:To analyze the clinical features of Vestibular migraine（VM） and provide evidence for its accurate diagnosis and medical identification of flight personnel. Method:A total of 490 samples of VM patients were collected. Among them, 88 samples were secondary to benign paroxysmal positional vertigo（BPPV）, and 11 samples were co-occurring with Meniere's disease（MD）. All patients received drugs, lifestyle management, vestibular rehabilitation and other comprehensive treatment, and analyzed the clinical features and effect within 6 months. Result:①The male-female ratio of VM patients was 1∶1.95, the average age was （50.2±14.3） years old, （48.7±15.0） years old for males and （51.0±13.9） years old for females. No statistically significant differences were found（P>0.05）. The average duration was（54.5±84.8） months, （35.0±59.0） months for males and（64.7±94.0） months for females. The difference was statistically significant（P<0.05）. ②The main clinical symptoms are dizziness, migraine or previous history of migraine, fear of sound/noisy environment sensitivity, photophobia/visual sensitivity, nausea/vomiting, vestibular posture symptoms, tinnitus, hearing loss, etc. , diarrhea during dizziness or headache was one special symptom of VM; ③The abnormal rate of vestibular autorotation test（VAT） in 118 VM patients was 72.3%, while the abnormal rate of caloric test in 170 VM patients was 32.9%; ④The effective remission rate within 6 months of VM patients with secondary BPPV and MD was 78.6% and 83.4%, while the VM patients without secondary benign paroxysmal positional vertigo（BPPV） and Meniere's disease（MD） was 93.3%. The difference was statistically significant（P<0.05）. Conclusion:The clinical manifestations of VM patients were various. Female VM patients had higher incidence, the course of disease than male VM patients, diarrhea can be regarded as one of the clinical features distinguished from MD. The abnormal rate of VAT was higher in the common clinical examiniations of VM patients. VM patients treatment should focus on personalized prescription and lifestyle management, vestibular rehabilitation, and corresponding treatment at the same time should be given to patients with secondary BPPV and MD to improve the efficacy. The medical identification of flight personnel VM patients should be strictly controlled, pilots should be grounded, while flight combat personnel and flight technical personnel need chartered medical identification.

[Efficacy of semicircular canal occlusion in the treatment of fifteen pateints with Meniere's disease]

Objective:To investigate the long-term efficacy of semicircular canal occlusion in the treatment of refractory Meniere's disease. Method:Fifteen patients with Meniere's disease who underwent semicircular canal occlusion were reviewed. The preoperative and postoperative frequency of vertigo ,quality of life, hearing and tinnitus level were compared. All patients were followed for more than 24 months. Result:Postoperatively, vertigo was controlled effectively in all 15 cases, and the control rate was 100%, of which 11 cases were completely controlled（Grade A） and 4 cases were basically controlled（Grade B）. The improvement rate of quality of life was 100%. The hearing worse in 4 cases（26.7%） and stabilized in 11 cases（73.3%）. The tinnitus was relieved in 7 cases（46.7%）, unchanged in 7 cases（46.7%） and aggravated in 1 case（6.7%）. Conclusion:Semicircular canal occlusion can effectively control the vertigo symptoms of refractory Meniere's disease and improve the quality of life. The long-term efficacy of semicircular canal occlusion is definite, but there is a risk of hearing loss.

[Etiology and clinical symptoms of bilateral vestibulopathy]

OBJECTIVE

To identify etiology, clinical symptoms of bilateral vestibulopathy (BV) depending on etiology.

RESULTS

Idiopathic BV was identifies in one third of patients. The most common identified reasons are Meniere's disease, meningitis and ototoxicity. BV develops more often without incidental hearing loss in case of idiopathic, autoimmune etiology, ototoxicity and bilateral vestibular neuronitis. BV after neuroinfection is characterized by prompt symptoms development, bilateral severe hearing loss, Gain reduction in vHIT lower 0.4 and loss of more than 8 lines in DVA test.

CONCLUSION

BV after bilateral Meniere's disease is characterized by Gain higher than 0.4 and typical clinical picture of the primary disease.

[Clinical features and imaging characteristics of Meniere's disease verified by intravenous gadolinium contrast-enhanced magnetic resonance imaging]

Objective: To analyze the clinical features and imaging characteristics of Meniere's disease (MD)verified by intravenous gadolinium contrast-enhanced magnetic resonance imaging(MRI). Methods: A total of 174 patients with Meniere's disease were involved in this study between March 2016 and October 2017. All of them underwent 3D-fluid attenuated inversion recovery (FLAIR) MRI and presented endolymphatic hydrops and clinical characteristics of suspected Meniere's disease. The clinical characteristics, the grades of endolymphatic hydrops (EH) using Nakashima grading standard were analyzed, and the correlation between grade and clinical features was evaluated. Results: There were totally 174 patients (88 males, 86 females), with the age of 7-83 years [mean age of (51.0±15.0)] years. Age of onset and disease course was 7-83 years [mean age of (44.6±16.6) years], 36.0 (12.0, 111.0) months (from 2 days to 70 years), respectively. EH was found in all the patients, and 169 cases (97.1%) manifested as modest or severe hydrops. Among the 174 patients, 139 cases (79.9%) presented unilateral EH, and 35 cases (20.1%) presented bilateral EH. The degree of EH in the latter was more serious than the former. For 174 patients, clinical characteristics were inconsistent, which was not in accord with the existing diagnostic criteria. Furthermore, there was a correlation between degree of hydrops and degree of hearing loss (P<0.05). Conclusions: EH in Meniere's disease can be measured objectively by intravenous gadolinium contrast-enhanced MRI. Clinical characteristics in MD verified by EH are not accordant with the existing criteria, which means the significance of EH in diagnosis of MD. Moreover, there's a correlation between degree and distribution of hydrops and degree of hearing loss.