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Sample records for vestibular loss patients

  1. Vestibular Aqueduct Midpoint Width and Hearing Loss in Patients With an Enlarged Vestibular Aqueduct.

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    Ascha, Mustafa S; Manzoor, Nauman; Gupta, Amit; Semaan, Maroun; Megerian, Cliff; Otteson, Todd D

    2017-06-01

    Elucidating the relationship between vestibular aqueduct size and hearing loss progression may inform the prognosis and counseling of patients who have an enlarged vestibular aqueduct (EVA). To examine the association between vestibular aqueduct size and repeated measures of hearing loss. For this retrospective medical record review, 52 patients with a diagnosis of hearing loss and radiologic diagnosis of EVA according to the Valvassori criterion were included. All available speech reception threshold and word recognition score data was retrieved; mixed-effects models were constructed where vestibular aqueduct size, age at diagnosis of hearing loss, and time since diagnosis of hearing loss were used to predict repeated measures of hearing ability. This study was performed at an academic tertiary care center. Variable vestibular aqueduct size, age at first audiogram, length of time after first audiogram. Speech reception threshold (dB) and word recognition score (%) during routine audiogram. Overall, 52 patients were identified (29 females [56%] and 23 males [44%]; median age at all recorded audiograms, 7.8 years) with a total of 74 ears affected by EVA. Median (range) vestibular aqueduct size was 2.15 (1.5-5.9) mm, and a median (range) of 5 (1-18) tests were available for each patient. Each millimeter increase in vestibular aqueduct size above 1.5 mm was associated with an increase of 17.5 dB in speech reception threshold (95% CI, 7.2 to 27.9 dB) and a decrease of 21% in word recognition score (95% CI, -33.3 to -8.0 dB). For each extra year after a patient's first audiogram, there was an increase of 1.5 dB in speech recognition threshold (95% CI, 0.22 to 3.0 dB) and a decrease of 1.7% in word recognition score (95% CI, -3.08 to -0.22 dB). Hearing loss in patients with an EVA is likely influenced by vestibular aqueduct midpoint width. When considering hearing loss prognosis, vestibular aqueduct midpoint width may be useful for the clinician who counsels patients

  2. Effects of electrotactile vestibular substitution on rehabilitation of patients with bilateral vestibular loss.

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    Barros, Camila Giacomo Carneiro; Bittar, Roseli Saraiva Moreira; Danilov, Yuri

    2010-06-07

    The present study evaluated the effectiveness of electrotactile tongue biofeedback (BrainPort((R))) as a sensory substitute for the vestibular apparatus in patients with bilateral vestibular loss (BVL) who did not have a good response to conventional vestibular rehabilitation (VR). Seven patients with BVL were trained to use the device. Stimulation on the surface of the tongue was created by a dynamic pattern of electrical pulses and the patient was able to adjust the intensity of stimulation and spatially centralize the stimulus on the electrode array. Patients were directed to continuously adjust head orientation and to maintain the stimulus pattern at the center of the array. Postural tasks that present progressive difficulties were given during the use of the device. Pre- and post-treatment distribution of the sensory organization test (SOT) composite score showed an average value of 38.3+/-8.7 and 59.9+/-11.3, respectively, indicating a statistically significant improvement (p=0.01). Electrotactile tongue biofeedback significantly improved the postural control of the study group, even if they had not improved with conventional VR. The electrotactile tongue biofeedback system was able to supply additional information about head position with respect to gravitational vertical orientation in the absence of vestibular input, improving postural control. Patients with BVL can integrate electrotactile information in their postural control in order to improve stability after conventional VR. These results were obtained and verified not only by the subjective questionnaire but also by the SOT composite score. The limitations of the study are the small sample size and short duration of the follow-up. The current findings show that the sensory substitution mediated by electrotactile tongue biofeedback may contribute to the improved balance experienced by these patients compared to VR. Copyright 2010 Elsevier Ireland Ltd. All rights reserved.

  3. Postural performance of vestibular loss patients under increased postural threat.

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    Young, Laurence R; Bernard-Demanze, Laurence; Dumitrescu, Michel; Magnan, Jacques; Borel, Liliane; Lacour, Michel

    2012-01-01

    The effects of increasing postural task difficulty on balance control was investigated in 9 compensated vestibular loss patients whose results were compared to 11 healthy adults. Subjects were tested in static (stable support) and dynamic (sinusoidal translation of the support) conditions, both at floor level and at height (62 cm above the floor), and with and without vision, to create an additional postural threat. Wavelet analysis of the center of foot pressure displacement and motion analysis of the body segments were used to evaluate the postural performance. Evaluation questionnaires were used to examine the compensation level of the patients (DHI test), their general anxiety level (SAST), fear of height (subjective scale), and workload (NASA TLX test). (Vestibular loss patients rely more on vision and spend more energy maintaining balance than controls, but they use the same postural strategy as normals in both static and dynamic conditions.) Questionnaire data all showed differences in behavior and perceptions between the controls and the patients. However, at height and without vision, a whole body strategy leading to rigid posture replaces the head stabilization strategy found for standing at floor level. The effects of height on postural control can be attributable to an increase in postural threat and attention changes resulting from modifications in perception.

  4. Vestibular Loss Predicts Poorer Spatial Cognition in Patients with Alzheimer's Disease.

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    Wei, Eric X; Oh, Esther S; Harun, Aisha; Ehrenburg, Matthew; Agrawal, Yuri

    2018-01-01

    The vestibular system is an important contributor to balance control, spatial orientation, and falls risk. Recent evidence has shown that Alzheimer's disease (AD) patients have a higher prevalence of vestibular impairment relative to healthy controls. We sought to evaluate whether vestibular loss is specifically associated with poor spatial cognitive skills among patients with mild cognitive impairment (MCI) and AD. We enrolled 50 patients (22 MCI and 28 AD) from an interdisciplinary Memory Clinic and measured vestibular physiologic function in all patients. Spatial cognitive function was assessed using the Money Road Map Test (MRMT) and the Trail Making Test Part B (TMT-B). General cognitive function was assessed with the Mini-Mental Status Examination (MMSE). In multivariable linear regression analyses adjusted for age, gender, education level, and MMSE, MCI and AD patients with vestibular loss made significantly more errors on the MRMT relative to patients with normal vestibular function (β= 7.3, 95% CI 2.4, 12.1 for unilateral vestibular loss and β= 6.4, 95% CI 1.9, 10.9 for bilateral vestibular loss). We further stratified AD patients into "spatially normal" and "spatially impaired" groups based on MRMT performance, and found that the prevalence of vestibular loss was significantly higher in the spatially impaired AD group relative to the spatially normal AD group. These findings support the hypothesis that vestibular loss contributes specifically to a decline in spatial cognitive ability in MCI and AD patients, independently of general cognitive decline, and may predict a "spatially impaired" subtype of AD.

  5. Enlarged Vestibular Aqueducts and Childhood Hearing Loss

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    ... Infections, and Deafness Enlarged Vestibular Aqueducts and Childhood Hearing Loss On this page: What are vestibular aqueducts? How ... How are enlarged vestibular aqueducts related to childhood hearing loss? Research suggests that most children with enlarged vestibular ...

  6. Unilateral Vestibular Loss Impairs External Space Representation

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    Borel, Liliane; Redon-Zouiteni, Christine; Cauvin, Pierre; Dumitrescu, Michel; Devèze, Arnaud; Magnan, Jacques; Péruch, Patrick

    2014-01-01

    The vestibular system is responsible for a wide range of postural and oculomotor functions and maintains an internal, updated representation of the position and movement of the head in space. In this study, we assessed whether unilateral vestibular loss affects external space representation. Patients with Menière's disease and healthy participants were instructed to point to memorized targets in near (peripersonal) and far (extrapersonal) spaces in the absence or presence of a visual background. These individuals were also required to estimate their body pointing direction. Menière's disease patients were tested before unilateral vestibular neurotomy and during the recovery period (one week and one month after the operation), and healthy participants were tested at similar times. Unilateral vestibular loss impaired the representation of both the external space and the body pointing direction: in the dark, the configuration of perceived targets was shifted toward the lesioned side and compressed toward the contralesioned hemifield, with higher pointing error in the near space. Performance varied according to the time elapsed after neurotomy: deficits were stronger during the early stages, while gradual compensation occurred subsequently. These findings provide the first demonstration of the critical role of vestibular signals in the representation of external space and of body pointing direction in the early stages after unilateral vestibular loss. PMID:24523916

  7. Unilateral vestibular loss impairs external space representation.

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    Liliane Borel

    Full Text Available The vestibular system is responsible for a wide range of postural and oculomotor functions and maintains an internal, updated representation of the position and movement of the head in space. In this study, we assessed whether unilateral vestibular loss affects external space representation. Patients with Menière's disease and healthy participants were instructed to point to memorized targets in near (peripersonal and far (extrapersonal spaces in the absence or presence of a visual background. These individuals were also required to estimate their body pointing direction. Menière's disease patients were tested before unilateral vestibular neurotomy and during the recovery period (one week and one month after the operation, and healthy participants were tested at similar times. Unilateral vestibular loss impaired the representation of both the external space and the body pointing direction: in the dark, the configuration of perceived targets was shifted toward the lesioned side and compressed toward the contralesioned hemifield, with higher pointing error in the near space. Performance varied according to the time elapsed after neurotomy: deficits were stronger during the early stages, while gradual compensation occurred subsequently. These findings provide the first demonstration of the critical role of vestibular signals in the representation of external space and of body pointing direction in the early stages after unilateral vestibular loss.

  8. Gentamicin perfusion vestibular response and hearing loss.

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    Light, Joshua P; Silverstein, Herbert; Jackson, Lance E

    2003-03-01

    To compare hearing results as a function of vestibular ablation in the treatment of Ménière's Disease, using gentamicin perfusion. A retrospective review of patients with Ménière's Disease treated by gentamicin perfusion of the inner ear via the MicroWick device. A tertiary otologic referral center. The charts of patients treated with gentamicin perfusion via the MicroWick between the years 1998 and 2000 were reviewed. The results for patients with functional hearing in the affected ear were analyzed and were compared with the results in patients without functional hearing. Audiologic and vestibular test results as well as subjective symptoms. There were 45 patients who met the inclusion criteria. The averages for speech discrimination score and pure tone average before treatment were 92% and 38 dB, and after treatment were 82% and 47 dB. Patients were divided into two groups: Group 1 (20 patients), less than 75% ice air caloric reduced vestibular response (RVR); Group 2 (25 patients), those who reached greater than 75% ice air caloric RVR. There were 8 patients (17.6%) with persistent vertigo; 7 were from Group 1, and 1 was from Group 2, which was statistically significant (p = 0.007)wwww. The pure tone average dropped an average of 3 dB for Group 1 and 15 dB for Group 2. The difference in hearing loss between the two groups was statistically significant (p = 0.01). This study suggests that there is a correlation between the degree of vestibular ablation, the control of vertigo, and the risk of hearing loss. Patients with functional hearing seem to have a similar success rate for vertigo control, compared with patients who already had lost functional hearing before treatment. Future investigation may determine if less than 100% RVR, but greater than 75% RVR, is an alternative end point with adequate vertigo control and reduced risk of hearing loss.

  9. The combination of vestibular impairment and congenital sensorineural hearing loss predisposes patients to ocular anomalies, including Usher syndrome.

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    Kletke, S; Batmanabane, V; Dai, T; Vincent, A; Li, S; Gordon, K A; Papsin, B C; Cushing, S L; Héon, E

    2017-07-01

    The co-occurrence of hearing impairment and visual dysfunction is devastating. Most deaf-blind etiologies are genetically determined, the commonest being Usher syndrome (USH). While studies of the congenitally deaf population reveal a variable degree of visual problems, there are no effective ophthalmic screening guidelines. We hypothesized that children with congenital sensorineural hearing loss (SNHL) and vestibular impairment were at an increased risk of having USH. A retrospective chart review of 33 cochlear implants recipients for severe to profound SNHL and measured vestibular dysfunction was performed to determine the ocular phenotype. All the cases had undergone ocular examination and electroretinogram (ERG). Patients with an abnormal ERG underwent genetic testing for USH. We found an underlying ocular abnormality in 81.81% (27/33) of cases; of which 75% had refractive errors, and 50% of those patients showed visual improvement with refractive correction. A total of 14 cases (42.42%; 14/33) had generalized rod-cone dysfunction on ERG suggestive of Usher syndrome type 1, confirmed by mutational analysis. This work shows that adding vestibular impairment as a criterion for requesting an eye exam and adding the ERG to detect USH increases the chances of detecting ocular anomalies, when compared with previous literature focusing only on congenital SNHL. © 2016 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  10. Vestibular Evoked Myogenic Potential Produced by Bone-Conducted Stimuli: A Study on its Basics and Clinical Applications in Patients With Conductive and Sensorineural Hearing Loss and a Group With Vestibular Schawannoma

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    Parvane Mahdi

    2013-06-01

    Full Text Available Introduction: Vestibular evoked myogenic potential (VEMP has recently been broadly studied in vestibular disorders. As it is evoked by loud sound stimulation, even mild conductive hearing loss may affect VEMP results. Bone-conducted (BC stimulus is an alternative stimulation for evoking this response. This study aims to assess the characteristics of BC-VEMP in different groups of patients.   Materials and Methods: We performed a cross sectional analysis on 20 healthy volunteers with normal pure-tone audiometry as a control group; and on a group of patients consisted of 20 participants with conductive hearing loss, five with bilateral sensorineural hearing loss and four with vestibular schawannoma. AC and BC-VEMP were performed in all participants.   Results: In control group the VEMP responses to both kinds of stimuli had an acceptable morphology and consisted of p13 and n23 waves. Latency value of these main components in each type of stimulus was not significantly different (P>0.05. However, the mean amplitude was larger in BC modality than AC stimulation (P=0.025. In the group with conductive hearing loss, the VEMP response was absent in fifteen (46.87% of the 32 ears using the AC method, whereas all (100% displayed positive elicitability of VEMP by BC method. Normal VEMP responses in both stimuli were evoked in all patients with sensorineural hearing loss. In patients with unilateral vestibular schwannomas (VS, 2 (50.00% had neither AC-VEMP nor BC-VEMP. Conclusion:  Auditory stimuli delivered by bone conduction can evoke VEMP response. These responses are of vestibular origin and can be used in vestibular evaluation of patients with conductive hearing loss.

  11. Hearing loss in patients with enlarged vestibular aqueduct: air-bone gap and audiological Bing test.

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    Mimura, Tamie; Sato, Eisuke; Sugiura, Makoto; Yoshino, Takahiko; Naganawa, Shinji; Nakashima, Tsutomu

    2005-08-01

    The Bing test is based on the principle that occlusion of the external auditory meatus improves the perception of bone-conducted sounds unless there is a conductive hearing impairment. An air-bone gap has been reported in patients with large vestibular aqueduct (LVA) syndrome without apparent middle ear dysfunction. We therefore performed the Bing test on nine patients with this syndrome to evaluate whether it is associated with an air-bone gap or middle ear dysfunction. Bone conduction thresholds did not change significantly during the Bing test in any patient. Because an air-bone gap is observed in patients with abnormal communication between the inner ear and cerebrospinal fluid through the LVA, dehiscent superior canal, or dilated inner ear meatus; we propose that a 'three windows' model (in which the abnormal communication provided by the enlarged endolymphatic duct and sac in LVA acts as the 'third window' for sound conductance) might explain the air-bone gap in such patients.

  12. Personality changes in patients with vestibular dysfunction.

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    Smith, Paul F; Darlington, Cynthia L

    2013-10-29

    The vestibular system is a sensory system that has evolved to detect linear and angular acceleration of the head in all planes so that the brain is not predominantly reliant on visual information to determine self-motion. Since the vestibular system first evolved in invertebrate species in order to detect gravitational vertical, it is likely that the central nervous system has developed a special dependence upon vestibular input. In addition to the deficits in eye movement and postural reflexes that occur following vestibular dysfunction, there is convincing evidence that vestibular loss also causes cognitive and emotional disorders, some of which may be due to the reflexive deficits and some of which are related to the role that ascending vestibular pathways to the limbic system and neocortex play in the sense of spatial orientation. Beyond this, however, patients with vestibular disorders have been reported to experience other personality changes that suggest that vestibular sensation is implicated in the sense of self. These are depersonalization and derealization symptoms such as feeling "spaced out", "body feeling strange" and "not feeling in control of self". We propose in this review that these symptoms suggest that the vestibular system may make a unique contribution to the concept of self through information regarding self-motion and self-location that it transmits, albeit indirectly, to areas of the brain such as the temporo-parietal junction (TPJ).

  13. Personality Changes in Patients with Vestibular Dysfunction

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    Paul eSmith

    2013-10-01

    Full Text Available The vestibular system is a sensory system that has evolved to detect linear and angular acceleration of the head in all planes so that the brain is not predominantly reliant on visual information to determine self-motion. Since the vestibular system first evolved in invertebrate species in order to detect gravitational vertical, it is likely that the central nervous system has developed a special dependence upon vestibular input. In addition to the deficits in eye movement and postural reflexes that occur following vestibular dysfunction, there is convincing evidence that vestibular loss also causes cognitive and emotional disorders, some of which may be due to the reflexive deficits and some of which are related to the role that ascending vestibular pathways to the limbic system and cortex play in the sense of spatial orientation. Beyond this, however, patients with vestibular disorders have been reported to experience other personality changes that suggest that vestibular sensation is implicated in the sense of self. These are depersonalisation and derealisation symptoms such as feeling ‘spaced out’, ‘body feeling strange’ and ‘not feeling in control of self’. We suggest in this review that these symptoms suggest that the vestibular system may make a unique contribution to the concept of self through the information regarding self-motion and self-location that it transmits, albeit indirectly, to areas of the brain such as the temporo-parietal junction.

  14. The relationship between senile hearing loss and vestibular activity

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    Hanifi Kurtaran

    Full Text Available Abstract Introduction: A considerable high number of SNHL patients also suffer from dizziness and related vestibular symptoms. Objective: To evaluate the association of vestibular dysfunction and sensorineural hearing loss (SNHL in adult patients. Methods: Prospective, double-blinded, controlled studies composed by 63 adult patients without any vestibular symptoms or diagnosed vestibular diseases. Audiological status was measured with pure tone audiometry and the vestibular system was tested with vestibular evoked myogenic potential (VEMP. Patients were divided into two groups: a study group (patients with SNHL and a control group (patients without SNHL. VEMP results of the groups were calculated and compared. Results: Mean P1 (23.54 and N1 (30.70 latencies were prolonged in the study group (p < 0.001 and the amplitudes of the study group were significantly reduced (p < 0.001. Both parameters of the VEMP test were abnormal in the study group when compared to the control group. Conclusions: These findings suggest that age-related SNHL may be accompanied by vestibular weakness without any possible predisposing factors for vestibulopathy.

  15. The relationship between senile hearing loss and vestibular activity.

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    Kurtaran, Hanifi; Acar, Baran; Ocak, Emre; Mirici, Emre

    A considerable high number of SNHL patients also suffer from dizziness and related vestibular symptoms. To evaluate the association of vestibular dysfunction and sensorineural hearing loss (SNHL) in adult patients. Prospective, double-blinded, controlled studies composed by 63 adult patients without any vestibular symptoms or diagnosed vestibular diseases. Audiological status was measured with pure tone audiometry and the vestibular system was tested with vestibular evoked myogenic potential (VEMP). Patients were divided into two groups: a study group (patients with SNHL) and a control group (patients without SNHL). VEMP results of the groups were calculated and compared. Mean P1 (23.54) and N1 (30.70) latencies were prolonged in the study group (p<0.001) and the amplitudes of the study group were significantly reduced (p<0.001). Both parameters of the VEMP test were abnormal in the study group when compared to the control group. These findings suggest that age-related SNHL may be accompanied by vestibular weakness without any possible predisposing factors for vestibulopathy. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  16. [Vestibular rehabilitation in elderly patients with dizziness].

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    Zanardini, Francisco Halilla; Zeigelboim, Bianca Simone; Jurkiewicz, Ari Leon; Marques, Jair Mendes; Martins-Bassetto, Jackeline

    2007-01-01

    The aging of the population is a natural process and is manifested by a decline in the functions of several organs. Vestibular rehabilitation (VR) is a therapeutic process that seeks to promote a significant reduction in the symptoms of the labyrinth. To verify the benefits of VR exercises through the application of the Dizziness Handicap Inventory (DHI) questionnaire--Brazilian version--pre and post rehabilitation. Participants of this study were eight elderly patients with dizziness, ages between 63 and 82 years, three male and five female. The following procedures were carried out: medical history, otologic inspection, vestibular evaluation with vectoelectronystagmography (VENG), application of the DHI questionnaire and of the Cawthorne (1944) and Cooksey (1946) VR exercises. Regarding the auditory and vestibular complaints which were referred to in the medical history, the following was observed: presence of tinnitus, hearing loss, postural vertigo and of unbalance. In the evaluation of the vestibular function alterations were observed for all of the participants, mainly in the caloric test, with a prevalence of unilateral and bilateral hypofunction. In the vestibular exam the following was observed: three cases of unilateral peripheral vestibular deficit syndrome, three cases of bilateral peripheral vestibular deficit syndrome, one case of bilateral central vestibular deficit syndrome and one case of irritating bilateral central vestibular syndrome. There was a statistically significant improvement of the following aspects after VR: physical (p=0.00413), functional (p=0.00006) and emotional (p=0.03268). The VR protocol favored the improvement of life quality of the participants and was of assistance in the process of vestibular compensation.

  17. Vestibular findings in fibromyalgia patients

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    Zeigelboim, Bianca Simone

    2011-07-01

    Full Text Available Introduction: Fibromyalgia (FM is a non-inflammatory musculoskeletal chronic syndrome, whose etiology is unknown, characterized by a diffuse pain, increase in palpation sensitivity and such symptoms as tiredness, insomnia, anxiety, depression, cold intolerance and otologic complaints. Objective: Evaluate the vestibular behavior in fibromyalgia patients. Method: A retrospective transversal study was performed. 25 patients aged between 26 and 65 (average age - 52.2 and standard deviation - 10.3 were evaluated and submitted to the following procedures: anamnesis, otorhinolaryngologic and vestibular evaluation by way of vector electronystamography. Results: a The most evident otoneurologic symptoms were: difficulty or pain when moving the neck and pain was spread to an arm or shoulder (92.0% in each, dizziness (84.0% and headache (76.0%. The different clinical symptoms mostly reported were: depression (80.0%, anxiety (76.0% and insomnia (72.0%; b vestibular examination showed an alteration in 12 patients (48.0% in the caloric test; c an alteration in the peripheral vestibular system prevailed, and d deficient peripheral vestibular disorders were prevalent. Conclusion: This study enabled the importance of the labyrinthic test to be verified, thus emphasizing that this kind of people must be studied better, since a range of rheumatologic diseases can cause severe vestibular changes as a result of their manifestations and impairment areas.

  18. Cost-effectiveness analysis of a non-contrast screening MRI protocol for vestibular schwannoma in patients with asymmetric sensorineural hearing loss

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    Crowson, Matthew G.; Rocke, Daniel J.; Kaylie, David M. [Duke University Medical Center, Division of Otolaryngology-Head and Neck Surgery, Durham, NC (United States); Hoang, Jenny K. [Duke University Medical Center, Department of Radiology, Durham, NC (United States); Weissman, Jane L. [Oregon Health Sciences University, Professor Emerita of Diagnostic Radiology, Portland, OR (United States)

    2017-08-15

    We aimed to determine if a non-contrast screening MRI is cost-effective compared to a full MRI protocol with contrast for the evaluation of vestibular schwannomas. A decision tree was constructed to evaluate full MRI and screening MRI strategies for patients with asymmetric sensorineural hearing loss. If a patient were to have a positive screening MRI, s/he received a full MRI. Vestibular schwannoma prevalence, MRI specificity and sensitivity, and gadolinium anaphylaxis incidence were obtained through literature review. Institutional charge data were obtained using representative patient cohorts. One-way and probabilistic sensitivity analyses were completed to determine CE model threshold points for MRI performance characteristics and charges. The mean charge for a full MRI with contrast was significantly higher than a screening MRI ($4089 ± 1086 versus $2872 ± 741; p < 0.05). The screening MRI protocol was more cost-effective than a full MRI protocol with a willingness-to-pay from $0 to 20,000 USD. Sensitivity analyses determined that the screening protocol dominated when the screening MRI charge was less than $4678, and the imaging specificity exceeded 78.2%. The screening MRI protocol also dominated when vestibular schwannoma prevalence was varied between 0 and 1000 in 10,000 people. A screening MRI protocol is more cost-effective than a full MRI with contrast in the diagnostic evaluation of a vestibular schwannoma. A screening MRI likely also confers benefits of shorter exam time and no contrast use. Further investigation is needed to confirm the relative performance of screening protocols for vestibular schwannomas. (orig.)

  19. Saccadic entropy of head impulses in acute unilateral vestibular loss

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    Hsieh, Li-Chun; Lin, Hung-Ching; Lee, Guo-She

    2016-01-01

    To evaluate the complexity of vestibular–ocular reflex (VOR) in patients with acute unilateral vestibular loss (AUVL) via entropy analysis of head impulses. Methods: Horizontal head impulse test (HIT) with high-velocity alternating directions was used to evaluate 12 participants with AUVL and 16 healthy volunteers. Wireless electro-oculography and electronic gyrometry were used to acquire eye positional signals and head velocity signals. The eye velocity signals were then obtained through ...

  20. Hyperventilation-induced nystagmus in vestibular schwannoma and unilateral sensorineural hearing loss.

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    Mandalà, Marco; Giannuzzi, Annalisa; Astore, Serena; Trabalzini, Franco; Nuti, Daniele

    2013-07-01

    We evaluated the incidence and characteristics of hyperventilation-induced nystagmus (HVN) in 49 patients with gadolinium-enhanced magnetic resonance imaging evidence of vestibular schwannoma and 53 patients with idiopathic unilateral sensorineural hearing loss and normal radiological findings. The sensitivity and specificity of the hyperventilation test were compared with other audio-vestibular diagnostic tests (bedside examination of eye movements, caloric test, auditory brainstem responses) in the two groups of patients. The hyperventilation test scored the highest diagnostic efficiency (sensitivity 65.3 %; specificity 98.1 %) of the four tests in the differential diagnosis of vestibular schwannoma and idiopathic unilateral sensorineural hearing loss. Small tumors with a normal caloric response or caloric paresis were associated with ipsilateral HVN and larger tumors and severe caloric deficits with contralateral HVN. These results confirm that the hyperventilation test is a useful diagnostic test for predicting vestibular schwannoma in patients with unilateral sensorineural hearing loss.

  1. Is the Headache in Patients with Vestibular Migraine Attenuated by Vestibular Rehabilitation?

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    Sugaya, Nagisa; ARAI, Miki; Goto, Fumiyuki

    2017-01-01

    Background Vestibular rehabilitation is the most effective treatment for dizziness due to vestibular dysfunction. Given the biological relationship between vestibular symptoms and headache, headache in patients with vestibular migraine (VM) could be improved by vestibular rehabilitation that leads to the improvement of dizziness. This study aimed to compare the effects of vestibular rehabilitation on headache and other outcomes relating to dizziness, and the psychological factors in patien...

  2. Saccadic entropy of head impulses in acute unilateral vestibular loss.

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    Hsieh, Li-Chun; Lin, Hung-Ching; Lee, Guo-She

    2017-10-01

    To evaluate the complexity of vestibular-ocular reflex (VOR) in patients with acute unilateral vestibular loss (AUVL) via entropy analysis of head impulses. Horizontal head impulse test (HIT) with high-velocity alternating directions was used to evaluate 12 participants with AUVL and 16 healthy volunteers. Wireless electro-oculography and electronic gyrometry were used to acquire eye positional signals and head velocity signals. The eye velocity signals were then obtained through differentiation, band-pass filtering. The approximate entropy of eye velocity to head velocity (RApEn) was used to evaluate chaos property. VOR gain, gain asymmetry ratio, and RApEn asymmetry ratio were also used to compare the groups. For the lesion-side HIT of the patient group, the mean VOR gain was significantly lower and the mean RApEn was significantly greater compared with both nonlesion-side HIT and healthy controls (p < 0.01, one-way analysis of variance). Both the RApEn asymmetry ratio and gain asymmetry ratio of the AUVL group were significantly greater compared with those of the control group (p < 0.05, independent sample t test). Entropy and gain analysis of HIT using wireless electro-oculography system could be used to detect the VOR dysfunctions of AUVL and may become effective methods for evaluating vestibular disorders. Copyright © 2017. Published by Elsevier B.V.

  3. Fractionated Stereotactic Radiotherapy of Vestibular Schwannomas Accelerates Hearing Loss

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    Rasmussen, Rune, E-mail: rune333@gmail.com [Department of Neurosurgery, Rigshospitalet, Copenhagen (Denmark); Claesson, Magnus [Department of Neurosurgery, Rigshospitalet, Copenhagen (Denmark); Stangerup, Sven-Eric [Ear, Nose, and Throat Department, Rigshospitalet, Copenhagen (Denmark); Roed, Henrik [Department of Radiation Oncology, Rigshospitalet, Copenhagen (Denmark); Christensen, Ib Jarle [Finsen Laboratory, Rigshospitalet, Copenhagen (Denmark); Caye-Thomasen, Per [Ear, Nose, and Throat Department, Rigshospitalet, Copenhagen (Denmark); Juhler, Marianne [Department of Neurosurgery, Rigshospitalet, Copenhagen (Denmark)

    2012-08-01

    Objective: To evaluate long-term tumor control and hearing preservation rates in patients with vestibular schwannoma treated with fractionated stereotactic radiotherapy (FSRT), comparing hearing preservation rates to an untreated control group. The relationship between radiation dose to the cochlea and hearing preservation was also investigated. Methods and Materials: Forty-two patients receiving FSRT between 1997 and 2008 with a minimum follow-up of 2 years were included. All patients received 54 Gy in 27-30 fractions during 5.5-6.0 weeks. Clinical and audiometry data were collected prospectively. From a 'wait-and-scan' group, 409 patients were selected as control subjects, matched by initial audiometric parameters. Radiation dose to the cochlea was measured using the original treatment plan and then related to changes in acoustic parameters. Results: Actuarial 2-, 4-, and 10-year tumor control rates were 100%, 91.5%, and 85.0%, respectively. Twenty-one patients had serviceable hearing before FSRT, 8 of whom (38%) retained serviceable hearing at 2 years after FSRT. No patients retained serviceable hearing after 10 years. At 2 years, hearing preservation rates in the control group were 1.8 times higher compared with the group receiving FSRT (P=.007). Radiation dose to the cochlea was significantly correlated to deterioration of the speech reception threshold (P=.03) but not to discrimination loss. Conclusion: FSRT accelerates the naturally occurring hearing loss in patients with vestibular schwannoma. Our findings, using fractionation of radiotherapy, parallel results using single-dose radiation. The radiation dose to the cochlea is correlated to hearing loss measured as the speech reception threshold.

  4. Current and Future Management of Bilateral Loss of Vestibular Sensation – An update on the Johns Hopkins Multichannel Vestibular Prosthesis Project

    Science.gov (United States)

    Della Santina, Charles C.; Migliaccio, Americo A.; Hayden, Russell; Melvin, Thuy-Anh; Fridman, Gene Y.; Chiang, Bryce; Davidovics, Natan S.; Dai, Chenkai; Carey, John P.; Minor, Lloyd B.; Anderson, Iee-Ching; Park, HongJu; Lyford-Pike, Sofia; Tang, Shan

    2012-01-01

    Bilateral loss of vestibular sensation can disable individuals whose vestibular hair cells are injured by ototoxic medications, infection, Ménière’s disease or other insults to the labyrinth including surgical trauma during cochlear implantation. Without input to vestibulo-ocular and vestibulo-spinal reflexes that normally stabilize the eyes and body, affected patients suffer blurred vision during head movement, postural instability, and chronic disequilibrium. While individuals with some residual sensation often compensate for their loss through rehabilitation exercises, those who fail to do so are left with no adequate treatment options. An implantable neuroelectronic vestibular prosthesis that emulates the normal labyrinth by sensing head movement and modulating activity on appropriate branches of the vestibular nerve could significantly improve quality of life for these otherwise chronically dizzy patients. This brief review describes the impact and current management of bilateral loss of vestibular sensation, animal studies supporting the feasibility of prosthetic vestibular stimulation, and a vestibular prosthesis designed to restore sensation of head rotation in all directions. Similar to a cochlear implant in concept and size, the Johns Hopkins Multichannel Vestibular Prosthesis (MVP) includes miniature gyroscopes to sense head rotation, a microcontroller to process inputs and control stimulus timing, and current sources switched between pairs of electrodes implanted within the vestibular labyrinth. In rodents and rhesus monkeys rendered bilaterally vestibular-deficient via treatment with gentamicin and/or plugging of semicircular canals, the MVP partially restores the vestibulo-ocular reflex for head rotations about any axis of rotation in 3-dimensional space. Our efforts now focus on addressing issues prerequisite to human implantation, including refinement of electrode designs and surgical technique to enhance stimulus selectivity and preserve

  5. Fractionated stereotactic radiotherapy of vestibular schwannomas accelerates hearing loss

    DEFF Research Database (Denmark)

    Rasmussen, Rune; Claesson, Magnus; Stangerup, Sven-Eric

    2012-01-01

    To evaluate long-term tumor control and hearing preservation rates in patients with vestibular schwannoma treated with fractionated stereotactic radiotherapy (FSRT), comparing hearing preservation rates to an untreated control group. The relationship between radiation dose to the cochlea and hear......To evaluate long-term tumor control and hearing preservation rates in patients with vestibular schwannoma treated with fractionated stereotactic radiotherapy (FSRT), comparing hearing preservation rates to an untreated control group. The relationship between radiation dose to the cochlea...

  6. The molecular biology of vestibular schwannomas and its association with hearing loss: a review.

    Science.gov (United States)

    Celis-Aguilar, Erika; Lassaletta, Luis; Torres-Martín, Miguel; Rodrigues, F Yuri; Nistal, Manuel; Castresana, Javier S; Gavilan, Javier; Rey, Juan A

    2012-01-01

    Hearing loss is the most common symptom in patients with vestibular schwannoma (VS). In the past, compressive mechanisms caused by the tumoral mass and its growth have been regarded as the most likely causes of the hearing loss associated with VS. Interestingly, new evidence proposes molecular mechanisms as an explanation for such hearing loss. Among the molecular mechanisms proposed are methylation of TP73, negative expression of cyclin D1, expression of B7-H1, increased expression of the platelet-derived growth factor A, underexpression of PEX5L, RAD54B, and PSMAL, and overexpression of CEA. Many molecular mechanisms are involved in vestibular schwannoma development; we review some of these mechanisms with special emphasis on hearing loss associated with vestibular schwannoma.

  7. The Molecular Biology of Vestibular Schwannomas and Its Association with Hearing Loss: A Review

    Directory of Open Access Journals (Sweden)

    Erika Celis-Aguilar

    2012-01-01

    Full Text Available Hearing loss is the most common symptom in patients with vestibular schwannoma (VS. In the past, compressive mechanisms caused by the tumoral mass and its growth have been regarded as the most likely causes of the hearing loss associated with VS. Interestingly, new evidence proposes molecular mechanisms as an explanation for such hearing loss. Among the molecular mechanisms proposed are methylation of TP73, negative expression of cyclin D1, expression of B7-H1, increased expression of the platelet-derived growth factor A, underexpression of PEX5L, RAD54B, and PSMAL, and overexpression of CEA. Many molecular mechanisms are involved in vestibular schwannoma development; we review some of these mechanisms with special emphasis on hearing loss associated with vestibular schwannoma.

  8. Molecular epidemiology and functional assessment of novel allelic variants of SLC26A4 in non-syndromic hearing loss patients with enlarged vestibular aqueduct in China.

    Directory of Open Access Journals (Sweden)

    Yongyi Yuan

    Full Text Available Mutations in SLC26A4, which encodes pendrin, are a common cause of deafness. SLC26A4 mutations are responsible for Pendred syndrome and non-syndromic enlarged vestibular aqueduct (EVA. The mutation spectrum of SLC26A4 varies widely among ethnic groups. To investigate the incidence of EVA in Chinese population and to provide appropriate genetic testing and counseling to patients with SLC26A4 variants, we conducted a large-scale molecular epidemiological survey of SLC26A4.A total of 2352 unrelated non-syndromic hearing loss patients from 27 different regions of China were included. Hot spot regions of SLC26A4, exons 8, 10 and 19 were sequenced. For patients with one allelic variant in the hot spot regions, the other exons were sequenced one by one until two mutant alleles had been identified. Patients with SLC26A4 variants were then examined by temporal bone computed tomography scan for radiological diagnosis of EVA. Ten SLC26A4 variants were cloned for functional study. Confocal microscopy and radioisotope techniques were used to examine the membrane expression of pendrin and transporter function.Of the 86 types of variants found, 47 have never been reported. The ratio of EVA in the Chinese deaf population was at least 11%, and that in patients of Han ethnicity reached at least 13%. The mutational spectrum and mutation detection rate of SLC26A4 are distinct among both ethnicities and regions of Mainland China. Most of the variants caused retention of pendrin in the intracellular region. All the mutant pendrins showed significantly reduced transport capability.An overall description of the molecular epidemiological findings of SLC26A4 in China is provided. The functional assessment procedure can be applied to identification of pathogenicity of variants. These findings are valuable for genetic diagnosis, genetic counseling, prenatal testing and pre-implantation diagnosis in EVA families.

  9. Effects of Vestibular Loss on Orthostatic Responses to Tilts in the Pitch Plane

    Science.gov (United States)

    Wood, Scott J.; Serrador, Jorge M.; Black, F. Owen; Rupert,Angus H.; Schlegel, Todd T.

    2004-01-01

    The purpose of this study was to determine the extent to which vestibular loss might impair orthostatic responses to passive tilts in the pitch plane in human subjects. Data were obtained from six subjects having chronic bilateral vestibular loss and six healthy individuals matched for age, gender, and body mass index. Vestibular loss was assessed with a comprehensive battery including dynamic posturography, vestibulo-ocular and optokinetic reflexes, vestibular evoked myogenic potentials, and ocular counterrolling. Head up tilt tests were conducted using a motorized two-axis table that allowed subjects to be tilted in the pitch plane from either a supine or prone body orientation at a slow rate (8 deg/s). The sessions consisted of three tilts, each consisting of20 min rest in a horizontal position, tilt to 80 deg upright for 10 min, and then return to the horizontal position for 5 min. The tilts were performed in darkness (supine and prone) or in light (supine only). Background music was used to mask auditory orientation cues. Autonomic measurements included beat-to-beat recordings of blood pressure (Finapres), heart rate (ECG), cerebral blood flow velocity in the middle cerebral artery (transcranial Doppler), end tidal CO2, respiratory rate and volume (Respritrace), and stroke volume (impedance cardiography). For both patients and control subjects, cerebral blood flow appeared to exhibit the most rapid adjustment following transient changes in posture. Outside of a greater cerebral hypoperfusion in patients during the later stages of tilt, responses did not differ dramatically between the vestibular loss and control subjects, or between tilts performed in light and dark room conditions. Thus, with the 'exception of cerebrovascular regulation, we conclude that orthostatic responses during slow postural tilts are not substantially impaired in humans following chronic loss of vestibular function, a result that might reflect compensation by nonvisual graviceptor

  10. The Molecular Biology of Vestibular Schwannomas and Its Association with Hearing Loss: A Review

    OpenAIRE

    Erika Celis-Aguilar; Luis Lassaletta; Miguel Torres-Martín; F. Yuri Rodrigues; Manuel Nistal; CASTRESANA, JAVIER S.; Javier Gavilan; Rey, Juan A.

    2012-01-01

    Hearing loss is the most common symptom in patients with vestibular schwannoma (VS). In the past, compressive mechanisms caused by the tumoral mass and its growth have been regarded as the most likely causes of the hearing loss associated with VS. Interestingly, new evidence proposes molecular mechanisms as an explanation for such hearing loss. Among the molecular mechanisms proposed are methylation of TP73, negative expression of cyclin D1, expression of B7-H1, increased expression of the pl...

  11. Linear accelerator-based stereotactic radiosurgery for bilateral vestibular schwannomas in patients with neurofibromatosis type 2

    NARCIS (Netherlands)

    Meijer, Otto W. M.; Vandertop, W. Peter; Lagerwaard, Frank J.; Slotman, Ben J.

    2008-01-01

    OBJECTIVE: Patients with neurofibromatosis Type 2 (NF2) patients typically have bilateral vestibular schwannomas (VS) and are at risk for developing bilateral deafness, bilateral trigeminal, and bilateral facial nerve function loss. Previous reports suggested that treatment outcomes in these

  12. [Effectiveness of Self-efficacy Promoting Vestibular Rehabilitation Program for Patients with Vestibular Hypofunction].

    Science.gov (United States)

    Lee, Hyun Jung; Choi-Kwon, Smi

    2016-10-01

    In this study an examination was done of the effect of self-efficacy promoting vestibular rehabilitation (S-VR) on dizziness, exercise selfefficacy, adherence to vestibular rehabilitation (VR), subjective and objective vestibular function, vestibular compensation and the recurrence of dizziness in patients with vestibular hypofunction. This was a randomized controlled study. Data were collected 3 times at baseline, 4 and 8 weeks after beginning the intervention. Outcome measures were level of dizziness, exercise self-efficacy, and level of adherence to VR. Subjective and objective vestibular function, vestibular compensation and the recurrence of dizziness were also obtained. Data were analyzed using Windows SPSS 21.0 program. After 4 weeks of S-VR, there was no difference between the groups for dizziness, subjective and objective vestibular functions. However, exercise self-efficacy and adherence to VR were higher in the experimental group than in the control group. After 8 weeks of S-VR, dizziness (p=.018) exercise self-efficacy (pVR (pVR is effective in reducing dizziness, and improving exercise self-efficacy, subjective vestibular function and adherence to VR. Objective vestibular function and vestibular compensation were also improved in the experimental group at the end of 8 weeks of S-VR.

  13. Vestibular Involvement in Patients With Otitis Media With Antineutrophil Cytoplasmic Antibody-associated Vasculitis.

    Science.gov (United States)

    Morita, Yuka; Takahashi, Kuniyuki; Izumi, Shuji; Kubota, Yamato; Ohshima, Shinsuke; Horii, Arata

    2017-01-01

    Otitis media (OM) with antineutrophil cytoplasmic antibody (ANCA)-associated vasculitis (OMAAV) is a novel concept of ear disease that is characterized by progressive mixed or sensorineural hearing loss with occasional systemic involvement. Considering the accumulating knowledge about the characteristics of and treatment for auditory dysfunction in OMAAV, the objective of this study was to investigate the vestibular function and symptoms of patients with OMAAV. Retrospective chart review. University hospital. Thirty-one OMAAV patients met criteria proposed by the OMAAV study group in Japan. Clinical characteristics and vestibular tests. Eleven of 31 OMAAV patients had vestibular symptoms; 3 patients had acute vertigo attack with sudden hearing loss and 8 patients had chronic dizziness. Episodic vertigo was not seen in any of the patients. Three patients who received a less intensive therapy without immunosuppressive agents developed intractable persistent dizziness. All symptomatic patients and six of the nine OMAAV patients without vestibular symptoms showed unilateral or bilateral caloric weakness; therefore, vestibular involvement was present in 84% of OMAAV patients. Gain of vestibulo-ocular reflex was reduced in symptomatic patients. The eye-tracking test and optokinetic nystagmus revealed no evidence of central dysfunction. Vestibular dysfunction was seen in 84% of OMAAV patients. One-third of OMAAV patients showed vestibular symptoms such as acute vertigo attack or chronic dizziness, which are of peripheral origin. One-third of the symptomatic patients developed intractable dizziness. Initial intensive treatment by combination therapy with steroid and immunosuppressive agents may be essential for preventing the development of intractable dizziness.

  14. Vergence and Standing Balance in Subjects with Idiopathic Bilateral Loss of Vestibular Function.

    Science.gov (United States)

    Kapoula, Zoï; Gaertner, Chrystal; Yang, Qing; Denise, Pierre; Toupet, Michel

    2013-01-01

    There is a natural symbiosis between vergence and vestibular responses. Deficits in vergence can lead to vertigo, disequilibrium, and postural instability. This study examines both vergence eye movements in patients with idiopathic bilateral vestibular loss, and their standing balance in relation to vergence. Eleven patients participated in the study and 16 controls. Bilateral loss of vestibular function was objectified with many tests; only patients without significant response to caloric tests, to video head impulse tests and without vestibular evoked myogenic potentials were included in the study. A LED display with targets at 20, 40, and 100 cm along the median plane was used to elicit vergence eye movements, recorded with the IRIS device. Four conditions were run, each lasting 1 min: fixation of a LED at 40 cm (convergence of 9°), at 150 cm (convergence of 2.3°); this last condition was repeated with eyes closed. Comparison of the eyes closed-eyes open conditions at 150 cm allowed evaluation of the Romberg Quotient. In the forth condition, two LEDS, at 20 and at 100 cm, were light on, one after the other for 1 sec, causing the eyes to converge then diverge. Standing balance was recorded with an accelerometer placed at the back near the center of mass (McRoberts, Dynaport). Relative to controls, convergence eye movements in patients showed significantly lower accuracy, lower mean velocity, and saccade intrusions of significantly higher amplitude. The normalized 90% area of body sway was significantly higher for patients than for controls for all conditions. Yet, similarly to controls, postural stability was better while fixating at near (sustained convergence) than at far, or while making active vergence movements. We argue that vestibular loss deteriorates convergence, but even deficient, convergence can be helpful for postural control.

  15. Vergence and Standing Balance in Subjects with Idiopathic Bilateral Loss of Vestibular Function.

    Directory of Open Access Journals (Sweden)

    Zoï Kapoula

    Full Text Available There is a natural symbiosis between vergence and vestibular responses. Deficits in vergence can lead to vertigo, disequilibrium, and postural instability. This study examines both vergence eye movements in patients with idiopathic bilateral vestibular loss, and their standing balance in relation to vergence. Eleven patients participated in the study and 16 controls. Bilateral loss of vestibular function was objectified with many tests; only patients without significant response to caloric tests, to video head impulse tests and without vestibular evoked myogenic potentials were included in the study.A LED display with targets at 20, 40, and 100 cm along the median plane was used to elicit vergence eye movements, recorded with the IRIS device.Four conditions were run, each lasting 1 min: fixation of a LED at 40 cm (convergence of 9°, at 150 cm (convergence of 2.3°; this last condition was repeated with eyes closed. Comparison of the eyes closed-eyes open conditions at 150 cm allowed evaluation of the Romberg Quotient. In the forth condition, two LEDS, at 20 and at 100 cm, were light on, one after the other for 1 sec, causing the eyes to converge then diverge. Standing balance was recorded with an accelerometer placed at the back near the center of mass (McRoberts, Dynaport.Relative to controls, convergence eye movements in patients showed significantly lower accuracy, lower mean velocity, and saccade intrusions of significantly higher amplitude.The normalized 90% area of body sway was significantly higher for patients than for controls for all conditions. Yet, similarly to controls, postural stability was better while fixating at near (sustained convergence than at far, or while making active vergence movements. We argue that vestibular loss deteriorates convergence, but even deficient, convergence can be helpful for postural control.

  16. Evaluation of vestibular function in patients with chronic suppurative otitis media.

    Science.gov (United States)

    Mostafa, Badr Eldin; Shafik, Amr Gouda; El Makhzangy, Aly M N; Taha, Hesham; Abdel Mageed, Heba Mahmoud

    2013-01-01

    The objective of this study was to assess vestibular functions in patients with chronic suppurative otitis media (CSOM) with and without sensorineural hearing loss. This was a prospective case study performed at a tertiary referral university hospital. Sixty patients with CSOM were included, and patients with a history of head trauma, diabetes, hypertension, previous ear surgery, use of ototoxic drugs, neurological deficits and suspected fistulae were excluded. The patients underwent basic audiological evaluation, and clinical and instrumental vestibular evaluation. The incidence and extent of vestibular dysfunction in patients with CSOM were analyzed. A total of 42 males and 16 females with a mean age of 29.5 years were included in this study. Forty ears had tubotympanic disease and 19 had cholesteatoma. There were 14 ears with sensorineural hearing loss. A positive history of vertigo was reported in 53.5% of the cases. Rotatory chair abnormalities were found in 70% of the cases, caloric hypofunction was found in 61.6%, and vestibular myogenic evoked potentials were abnormal in 25%. The only positive correlation with vestibular dysfunction was the duration of disease. The vestibular system is significantly affected in cases with CSOM. Both semicircular canals and the saccule are affected. All patients with long-standing CSOM should be evaluated for vestibular dysfunction irrespective of their hearing levels. © 2014 S. Karger AG, Basel.

  17. Balance in Virtual reality: effect of age and Bilateral Vestibular loss

    OpenAIRE

    Chiarovano, Elodie,; Wang, Wei; Rogers, Stephen J.; MacDougall, Hamish G; Curthoys, Ian S.; de Waele, Catherine

    2017-01-01

    International audience; Background: Quantitative balance measurement is used in clinical practice to prevent falls. The conditions of the test were limited to eyes open, eyes closed, and sway-referenced vision. We developed a new visual perturbation to challenge balance using virtual reality (VR), measuring postural stability by a Wii Balance Board (WBB).Methods: In this study, we recorded balance performance of 116 healthy subjects and of 10 bilateral vestibular loss patients using VR to ass...

  18. Anxiety changes depersonalization and derealization symptoms in vestibular patients.

    Science.gov (United States)

    Kolev, Ognyan I; Georgieva-Zhostova, Spaska O; Berthoz, Alain

    2014-01-01

    Depersonalization and derealization are common symptoms reported in the general population. Objective. The aim of the present study was to establish the relationship between anxiety and depersonalization and derealization symptoms in patients with peripheral vestibular disorders. Twenty-four vestibular patients with anxiety and 18 vestibular patients without anxiety were examined for depersonalization and derealization symptoms. They were also compared to healthy controls. The results revealed that anxiety consistently changes depersonalization and derealization symptoms in vestibular patients. They are more frequent, more severe, and qualitatively different in vestibular patients with anxiety than in those without anxiety. Anxiety has an effect on depersonalization and derealization symptoms in vestibular patients. The various hypotheses about the underlying mechanism of this effect were discussed.

  19. Anxiety Changes Depersonalization and Derealization Symptoms in Vestibular Patients

    OpenAIRE

    Kolev, Ognyan I.; Georgieva-Zhostova, Spaska O.; Alain Berthoz

    2014-01-01

    Background. Depersonalization and derealization are common symptoms reported in the general population. Objective. The aim of the present study was to establish the relationship between anxiety and depersonalization and derealization symptoms in patients with peripheral vestibular disorders. Methods. Twenty-four vestibular patients with anxiety and 18 vestibular patients without anxiety were examined for depersonalization and derealization symptoms. They were also compared to healthy controls...

  20. Balance in Virtual Reality: Effect of Age and Bilateral Vestibular Loss.

    Science.gov (United States)

    Chiarovano, Elodie; Wang, Wei; Rogers, Stephen J; MacDougall, Hamish G; Curthoys, Ian S; de Waele, Catherine

    2017-01-01

    Quantitative balance measurement is used in clinical practice to prevent falls. The conditions of the test were limited to eyes open, eyes closed, and sway-referenced vision. We developed a new visual perturbation to challenge balance using virtual reality (VR), measuring postural stability by a Wii Balance Board (WBB). In this study, we recorded balance performance of 116 healthy subjects and of 10 bilateral vestibular loss patients using VR to assess the effect of age and the effect of total loss of vestibular function. We used several conditions: eyes open (normal visual inputs), eyes closed (no visual inputs), stable visual world (vision referenced), and perturbed visual world (visual perturbation) at different amplitudes of perturbation. Balance under these visual conditions was assessed on the WBB (stable support surface) and on the WBB plus foam rubber (unstable support surface). In healthy subjects, we found that the percentage of falls increased with age and with the amplitude of perturbation for both conditions: WBB or WBB + foam. Moreover, we can define a threshold for falls in each age group as the amplitude of perturbation which induced falls. For bilateral vestibular loss patients, on the WBB + foam, all of them failed with eyes closed and with perturbed visual world even at the minimal amplitude of perturbation. Finally, we observed that stable visual world induced fewer falls than eyes closed whatever the subject's group (healthy or bilateral vestibular loss) and whatever the age decade. VR allowed us to develop a useful new tool with a wide range of visual perturbations. Rather than only two levels of visual condition (eyes open and eyes closed), the VR stimulus can be continuously adjusted to produce a visual perturbation powerful enough to induce falls even in young healthy subjects and which has allowed us to determine a threshold for falls.

  1. Static Balance in Patients with Vestibular Impairments: A Preliminary Study

    OpenAIRE

    Hossein Talebi; Mohammad Taghi Karimi; Seyed Hamid Reza Abtahi; Niloofar Fereshtenejad

    2016-01-01

    Aims. Vestibular system is indicated as one of the most important sensors responsible for static and dynamic postural control. In this study, we evaluated static balance in patients with unilateral vestibular impairments. Materials and Methods. We compared static balance control using Kistler force plate platform between 10 patients with unilateral vestibular impairments and 20 normal counterparts in the same sex ratio and age limits (50 ? 7). We evaluated excursion and velocity of center of ...

  2. Peripheral Vestibular System Disease in Vestibular Schwannomas

    DEFF Research Database (Denmark)

    Møller, Martin Nue; Hansen, Søren; Caye-Thomasen, Per

    2015-01-01

    that this may be caused by both cochlear and retrocochlear mechanisms. Multiple mechanisms may also be at play in the case of dizziness, which may broaden perspectives of therapeutic approach. This study presents a systematic and detailed assessment of vestibular histopathology in temporal bones from patients...... with VS. METHODS: Retrospective analysis of vestibular system histopathology in temporal bones from 17 patients with unilateral VS. The material was obtained from The Copenhagen Temporal Bone Collection. RESULTS: Vestibular schwannomas were associated with atrophy of the vestibular ganglion, loss of fiber...... density of the peripheral vestibular nerve branches, and atrophy of the neuroepithelium of the vestibular end organs. In cases with small tumors, peripheral disease occurred only in the tissue structures innervated by the specific nerve from which the tumor originated. CONCLUSION: Vestibular schwannomas...

  3. [Does virus diagnosis open new ways for the classification and treatment of sudden deafness, unilateral vestibular loss and idiopathic facial paralysis?].

    Science.gov (United States)

    Leitner, C

    1986-09-01

    Paired sera from 51 patients with sudden deafness, 21 patients with acute vestibular loss and 28 patients with Bell's palsy were examined for antibodies against mumps-, echo-, herpes simplex- and coxsackie viruses. Only two serum samples showed a significant titer increase or decrease. So viral etiology of sudden deafness, acute vestibular loss and Bell's palsy seems to be unlikely and does not change the assignment and therapy of this disease.

  4. Effects of vestibular rehabilitation therapy on emotional aspects in chronic vestibular patients.

    Science.gov (United States)

    Meli, Annalisa; Zimatore, Giovanna; Badaracco, Carlo; De Angelis, Ezio; Tufarelli, Davide

    2007-08-01

    A strong relationship exists between vestibular dysfunction and anxiety disorders. The aim of this study was to assess the anxiety and depression levels in patients with chronic dizziness and to assess the effects of vestibular rehabilitation (VR) therapy, on the anxiety and depression levels, without a behavioural or pharmacological therapy. Two groups of 40 patients, each affected by chronic vestibular deficit, were studied. The first one underwent VR, and the latter did not. The psychometric tests used were the State-Trait Anxiety Inventory (STAI) and the Centre for Epidemiological Studies Depression Scale (CES-D). Psychological factors influence the level of handicap experienced by chronic dizziness patients, and disequilibrium influences the anxiety and depression levels. STAI and CES-D scales significantly decrease after VR therapy (PVR therapy positively influences the emotional condition of chronic vestibular deficit patients without pharmacological or psychotherapy treatments.

  5. Effectiveness of conventional versus virtual reality-based balance exercises in vestibular rehabilitation for unilateral peripheral vestibular loss: results of a randomized controlled trial.

    Science.gov (United States)

    Meldrum, Dara; Herdman, Susan; Vance, Roisin; Murray, Deirdre; Malone, Kareena; Duffy, Douglas; Glennon, Aine; McConn-Walsh, Rory

    2015-07-01

    To compare the effectiveness of virtual reality-based balance exercises to conventional balance exercises during vestibular rehabilitation in patients with unilateral peripheral vestibular loss (UVL). Assessor-blind, randomized controlled trial. Two acute care university teaching hospitals. Patients with UVL (N=71) who had dizziness/vertigo, and gait and balance impairment. Patients with UVL were randomly assigned to receive 6 weeks of either conventional (n=36) or virtual reality-based (n=35) balance exercises during vestibular rehabilitation. The virtual reality-based group received an off-the-shelf virtual reality gaming system for home exercise, and the conventional group received a foam balance mat. Treatment comprised weekly visits to a physiotherapist and a daily home exercise program. The primary outcome was self-preferred gait speed. Secondary outcomes included other gait parameters and tasks, Sensory Organization Test (SOT), dynamic visual acuity, Hospital Anxiety and Depression Scale, Vestibular Rehabilitation Benefits Questionnaire, and Activities Balance Confidence Questionnaire. The subjective experience of vestibular rehabilitation was measured with a questionnaire. Both groups improved, but there were no significant differences in gait speed between the groups postintervention (mean difference, -.03m/s; 95% confidence interval [CI], -.09 to .02m/s). There were also no significant differences between the groups in SOT scores (mean difference, .82%; 95% CI, -5.00% to 6.63%) or on any of the other secondary outcomes (P>.05). In both groups, adherence to exercise was high (∼77%), but the virtual reality-based group reported significantly more enjoyment (P=.001), less difficulty with (P=.009) and less tiredness after (P=.03) balance exercises. At 6 months, there were no significant between-group differences in physical outcomes. Virtual reality-based balance exercises performed during vestibular rehabilitation were not superior to conventional balance

  6. Vestibular evoked myogenic potential in noise-induced hearing loss

    Directory of Open Access Journals (Sweden)

    Kaushlendra Kumar

    2010-01-01

    Full Text Available Noise affects one′s hearing as well as balance mechanism. The hearing mechanism of the noise-exposed individuals has been extensively studied. However, in view of the poor research focus on the sacculo-collic reflexes, especially in this study area, the present study was undertaken to examine the vestibular evoked myogenic potentials (VEMP in subjects with noise-induced hearing loss (NIHL. A total of 30 subjects (55 ears with NIHL participated in the present study within the age range of 30-40 years. VEMP recordings were done at 99 dBnHL using IHS instrument. The results indicated that as the average pure tone hearing threshold increased, the VEMP latencies were prolonged and peak to peak amplitude was reduced in NIHL subjects. Out of the 55 ears, VEMP was absent in 16 (29.0% ears. The latency was prolonged and the peak to peak amplitude was reduced in 19 (34.6% ears. VEMP results were normal in 20 (36.4% ears. Therefore, VEMP was abnormal or absent in 67% of NIHL subjects in the present study. Hence it can be concluded that the possibility of vestibular dysfunction, specially the saccular pathway, is high in individuals with NIHL. VEMP, a non-invasive and user friendly procedure, can be employed in these individuals to assess sacculo-collic reflex.

  7. Vestibular Dysfunctions in Cochlear Implant Patients; A Vestibular Evoked Myogenic Potential Study

    Directory of Open Access Journals (Sweden)

    Masoud Motasaddi Zarandy

    2011-12-01

    Full Text Available Background and Aim: Vestibular evoked myogenic potential in response to click or short tone burst stimuli have been used as a clinical test for distinguish saccule and inferior vestibular nerve diseases. Different studies show that cochlear implant could have inverse effects on vestibular structures. We aimed to investigate vestibular evoked myogenic potential in unilateral cochlear implanted individuals in compare to normal individuals.Methods: Thirty-three unilateral cochlear implanted patients (mean age 19.96 years and 30 normal hearing individuals (mean age 24-27 years as control group were enrolled in this cross- sectional study. Absolute latencies and amplitudes of myogenic potential responses were measured and compared in both groups.Results: Myogenic potential recorded in both ears of all controls were normal. No response could be recorded in 16 patients (48.48% from both ears. In three patients, responses were recorded in both ears though the amplitude of waves was reduced in implanted ear. Unilateral response could be recorded in 14 patients only in their non-implanted ear.Conclusion: Vestibular evoked myogenic potential test is a useful tool for assessing saccular function in cochlear implant patients. Damages of osseous spiral lamina and basilar membrane after cochlear implantation could result in dysfunctions of vestibular organs specially saccule. It seems that saccule could be easily damaged after cochlear implantation. This would cause absence or reduced amplitudes in myogenic potential.

  8. Effectiveness of conventional versus virtual reality based vestibular rehabilitation in the treatment of dizziness, gait and balance impairment in adults with unilateral peripheral vestibular loss: a randomised controlled trial.

    OpenAIRE

    Dara Meldrum; Susan Herdman; Roisin Moloney; Deirdre Murray; Douglas Duffy; Kareena Malone; Helen French; Stephen Hone; Ronan Conroy; Rory McConn-Walsh

    2012-01-01

    Abstract Background Unilateral peripheral vestibular loss results in gait and balance impairment, dizziness and oscillopsia. Vestibular rehabilitation benefits patients but optimal treatment remains unkown. Virtual reality is an emerging tool in rehabilitation and provides opportunities to improve both outcomes and patient satisfaction with treatment. The Nintendo Wii Fit Plus® (NWFP) is a low cost virtual reality system that challenges balance and provides visual and auditory feedback. It ma...

  9. Vibration-induced nystagmus in patients with vestibular schwannoma: Characteristics and clinical implications.

    Science.gov (United States)

    Lee, Jeon Mi; Kim, Mi Joo; Kim, Jin Won; Shim, Dae Bo; Kim, Jinna; Kim, Sung Huhn

    2017-07-01

    To investigate the clinical significance of vibration-induced nystagmus (VIN) in unilateral vestibular asymmetry and vestibular schwannoma. Thirteen patients with vestibular schwannoma underwent the VIN test, in which stimulation was applied to the mastoid processes and sternocleidomastoid (SCM) muscles on the ipsilateral and contralateral sides of lesions. Preoperative VIN was measured, and changes in VIN were followed up for 6months after tumor removal. Significance of VIN was determined by evaluation of its sensitivity, correlation with vestibular function tests and tumor volume, and postoperative changes. The overall pre and postoperative sensitivities of VIN were 92.3% and 100%, respectively, considering stimulation at all four sites. Maximum slow-phase velocity (MSPV) of VIN was linearly correlated with caloric weakness and tumor volume, especially when stimulation was applied to the SCM muscle. Postoperative MSPV of VIN exhibited stronger linear correlation with postoperative changes in canal paresis value and inverse correlation with tumor size upon stimulation of the ipsilateral SCM muscle than upon stimulation of other sites. During the 6-month follow-up period, persistence of VIN without changes in MSPV was observed even after vestibular compensation. Evoking VIN by stimulation of the mastoid processes and SCM muscles is effective for detecting vestibular asymmetry. It could also help determine the degree of vestibular asymmetry and volume of vestibular schwannoma if stimulation is applied to the SCM muscle. The results of this study could provide clues for the basic application of VIN in patients with vestibular loss and vestibular schwannoma. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

  10. A new method to improve the imbalance in chronic unilateral vestibular loss: the organization of refixation saccades.

    Science.gov (United States)

    Matiñó-Soler, Eusebi; Rey-Martinez, Jorge; Trinidad-Ruiz, Gabriel; Batuecas-Caletrio, Angel; Pérez Fernández, Nicolás

    2016-09-01

    VOR adaptation and organization of refixation saccades in a gathered pattern is a process that can be artificially induced in patients with unilateral vestibular loss who have not developed it naturally, improving imbalance and vestibular disability. To test that temporary grouping of refixation saccades should be linked to better clinical status without gain recovery. A training to induce the refixation saccades into gathered fashion is performed. The outcome measures are handicap level measured by the dizziness handicap index (DHI) and refixation saccades organization pattern measured by a numeric score called 'PR' given by a software developed by the authors. Analysis is done before the training and 1 and 3 months after ending, Non-parametric tests were used for statistical analysis. This study has included 10 healthy subjects (four males, six females), and 16 patients with chronic unsteadiness due to unilateral vestibular loss (nine vestibular neuritis, four post-surgical vestibular schwannoma, and three cases after intra-tympanic gentamycin in patients with Ménière's disease). The reduction in the DHI score was significant at 1 (p = 0.028) and 3 months (p = 0.042) post-treatment. Also, statistically significant differences were found between the PR score before and PR score 1 (p = 0.005) and 3 months after the treatment (p = 0.003).

  11. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Emerging Therapies for the Treatment of Patients With Vestibular Schwannomas.

    Science.gov (United States)

    Van Gompel, Jamie J; Agazzi, Siviero; Carlson, Matthew L; Adewumi, Dare A; Hadjipanayis, Constantinos G; Uhm, Joon H; Olson, Jeffrey J

    2017-12-20

    Adults with histologically proven or suspected vestibular schwannomas with neurofibromatosis type 2 (NF2). What is the role of bevacizumab in the treatment of patients with vestibular schwannomas? Level 3: It is recommended that bevacizumab be administered in order to radiographically reduce the size or prolong tumor stability in patients with NF2 without surgical options. Level 3: It is recommended that bevacizumab be administered to improve hearing or prolong time to hearing loss in patients with NF2 without surgical options. Is there a role for lapatinib, erlotinib, or everolimus in the treatment of patients with vestibular schwannomas? Level 3: Lapatinib may be considered for use in reducing vestibular schwannoma size and improvement in hearing in NF2. Level 3: Erlotinib is not recommended for use in reducing vestibular schwannoma size or improvement in hearing in patients with NF2. Level 3: Everolimus is not recommended for use in reducing vestibular schwannoma size or improvement in hearing in NF2. What is the role of aspirin, to augment inflammatory response, in the treatment of patients with vestibular schwannomas? Any patient with a vestibular schwannoma undergoing observation. Level 3: It is recommended that aspirin administration may be considered for use in patients undergoing observation of their vestibular schwannomas. Is there a role for treatment of vasospasm, ie, nimodipine or hydroxyethyl starch, perioperatively to improve facial nerve outcomes in patients with vestibular schwannomas? Adults with histologically proven or suspected vestibular schwannomas. Level 3: Perioperative treatment with nimodipine (or with the addition of hydroxyethyl starch) should be considered to improve postoperative facial nerve outcomes and may improve hearing outcomes. Is there a role for preoperative vestibular rehab or vestibular ablation with gentamicin for patients surgically treated for vestibular schwannomas? Adults with histologically proven or suspected

  12. Vestibular loss and balance training cause similar changes in human cerebral white matter fractional anisotropy.

    Directory of Open Access Journals (Sweden)

    Nadine Hummel

    Full Text Available Patients with bilateral vestibular loss suffer from severe balance deficits during normal everyday movements. Ballet dancers, figure skaters, or slackliners, in contrast, are extraordinarily well trained in maintaining balance for the extreme balance situations that they are exposed to. Both training and disease can lead to changes in the diffusion properties of white matter that are related to skill level or disease progression respectively. In this study, we used diffusion tensor imaging (DTI to compare white matter diffusivity between these two study groups and their age- and sex-matched controls. We found that vestibular patients and balance-trained subjects show a reduction of fractional anisotropy in similar white matter tracts, due to a relative increase in radial diffusivity (perpendicular to the main diffusion direction. Reduced fractional anisotropy was not only found in sensory and motor areas, but in a widespread network including long-range connections, limbic and association pathways. The reduced fractional anisotropy did not correlate with any cognitive, disease-related or skill-related factors. The similarity in FA between the two study groups, together with the absence of a relationship between skill or disease factors and white matter changes, suggests a common mechanism for these white matter differences. We propose that both study groups must exert increased effort to meet their respective usual balance requirements. Since balance training has been shown to effectively reduce the symptoms of vestibular failure, the changes in white matter shown here may represent a neuronal mechanism for rehabilitation.

  13. Vestibular loss and balance training cause similar changes in human cerebral white matter fractional anisotropy.

    Science.gov (United States)

    Hummel, Nadine; Hüfner, Katharina; Stephan, Thomas; Linn, Jennifer; Kremmyda, Olympia; Brandt, Thomas; Flanagin, Virginia L

    2014-01-01

    Patients with bilateral vestibular loss suffer from severe balance deficits during normal everyday movements. Ballet dancers, figure skaters, or slackliners, in contrast, are extraordinarily well trained in maintaining balance for the extreme balance situations that they are exposed to. Both training and disease can lead to changes in the diffusion properties of white matter that are related to skill level or disease progression respectively. In this study, we used diffusion tensor imaging (DTI) to compare white matter diffusivity between these two study groups and their age- and sex-matched controls. We found that vestibular patients and balance-trained subjects show a reduction of fractional anisotropy in similar white matter tracts, due to a relative increase in radial diffusivity (perpendicular to the main diffusion direction). Reduced fractional anisotropy was not only found in sensory and motor areas, but in a widespread network including long-range connections, limbic and association pathways. The reduced fractional anisotropy did not correlate with any cognitive, disease-related or skill-related factors. The similarity in FA between the two study groups, together with the absence of a relationship between skill or disease factors and white matter changes, suggests a common mechanism for these white matter differences. We propose that both study groups must exert increased effort to meet their respective usual balance requirements. Since balance training has been shown to effectively reduce the symptoms of vestibular failure, the changes in white matter shown here may represent a neuronal mechanism for rehabilitation.

  14. Vestibular loss promotes procedural response during a spatial task in rats.

    Science.gov (United States)

    Machado, Marie-Laure; Lelong-Boulouard, Véronique; Philoxene, Bruno; Davis, Audrey; Denise, Pierre; Besnard, Stéphane

    2014-05-01

    Declarative memory refers to a spatial strategy using numerous sources of sensory input information in which visual and vestibular inputs are assimilated in the hippocampus. In contrast, procedural memory refers to a response strategy based on motor skills and familiar gestures and involves the striatum. Even if vestibular loss impairs hippocampal activity and spatial memory, vestibular-lesioned rats remain able to find food rewards during complex spatial memory task. Since hippocampal lesions induce a switch from declarative memory to procedural memory, we hypothesize that vestibular-lesioned rats use a strategy other than that of hippocampal spatial response to complete the task and to counterbalance the loss of vestibular information. We test, in a reverse T-maze paradigm, the types of strategy vestibular-lesioned rats preferentially uses in a spatial task. We clearly demonstrate that all vestibular-lesioned rats shift to a response strategy to solve the spatial task, while control rats use spatial and response strategies equally. We conclude that the loss of vestibular informations leading to spatial learning impairments is not offset at the hippocampus level by integration process of other sense mainly visual informations; but favors a response strategy through procedural memory most likely involving the striatum, cerebellum, and motor learning. Copyright © 2014 Wiley Periodicals, Inc.

  15. Interaction between Vestibular Compensation Mechanisms and Vestibular Rehabilitation Therapy: 10 Recommendations for Optimal Functional Recovery

    OpenAIRE

    Lacour, Michel; Bernard-Demanze, Laurence

    2015-01-01

    This review questions the relationships between the plastic events responsible for the recovery of vestibular function after a unilateral vestibular loss (vestibular compensation), which has been well described in animal models in the last decades, and the vestibular rehabilitation (VR) therapy elaborated on a more empirical basis for vestibular loss patients. The main objective is not to propose a catalog of results but to provide clinicians with an understandable view on when and how to per...

  16. Interaction between vestibular compensation mechanisms and vestibular rehabilitation therapy: ten recommendations for optimal functional recovery

    OpenAIRE

    LACOUR eMichel; BERNARD DEMANZE eLaurence

    2015-01-01

    This review questions the relationships between the plastic events responsible for the recovery of vestibular function after a unilateral vestibular loss (vestibular compensation), which has been well described in animal models in the last decades, and the vestibular rehabilitation (VR) therapy elaborated on a more empirical basis for vestibular loss patients. The main objective is not to propose a catalogue of results but to provide clinicians with an understandable view on when and how to p...

  17. The dizzy patient: don't forget disorders of the central vestibular system.

    Science.gov (United States)

    Brandt, Thomas; Dieterich, Marianne

    2017-06-01

    Vertigo and dizziness are among the most common complaints in neurology clinics, and they account for about 13% of the patients entering emergency units. In this Review, we focus on central vestibular disorders, which are mostly attributable to acute unilateral lesions of the bilateral vestibular circuitry in the brain. In a tertiary interdisciplinary outpatient dizziness unit, central vestibular disorders, including vestibular migraine, comprise about 25% of the established diagnoses. The signs and symptoms of these disorders can mimic those of peripheral vestibular disorders with sustained rotational vertigo. Bedside examinations, such as the head impulse test and ocular motor testing to determine spontaneous and gaze-evoked nystagmus or skew deviation, reliably differentiate central from peripheral syndromes. We also consider disorders of 'higher vestibular functions', which involve more than one sensory modality as well as cognitive domains (for example, orientation, spatial memory and navigation). These disorders include hemispatial neglect, the room tilt illusion, pusher syndrome, and impairment of spatial memory and navigation associated with hippocampal atrophy in cases of peripheral bilateral vestibular loss.

  18. Personality changes in patients with vestibular dysfunction

    OpenAIRE

    Paul eSmith; Cynthia eDarlington

    2013-01-01

    The vestibular system is a sensory system that has evolved to detect linear and angular acceleration of the head in all planes so that the brain is not predominantly reliant on visual information to determine self-motion. Since the vestibular system first evolved in invertebrate species in order to detect gravitational vertical, it is likely that the central nervous system has developed a special dependence upon vestibular input. In addition to the deficits in eye movement and postural reflex...

  19. The effects of bilateral vestibular loss on hippocampal volume, neuronal number and cell proliferation in rats

    Directory of Open Access Journals (Sweden)

    Yiwen eZheng

    2012-02-01

    Full Text Available Previous studies in humans have shown that bilateral loss of vestibular function is associated with a significant bilateral atrophy of the hippocampus, which correlated with the patients’ spatial memory deficits. More recently, patients who had recovered from unilateral vestibular neuritis have been reported to exhibit a significant atrophy of the left posterior hippocampus. Therefore, we investigated whether bilateral vestibular deafferentation (BVD would result in a decrease in neuronal number or volume in the rat hippocampus, using stereological methods. At 16 months post-BVD, we found no significant differences in hippocampal neuronal number or volume compared to sham controls, despite the fact that these animals exhibited severe spatial memory deficits. By contrast, using bromodeoxyuridine (BrdU as a marker of cell proliferation, we found that the number of BrdU-labelled cells significantly increased in the dentate gyrus of the hippocampus between 48 h and 1 week following BVD. Although a substantial proportion of these cells survived for up to 1 month, the survival rate was significantly lower in BVD animals when compared with that in sham animals. These results suggest a dissociation between the effects of BVD on spatial memory and hippocampal structure in rats and humans, which cannot be explained by an injury-induced increase in cell proliferation.

  20. Treating vertigo with vestibular rehabilitation: results in 155 patients.

    Science.gov (United States)

    Bittar, R S M; Pedalini, M E B; Lorenzi, M C; Formigoni, L G

    2002-01-01

    Balance is fundamental to our daily activities and the vestibular system, together with vision and proprioceptive functions, are the main structures involved in this process. Dizziness is the main clinical manifestation of malfunction of these systems. The mechanisms of vestibular compensation are one of the most studied aspects since they play an important role in the patient's everyday activities. In this retrospective description of a series of cases the authors present their results in 155 patients that underwent a program of vestibular rehabilitation (VR). The program, first described by Cawthorne and Coosey, is based on mechanisms of potentiation of the cervico-ocular reflex and substitution of the lost vestibular cues for visual and somatosensory cues. The results were satisfactory (remission or partial cure) in 75.5% of the patients, with an average treatment time of up to 2 months and 5 or fewer sessions performed in most of the cases. The results were somewhat inferior in those cases in which a central vestibular lesion or more than one etiologic factor was present. The results of a subgroup of elderly patients (age > 65 years) were similar to those of the total number of studied subjects. Vestibular rehabilitation, associated to the specific etiological treatment, appears to be a very useful tool in the management of patients suffering from dizziness of all ages, although different clinical responses to the therapy may vary according to the presence of a central or a peripheral vestibular lesion or multiple etiological factors.

  1. Hyperventilation-induced nystagmus in patients with vestibular schwannoma.

    Science.gov (United States)

    Califano, Luigi; Iorio, Giuseppina; Salafia, Francesca; Mazzone, Salvatore; Califano, Maria

    2015-02-01

    To determine the utility of the hyperventilation test (HVT) in the diagnosis of vestibular schwannoma (VS). A retrospective analysis of hyperventilation-induced nystagmus (HVIN) in 45 patients with unilateral VS. A tertiary referral center. Forty-five patients with VS; 30 patients with chronic vestibular neuritis; 20 healthy subjects with normal hearing and without symptoms or a history of vertigo, migraine, or neurological diseases (control group). Audiological and vestibular examination; "side-stream" measurement of end-tidal CO2 pressure (P(EtCO2)) to standardize the procedure; magnetic resonance imaging (MRI) centered on the cerebellopontine angle. An analysis of HVIN, its patterns, and its appearance threshold via the measurement of P(EtCO2) correlations with the tumor size. HVIN was observed in 40 of 45 cases (88.9%) in the schwannoma group and in 12 of 30 cases (40%) in the chronic vestibular neuritis group; HVIN was not observed in the control group (0/20 cases) (p hyperventilation event causes metabolic changes in the vestibular system and reveals a latent vestibular asymmetry. The presence of an excitatory pattern is the major criterion that suggests VS in patients with signs of unilateral vestibular deficit.

  2. Off-center yaw rotation: effect of naso-occipital linear acceleration on the nystagmus response of normal human subjects and patients after unilateral vestibular loss.

    Science.gov (United States)

    Curthoys, I S; Haslwanter, T; Black, R A; Burgess, A M; Halmagyi, G M; Topple, A N; Todd, M J

    1998-12-01

    ) of around 12 degrees]. The linear acceleration decreased the time constant of decay of the horizontal component of the post-rotatory nystagmus: from an average of 24.8 degrees/s facing-in to an average of 11.3 degrees/s facing-out. The linear acceleration dumps torsional eye velocity in an manner analogous to, but independent of, the dumping of horizontal eye velocity. Patients with UVD had dramatically reduced torsional eye velocities for both facing-in and facing-out headings, and there was little if any shift of the AEV in UVD patients. The relatively small effects of linear acceleration on human canal-induced nystagmus found here confirms other recent studies in humans (Fetter et al. 1996) in contrast to evidence from monkeys and emphasizes the large and important differences between humans and monkeys in otolith-canal interaction. Our results confirm the vestibular control of the axis of eye velocity of humans is essentially head-referenced whereas in monkeys that control is essentially space-referenced.

  3. Saccadic entropy of head impulses in acute unilateral vestibular loss

    Directory of Open Access Journals (Sweden)

    Li-Chun Hsieh

    2017-10-01

    Conclusion: Entropy and gain analysis of HIT using wireless electro-oculography system could be used to detect the VOR dysfunctions of AUVL and may become effective methods for evaluating vestibular disorders.

  4. Vestibular rehabilitation: clinical benefits to patients with Parkinson's disease.

    Science.gov (United States)

    Zeigelboim, Bianca Simone; Klagenberg, Karlin Fabianne; Teive, Hélio A Ghizoni; Munhoz, Renato Puppi; Martins-Bassetto, Jackeline

    2009-06-01

    To evaluate the effectiveness of the vestibular rehabilitation (VR) exercises by means of an assessment before and after the application of the Brazilian version of the Dizziness Handicap Inventory (DHI) questionnaire. Twelve patients were studied, the following procedures were carried out: anamnesis, otorhinolaryngological and vestibular evaluation, and the application of the DHI before and after the VR. Clinically resting tremors and subjective postural instability were the motor complaints most frequently associated with complaints of vertigo in 12 cases (100%); in the vestibular exam, all the patients presented abnormalities, frequently from the uni and bilateral peripheral vestibular deficiency syndromes in 10 cases (83.3%); there was significant improvement in the physical, functional and emotional aspects of the DHI after the completion of the VR. The VR following the Cawthorne and Cooksey protocol were shown to be useful in managing subjective complaints of several aspects evaluated in this protocol.

  5. Vestibular rehabilitation: clinical benefits to patients with Parkinson's disease

    OpenAIRE

    Zeigelboim, Bianca Simone [UNIFESP; Klagenberg, Karlin Fabianne; TEIVE, HÉLIO A. GHIZONI; Munhoz,Renato Puppi; Martins-Bassetto,Jackeline

    2009-01-01

    OBJECTIVE: To evaluate the effectiveness of the vestibular rehabilitation (VR) exercises by means of an assessment before and after the application of the Brazilian version of the Dizziness Handicap Inventory (DHI) questionnaire. METHOD: Twelve patients were studied, the following procedures were carried out: anamnesis, otorhinolaryngological and vestibular evaluation, and the application of the DHI before and after the VR. RESULTS: Clinically resting tremors and subjective postural instabili...

  6. Effectiveness of conventional versus virtual reality based vestibular rehabilitation in the treatment of dizziness, gait and balance impairment in adults with unilateral peripheral vestibular loss: a randomised controlled trial.

    Science.gov (United States)

    Meldrum, Dara; Herdman, Susan; Moloney, Roisin; Murray, Deirdre; Duffy, Douglas; Malone, Kareena; French, Helen; Hone, Stephen; Conroy, Ronan; McConn-Walsh, Rory

    2012-03-26

    Unilateral peripheral vestibular loss results in gait and balance impairment, dizziness and oscillopsia. Vestibular rehabilitation benefits patients but optimal treatment remains unknown. Virtual reality is an emerging tool in rehabilitation and provides opportunities to improve both outcomes and patient satisfaction with treatment. The Nintendo Wii Fit Plus® (NWFP) is a low cost virtual reality system that challenges balance and provides visual and auditory feedback. It may augment the motor learning that is required to improve balance and gait, but no trials to date have investigated efficacy. In a single (assessor) blind, two centre randomised controlled superiority trial, 80 patients with unilateral peripheral vestibular loss will be randomised to either conventional or virtual reality based (NWFP) vestibular rehabilitation for 6 weeks. The primary outcome measure is gait speed (measured with three dimensional gait analysis). Secondary outcomes include computerised posturography, dynamic visual acuity, and validated questionnaires on dizziness, confidence and anxiety/depression. Outcome will be assessed post treatment (8 weeks) and at 6 months. Advances in the gaming industry have allowed mass production of highly sophisticated low cost virtual reality systems that incorporate technology previously not accessible to most therapists and patients. Importantly, they are not confined to rehabilitation departments, can be used at home and provide an accurate record of adherence to exercise. The benefits of providing augmented feedback, increasing intensity of exercise and accurately measuring adherence may improve conventional vestibular rehabilitation but efficacy must first be demonstrated. Clinical trials.gov identifier: NCT01442623.

  7. Cognitive deficits in patients with a chronic vestibular failure.

    Science.gov (United States)

    Popp, Pauline; Wulff, Melanie; Finke, Kathrin; Rühl, Maxine; Brandt, Thomas; Dieterich, Marianne

    2017-03-01

    Behavioral studies in rodents and humans have demonstrated deficits of spatial memory and orientation in bilateral vestibular failure (BVF). Our aim was to explore the functional consequences of chronic vestibular failure on different cognitive domains including spatial as well as non-spatial cognitive abilities. Sixteen patients with a unilateral vestibular failure (UVF), 18 patients with a BVF, and 17 healthy controls (HC) participated in the study. To assess the cognitive domains of short-term memory, executive function, processing speed and visuospatial abilities the following tests were used: Theory of Visual Attention (TVA), TAP Alertness and Visual Scanning, the Stroop Color-Word, and the Corsi Block Tapping Test. The cognitive scores were correlated with the degree of vestibular dysfunction and the duration of the disease, respectively. Groups did not differ significantly in age, sex, or handedness. BVF patients were significantly impaired in all of the examined cognitive domains but not in all tests of the particular domain, whereas UVF patients exhibited significant impairments in their visuospatial abilities and in one of the two processing speed tasks when compared independently with HC. The degree of vestibular dysfunction significantly correlated with some of the cognitive scores. Neither the side of the lesion nor the duration of disease influenced cognitive performance. The results demonstrate that vestibular failure can lead to cognitive impairments beyond the spatial navigation deficits described earlier. These cognitive impairments are more significant in BVF patients, suggesting that the input from one labyrinth which is distributed into bilateral vestibular circuits is sufficient to maintain most of the cognitive functions. These results raise the question whether BVF patients may profit from specific cognitive training in addition to physiotherapy.

  8. Impaired math achievement in patients with acute vestibular neuritis.

    Science.gov (United States)

    Moser, Ivan; Vibert, Dominique; Caversaccio, Marco D; Mast, Fred W

    2017-12-01

    Broad cognitive difficulties have been reported in patients with peripheral vestibular deficit, especially in the domain of spatial cognition. Processing and manipulating numbers relies on the ability to use the inherent spatial features of numbers. It is thus conceivable that patients with acute peripheral vestibular deficit show impaired numerical cognition. Using the number Stroop task and a short math achievement test, we tested 20 patients with acute vestibular neuritis and 20 healthy, age-matched controls. On the one hand, patients showed normal congruency and distance effects in the number Stroop task, which is indicative of normal number magnitude processing. On the other hand, patients scored lower than healthy controls in the math achievement test. We provide evidence that the lower performance cannot be explained by either differences in prior math knowledge (i.e., education) or slower processing speed. Our results suggest that peripheral vestibular deficit negatively affects numerical cognition in terms of the efficient manipulation of numbers. We discuss the role of executive functions in math performance and argue that previously reported executive deficits in patients with peripheral vestibular deficit provide a plausible explanation for the lower math achievement scores. In light of the handicapping effects of impaired numerical cognition in daily living, it is crucial to further investigate the mechanisms that cause mathematical deficits in acute PVD and eventually develop adequate means for cognitive interventions. Copyright © 2017 Elsevier Ltd. All rights reserved.

  9. Coordination of eye and head movements during smooth pursuit in patients with vestibular failure.

    Science.gov (United States)

    Waterston, J A; Barnes, G R; Grealy, M A; Luxon, L M

    1992-12-01

    During pursuit of smoothly moving targets with combined eye and head movements in normal subjects, accurate gaze control depends on successful interaction of the vestibular and head movement signals with the ocular pursuit mechanisms. To investigate compensation for loss of the vestibulo-ocular reflex during head-free pursuit in labyrinthine-deficient patients, pursuit performance was assessed and compared under head-fixed and head-free conditions in five patients with isolated bilateral loss of vestibular function. Target motion consisted of predictable and unpredictable pseudo-random waveforms containing the sum of three or four sinusoids. Comparison of slow-phase gaze velocity gains under head-free and head-fixed conditions revealed no significant differences during pursuit of any of the three pseudo-random waveforms. The finding of significant compensatory eye movement during active head movements in darkness in labyrinthine-deficient patients, which were comparable in character and gain to the vestibular eye movement elicited in normal subjects, probably explains the similarity of the head-fixed and head-free responses. In two additional patients with cerebellar degeneration and vestibular failure, no compensatory eye movement response was observed, implying that the cerebellum is necessary for the generation of such responses in labyrinthine-deficient patients.

  10. Vestibular evoked myogenic potentials in patients with ankylosing spondylitis.

    Science.gov (United States)

    Özgür, Abdulkadir; Serdaroğlu Beyazal, Münevver; Terzi, Suat; Coşkun, Zerrin Özergin; Dursun, Engin

    2016-10-01

    Ankylosing spondylitis (AS) is a chronic systemic inflammatory disease with unknown etiology. Although sacroiliac joint involvement is the classic sign along with the formed immune mediators, it may result in immune-mediated inner ear disease and may cause damage to the audiovestibular system. Vestibular evoked myogenic potentials (VEMP) is a clinical reflex test used in the diagnosis of vestibular diseases and is performed by recording and evaluating the muscle potentials resulting from the stimulation of the vestibular system with different stimuli. The aim of this study is to evaluate the cervical VEMP test results in AS patients without vestibular symptoms. Thirty-three patients with AS and a control group of 30 healthy volunteers with similar demographic characteristics were evaluated in the study. VEMP wave latency, P13-N23 wave amplitude, and VEMP asymmetry ratio (VAR) values were compared between the groups. The relationship between clinical and laboratory findings of the AS patients and VEMP data were also investigated. Compared with healthy people, this study shows the response rate of patients with ankylosing spondylitis was reduced in the VEMP test, and P13-N23 wave amplitude showed a decrease in AS patients who had VEMP response (p ankylosing spondylitis. The data obtained from this study suggest that AS may lead to decreased sensitivity of the vestibular system.

  11. High Resolution Three-Dimensional Delayed Contrast MRI Detects Endolymphatic Hydrops in Patients With Vertigo and Vestibular Schwannoma.

    Science.gov (United States)

    Moayer, Roxana; Ishiyama, Gail P; Karnezis, Stellios; Sepahdari, Ali R; Ishiyama, Akira

    2018-01-01

    Advances in high resolution magnetic resonance imaging (MRI) have enabled the detection of endolymphatic hydrops (EH), a pathological ballooning of the endolymphatic fluid system, known to be associated with Menière's disease. When a patient has a known diagnosis of vestibular schwannoma and develops recurrent episodic vertigo spells, many surgeons recommend surgical intervention, attributing the vestibular symptoms to the vestibular schwannoma. The aim of this study is to evaluate the clinical outcome in patients with vestibular schwannoma and EH, treated medically, for recurrent spells of vertigo. Two patients with EH and vestibular schwannoma who presented with recurrent spells of vertigo are included. Both had characteristic low frequency hearing loss ipsilateral to the schwannoma. MRI sequences with 3T scanner (Skyra, Siemens Healthcare, Erlangen, Germany) using high resolution three-dimensional delayed postcontrast protocol included "cisternographic" T2 and delayed intravenous-enhanced three-dimensional fluid-attenuation inversion recovery (DIVE-3D-FLAIR) sequences, performed with 2350 ms (bright perilymph) and 2050 ms (bright endolymph) inversion times and with subtracted images. MRI FLAIR evaluation of EH and presence or absence of vestibular symptoms. Both patients had resolution of the disabling vertigo spells with a diuretic, and Patient 1 had unchanged EH, while Patient 2 had partial resolution of the EH and the FLAIR hyperintensity. When EH coexists with vestibular schwannoma in a patient presenting with recurrent vertigo spells, medical treatments for EH may alleviate the vestibular symptoms. We recommend that patients with small vestibular schwannomas who present with vertigo spells undergo high resolution MRI to evaluate for EH and undergo a trial of medical treatment with diuretics.

  12. [Vestibular rehabilitation in patients with relapsing-remitting multiple sclerosis].

    Science.gov (United States)

    Pavan, Karina; Marangoni, Bruna E M; Schmidt, Kizi B; Cobe, Fernanda A; Matuti, Gabriela S; Nishino, Lúcia K; Thomaz, Rodrigo B; Mendes, Maria Fernanda; Lianza, Sérgio; Tilbery, Charles Peter

    2007-06-01

    Multiple sclerosis (MS) is a demyelinating, inflammatory illness, that attack the white matter of the central nervous system, and abnormal vestibular sensations (vertigo, disequilibrium) are frequent. The vestibular rehabilitation (VR) is determined by mechanisms of adaptations, neural substitutions and compensations. This study evaluated the improvement of the central or peripheral vertigo in patients with relapsing-remitting MS submitted to the VR (exercises of Cawthorne-Cooksey), through the scale of Berg and Dizziness Handicap Inventory (DHI). In this sample of 4 cases the VR, carried through in a period of 2 months, demonstrated the improvement in 3 patients according to the Berg scale and in 2 patients considering that of the DHI.

  13. Vertigo in Vestibular Schwannoma Patients Due to Other Pathologies.

    Science.gov (United States)

    Sahyouni, Ronald; Moshtaghi, Omid; Haidar, Yarah M; Mahboubi, Hossein; Moshtaghi, Afsheen; Lin, Harrison W; Djalilian, Hamid R

    2017-12-01

    To report findings from a cohort of vestibular schwannoma (VS) patients presenting with vertigo from a secondary comorbid vestibular disorder; and to discuss management strategies for this subset of patients presenting with both episodic vertigo and VS. All VS patients who presented with vertigo as the primary symptom from 2012 to 2015 and endorsing no other major complaints were examined. Treatment with migraine lifestyle and prophylactic therapy, or Epley maneuver. Resolution of vertigo following medical treatment alone. Of the nine patients studied, seven (78%) suffered from vestibular migraine, and two (22%) experienced benign positional vertigo. All patients experienced complete resolution of symptoms after treatment. As a result of symptomatic improvement, seven patients (78%) avoided surgery in favor of observation, while two patients (22%) underwent radiosurgery due to continued tumor growth and other nonvertigo symptoms. VS patients can sometimes present with a history of recurrent episodic vertigo. The etiology of the vertigo could be due to the tumor itself or may be due to an underlying comorbidity such as vestibular migraine or benign positional vertigo. VS patients presenting with vertigo should undergo a standard vertigo history and examination to identify other potential causes of vertigo. Most VS patients in our cohort avoided intervention and had resolution of their vertigo.

  14. Vestibular Rehabilitation in a Patient with Whiplash-associated Disorders

    Directory of Open Access Journals (Sweden)

    Kwo-Shieng Tuo

    2006-12-01

    Full Text Available Whiplash-associated disorders are characterized by multiple physical complaints after a flexion-extension trauma to the neck. They are difficult to treat, and they often result in great impact on the patient's quality of life. In this paper, the comprehensive treatment of a patient with whiplash-associated disorders is presented. The purpose is to highlight the importance of accurate diagnosis and appropriate treatment plans to improve patients' quality of life. This 23-year-old woman experienced a traffic accident which caused severely painful neck disability, numbness over bilateral upper limbs, dizziness, double vision and loss of balance. Among these symptoms, dizziness was the problem that bothered the patient most. She received a comprehensive rehabilitation program including physical modalities, trigger point injections for relief of pain, as well as a vestibular rehabilitation program, which included exercises challenging and improving her balance function, head-eye coordination exercise, visual-ocular control exercise and sensory substitution-promoting exercises. She resumed her previous full-time work after 3 weeks of treatment. This successfully treated case illustrates the importance of correct diagnosis and appropriate treatment for patients who suffer from whiplash-associated disorders.

  15. Migraine patients consistently show abnormal vestibular bedside tests

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    Eliana Teixeira Maranhão

    2015-01-01

    Full Text Available Migraine and vertigo are common disorders, with lifetime prevalences of 16% and 7% respectively, and co-morbidity around 3.2%. Vestibular syndromes and dizziness occur more frequently in migraine patients. We investigated bedside clinical signs indicative of vestibular dysfunction in migraineurs.Objective To test the hypothesis that vestibulo-ocular reflex, vestibulo-spinal reflex and fall risk (FR responses as measured by 14 bedside tests are abnormal in migraineurs without vertigo, as compared with controls.Method Cross-sectional study including sixty individuals – thirty migraineurs, 25 women, 19-60 y-o; and 30 gender/age healthy paired controls.Results Migraineurs showed a tendency to perform worse in almost all tests, albeit only the Romberg tandem test was statistically different from controls. A combination of four abnormal tests better discriminated the two groups (93.3% specificity.Conclusion Migraine patients consistently showed abnormal vestibular bedside tests when compared with controls.

  16. Outcomes after vestibular rehabilitation and Wii® therapy in patients with chronic unilateral vestibular hypofunction.

    Science.gov (United States)

    Verdecchia, Daniel H; Mendoza, Marcela; Sanguineti, Florencia; Binetti, Ana C

    2014-01-01

    Vestibular rehabilitation therapy is an exercise-based programme designed to promote central nervous system compensation for inner ear deficit. The objective of the present study was to analyse the differences in the perception of handicap, the risk of falls, and gaze stability in patients diagnosed with chronic unilateral vestibular hypofunction before and after vestibular rehabilitation treatment with complementary Wii® therapy. A review was performed on the clinical histories of patients in the vestibular rehabilitation area of a university hospital between April 2009 and May 2011. The variables studied were the Dizziness Handicap Inventory, the Dynamic Gait Index and dynamic visual acuity. All subjects received complementary Wii® therapy. There were 69 cases (41 woman and 28 men), with a median age of 64 years. The initial median Dizziness Handicap Inventory score was 40 points (range 0-84, percentile 25-75=20-59) and the final, 24 points (range 0-76, percentile 25-75=10.40), P<.0001. The initial median for the Dynamic Gait Index score was 21 points (range 8-24, percentile 25-75=17.5-2.3) and the final, 23 (range 12-24, percentile 25-75=21-23), P<.0001. The initial median for dynamic visual acuity was 2 (range 0-6, percentile 25-75=1-4) and the final, 1 (range 0-3, percentile 25-75=0-2), P<.0001. A reduction was observed in the Dizziness Handicap Inventory Values. Values for the Dynamic Gait Index increased and dynamic visual acuity improved. All these variations were statistically significant. Copyright © 2013 Elsevier España, S.L.U. y Sociedad Española de Otorrinolaringología y Patología Cérvico-Facial. All rights reserved.

  17. Hearing Loss After Vestibular Implantation in Sand Rats With Normal Hearing.

    Science.gov (United States)

    Mizrachi, Aviram; Hilly, Ohad; Raveh, Eyal; Attias, Joseph; Nageris, Ben I

    2015-09-01

    B; P conduction thresholds did not change significantly after vestibular electrode insertion. Implantation of a vestibular device is associated with mild to moderate conductive hearing loss in fat sand rats with normal hearing, especially when the device is placed in the posterior and superior semicircular canals. Bilateral implantation is associated with major vestibular pathologic results. Further studies are needed in animals with cochlear or vestibular disorders before it can be definitively concluded that vestibular implantation carries only a minor risk to hearing.

  18. Misdiagnosis of otosclerosis in a patient with enlarged vestibular aqueduct syndrome: a case report

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    Távora-Vieira Dayse

    2012-07-01

    Full Text Available Abstract Introduction In the present case we report on the mismanagement of a patient misdiagnosed with otosclerosis, who was subsequently found to have enlarged vestibular aqueduct syndrome bilaterally. This highlights the need to not only be vigilant in pre-operative assessment of otosclerosis but also in post-operative investigations of stapedectomy failures. Case presentation Our patient, a 56-year-old Caucasian Australian woman, lost the hearing in her right ear following a stapedectomy approximately 25 years ago. It is thought that preoperative imaging was not conducted, while an inadequate (unmasked audiogram was used to formulate the initial diagnosis of otosclerosis. The hearing in her left ear deteriorated to the point that a cochlear implant was now being considered for her right ear. Imaging performed as part of our pre-cochlear implant battery revealed bilateral enlarged vestibular aqueducts and thus the decision to proceed with a right cochlear implant was made following discussion with our patient and her family in regard to not only general surgical risks but specifically the remote risk that the surgical drilling required during the procedure could risk a deterioration of the hearing in her left ear because of the enlarged vestibular aqueduct on that side. Conclusions This report illustrates a case of misdiagnosis and mismanagement of bilateral enlarged vestibular aqueduct resulting in profound hearing loss. Fortunately our patient has been successfully implanted with a right cochlear implant with remarkable outcomes.

  19. Static Balance in Patients with Vestibular Impairments: A Preliminary Study

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    Hossein Talebi

    2016-01-01

    Full Text Available Aims. Vestibular system is indicated as one of the most important sensors responsible for static and dynamic postural control. In this study, we evaluated static balance in patients with unilateral vestibular impairments. Materials and Methods. We compared static balance control using Kistler force plate platform between 10 patients with unilateral vestibular impairments and 20 normal counterparts in the same sex ratio and age limits (50±7. We evaluated excursion and velocity of center of pressure (COP and path length in anteroposterior (AP and mediolateral (ML planes with eyes open and with eyes closed. Results. There was no significant difference between COP excursions in ML and AP planes between both groups with eyes open and eyes closed (p value > 0.05. In contrast, the difference between velocity and path length of COP in the mentioned planes was significant between both groups with eyes open and eyes closed (p value < 0.05. Conclusions. The present study showed the static instability and balance of patients with vestibular impairments indicated by the abnormal characteristics of body balance.

  20. Static Balance in Patients with Vestibular Impairments: A Preliminary Study.

    Science.gov (United States)

    Talebi, Hossein; Karimi, Mohammad Taghi; Abtahi, Seyed Hamid Reza; Fereshtenejad, Niloofar

    2016-01-01

    Aims. Vestibular system is indicated as one of the most important sensors responsible for static and dynamic postural control. In this study, we evaluated static balance in patients with unilateral vestibular impairments. Materials and Methods. We compared static balance control using Kistler force plate platform between 10 patients with unilateral vestibular impairments and 20 normal counterparts in the same sex ratio and age limits (50 ± 7). We evaluated excursion and velocity of center of pressure (COP) and path length in anteroposterior (AP) and mediolateral (ML) planes with eyes open and with eyes closed. Results. There was no significant difference between COP excursions in ML and AP planes between both groups with eyes open and eyes closed (p value > 0.05). In contrast, the difference between velocity and path length of COP in the mentioned planes was significant between both groups with eyes open and eyes closed (p value static instability and balance of patients with vestibular impairments indicated by the abnormal characteristics of body balance.

  1. Enlarged Vestibular Aqueduct Syndrome: Sudden Hearing Loss in a Child with a Cerebral Shunt.

    Science.gov (United States)

    Wendt, Wendi-Jo; Hashikawa, Andrew

    2017-07-04

    Enlarged vestibular aqueduct syndrome (EVAS) is the most common congenital ear anomaly that causes sensorineural hearing loss in children and may predispose a child to sudden hearing loss from sudden pressure changes or minor head trauma. We report a case of a 4-year-old boy with a history of a ventriculoperitoneal shunt and migraines who presented to the emergency department with parental and child care provider reports of acute hearing loss, without a history of trauma, infection, or hardware malfunction, who was diagnosed with bilateral EVAS. Diagnosis of EVAS occurs with specific temporal bone imaging with either high-resolution, thin-cut computed tomography or magnetic resonance imaging scans. Enlarged vestibular aqueduct syndrome is typically refractory to medical treatment and often results in hearing loss that is too severe to benefit from amplification, requiring cochlear implantation.

  2. SLC26A4 mutation testing for hearing loss associated with enlargement of the vestibular aqueduct.

    Science.gov (United States)

    Ito, Taku; Muskett, Julie; Chattaraj, Parna; Choi, Byung Yoon; Lee, Kyu Yup; Zalewski, Christopher K; King, Kelly A; Li, Xiangming; Wangemann, Philine; Shawker, Thomas; Brewer, Carmen C; Alper, Seth L; Griffith, Andrew J

    2013-05-28

    Pendred syndrome (PS) is characterized by autosomal recessive inheritance of goiter associated with a defect of iodide organification, hearing loss, enlargement of the vestibular aqueduct (EVA), and mutations of the SLC26A4 gene. However, not all EVA patients have PS or SLC26A4 mutations. Two mutant alleles of SLC26A4 are detected in ¼ of North American or European EVA populations, one mutant allele is detected in another ¼ of patient populations, and no mutations are detected in the other ½. The presence of two mutant alleles of SLC26A4 is associated with abnormal iodide organification, increased thyroid gland volume, increased severity of hearing loss, and bilateral EVA. The presence of a single mutant allele of SLC26A4 is associated with normal iodide organification, normal thyroid gland volume, less severe hearing loss and either bilateral or unilateral EVA. When other underlying correlations are accounted for, the presence of a cochlear malformation or the size of EVA does not have an effect on hearing thresholds. This is consistent with observations of an Slc26a4 mutant mouse model of EVA in which hearing loss is independent of endolymphatic hydrops or inner ear malformations. Segregation analyses of EVA in families suggest that the patients carrying one mutant allele of SLC26A4 have a second, undetected mutant allele of SLC26A4, and the probability of a sibling having EVA is consistent with its segregation as an autosomal recessive trait. Patients without any mutations are an etiologically heterogeneous group in which siblings have a lower probability of having EVA. SLC26A4 mutation testing can provide prognostic information to guide clinical surveillance and management, as well as the probability of EVA affecting a sibling.

  3. Vestibular rehabilitation in elderly patients with dizziness

    OpenAIRE

    Zanardini, Francisco Halilla; Zeigelboim, Bianca Simone [UNIFESP; Jurkiewicz, Ari Leon; Marques, Jair Mendes; Martins-Bassetto,Jackeline

    2007-01-01

    TEMA: o envelhecimento populacional é um processo natural, manifesta-se por um declínio das funções de diversos órgãos. A reabilitação vestibular (RV) é um processo terapêutico que visa promover a redução significativa dos sintomas labirínticos. OBJETIVO: verificar os benefícios dos exercícios de RV por meio da avaliação pré e pós-aplicação do questionário Dizziness Handicap Inventory (DHI) - adaptação brasileira. MÉTODO: participaram deste estudo oito idosos com queixa de tontura, na faixa e...

  4. Effectiveness of conventional versus virtual reality based vestibular rehabilitation in the treatment of dizziness, gait and balance impairment in adults with unilateral peripheral vestibular loss: a randomised controlled trial

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    Dara Meldrum

    2012-03-01

    Full Text Available Abstract Background Unilateral peripheral vestibular loss results in gait and balance impairment, dizziness and oscillopsia. Vestibular rehabilitation benefits patients but optimal treatment remains unkown. Virtual reality is an emerging tool in rehabilitation and provides opportunities to improve both outcomes and patient satisfaction with treatment. The Nintendo Wii Fit Plus® (NWFP is a low cost virtual reality system that challenges balance and provides visual and auditory feedback. It may augment the motor learning that is required to improve balance and gait, but no trials to date have investigated efficacy. Methods/Design In a single (assessor blind, two centre randomised controlled superiority trial, 80 patients with unilateral peripheral vestibular loss will be randomised to either conventional or virtual reality based (NWFP vestibular rehabilitation for 6 weeks. The primary outcome measure is gait speed (measured with three dimensional gait analysis. Secondary outcomes include computerised posturography, dynamic visual acuity, and validated questionnaires on dizziness, confidence and anxiety/depression. Outcome will be assessed post treatment (8 weeks and at 6 months. Discussion Advances in the gaming industry have allowed mass production of highly sophisticated low cost virtual reality systems that incorporate technology previously not accessible to most therapists and patients. Importantly, they are not confined to rehabilitation departments, can be used at home and provide an accurate record of adherence to exercise. The benefits of providing augmented feedback, increasing intensity of exercise and accurately measuring adherence may improve conventional vestibular rehabilitation but efficacy must first be demonstrated. Trial registration Clinical trials.gov identifier: NCT01442623

  5. Vestibular Loss in Older Adults Is Associated with Impaired Spatial Navigation: Data from the Triangle Completion Task

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    Yanjun Xie

    2017-04-01

    Full Text Available BackgroundVestibular inputs have been shown to play a critical role in spatial navigation. In this study, we sought to evaluate whether vestibular loss due to aging contributes to impaired spatial navigation as measured by the triangle completion task (TCT.Materials and methodsWe recruited three types of participants: young controls <55 years of age, older controls ≥55 years of age, and older patients from a Neurotology Clinic with evidence of vestibular physiologic impairment but who did not have any known vestibular disorder. We performed the cervical vestibular-evoked myogenic potential to evaluate saccular function and video head impulse testing to quantify horizontal semicircular canal vestibulo-ocular reflex gain. To assess spatial navigation ability, we administered the TCT, in which participants were conveyed along two segments of a pre-drawn triangular path and instructed to complete the final segment independently. We measured the angle (degrees and distance (centimeters of deviation from the correct trajectory. We evaluated the influence of vestibular inputs on TCT performance.ResultsForty-eight adults participated in the study (mean age: 62.0 years; 52.1% females, including 9 young controls, 15 older controls, and 24 clinic patients. Clinic patients had the greatest distance of deviation (67.7 cm, followed by older controls (45.4 cm, then young controls (27.8 cm; p < 0.01. Similarly, clinic patients had greater rotational angles (22.1° compared to older (13.3° and younger controls (12.4°; p < 0.01. Following multivariate linear regression adjusting for demographic variables, loss of otolith function was associated with an 18.2 cm increase in distance of deviation (95% CI: 15.2–47.4 and a 9.2° increase in rotational angle (95% CI: 3.0–15.5. Abnormal semicircular canal function was associated with a 26.0 cm increase in distance of deviation (95% CI: 0.2–51.8 and a 10.8° increase in rotational angle

  6. Vestibular function of patients with profound deafness related to GJB2 mutation.

    Science.gov (United States)

    Kasai, Misato; Hayashi, Chieri; Iizuka, Takashi; Inoshita, Ayako; Kamiya, Kazusaku; Okada, Hiroko; Nakajima, Yukinori; Kaga, Kimitaka; Ikeda, Katsuhisa

    2010-09-01

    GJB2 mutations are responsible not only for deafness but also for the occurrence of vestibular dysfunction. However, vestibular dysfunction tends to be unilateral and less severe in comparison with that of bilateral deafness. The correlation between the cochlear and vestibular end-organs suggests that some children with congenital deafness may have vestibular impairments. On the other hand, GJB2 gene mutations are the most common cause of nonsyndromic deafness. The vestibular function of patients with congenital deafness (CD), which is related to GJB2 gene mutation, remains to be elucidated. The purpose of this study was to analyze the relationship between GJB2 gene mutation and vestibular dysfunction in adults with CD. A total of 31 subjects, including 10 healthy volunteers and 21 patients with CD, were enrolled in the study. A hearing test and genetic analysis were performed. The vestibular evoked myogenic potentials (VEMPs) were measured and a caloric test was performed to assess the vestibular function. The percentage of vestibular dysfunction was then statistically analyzed. The hearing level of all CD patients demonstrated a severe to profound impairment. In seven CD patients, their hearing impairment was related to GJB2 mutation. Five of the seven patients with CD related to GJB2 mutation demonstrated abnormalities in one or both of the two tests. The percentage of vestibular dysfunction of the patients with CD related to GJB2 mutation was statistically higher than in patients with CD unrelated to GJB2 mutation and in healthy controls.

  7. The Effect of Otic Melanocyte Destruction on Auditory and Vestibular Function: a Study on Vitiligo Patients

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    Parvane Mahdi

    2016-03-01

    Full Text Available The hallmark of vitiligo is the disappearance of melanocytes from the skin. As a result, of melanocytes presence in the auditory and vestibular apparatus, the involvement of these systems in vitiligo which targets the melanocytes of the whole body is possible; suggesting that vitiligo is a systemic disease rather than a purely cutaneous problem. A total of 21 patients with vitiligo were enrolled in this study. A group of 20 healthy subjects served as a control group. Pure tone audiometry (PTA, auditory brainstem responses (ABR and vestibular evoked myogenic potentials (VEMP were carried out in all participants. High frequency sensory neural hearing loss was seen in 8 (38.09% patients. ABR analysis revealed 10 (47.61% had an abnormal increase in latency of wave III, and 6 (28.57% had an abnormal prolongation of IPL I-III, however, regarding our VEMP findings, there were no recorded responses on left ear of 1 (4.76% patient and latency of p13 was prolonged in 5(23.80% patients. There was no correlation between ages, duration of disease, and any of the recorded parameters (P>0.05. In the present survey, we highlighted the auditory and vestibular involvement in vitiligo patients.

  8. Mouse Models for Pendrin-Associated Loss of Cochlear and Vestibular Function

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    Philine Wangemann

    2013-12-01

    Full Text Available The human gene SLC26A4 and the mouse ortholog Slc26a4 code for the protein pendrin, which is an anion exchanger expressed in apical membranes of selected epithelia. In the inner ear, pendrin is expressed in the cochlea, the vestibular labyrinth and the endolymphatic sac. Loss-of-function and hypo-functional mutations cause an enlargement of the vestibular aqueduct (EVA and sensorineural hearing loss. The relatively high prevalence of SLC26A4 mutations provides a strong imperative to develop rational interventions that delay, ameliorate or prevent pendrin-associated loss of cochlear and vestibular function. This review summarizes recent studies in mouse models that have been developed to delineate the role of pendrin in the physiology of hearing and balance and that have brought forward the concept that a temporally and spatially limited therapy may be sufficient to secure a life-time of normal hearing in children bearing mutations of SLC26A4.

  9. Is Vestibular Neuritis an Immune Related Vestibular Neuropathy Inducing Vertigo?

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    A. Greco

    2014-01-01

    Full Text Available Objectives. To review the current knowledge of the aetiology of vestibular neuritis including viral infections, vascular occlusion, and immunomediated mechanisms and to discuss the pathogenesis with relevance to pharmacotherapy. Systematic Review Methodology. Relevant publications on the aetiology and treatment of vestibular neuritis from 1909 to 2013 were analysed. Results and Conclusions. Vestibular neuritis is the second most common cause of peripheral vestibular vertigo and is due to a sudden unilateral loss of vestibular function. Vestibular neuronitis is a disorder thought to represent the vestibular-nerve equivalent of sudden sensorineural hearing loss. Histopathological studies of patients who died from unrelated clinical problems have demonstrated degeneration of the superior vestibular nerve. The characteristic signs and symptoms include sudden and prolonged vertigo, the absence of auditory symptoms, and the absence of other neurological symptoms. The aetiology and pathogenesis of the condition remain unknown. Proposed theories of causation include viral infections, vascular occlusion, and immunomediated mechanisms. The management of vestibular neuritis involves symptomatic treatment with antivertiginous drugs, causal treatment with corticosteroids, and physical therapy. Antiviral agents did not improve the outcomes.

  10. Precision contact of the fingertip reduces postural sway of individuals with bilateral vestibular loss

    Science.gov (United States)

    Lackner, J. R.; DiZio, P.; Jeka, J.; Horak, F.; Krebs, D.; Rabin, E.

    1999-01-01

    Contact of the hand with a stationary surface attenuates postural sway in normal individuals even when the level of force applied is mechanically inadequate to dampen body motion. We studied whether subjects without vestibular function would be able to substitute contact cues from the hand for their lost labyrinthine function and be able to balance as well as normal subjects in the dark without finger contact. We also studied the relative contribution of sight of the test chamber to the two groups. Subjects attempted to maintain a tandem Romberg stance for 25 s under three levels of fingertip contact: no contact; light-touch contact, up to 1 N (approximately 100 g) force; and unrestricted contact force. Both eyes open and eyes closed conditions were evaluated. Without contact, none of the vestibular loss subjects could stand for more than a few seconds in the dark without falling; all the normals could. The vestibular loss subjects were significantly more stable in the dark with light touch of the index finger than the normal subjects in the dark without touch. They also swayed less in the dark with light touch than when permitted sight of the test chamber without touch, and less with sight and touch than just sight. The normal subjects swayed less in the dark with touch than without, and less with sight and touch than sight alone. These findings show that during quiet stance light touch of the index finger with a stationary surface can be as effective or even more so than vestibular function for minimizing postural sway.

  11. Common Vestibular Disorders

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    Dimitrios G. Balatsouras

    2017-01-01

    Full Text Available The three most common vestibular diseases, benign paroxysmal positional vertigo (BPPV, Meniere's disease (MD and vestibular neuritis (VN, are presented in this paper. BPPV, which is the most common peripheral vestibular disorder, can be defined as transient vertigo induced by a rapid head position change, associated with a characteristic paroxysmal positional nystagmus. Canalolithiasis of the posterior semicircular canal is considered the most convincing theory of its pathogenesis and the development of appropriate therapeutic maneuvers resulted in its effective treatment. However, involvement of the horizontal or the anterior canal has been found in a significant rate and the recognition and treatment of these variants completed the clinical picture of the disease. MD is a chronic condition characterized by episodic attacks of vertigo, fluctuating hearing loss, tinnitus, aural pressure and a progressive loss of audiovestibular functions. Presence of endolymphatic hydrops on postmortem examination is its pathologic correlate. MD continues to be a diagnostic and therapeutic challenge. Patients with the disease range from minimally symptomatic, highly functional individuals to severely affected, disabled patients. Current management strategies are designed to control the acute and recurrent vestibulopathy but offer minimal remedy for the progressive cochlear dysfunction. VN is the most common cause of acute spontaneous vertigo, attributed to acute unilateral loss of vestibular function. Key signs and symptoms are an acute onset of spinning vertigo, postural imbalance and nausea as well as a horizontal rotatory nystagmus beating towards the non-affected side, a pathological headimpulse test and no evidence for central vestibular or ocular motor dysfunction. Vestibular neuritis preferentially involves the superior vestibular labyrinth and its afferents. Symptomatic medication is indicated only during the acute phase to relieve the vertigo and nausea

  12. Comparison of Vestibular Evoked Myogenic Potential and Caloric Tests Findings in Noise Induced Hearing Loss-Affected and Healthy Individuals

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    Farinoosh Fakharnia

    2010-06-01

    Full Text Available Background and Aim: Balance disturbance is one of the non-auditory effects of noisy industrial environments that is usually neglected. The aim of the current study was to investigate the effect of occupational noise on vestibular system among workers with noise-induced hearing loss (NIHL, based on both vestibular evoked myogenic potentials (VEMP and caloric tests.Methods: Thirty male workers with noise-induced hearing loss and thirty male matched controls were examined by VEMP and caloric tests. Study parameters included unilateral weakness, p13 and n23 latencies, and p13-n23 amplitude. Caloric test was performed only for 20 patients.Results: No significant difference was observed in unilateral weakness between the two groups. On the other hand, the difference in mean latencies of p13 in the right ear (p=0.003 and left ear (p=0.01 was significant between the two groups. However, the difference in n23 latency was significant only in the right ear (p=0.03. There was no significant difference between groups in p13-n23 amplitude.Conclusion: It seems that pars inferior of vestibule is the susceptible part in individuals with NIHL. In general, abnormal findings in both VEMP and caloric tests were more common compared to functional symptoms such as vertigo, which may be due to central compensation and the symmetry of the disorder.

  13. Vertigo Perception and Quality of Life in Patients after Surgical Treatment of Vestibular Schwannoma with Pretreatment Prehabituation by Chemical Vestibular Ablation

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    Zdeněk Čada

    2016-01-01

    Full Text Available Surgical removal of vestibular schwannoma causes acute vestibular symptoms, including postoperative vertigo and oscillopsia due to nystagmus. In general, the dominant symptom postoperatively is vertigo. Preoperative chemical vestibular ablation can reduce vestibular symptoms postoperatively. We used 1.0 mL of 40 mg/mL nonbuffered gentamicin in three intratympanic installations over 2 days, 2 months preoperatively in 10 patients. Reduction of vestibular function was measured by the head impulse test and the caloric test. Reduction of vestibular function was found in all gentamicin patient groups. After gentamicin vestibular ablation, patients underwent home vestibular exercising for two months. The control group consisted of 10 patients who underwent only home vestibular training two months preoperatively. Postoperative rates of recovery and vertigo in both groups were evaluated with the Glasgow Benefit Inventory (GBI, the Glasgow Health Status Inventory (GHSI, and the Dizziness Handicap Inventory questionnaires, as well as survey of visual symptoms by specific questionnaire developed by us. There were no statistically significant differences between both groups with regard to the results of questionnaires. Patients who received preoperative gentamicin were more resilient to optokinetic and optic flow stimulation (p<0.05. This trial is registered with clinical study registration number NCT02963896.

  14. Ocular vestibular evoked myogenic potential elicited from binaural air-conducted stimulations: clinical feasibility in patients with peripheral vestibular dysfunction.

    Science.gov (United States)

    Iwasaki, Shinichi; Egami, Naoya; Inoue, Aki; Kinoshita, Makoto; Fujimoto, Chisato; Murofushi, Toshihisa; Yamasoba, Tatsuya

    2013-07-01

    Ocular vestibular evoked myogenic potentials (oVEMPs) to binaural air-conducted stimulation (ACS) may provide a convenient way of assessing the crossed vestibulo-ocular reflex in patients with vestibular dysfunction as well as in healthy subjects. To investigate the clinical feasibility of using oVEMPs in response to binaural ACS to assess normal subjects and patients with vestibular dysfunction. The study investigated 24 normal subjects (14 men and 10 women, aged from 23 to 60 years) and 14 patients with unilateral peripheral vestibular dysfunction. Each subject underwent oVEMP testing in response to monaural ACS and binaural ACS (500 Hz tone burst, 135 dBSPL). In normal subjects, bilateral oVEMPs were elicited in 75% of subjects in response to monaural ACS and in 91% in response to binaural ACS. Asymmetry ratios (ARs) of the responses to binaural ACS were significantly smaller than those of the responses to monaural ACS (p binaural ACS. Approximately 30% of patients showed reduced ARs to binaural ACS relative to monaural ACS, primarily due to contamination by uncrossed responses elicited in healthy ears.

  15. Inferior vestibular neuritis: 3 cases with clinical features of acute vestibular neuritis, normal calorics but indications of saccular failure

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    Økstad Siri

    2006-12-01

    Full Text Available Abstract Background Vestibular neuritis (VN is commonly diagnosed by demonstration of unilateral vestibular failure, as unilateral loss of caloric response. As this test reflects the function of the superior part of the vestibular nerve only, cases of pure inferior nerve neuritis will be lost. Case presentations We describe three patients with symptoms suggestive of VN, but normal calorics. All 3 had unilateral loss of vestibular evoked myogenic potential. A slight, asymptomatic position dependent nystagmus, with the pathological ear down, was observed. Conclusion We believe that these patients suffer from pure inferior nerve vestibular neuritis.

  16. Central vestibular disorder due to ischemic injury on the parieto-insular vestibular cortex in patients with middle cerebral artery territory infarction: Observational study.

    Science.gov (United States)

    Yeo, Sang Seok; Jang, Sung Ho; Kwon, Jung Won

    2017-12-01

    Central vestibular disorder is common after middle cerebral artery (MCA) territory infarction. The MCA supplies blood to the parieto-insular vestibular cortex (PIVC), a core region of central vestibular symptoms. We report on patients that sustained injuries of the core vestibular pathway to the PIVC with central vestibular disorder following MCA territory infarction, demonstrated on diffusion tensor imaging (DTI). Nineteen patients with MCA territory infarction and 12 control subjects were recruited. To reconstruct the core vestibular pathway to the PIVC, we defined seed region of interest (ROI) as vestibular nuclei of pons and target ROI as the PIVC. Fractional anisotropy (FA), mean diffusivity, and tract volume were measured. In the affected hemisphere, FA value of the core vestibular pathway to the PIVC revealed significant difference between all patient groups and the control group (P territory infarction. Analysis of the core vestibular pathway to the PIVC using DTI would be beneficial in clinical evaluation and management of patients with MCA territory infarction. Copyright © 2017 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.

  17. Spontaneous tumour shrinkage in 1261 observed patients with sporadic vestibular schwannoma

    DEFF Research Database (Denmark)

    Huang, Xiaoshan; Caye-Thomasen, P; Stangerup, S-E

    2013-01-01

    To determine the rate of spontaneous tumour shrinkage in a group of patients with sporadic vestibular schwannoma managed with a 'wait and scan' approach.......To determine the rate of spontaneous tumour shrinkage in a group of patients with sporadic vestibular schwannoma managed with a 'wait and scan' approach....

  18. Acoustic neuroma: predominance of Antoni type B cells in tumors of patients with vestibular paresis.

    Science.gov (United States)

    Stipkovits, E M; Graamans, K; Jansen, G H; Velthof, M A

    2001-03-01

    This study aimed to investigate whether in patients with acoustic neuroma (AN), the presence or absence of vestibular symptoms is related to the histologic characteristics of the tumor. The study design was a retrospective clinical study. The study was conducted at a tertiary referral center. A group of eight patients with unilateral AN and normal vestibular function was compared with a group of AN patients, matched for tumor size, with vestibular paresis. The methods were vestibular examination of the patients and morphometric analysis of the histologic specimens of their tumors. The outcomes were measured by vestibular function and by the relative quantity of Antoni type A or type B cell tissue. The tumors of patients with vestibular paresis appeared to contain significantly more Antoni B cells and fewer Antoni A cells than did the tumors of patients with normal vestibular function. Besides morphologic differences, type B cells may display a distinct behavior compared with type A cells. Presumably, in AN patients the development of a vestibular paresis appears to be related to the biologic activity of type B cells in the tumor.

  19. Patient with headache and peripheral vestibular dysfunction: case report

    OpenAIRE

    Rossi,Tatiane Maria; Luciano,Naonne Santos Camargo; Oricoli, Polliay Freire; Marchiori,Luciana Lozza de Moraes; Melo, Juliana Jandre

    2009-01-01

    TEMA: a Reabilitação Vestibular constitui-se numa opção de tratamento para pacientes portadores de síndrome vestibular periférica e cefaleia. PROCEDIMENTOS: o paciente, do sexo feminino com 26 anos de idade apresentava síndrome vestibular periférica acompanhada de crises de cefaleia. Foi realizada avaliação e terapia fonoaudiológica com exercícios de habituação vestibular além de fisioterapia e dieta recomendada pelo nutricionista. RESULTADOS: no período de 3 meses com reabilitação vestibular...

  20. Paciente com cefaleia e síndrome vestibular periférica: relato de caso Patient with headache and peripheral vestibular dysfunction: case report

    Directory of Open Access Journals (Sweden)

    Tatiane Maria Rossi

    2009-01-01

    Full Text Available TEMA: a Reabilitação Vestibular constitui-se numa opção de tratamento para pacientes portadores de síndrome vestibular periférica e cefaleia. PROCEDIMENTOS: o paciente, do sexo feminino com 26 anos de idade apresentava síndrome vestibular periférica acompanhada de crises de cefaleia. Foi realizada avaliação e terapia fonoaudiológica com exercícios de habituação vestibular além de fisioterapia e dieta recomendada pelo nutricionista. RESULTADOS: no período de 3 meses com reabilitação vestibular realizada semanalmente observou-se melhora no quadro vertiginoso e da cefaleia da paciente. CONCLUSÕES: evidenciou-se boa eficácia clínica para o tratamento desta paciente através da reabilitação vestibular com exercícios de habituação vestibular. Salienta-se a eficácia da reabilitação para a melhora na qualidade de vida da paciente e minimização das crises de cefaleia.BACKGROUND: vestibular rehabilitation is an option for treating peripheral vestibular syndrome and headache patients. PROCEDURES: the patient is a 29-year old woman and has Peripheral Vestibular Syndrome along with headache attacks. Evaluation and Phonoaudiological therapy with exercises of habituation tests with physical and nutritional therapy were carried out. RESULTS: in 3 month period with weekly vestibular rehabilitation therapy, we observed an improvement in the condition of the patient's vertigo and migraine. CONCLUSIONS: it was evident that the patient's treatment through the rehabilitation test with habituation test exercises had good efficiency. Please note the effectiveness of the rehabilitation for the improvement in the patient's life quality and minimization of headache attacks.

  1. Visual and Postural Motion-Evoked Dizziness Symptoms Are Predominant in Vestibular Migraine Patients.

    Science.gov (United States)

    Vuralli, Doga; Yildirim, Funuzar; Akcali, Didem T; Ilhan, Mustafa N; Goksu, Nebil; Bolay, Hayrunnisa

    2018-01-01

    Vestibular migraine (VM) is one of the most common underdiagnosed disorders. We aimed to study the clinical characteristics of VM patients who were referred to a neurology-headache unit by otolaryngology after exclusion of peripheral causes of vertigo. One hundred and one patients diagnosed with VM in the headache unit were included. Description of vestibular symptoms, demographic and clinical features, trigger factors, accompanying diseases, and response to vestibular-suppressant medications and prophylactic migraine treatment were evaluated. Vestibular symptoms were triggered by daily head and body movements and mainly consisted of brief attacks lasting seconds (60.4% of patients) although the total duration of the vestibular episode lasted hours or days. Other aggravating factors were moving visual stimuli, passive motion, and visually busy environments. Visually induced vestibular symptoms were defined by 71.3% of the patients, and positional motion-induced vestibular symptoms were described by 82.2% of the patients. Vestibular symptoms were mainly defined as feeling the ground slipping from under their feet (40.6%), feeling like there is an earthquake or swaying (27.7%), sensation of rocking on a boat (26.7%), and sensation as if stepping on empty space (24.8%). The majority of the patients (83.2%) previously used vestibular-suppressant drugs, and these drugs were effective temporarily only in 12.9%. Chronic recurrent dizziness symptoms, rather than internal or external vertigo, are predominant in our VM patients. Recurrent brief dizziness attacks induced upon routine visual and/or postural motion, longstanding symptoms with limited response to vestibular suppressants, and precipitation by typical migraine triggers are suggestive of VM.

  2. Characterization of Cochlear, Vestibular and Cochlear-Vestibular Electrically Evoked Compound Action Potentials in Patients with a Vestibulo-Cochlear Implant

    NARCIS (Netherlands)

    Nguyen, T. A. K.; Cavuscens, Samuel; Ranieri, Maurizio; Schwarz, Konrad; Guinand, Nils; van de Berg, Raymond; van den Boogert, Thomas; Lucieer, Floor; van Hoof, Marc; Guyot, Jean-Philippe; Kingma, Herman; Micera, Silvestro; Perez Fornos, Angelica

    2017-01-01

    The peripheral vestibular system is critical for the execution of activities of daily life as it provides movement and orientation information to motor and sensory systems. Patients with bilateral vestibular hypofunction experience a significant decrease in quality of life and have currently no

  3. Current treatment of nasal vestibular stenosis with CO2-laser surgery; prolonged vestibular stenting versus intraoperative mitomycin application. A case series of 3 patients

    NARCIS (Netherlands)

    Schijndel, O. van; Heerbeek, N. van; Ingels, K.J.A.O.

    2014-01-01

    These case studies describe three cases of unilateral nasal vestibular stenoses caused by chemical cauterization. Each case was treated with CO2-laser surgery together with intraoperative topic application of mitomycin or prolonged vestibular stenting for prevention of restenosis. Two patients

  4. A common SLC26A4-linked haplotype underlying non-syndromic hearing loss with enlargement of the vestibular aqueduct

    DEFF Research Database (Denmark)

    Chattaraj, Parna; Munjal, Tina; Honda, Keiji

    2017-01-01

    BACKGROUND: Enlargement of the vestibular aqueduct (EVA) is the most common radiological abnormality in children with sensorineural hearing loss. Mutations in coding regions and splice sites of the SLC26A4 gene are often detected in Caucasians with EVA. Approximately one-fourth of patients with EVA...... and their families. RESULTS: We identified a shared novel haplotype, termed CEVA (Caucasian EVA), composed of 12 uncommon variants upstream of SLC26A4. The presence of the CEVA haplotype on seven of ten 'mutation-negative' chromosomes in a National Institutes of Health M1 EVA discovery cohort and six of six mutation......-negative chromosomes in a Danish M1 EVA replication cohort is higher than the observed prevalence of 28 of 1006 Caucasian control chromosomes (pprevalence of CEVA (11 of 126) is also increased among M0 EVA chromosomes (p=0...

  5. Role of the insula and vestibular system in patients with chronic subjective dizziness: An fMRI study using sound-evoked vestibular stimulation

    Directory of Open Access Journals (Sweden)

    Iole eIndovina

    2015-12-01

    Full Text Available Chronic subjective dizziness (CSD is a common vestibular disorder characterized by persistent non-vertiginous dizziness, unsteadiness, and heightened sensitivity to motion stimuli that may last for months to years after events that cause acute vestibular symptoms or disrupt balance. CSD is not associated with abnormalities of basic vestibular or oculomotor reflexes. Rather, it is thought to arise from persistent use of high-threat postural control strategies and greater reliance on visual cues for spatial orientation (i.e., visual dependence, long after triggering events resolve. Anxiety-related personality traits confer vulnerability to CSD. Anomalous interactions between the central vestibular system and neural structures related to anxiety may sustain it. Vestibular- and anxiety-related processes overlap in the brain, particularly in the insula and hippocampus. Alterations in activity and connectivity in these brain regions in response to vestibular stimuli may be the neural basis of CSD.We examined this hypothesis by comparing brain activity from 18 patients with CSD and 18 healthy controls measured by functional magnetic resonance imaging during loud short tone bursts, which are auditory stimuli that evoke robust vestibular responses. Relative to controls, patients with CSD showed reduced activations to sound-evoked vestibular stimulation in the parieto-insular vestibular cortex (PIVC including the posterior insula, and in the anterior insula, inferior frontal gyrus, hippocampus, and anterior cingulate cortex. Patients with CSD also showed altered connectivity between the anterior insula and PIVC, anterior insula and middle occipital cortex, hippocampus and PIVC, and anterior cingulate cortex and PIVC.We conclude that reduced activation in PIVC, hippocampus, anterior insula, inferior frontal gyrus, and anterior cingulate cortex, as well as connectivity changes among these regions, may be linked to long-term vestibular symptoms in patients

  6. Ocular Motor Function in Patients with Bilateral Vestibular Weakness

    Directory of Open Access Journals (Sweden)

    Seyyed Amir Hossein Ghazizadeh Hashemi

    2016-05-01

    Full Text Available Introduction: Patients with bilateral weakness (BW have many difficulties in gaze stability that interfere with their normal function. The aim of this study was to evaluate ocular motor functions in patients with BW to better understand the problem of gaze instability in these patients.   Materials and Methods: Patients were referred from the Otolaryngology Department for Vestibular Assessment to our clinic between November 2014 and March 2015. We assessed ocular motor function (gaze, saccade, and smooth pursuit in patients over the age of 18 years with BW, as verified by a caloric test.   Results: Seventy-eight patients completed all the tests. The mean age of patients was 51.9 (±15.9 years, and 47 (60% were female. Abnormal results were found in five (6.4%, 32 (41%, and seven (9% patients with respect to gaze, smooth pursuit, and saccade, respectively. There were positive but relatively weak relationships between age and ocular motor results.   Conclusion:  Patients with BW suffer from dizziness and unsteadiness. These patients have abnormal function in ocular motor (especially smooth pursuit tests. The ocular motor dysfunction is responsible for gaze instability in static positions such as standing.

  7. Characterization of Cochlear, Vestibular and Cochlear-Vestibular Electrically Evoked Compound Action Potentials in Patients with a Vestibulo-Cochlear Implant

    Directory of Open Access Journals (Sweden)

    T. A. K. Nguyen

    2017-11-01

    Full Text Available The peripheral vestibular system is critical for the execution of activities of daily life as it provides movement and orientation information to motor and sensory systems. Patients with bilateral vestibular hypofunction experience a significant decrease in quality of life and have currently no viable treatment option. Vestibular implants could eventually restore vestibular function. Most vestibular implant prototypes to date are modified cochlear implants to fast-track development. These use various objective measurements, such as the electrically evoked compound action potential (eCAP, to supplement behavioral information. We investigated whether eCAPs could be recorded in patients with a vestibulo-cochlear implant. Specifically, eCAPs were successfully recorded for cochlear and vestibular setups, as well as for mixed cochlear-vestibular setups. Similarities and slight differences were found for the recordings of the three setups. These findings demonstrated the feasibility of eCAP recording with a vestibulo-cochlear implant. They could be used in the short term to reduce current spread and avoid activation of non-targeted neurons. More research is warranted to better understand the neural origin of vestibular eCAPs and to utilize them for clinical applications.

  8. Hyperventilation-induced nystagmus in a large series of vestibular patients.

    Science.gov (United States)

    Califano, L; Melillo, M G; Vassallo, A; Mazzone, S

    2011-02-01

    The Hyperventilation Test is widely used in the "bed-side examination" of vestibular patients. It can either activate a latent nystagmus in central or peripheral vestibular diseases or it can interact with a spontaneous nystagmus, by reducing it or increasing it. Aims of this study were to determine the incidence, patterns and temporal characteristics of Hyperventilation-induced nystagmus in patients suffering from vestibular diseases, as well as its contribution to the differential diagnosis between vestibular neuritis and neuroma of the 8(th) cranial nerve, and its behaviour in some central vestibular diseases. The present study includes 1202 patients featuring, at vestibular examination, at least one sign of vestibular system disorders or patients diagnosed with a "Migraine-related vertigo" or "Chronic subjective dizziness". The overall incidence of Hyperventilation-induced nystagmus was 21.9%. It was detected more frequently in retrocochlear vestibular diseases rather than in end-organ vestibular diseases: 5.3% in Paroxysmal Positional Vertigo, 37.1% in Menière's disease, 37.6% in compensated vestibular neuritis, 77.2% in acute vestibular neuritis and 91.7% in neuroma of the 8(th) cranial nerve. In acute vestibular neuritis, three HVIN patterns were observed: Paretic pattern: temporary enhancement of the spontaneous nystagmus; Excitatory pattern: temporary inhibition of the spontaneous nystagmus; Strong excitatory pattern: temporary inversion of the spontaneous nystagmus. Excitatory patterns proved to be time-dependent in that they disappeared and were replaced by the paretic pattern over a period of maximum 18 days since the beginning of the disorder. In acoustic neuroma, Hyperventilation-induced nystagmus was frequently observed (91.7%), either in the form of an excitatory pattern (fast phases towards the affected site) or in the form of a paretic pattern (fast phases towards the healthy side). The direction of the nystagmus is only partially related to

  9. Reabilitação vestibular em idosos com Parkinson Vestibular rehabilitation in elderly patients with Parkinson

    Directory of Open Access Journals (Sweden)

    Jackeline Martins-Bassetto

    2007-06-01

    Full Text Available OBJETIVO: verificar a efetividade dos exercícios de reabilitação vestibular (RV por meio de avaliação pré e pós-aplicação do questionário Dizziness Handicap Inventory (DHI - adaptação brasileira. MÉTODOS: avaliaram-se oito pacientes (três do sexo feminino e cinco do sexo masculino, na faixa etária de 48 a 71 anos, encaminhados da Associação Paranaense de Parkinson para o Laboratório de Otoneurologia da Universidade Tuiuti do Paraná. Os pacientes foram divididos em dois grupos e submetidos aos seguintes procedimentos: anamnese, avaliação otorrinolaringológica, avaliação vestibular por meio da vectoeletronistagmografia (VENG e aplicação do questionário DHI - adaptação brasileira pré e pós RV utilizando-se os protocolos de Cawthorne e Cooksey (grupo A e Herdman (grupo B. RESULTADOS: a conforme as queixas otoneurológicas referidas na anamnese, observou-se a prevalência da tontura (100,0%, tremor (100,0% e desvio de marcha (75,0&; b no exame vestibular, todos os pacientes (100,0% apresentaram alteração, sendo a maior freqüência das síndromes vestibulares periféricas deficitárias (62,5%; c houve melhora significativa dos aspectos funcional (p = 0,020470 e emocional (p = 0,013631 após a realização dos exercícios de RV utilizando-se o protocolo de Cawthorne e Cooksey e do aspecto emocional (p=0,007316 utilizando-se o protocolo de Herdman. CONCLUSÃO: comparando-se os dois protocolos utilizados, verificou-se uma melhora significativa dos pacientes do grupo A, submetidos ao protocolo de Cawthorne e Cooksey (p=0.0231.PURPOSE: to check the effectiveness of vestibular rehabilitation exercises (RV by means of an evaluation of a pre and post application of the Dizziness Handicap Inventory (DHI questionnaire (Brazilian version. METHODS: eight patients were evaluated (three female and five male, in the age group varying from 48 to 71, referred from the Paraná Association of Parkinson to the Otoneurological Laboratory

  10. Vestibular evoked myogenic potentials and digital vectoelectronystagmography's study in patients with benign paroxysmal positional vertigo

    Directory of Open Access Journals (Sweden)

    Lira-Batista, Marta Maria da Silva

    2013-04-01

    Full Text Available Introduction: Benign Paroxysmal Positional Vertigo (BPPV is a very common vestibular disorder characterized by brief but intense attacks of rotatory vertigo triggered by simple rapid movement of the head. The integrity of the vestibular pathways can be assessed using tests such as digital vectoelectronystagmography (VENG and vestibular evoked myogenic potentials (VEMP. Aim: This study aimed to determine the VEMP findings with respect to latency, amplitude, and waveform peak to peak and the results of the oculomotor and vestibular components of VENG in patients with BPPV. Method: Although this otoneurological condition is quite common, little is known of the associated VEMP and VENG changes, making it important to research and describe these results. Results: We examined the records of 4438 patients and selected 35 charts after applying the inclusion and exclusion criteria. Of these, 26 patients were women and 9 men. The average age at diagnosis was 52.7 years, and the most prevalent physiological cause, accounting for 97.3% of cases, was ductolithiasis. There was a statistically significant association between normal hearing and mild contralateral sensorineural hearing loss. The results of the oculomotor tests were within the normal reference ranges for all subjects. Patients with BPPV exhibited symmetrical function of the semicircular canals in their synergistic pairs (p < 0.001. The caloric test showed statistically normal responses from the lateral canals. The waveforms of all patients were adequate, but the VEMP results for the data-crossing maneuver with positive positioning showed a trend toward a relationship for the left ear Lp13. There was also a trend towards an association between normal reflexes in the caloric test and the inter-peak VEMP of the left ear. It can be concluded that although there are some differences between the average levels of the VENG and VEMP results, these differences were not statistically significant

  11. [From gene to disease; genetic causes of hearing loss and visual impairment sometimes accompanied by vestibular problems (Usher syndrome)

    NARCIS (Netherlands)

    Pennings, R.J.E.; Kremer, J.M.J.; Deutman, A.F.; Kimberling, W.J.; Cremers, C.W.R.J.

    2002-01-01

    Usher syndrome is an autosomal recessively inherited disease, characterised by sensorineural hearing loss, tapetoretinal degeneration and in some cases vestibular problems. Based on the clinical heterogeneity, the disease can be classified into three clinical types (I, II and III), which have their

  12. Change in hearing during 'wait and scan' management of patients with vestibular schwannoma

    DEFF Research Database (Denmark)

    Stangerup, Sven-Eric; Caye-Thomasen, P.; Tos, M.

    2008-01-01

    Aim: To evaluate hearing changes during 'wait and scan' management of patients with vestibular schwannoma. Subjects: Over a 10-year period, 636 patients have prospectively been allocated to 'wait and scan' management, with annual magnetic resonance scanning and audiological examination. Results...... surgery and of radiation therapy with those of 'wait and scan' management, it appears that, in vestibular schwannoma patients with a small tumour and normal speech discrimination, the main indication for active treatment should be established tumour growth Udgivelsesdato: 2008/7...

  13. Postural response characterization in elderly patients with bilateral vestibular hypofunction.

    Science.gov (United States)

    Suarez, Hamlet; Sotta, Gonzalo; San Roman, Cecilia; Arocena, Sofia; Ferreira, Enrique; Geisinger, Dario; Suarez, Alejo; Picerno, Juan

    2013-04-01

    The measurement of the energy consumption (EC) of the body's center of pressure (COP) to maintain the upright stance position was higher in elderly patients with bilateral vestibular hypofunction (BVH) compared with a control group and may be a valid parameter in the assessment of balance disorders. The aim of the study was to evaluate the energy consumption of the COP in elderly patients with BVH. The COP was recorded on a force platform (FP) for eight elderly patients with BVH related to aging and eight normal control group subjects. The EC of the COP was calculated using the discrete wavelet transform. The two groups were tested in standing position on the FP in three sensory conditions:1, eyes open; 2, eyes closed; and 3, standing on a foam pad placed on the force platform. Wilcoxon's rank test and multi-factor analysis of variance were used, with the level of significance set at 0.05. BVH patients showed higher values of EC of the COP signal measured in arbitrary units compared with the control group (conditions 1 and 2). None of the BVH patients could perform the test in condition 3. BVH patients had increased EC in the frequency band between 0.1 and 0.78 Hz when the visual information was canceled (condition 2).

  14. Long-term socio-economic impact of vestibular schwannoma for patients under observation and after surgery

    DEFF Research Database (Denmark)

    Tos, Tina; Caye-Thomasen, Per; Stangerup, Sven-Eric

    2003-01-01

    This study describes and compares the long-term socio-economic impact for patients diagnosed with a vestibular schwannoma and either operated on or observed. A consecutive sample of patients diagnosed with vestibular schwannoma in Denmark and either operated on (748 patients) or observed...... on and observed for vestibular schwannoma. However, the negative changes were more frequent among the operated patients, although the differences were surprisingly modest, especially when comparing observed patients with patients operated on for a small tumour....

  15. Relationship of Vertigo and Postural Instability in Patients With Vestibular Schwannoma.

    Science.gov (United States)

    Nam, Gi-Sung; Jung, Chan Min; Kim, Ji Hyung; Son, Eun Jin

    2018-01-09

    Growth of vestibular schwannomas (VS) causes progressive vestibular symptoms and postural instability. Since the tumor grows slowly, compensation of decaying vestibular input may decrease subjective symptoms of dizziness. This study aims to estimate the relationship of subjective vestibular symptoms and objective postural instability in patients with VS. A retrospective review of 18 patients newly diagnosed with VS and with subjective vertigo symptoms was performed. The Results of vestibular function tests including the sensory organization test (SOT) using computerized dynamic posturography, caloric test, and self-report measures of subjective dizziness handicap (Dizziness Handicap Inventory) and visual analogue scale were compared according to the onset of vertigo symptoms. In VS patients, SOT showed decreased equilibrium score for all vestibular function related conditions, condition (C) 5 and 6, and composite (COMP) score. COMP scores were not correlated with visual analogue scale or Dizziness Handicap Inventory scores. Acute onset group included six patients and insidious onset group, 12 patients. Equilibrium scores for C5 and C6, and COMP scores were lower for insidious onset group, but the difference was not statistically significant. Our findings confirmed postural instability is prevalent in VS patients. SOT parameters did not differ significantly between acute onset and insidious onset groups, but increased tumor size and canal weakness were noted in the insidious onset group. Clinicians should consider that postural instability is likely present even in patients who do not complain of acute vertigo, and appropriate counseling should be discussed with the patients.

  16. Vibration-Induced Nystagmus in Patients with Unilateral Peripheral Vestibular Disorders

    National Research Council Canada - National Science Library

    Xie, Sujiang; Guo, Jia; Wu, Ziming; Qiang, Dongchang; Huang, Jing; Zheng, Yingjuan; Yao, Qin; Chen, Shan; Tian, Dawei

    2013-01-01

    ...) and to calculate the sensitivity and the specificity of the vibration test. One hundred and twelve patients with unilateral peripheral vestibular disorders and thirty normal subjects were enrolled into this study...

  17. Interactive 3-dimensional virtual reality rehabilitation for patients with chronic imbalance and vestibular dysfunction.

    Science.gov (United States)

    Yeh, Shih-Ching; Chen, Shuya; Wang, Pa-Chun; Su, Mu-Chun; Chang, Chia-Huang; Tsai, Po-Yi

    2014-01-01

    Chronic imbalance is common in patients with vestibular dysfunction. Vestibular rehabilitation is effective in improving upright balance control. Vestibular rehabilitation exercises, such as Cawthorne-Cooksey exercises, include simple repetitive movements and have limited feedback and adaptive training protocols. Interactive systems based on virtual reality (VR) technology may improve vestibular rehabilitation. The objective of this study was to examine the effectiveness of an interactive 3-dimensional VR system for vestibular rehabilitation. In 49 subjects with vestibular dysfunction, VR rehabilitation exercises were performed in 6 sessions. Before and after rehabilitation, subjects were evaluated for performance of the training exercises; the center of pressure was measured for 20 seconds and balance indices were determined. Five training scores (total 6) showed a significant improvement. For balance indices in condition of non-stimulation, all of them (total 5) showed a trend of improvement, in which there was a significant improvement in mean mediolateral. For balance indices in condition of post-stimulation, there was a significant improvement in statokinesigram and maximum mediolateral. The VR rehabilitation exercises were effective in improving upright balance control in patients with vestibular dysfunction.

  18. Utility of Stepping, Walking, and Head Impulses for Screening Patients for Vestibular Impairments.

    Science.gov (United States)

    Cohen, Helen S; Sangi-Haghpeykar, Haleh; Ricci, Natalia A; Kampangkaew, June; Williamson, Robert A

    2014-07-01

    To determine if some common screening tests predict scores on detailed, objective diagnostic tests of the vestibular system. Sixty patients with vestibular disorders were compared with 60 asymptomatic controls. Vestibular diagnostic laboratory, tertiary care center. Subjects were screened with head impulse tests, Fukuda stepping tests while walking and marching in place, and tandem walking tests with eyes open and closed. All subjects underwent bithermal caloric tests and Dix-Hallpike maneuvers; patients underwent low-frequency sinusoidal tests of the vestibulo-ocular reflex in darkness and cervical vestibular evoked myogenic potentials. On tandem walking tests, patients differed significantly from controls, but receiver operating characteristic scores were impulse tests, patients with bithermal caloric weakness (≥20% and 0.80 only for subjects with severe bithermal caloric weakness and were highest, at 0.88, for subjects with severe weakness and age ≥ 60 years. The Fukuda test is a poor screening test because it does not correlate well with objective test findings. Tandem walking is best used for screening older patients for vestibular disorders. Positive findings on a head impulse test are probably consistent with severe peripheral vestibular impairment and may be most useful in older patients. In younger patients with vertigo, negative results on head impulse tests may not be informative. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

  19. Effectiveness of Vestibular Rehabilitation in Hemodialysis Patients With Dizziness.

    Science.gov (United States)

    Dai, Chin-Ying; Lin, Su-Chun; Peng, Hui-Ling; Chung, Yueh-Chin; Chen, Shu-Wen; Feng, Ying-Feng; Tung, Yi-Chen; Liu, Wen-Miao

    This study evaluated the effectiveness of vestibular rehabilitation (VR) for hemodialysis (HD) patients with chronic dizziness. A single-blind, randomized controlled study was performed. Cluster-randomized sampling was used to select the experimental group from two outpatient dialysis clinics. A total of 26 patients participated in the study. Dizziness Handicap Inventory (DHI) and falls were used as outcome measures. Data were collected at baseline (T1), 3 months (T2), and 6 months (T3). Two-way repeated-measures ANOVA of DHI revealed a statistically significant group and time interaction. Dizziness handicap outcome was significantly reduced over time in the experimental group (DHI total score, T1 = 35.29, T2 = 32.86, T3 = 27.86, p = .001). VR exercise instructed by nurses can be effective in alleviating handicap imposed by dizziness in dialysis patients. Nurses are encouraged to learn VR as a simple exercise to improve well-being in dialysis patients with chronic dizziness.

  20. Progressive late-onset sensorineural hearing loss and vestibular impairment with vertigo (DFNA9/COCH): longitudinal analyses in a belgian family.

    NARCIS (Netherlands)

    Lemaire, F.X.; Feenstra, L.; Huygen, P.L.M.; Fransen, E.; Devriendt, K.; Camp, G. van; Vantrappen, G.; Cremers, C.W.R.J.; Wackym, P.A.; Koss, J.C.

    2003-01-01

    OBJECTIVE: To evaluate audiometric and vestibular signs and symptoms in a new DFNA9 family. SETTING: Tertiary referral centers. METHODS: A multigeneration Belgian family with late-onset progressive sensorineural hearing loss and concomitant ves-tibular impairment with an autosomal dominant pattern

  1. Mutations of KCNJ10 Together with Mutations of SLC26A4 Cause Digenic Nonsyndromic Hearing Loss Associated with Enlarged Vestibular Aqueduct Syndrome

    OpenAIRE

    YANG, TAO; Gurrola II, Jose G.; Wu, Hao; Chiu, Sui M.; Wangemann, Philine; Snyder, Peter M.; Smith, Richard J. H.

    2009-01-01

    Mutations in SLC26A4 cause nonsyndromic hearing loss associated with an enlarged vestibular aqueduct (EVA, also known as DFNB4) and Pendred syndrome (PS), the most common type of autosomal-recessive syndromic deafness. In many patients with an EVA/PS phenotype, mutation screening of SLC26A4 fails to identify two disease-causing allele variants. That a sizable fraction of patients carry only one SLC26A4 mutation suggests that EVA/PS is a complex disease involving other genetic factors. Here, w...

  2. Effectiveness of conventional versus virtual reality based vestibular rehabilitation in the treatment of dizziness, gait and balance impairment in adults with unilateral peripheral vestibular loss: a randomised controlled trial

    National Research Council Canada - National Science Library

    Meldrum, Dara; Herdman, Susan; Moloney, Roisin; Murray, Deirdre; Duffy, Douglas; Malone, Kareena; French, Helen; Hone, Stephen; Conroy, Ronan; McConn-Walsh, Rory

    2012-01-01

    .... Vestibular rehabilitation benefits patients but optimal treatment remains unknown. Virtual reality is an emerging tool in rehabilitation and provides opportunities to improve both outcomes and patient satisfaction with treatment...

  3. Long-term socio-economic impact of vestibular schwannoma for patients under observation and after surgery

    DEFF Research Database (Denmark)

    Tos, Tina; Caye-Thomasen, Per; Stangerup, Sven-Eric

    2003-01-01

    This study describes and compares the long-term socio-economic impact for patients diagnosed with a vestibular schwannoma and either operated on or observed. A consecutive sample of patients diagnosed with vestibular schwannoma in Denmark and either operated on (748 patients) or observed by the w......This study describes and compares the long-term socio-economic impact for patients diagnosed with a vestibular schwannoma and either operated on or observed. A consecutive sample of patients diagnosed with vestibular schwannoma in Denmark and either operated on (748 patients) or observed...

  4. Responses evoked by a vestibular implant providing chronic stimulation

    OpenAIRE

    Thompson L.A.; Haburcakova C.; Gong W; Lee D.J.; Wall Iii C.; Merfeld D.M.; Lewis R.F.

    2012-01-01

    Patients with bilateral vestibular loss experience dehabilitating visual, perceptual, and postural difficulties, and an implantable vestibular prosthesis that could improve these symptoms would be of great benefit to these patients. In previous work, we have shown that a one-dimensional, unilateral canal prosthesis can improve the vestibulooccular reflex (VOR) in canal-plugged squirrel monkeys. In addition to the VOR, the potential effects of a vestibular prosthesis on more complex, highly in...

  5. Variables associated with outcome in patients with bilateral vestibular hypofunction: Preliminary study.

    Science.gov (United States)

    Herdman, Susan J; Hall, Courtney D; Maloney, Brian; Knight, Sara; Ebert, Marti; Lowe, Jessica

    2015-01-01

    Vestibular rehabilitation (VR) improves symptoms and function in some but not all patients with bilateral vestibular hypofunction (BVH). The purpose of this retrospective study was to examine change following vestibular rehabilitation and to identify factors associated with rehabilitation outcome in patients with BVH. Data from 69 patients with BVH were analyzed. Factors studied included patient characteristics, subjective complaints and physical function. Outcome measures included symptom intensity, balance confidence, quality of life, gait speed, fall risk, and dynamic visual acuity. Bivariate correlations were used to examine relationships of patient characteristics and baseline measures with outcome measures. One-way ANOVAs were used to compare outcomes in patients with BVH versus unilateral vestibular hypofunction (UVH). As a group, patients with BVH improved in all outcome measures except disability following a course of vestibular rehabilitation (VR); however, only 38-86% demonstrated a meaningful improvement, depending on the specific outcome measure examined. Several factors measured at baseline - age, DGI score, gait speed and perceived dysequilibrium - were associated with outcomes. For example, greater age was related to higher DVA scores at discharge; lower initial DGI scores were related to higher Disability scores at discharge. Compared to patients with UVH, reported previously [9], a smaller percentage of patients with BVH improve and to a lesser extent. Consideration of baseline factors may provide guidance for setting patient goals. Further research is needed determine what factors predict outcome and to develop more effective treatment strategies for those patients who do not improve.

  6. Age-Related Vestibular Loss: Current Understanding and Future Research Directions.

    Science.gov (United States)

    Arshad, Qadeer; Seemungal, Barry M

    2016-01-01

    The vestibular system sub-serves a number of reflex and perceptual functions, comprising the peripheral apparatus, the vestibular nerve, the brainstem and cerebellar processing circuits, the thalamic relays, and the vestibular cerebral cortical network. This system provides signals of self-motion, important for gaze and postural control, and signals of traveled distance, for spatial orientation, especially in the dark. Current evidence suggests that certain aspects of this multi-faceted system may deteriorate with age and sometimes with severe consequences, such as falls. Often the deterioration in vestibular functioning relates to how the signal is processed by brain circuits rather than an impairment in the sensory transduction process. We review current data concerning age-related changes in the vestibular system, and how this may be important for clinicians dealing with balance disorders.

  7. Age-Related Vestibular Loss: Current Understanding and Future Research Directions

    Directory of Open Access Journals (Sweden)

    Dominic Allen

    2016-12-01

    Full Text Available The vestibular system sub-serves a number of reflex and perceptual functions, comprising the peripheral apparatus, the vestibular nerve, the brainstem and cerebellar processing circuits, the thalamic relays, and the vestibular cerebral cortical network. This system provides signals of self-motion, important for gaze and postural control, and signals of traveled distance, for spatial orientation, especially in the dark. Current evidence suggests that certain aspects of this multi-faceted system may deteriorate with age and sometimes with severe consequences, such as falls. Often the deterioration in vestibular functioning relates to how the signal is processed by brain circuits rather than an impairment in the sensory transduction process. We review current data concerning age-related changes in the vestibular system, and how this may be important for clinicians dealing with balance disorders.

  8. Comparison of different exercise programs in the rehabilitation of patients with chronic peripheral vestibular dysfunction.

    Science.gov (United States)

    Szturm, T; Ireland, D J; Lessing-Turner, M

    1994-01-01

    standing balance performance under dynamic conditions for patients in the Reh program (Reh and B groups) but not for patients performing the eye-head exercise (Home or A groups). Thus, even in patients with chronic vestibular dysfunction, compensation for the loss or disruption of peripheral vestibular inputs can be effectively induced by exercises that provide sensory feedback appropriate for behavioral changes involving sensory substitution or sensory-motor reorganization.(ABSTRACT TRUNCATED AT 400 WORDS)

  9. Results achieved in the treatment of patients with vestibular schwannoma.

    Science.gov (United States)

    Freigang, Bernd; Rudolf, Jan

    2004-01-01

    Personal experience gathered with the treatment of 264 vestibular schwannoma (VS) at the Magdeburg University ENT Hospital is analysed. ABR Audiometry is useful as a screening, even though it yielded false-negative values in 12.7% (n = 33) for intrameatal VS and 16.9% for all VS, despite accurate evaluation. Latency increases of Waves I, III and V and their intraaural comparison exhibited a statistically significant difference for the VS levels proposed by TOS. The mean of intrameatal VS too was found to have longer latencies compared with the normal-hearing ears of the patients. In the individual case, with threshold hearing normal, anamnestic findings as well as otoneurological evidence provide an early indication for enhanced MRI, CISS imaging, or individual 3D reconstruction of the pontocerebellar cisterna. Adopting intraoperative monitoring of the facial nerve and the cochlea as well as the Pars acustica by means of far-field and near-field electrodes, a good facial 'mobility' was achieved in 95.3%, and a useful audition (AAO-HNS Types A and B) in 60%. Monitoring is beneficial as it enhances the reliability and improves the subtle preparation during surgery. The power of hearing improved postoperatively within six months and remained at a good level over two years. From our perspective, otorhinolaryngologists are the right specialists to attend to VS.

  10. Interactions between Stress and Vestibular Compensation - A Review.

    Science.gov (United States)

    Saman, Yougan; Bamiou, D E; Gleeson, Michael; Dutia, Mayank B

    2012-01-01

    Elevated levels of stress and anxiety often accompany vestibular dysfunction, while conversely complaints of dizziness and loss of balance are common in patients with panic and other anxiety disorders. The interactions between stress and vestibular function have been investigated both in animal models and in clinical studies. Evidence from animal studies indicates that vestibular symptoms are effective in activating the stress axis, and that the acute stress response is important in promoting compensatory synaptic and neuronal plasticity in the vestibular system and cerebellum. The role of stress in human vestibular disorders is complex, and definitive evidence is lacking. This article reviews the evidence from animal and clinical studies with a focus on the effects of stress on the central vestibular pathways and their role in the pathogenesis and management of human vestibular disorders.

  11. Interactions between stress and vestibular compensation – a review

    Directory of Open Access Journals (Sweden)

    Yougan eSaman

    2012-07-01

    Full Text Available Elevated levels of stress and anxiety often accompany vestibular dysfunction, while conversely complaints of dizziness and loss of balance are common in patients with panic and other anxiety disorders. The interactions between stress and vestibular function, and plasticity have been investigated both in animal models and in clinical studies. Evidence from animal studies indicates that vestibular symptoms are effective in activating the stress axis, and that the acute stress response is important in promoting compensatory synaptic and neuronal plasticity in the vestibular system and cerebellum. The role of stress in human vestibular disorders is complex, and definitive evidence is lacking. This article reviews the evidence from animal and clinical studies with a focus on the effects of stress on the central vestibular pathways and their role in the pathogenesis and management of human vestibular disorders.

  12. Interactions between Stress and Vestibular Compensation – A Review

    Science.gov (United States)

    Saman, Yougan; Bamiou, D. E.; Gleeson, Michael; Dutia, Mayank B.

    2012-01-01

    Elevated levels of stress and anxiety often accompany vestibular dysfunction, while conversely complaints of dizziness and loss of balance are common in patients with panic and other anxiety disorders. The interactions between stress and vestibular function have been investigated both in animal models and in clinical studies. Evidence from animal studies indicates that vestibular symptoms are effective in activating the stress axis, and that the acute stress response is important in promoting compensatory synaptic and neuronal plasticity in the vestibular system and cerebellum. The role of stress in human vestibular disorders is complex, and definitive evidence is lacking. This article reviews the evidence from animal and clinical studies with a focus on the effects of stress on the central vestibular pathways and their role in the pathogenesis and management of human vestibular disorders. PMID:22866048

  13. Emotional intelligence in association with quality of life in patients recently diagnosed with vestibular schwannoma.

    Science.gov (United States)

    van Leeuwen, Bibian M; Borst, Jacoba M; Putter, Hein; Jansen, Jeroen C; van der Mey, Andel G L; Kaptein, Adrian A

    2014-10-01

    The objective of this study was two-fold. First, to examine the levels of emotional intelligence in patients recently diagnosed with vestibular schwannoma, in comparison to those of healthy individuals and patients with other physical illness. Second, to evaluate the correlation between Emotional Intelligence and quality of life. Cross sectional study in a university tertiary referral center. Consecutive patients (mean age [range], 56.4 [17-85] yr) diagnosed with vestibular schwannoma between April 2011 and October 2012 (N = 254). Sociodemographic characteristics, clinical characteristics, disease-specific quality of life (PANQOL), and Emotional Intelligence (TEIQue-SF) were assessed by questionnaire before the start of medical treatment. Levels of Emotional Intelligence in patients with vestibular schwannoma (N = 178; response rate 70.1%) were significantly lower compared with healthy individuals and patients with cancer. Emotional Intelligence was highly positively correlated to disease-specific quality of life. Balance disorders and cranial nerve dysfunction made a significant negative contribution to the quality of life. For educational level, a significant positive contribution was found as well. The substantial impact of a vestibular schwannoma-diagnosis on a psychological measure (i.e., Emotional Intelligence) in the affected patients as demonstrated in our study has important clinical and research implications when developing guidelines about counselling of these patients. This also has to be taken into account when making clinical decisions about the proposed treatment. Addressing Emotional Intelligence may be helpful in the development of a self-management program for patients with vestibular schwannoma.

  14. Paroxismia vestibular: estudo clínico e tratamento de oito pacientes Vestibular paroxysmia: clinical study and treatment of eight patients

    Directory of Open Access Journals (Sweden)

    Aline Mizuta Kozoroski Kanashiro

    2005-09-01

    Full Text Available A paroxismia vestibular é uma síndrome de compressão do VIII nervo craniano e foi denominada inicialmente por Janetta "vertigem posicional incapacitante". Esta síndrome é caracterizada por episódios curtos de vertigem, zumbido, déficit vestibular e auditivo. A RM pode mostrar compressão do VIII nervo por vasos da fossa posterior, como a artéria basilar, artéria vertebral, artéria cerebelar inferior anterior, artéria cerebelar inferior posterior. A paroxismia vestibular pode ser tratada com terapia medicamentosa tais como carbamazepina, fenitoína ou gabapentina, ou com descompressão microvascular do VIII nervo. Este estudo descreve oito pacientes com paroxismia vestibular. Quatro deles mostraram também sinais clínicos sugerindo compressão do V e/ou VII nervos. Sete pacientes tratados com carbamazepina tiveram melhora significativa da vertigem e zumbido.Vestibular paroxysmia is a syndrome of cross-compression of the VIII cranial nerve and was first described by Jannetta who used the term "disabling positional vertigo". This syndrome is characterized by brief attacks of vertigo, tinnitus, vestibular and auditory deficits. MRI may show the VIII nerve compression from vessels in the posterior fossa, such as the basilar, vertebral, anterior-inferior cerebellar or the posterior-inferior cerebellar arteries. Vestibular paroxysmia may be treated either with medical therapy, such as carbamazepine, phenytoin or gabapentin or with the microvascular decompression of the VIII nerve. This study describes eight patients with vestibular paroxysmia. Four of them showed also clinical signs suggesting cross-compression of the V and/or VII nerve. Seven patients treated with carbamazepine had significant improvement of vertigo and tinnitus.

  15. Compensation following bilateral vestibular damage

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    Bill J Yates

    2011-12-01

    Full Text Available Bilateral loss of vestibular inputs affects far fewer patients than unilateral inner ear damage, and thus has been understudied. In both animal subjects and human patients, bilateral vestibular hypofunction (BVH produces a variety of clinical problems, including impaired balance control, inability to maintain stable blood pressure during postural changes, difficulty in visual targeting of images, and disturbances in spatial memory and navigational performance. Experiments in animals have shown that nonlabyrinthine inputs to the vestibular nuclei are rapidly amplified following the onset of BVH, which may explain the recovery of postural stability and orthostatic tolerance that occurs within 10 days. However, the loss of the vestibulo-ocular reflex and degraded spatial cognition appear to be permanent in animals with BVH. Current concepts of the compensatory mechanisms in humans with BVH are largely inferential, as there is a lack of data from patients early in the disease process. Translation of animal studies of compensation for BVH into therapeutic strategies and subsequent application in the clinic is the most likely route to improve treatment. In addition to physical therapy, two types of prosthetic devices have been proposed to treat individuals with bilateral loss of vestibular inputs: those that provide tactile stimulation to indicate body position in space, and those that deliver electrical stimuli to branches of the vestibular nerve in accordance with head movements. The relative efficacy of these two treatment paradigms, and whether they can be combined to facilitate recovery, is yet to be ascertained.

  16. Compensation following bilateral vestibular damage.

    Science.gov (United States)

    McCall, Andrew A; Yates, Bill J

    2011-01-01

    Bilateral loss of vestibular inputs affects far fewer patients than unilateral inner ear damage, and thus has been understudied. In both animal subjects and human patients, bilateral vestibular hypofunction (BVH) produces a variety of clinical problems, including impaired balance control, inability to maintain stable blood pressure during postural changes, difficulty in visual targeting of images, and disturbances in spatial memory and navigational performance. Experiments in animals have shown that non-labyrinthine inputs to the vestibular nuclei are rapidly amplified following the onset of BVH, which may explain the recovery of postural stability and orthostatic tolerance that occurs within 10 days. However, the loss of the vestibulo-ocular reflex and degraded spatial cognition appear to be permanent in animals with BVH. Current concepts of the compensatory mechanisms in humans with BVH are largely inferential, as there is a lack of data from patients early in the disease process. Translation of animal studies of compensation for BVH into therapeutic strategies and subsequent application in the clinic is the most likely route to improve treatment. In addition to physical therapy, two types of prosthetic devices have been proposed to treat individuals with bilateral loss of vestibular inputs: those that provide tactile stimulation to indicate body position in space, and those that deliver electrical stimuli to branches of the vestibular nerve in accordance with head movements. The relative efficacy of these two treatment paradigms, and whether they can be combined to facilitate recovery, is yet to be ascertained.

  17. Vestibular compensation following vestibular neurotomy.

    Science.gov (United States)

    Devèze, A; Montava, M; Lopez, C; Lacour, M; Magnan, J; Borel, L

    2015-09-01

    Four studies assessing vestibular compensation in Menière's disease patients undergoing unilateral vestibular neurotomy, using different analysis methods, are reviewed, with a focus on the different strategies used by patients according to their preoperative sensory preference. Four prospective studies performed in a university tertiary referral center were reviewed, measuring the pattern of vestibular compensation in Menière's disease patients before and after unilateral vestibular neurotomy on various assessment protocols: postural syndrome assessed on static posturography and gait analysis; perceptual syndrome assessed on subjective visual vertical perception; and oculomotor syndrome assessed on ocular cyclotorsion. Vestibular compensation occurred at variable intervals depending on the parameter investigated. Open-eye postural control and gait/walking returned to normal one month after neurotomy. Fine balance analysis found that visual perception of the vertical and ocular cyclotorsion impairment persisted at long-term follow-up. Clinical postural disturbance persisted only when visual afferents were cut off (eyes closed). These impairments were the expression of a postoperative change in postural strategy related to the new use of visual and non-visual references. Understanding pre-operative interindividual variation in balance strategy is critical to screening for postural instability and tailoring vestibular rehabilitation. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  18. Vestibular rehabilitation in elderly patients with benign paroxysmal positional vertigo

    OpenAIRE

    Resende Carolina R.; Taguchi Carlos K.; Almeida Juliane G. de; Fujita Reginaldo R.

    2003-01-01

    A Vertigem Posicional Paroxística Benigna (VPPB) é um distúrbio vestibular no qual os pacientes relatam breves momentos de vertigem e/ou leve instabilidade postural, ocasionados por uma mudança brusca na movimentação cefálica ou corporal. OBJETIVO: Verificar o benefício da reabilitação vestibular, realizada em grupo, em pacientes idosos portadores de VPPB. FORMA DE ESTUDO: Clínico prospectivo. MATERIAL E MÉTODO: Foram selecionados aleatoriamente 16 pacientes portadores de VPPB, todos medicado...

  19. Interactions between Stress and Vestibular Compensation – A Review

    OpenAIRE

    Saman, Yougan; Bamiou, D. E.; Gleeson, Michael; Dutia, Mayank B

    2012-01-01

    Elevated levels of stress and anxiety often accompany vestibular dysfunction, while conversely complaints of dizziness and loss of balance are common in patients with panic and other anxiety disorders. The interactions between stress and vestibular function have been investigated both in animal models and in clinical studies. Evidence from animal studies indicates that vestibular symptoms are effective in activating the stress axis, and that the acute stress response is important in promoting...

  20. Vestibular Schwannoma (Acoustic Neuroma) and Neurofibromatosis

    Science.gov (United States)

    ... vestibular schwannoma is key to preventing its serious consequences. There are three options for managing a vestibular ... Disorders Balance Problems and Disorders - National Institute on Aging Enlarged Vestibular Aqueducts and Childhood Hearing Loss Genetics ...

  1. Does Hospital Volume Affect Outcomes in Patients Undergoing Vestibular Schwannoma Surgery?

    Science.gov (United States)

    Hatch, Jonathan L; Bauschard, Michael J; Nguyen, Shaun A; Lambert, Paul R; Meyer, Ted A; McRackan, Theodore R

    2018-01-16

    To determine the effect of hospital surgical case volume on the outcomes of vestibular schwannoma surgery. Retrospective case review. University HealthSystem Consortium member hospitals (includes nearly every US academic medical center). Three thousand six hundred ninety-seven patients who underwent vestibular schwannoma resection over a 3-year timespan (2012-2015) grouped by race, age, comorbidities, payer, and sex. Surgical resection of vestibular schwannoma. Morbidity and mortality following vestibular schwannoma excision are compared by hospital volume (low, medium, and high) including deciles. There was significantly longer length of stay (p ≤ 0.005) among groups with low-volume hospitals followed by medium-volume hospitals and high-volume hospitals. Low-volume hospitals had a significantly higher rate of complications including stroke, aspiration, and respiratory failure (p ≤ 0.0175). Patient characteristics of age, sex, sex, and baseline comorbidities were similar between hospital groups. However, patients at high-volume hospitals were more likely to be Caucasian (83.1%, p = 0.0001) and have private insurance (76.7%, p < 0.0001). There was a strong negative correlation between complication rates and hospital volume (r = -0.8164, p = 0.0040). The volume of vestibular schwannoma surgeries performed at a hospital impacts length of stay and rates of postoperative complications. Demographics among hospital groups were similar though high-volume hospitals had significantly more patients who were privately insured and Caucasian.

  2. Bionic balance organs: progress in the development of vestibular prostheses.

    Science.gov (United States)

    Smith, Paul F

    2017-09-01

    The vestibular system is a sensory system that is critically important in humans for gaze and image stability as well as postural control. Patients with complete bilateral vestibular loss are severely disabled and experience a poor quality of life. There are very few effective treatment options for patients with no vestibular function. Over the last 10 years, rapid progress has been made in developing artificial 'vestibular implants' or 'prostheses', based on cochlear implant technology. As of 2017, 13 patients worldwide have received vestibular implants and the results are encouraging. Vestibular implants are now becoming part of an increasing effort to develop artificial, bionic sensory systems, and this paper provides a review of the progress in this area.

  3. The effect of vestibular rehabilitation supplemented by training of the breathing rhythm or proprioception exercises, in patients with chronic peripheral vestibular disease.

    Science.gov (United States)

    Jáuregui-Renaud, Kathrine; Villanueva Padrón, Laura Alejandra; Cruz Gómez, Nora Silvia

    2007-01-01

    To assess the effect of performing vestibular rehabilitation using the Cawthorne & Cooksey exercises supplemented by training of the breathing rhythm or proprioception exercises on self-reported disability and postural control, in patients with chronic, peripheral, vestibular disease. Fifty one patients with peripheral vestibular disease and abnormal caloric test participated in the study (mean age 43 +/- S.D. 9 years). They were assigned to one of 3 treatment groups: I. Cawthorne &} Cooksey exercises with training of the breathing rhythm (n=17); II. Cawthorne & Cooksey exercises with proprioception exercises (n=17) and III. Cawthorne & Cooksey exercises with no additional intervention (n=17). The Dizziness Handicap Inventory and static posturography were evaluated prior to treatment and at week 8 of follow-up. Prior to treatment, composite scores on the Dizziness Handicap Inventory and static posturography were similar in the 3 groups. After treatment, a decrease of the composite score of at least 18 points was observed more frequently in patients of the respiration group (94%), compared to the proprioception group (53%) and the Cawthorne & Cooksey group (70%) (p=0.03); while the proprioception group showed a significant decrease of oscillation during all sensory conditions of static posturography (p< 0.05). The results suggest that regulation of the breathing pattern may have an influence on disability related to chronic vestibular disease, while proprioception exercises may improve postural control. However, further studies are needed to evaluate if training of the breathing rhythm could be an additional tool for vestibular rehabilitation.

  4. Avaliação vestibular por videonistagmografia de portadores de deficiência crônica de zinco por síndrome do intestino curto Vestibular evaluation using videonystagmography of chronic zinc deficient patients due to short bowell syndrome

    Directory of Open Access Journals (Sweden)

    Gustavo Duarte Paiva Ferreira

    2009-04-01

    Full Text Available A presença do elemento químico zinco na via auditiva e a sua provável participação na gênese de alguns tipos de disacusia estão bem documentadas, porém não há estudos funcionais que mostrem os impacto da deficiência sistêmica de zinco no sistema vestibular, nem estudos anatômicos descritivos comprovando a existência do íon nas estruturas da via vestibular. OBJETIVO: Este estudo foi realizado com o objetivo de relacionar a alteração na homeostase do zinco com anormalidades do funcionamento da via vestibular. MATERIAL E MÉTODOS: Este é um estudo de casos, retrospectivo, clínico, onde nove indivíduos portadores de deficiência crônica de zinco, entre outros distúrbios nutricionais, consequentes à síndrome de má absorção, foram submetidos à avaliação vestibular. Os resultados deste grupo foram comparados com os resultados de um grupo considerado normal do ponto de vista nutricional (grupo controle. RESULTADOS: Todos os parâmetros da análise vestibular do grupo experimental mostraram-se alterados em comparação com o grupo controle. CONCLUSÃO: A comparação entre os grupos mostrou diferenças significativas em diversos parâmetros da análise vestibular e chamou a atenção para uma possível participação das alterações disabsortivas na origem das desordens vestibulares.The presence of zinc in the auditory pathways and its probable participation in tinnitus and hearing loss are known facts, although there are no clinical trials and experimental studies showing the impact of hypozincemia in the vestibular system and zinc existence in the vestibular pathway, respectively. AIM: This study is an attempt to correlate hypozincemia and abnormal vestibular function. METHODS: This is a clinical retrospective case study where nine patients suffering of chronic zinc deficiency had their serum zinc determined and were submitted to videonystagmography. Results were compared to a normal (control group. RESULTS: All

  5. Out-of-body experience in vestibular disorders - A prospective study of 210 patients with dizziness.

    Science.gov (United States)

    Lopez, Christophe; Elzière, Maya

    2017-06-08

    Out-of-body experiences (OBEs) are states during which people experience their centre of awareness as located outside of their physical body, along with the sensation of seeing the environment from an elevated viewpoint. OBE is encountered in epilepsy, migraine and depersonalization, and it is not an uncommon experience in the general population. Current neuroscientific models of bodily self-consciousness consider that OBE are related to a failure to integrate visual, somatosensory and vestibular signals. These models have highlighted the importance of visual-vestibular mismatch in OBE. Case reports from older clinical literature suggest that vestibular disorders may precipitate OBE, but we were lacking population-based evidence that OBE is related to vestibular disorders. The present observational, prospective study describes otoneurological, neuropsychological and phenomenological correlates of OBE in the largest sample of patients with dizziness to date (n = 210) compared to a group of age- and gender-matched controls with no history of dizziness (n = 210). We show a significantly higher occurrence of OBE in patients with dizziness (14%) than in healthy participants (5%). Most of the patients experienced OBE only after they started having dizziness for the first time. OBE in patients with dizziness were mainly related to peripheral vestibular disorders. We also identify depersonalization-derealization, depression and anxiety as the main predictors of OBE in patients with dizziness, as well as a contribution of migraine. Depersonalization-derealization was the only significant predictor of OBE in healthy controls. Altogether, our data indicate that OBE in patients with dizziness may arise from a combination of perceptual incoherence evoked by the vestibular dysfunction with psychological factors (depersonalization-derealization, depression and anxiety) and neurological factors (migraine). Copyright © 2017 Elsevier Ltd. All rights reserved.

  6. Cochlear implantation in patients with enlarged vestibular aqueduct. A case series with literature review.

    Science.gov (United States)

    Clarós, Pedro; Fokouo, Jean Valentin F; Clarós, Andrés

    2017-05-01

    To report our institutional experience of the management of patients with enlarged vestibular aqueduct (EVA) and compare it to the literature. We carried out a retrospective review of patients' records from 1993 to 2015. The age, sex, associated malformations, relevant past medical history, genetic screening results, possible surgical incident, implant model and duration of follow- up, outcome in terms of Categories of Auditory Performance (CAP scores), and integration or resuming mainstream school or work were recorded. We had 11 patients (six boys and five girls) with EVA who underwent cochlear implant surgery in our center during the 22-year study period, out of a total of 827 implanted (1.3%). The mean age at surgery was 8.9 years ranging from 0.6 to 35 years. EVA was bilateral in 10 cases, isolated anatomical finding in seven cases, and associated with other malformations in four. Cochlear implantation was bilateral in five cases and unilateral in six. The mean follow- up duration was 48.3 months (range: 3-120). No postoperative complication was observed and all the patients could regain a serviceable hearing, attending normal school and working normally. EVA is frequently observed in the deaf population without an identifiable cause. The hearing loss is usually progressive and may result in cochlear implantation which has proved its efficiency in rehabilitating EVA patients.

  7. 7-Tesla MRI demonstrates absence of structural lesions in patients with vestibular paroxysmia.

    Science.gov (United States)

    Rommer, Paulus S; Wiest, Gerald; Kronnerwetter, Claudia; Zach, Heidemarie; Loader, Benjamin; Elwischger, Kirsten; Trattnig, Siegfried

    2015-01-01

    Vestibular parxoysmia (VP) is a rare vestibular disorder. A neurovascular cross-compression (NVCC) between the vestibulochochlear nerve and an artery seems to be responsible for short attacks of vertigo in this entity. An NVCC can be seen in up to every fourth subject. The significance of these findings is not clear, as not all subjects suffer from symptoms. The aim of the present study was to assess possible structural lesions of the vestibulocochlear nerve by means of high field magnetic resonance imaging (MRI), and whether high field MRI may help to differentiate symptomatic from asymptomatic subjects. 7 Tesla MRI was performed in six patients with VP and confirmed NVCC seen on 1.5 and 3.0 MRI. No structural abnormalities were detected in any of the patients in 7 Tesla MRI. These findings imply that high field MRI does not help to differentiate between symptomatic and asymptomatic NVCC and that the symptoms of VP are not caused by structural nerve lesions. This supports the hypothesis that the nystagmus associated with VP has to be conceived pathophysiologically as an excitatory vestibular phenomenon, being not related to vestibular hypofunction. 7 Tesla MRI outperforms conventional MRI in image resolution and may be useful in vestibular disorders.

  8. Vestibular rehabilitation's effect over the quality of life of geriatric patients with labyrinth disease.

    Science.gov (United States)

    Mantello, Erika Barioni; Moriguti, Julio Cesar; Rodrigues-Júnior, Antonio Luiz; Ferrioli, Eduardo

    2008-01-01

    Dizziness is a symptom that affects the population world over, being more prevalent in the elderly due to the process of functional deterioration of the hearing and vestibular systems with aging. The objective of this study was to evaluate prospectively the effect of Vestibular Rehabilitation (VR) as treatment for labyrinth disease of vascular and metabolic origin in the quality of life of geriatric patients. The study was outlined as clinical-prospective, longitudinal, and observed, with the participation of 40 elder citizens of both genders, divided in 2 groups, dizziness of vascular or metabolic origin. The patients were evaluated and underwent VR - based on Cawthorne and Cooksey's protocol. The statistical analysis from the data was done through the t-Student test, the coefficients of Pearson and Spearman. based on quality of life scales showed that the individuals treated and assessed improved after Vestibular Rehabilitation. we concluded that VR, based on the protocols of Cawthorne and Cooksey, could be beneficial to this population.

  9. [Vestibular and oculomotor disorders in patients with congenital strabismus].

    Science.gov (United States)

    Corvera, J; Corvera-Behar, G; Limón, E; Brown-Limón, A

    1994-01-01

    A group of patients with congenital endotropia or exotropia was investigated in their capacity to perform reflex eye movements. Some patients had a successful surgical correction of their eye defect. The functions measured were the vestibulo-oculomotor reflex, the feedback control loop for searching and following eye movements and the optomotor reflex. A loss in the functional capacity was displayed in all the tests done. The average value of the losses found for the whole group, according to the test used, were from 8 to 27% for the vestibulo-oculomotor reflex; 22 to 42% for the eye tracking feedback loop, and 48% for the optomotor reflex. The deficit was not due to the incorrect eye position, because the successfully operated subjects had the same magnitude of the motor defect than the non-operated patients.

  10. The relationship between vestibular aqueduct diameter and sensorineural hearing loss is linear: a review and meta-analysis of large case series.

    Science.gov (United States)

    Spencer, C R

    2012-11-01

    Inner ear homeostasis is dependent on the vestibular aqueduct and its content, the endolymphatic duct. Narrow and enlarged vestibular aqueducts have both been associated with hearing loss in Ménière's and large vestibular aqueduct syndromes. This review investigated the correlation between vestibular aqueduct diameter and pure tone average, and the effect of measurement site (i.e. the midpoint or the external aperture). A systematic review of the literature and meta-analysis of large case series published on the Allied and Complementary Medicine, British Nursing Index, Cumulative Index to Nursing and Allied Health, Embase, Health Business Elite, Health Management Information Consortium, Medline, PsycInfo and PubMed databases. References and personal books were also scrutinised. A linear relationship between vestibular aqueduct diameter and hearing loss was observed, with a projected increase of 6 dBHL per unit of vestibular aqueduct diameter (95 per cent confidence interval, 2-10; p = 0.003). This relationship was independent of measurement site. This dose-dependent or linear relationship supports the role of flow and/or pressure change as aetiological factors in the pathogenesis of hearing loss, as per Poiseuille's law. This aetiological association is strengthened by the fact that the observed relationship is independent of measurement site.

  11. The Effect of Peripheral Vestibular Recovery on Improvements in Vestibulo-ocular Reflexes and Balance Control After Acute Unilateral Peripheral Vestibular Loss.

    Science.gov (United States)

    Allum, John H J; Scheltinga, Alja; Honegger, Flurin

    2017-12-01

    Patients with an acute unilateral peripheral vestibular deficit (aUPVD), presumed to be caused by vestibular neuritis, show asymmetrical vestibular ocular reflexes (VORs) that improve over time. Questions arise regarding how much of the VOR improvement is due to peripheral recovery or central compensation, and whether differences in peripheral recovery influence balance control outcomes. Thirty patients were examined at aUPVD onset and 3, 6, and 13 weeks later with four different VOR tests: caloric tests; rotating (ROT) chair tests performed in yaw with angular accelerations of 5 and 20 degrees/s; and video head impulse tests (vHIT) in the yaw plane. ROT and vHIT responses and balance control of 11 patients who had a caloric canal paresis (CP) more than 90% at aUPVD onset and no CP recovery (no-CPR) at 13 weeks in caloric tests were compared with those of 19 patients with CP recovery (CPR) to less than 30%, on average. Balance control was measured with a gyroscope system (SwayStar) recording trunk sway during stance and gait tasks. ROT and vHIT asymmetries of no-CPR and CPR patients reduced over time. The reduction was less at 13 weeks (36.2% vs. 83.5% on average) for the no-CPR patients. The no-CPR group asymmetries at 13 weeks were greater than those of CPR patients who had normal asymmetries. The greater asymmetries were caused by weaker deficit side responses which remained deficient in no-CPR patients at 13 weeks. Contra-deficit side vHIT and ROT responses remained normal. For all balance tests, sway was slightly greater for no-CPR compared with CPR patients at aUPVD onset and 3 weeks later. At 13 weeks, only sway during walking eyes closed was greater for the no-CPR group. A combination of 5 degrees/s ROT and balance tests could predict at onset (90% accuracy) which patients would have no-CPR at 13 weeks. These results indicate that for ROT and vHIT tests, central compensation is observed in CPR and no-CPR patients. It acts primarily by increasing deficit

  12. Betahistine in the treatment of tinnitus in patients with vestibular disorders Betaistina no tratamento do zumbido em pacientes com distúrbios vestibulares

    Directory of Open Access Journals (Sweden)

    Maurício Malavasi Ganança

    2011-08-01

    Full Text Available Betahistine is a medicine used to treat vestibular disorders that has also been used to treat tinnitus. AIM: To assess the effects of betahistine on tinnitus in patients with vestibular disorders. MATERIAL AND METHOD: Retrospective data were collected from patient records for individuals presenting with vestibular dysfunction and tinnitus. Patients included had received betahistine 48 mg/day and clinical outcomes were compared with a control group comprising individuals who were unable to receive betahistine due to gastritis, ulcers, pregnancy, asthma or hypersensitivity to the drug. Patients underwent control of any aggravating factors and also standard vestibular exercises as a basis for treatment. The intensity, frequency and duration of tinnitus were assessed on the first day of dosing and after 120 days of treatment. Clinical improvement was defined as a total or partial reduction of tinnitus after treatment. RESULTS: Clinical improvement was observed in 80/262 (30. 5% of patients treated with betahistine and 43/252 (17. 1% of control patients. Betahistine significantly (pA betaistina é um medicamento utilizado no tratamento de distúrbios da função vestibular, que também tem sido utilizado para tratar o zumbido. OBJETIVO: Avaliar o efeito da betaistina sobre o zumbido de pacientes com distúrbios vestibulares. MATERIAL E MÉTODO: Foram coletados dados retrospectivos de pacientes com vestibulopatia e zumbido. Os pacientes incluídos receberam 48 mg/dia de betaistina ao dia e os resultados clínicos foram comparados com os de um grupo controle, que incluiu indivíduos impossibilitados de receber betaistina devido à gastrite, úlceras, gravidez, asma ou hipersensibilidade ao medicamento. Os pacientes realizaram controle de fatores agravantes e exercícios de reabilitação vestibular, como tratamento de base para a vestibulopatia. A intensidade, frequência e duração do zumbido foram avaliadas no primeiro dia e após 120 dias de

  13. Preoperative balance control compensation in patients with a vestibular schwannoma: does tumor size matter?

    Science.gov (United States)

    Ribeyre, Laurence; Frère, Julien; Gauchard, Gérome; Lion, Alexis; Perrin, Philippe; Spitz, Elisabeth; Parietti-Winkler, Cécile

    2015-04-01

    The influence of tumor size on postural control of patients with vestibular schwannoma (VS) remains to be determined. This study aimed to compare the postural performances of VS patients, according to the size of the tumor, with healthy subjects. The six conditions (C1-C6) of the sensory organization test (SOT) were carried out in 87 patients, split into four groups according to the Koos classification (stage I-IV), and in 72 aged-matched controls to evaluate postural control. The vestibular reflectivity and compensation were estimated with videonystagmography. Among patients, lower C5 and C6 scores were found in stage I and IV patients than in stage II and III patients, whereas vestibular compensation did not impact the tumor size influence on the postural control. The scores were significantly (pbalance control. The tumor size could be seen as a determining factor in the implementation of adaptive mechanisms that lead to the postural compensation and might be dissociated from vestibular compensation. Copyright © 2014 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  14. Quality of life in patients with unilateral vestibular schwannoma on wait and see - strategy.

    Science.gov (United States)

    Klersy, P C; Arlt, F; Hofer, M; Meixensberger, J

    2018-01-01

    A 'wait and see' strategy is an option when managing patients with small vestibular schwannomas (VS). A risk of growth and worsening of hearing may influence a patient's daily quality of life (QOL). Therefore, the present study focused on QOL parameters in patients who are on a 'wait and see' strategy following magnetic resonance imaging (MRI)-based diagnosis of small unilateral VS. Sixty-five patients (mean age 64.4 years; male:female, 32:33) who suffered from a small unilateral VS (9.34 mm, range 1.5-23 mm) between 2013 and 2016 were included in a prospective single center study. During follow-up, in addition to clinical and neurological examinations and MRI imaging, all patients answered the Short Form 36 questionnaire once to characterize QOL. Additionally, the severity of tinnitus was determined by the Mini-TQ-12 from Hiller and Goebel. It was found during follow-up that there was no lowering of QOL in patients with small VS who were on 'wait and see' strategy compared with Germany's general population and no tumor growth was detected in 53 patients (81.5%). Patients with a tumor diameter larger than 10 mm did not suffer from stronger tinnitus, vertigo or unsteadiness than the group with an average tumor size, which is smaller than 10 mm. Sixty-two patients (95.4%) showed ipsilateral hearing loss and three of these reported deafness (4.6%). Severe vertigo or tinnitus is connected with lower levels of mental component scale and physical component scale. These findings reduced the QOL (p = 0.05). In our series, QOL is not influenced in patients with unilateral untreated small VS in comparison to Germany's general population. This is helpful information when advising patients during follow-up and finding out the optimal timing of individual treatment.

  15. Progressive irreversible hearing loss is caused by stria vascularis degeneration in an Slc26a4-insufficient mouse model of large vestibular aqueduct syndrome.

    Science.gov (United States)

    Ito, T; Nishio, A; Wangemann, P; Griffith, A J

    2015-12-03

    Hearing loss of patients with enlargement of the vestibular aqueduct (EVA) can fluctuate or progress, with overall downward progression. The most common detectable cause of EVA is mutations of SLC26A4. We previously described a transgenic Slc26a4-insufficient mouse model of EVA in which Slc26a4 expression is controlled by doxycycline administration. Mice that received doxycycline from conception until embryonic day 17.5 (DE17.5; doxycycline discontinued at embryonic day 17.5) had fluctuating hearing loss between 1 and 6 months of age with an overall downward progression after 6 months of age. In this study, we characterized the cochlear functional and structural changes underlying irreversible hearing loss in DE17.5 mice at 12 months of age. The endocochlear potential was decreased and inversely correlated with auditory brainstem response thresholds. The stria vascularis was thickened and edematous in ears with less severe hearing loss, and thinned and atrophic in ears with more severe hearing loss. There were pathologic changes in marginal cell morphology and gene expression that were not observed at 3 months. We conclude that strial dysfunction and degeneration are the primary causes of irreversible progressive hearing loss in our Slc26a4-insufficient mouse model of EVA. This model of primary strial atrophy may be used to explore the mechanisms of progressive hearing loss due to strial dysfunction. Published by Elsevier Ltd.

  16. Congenital and compensated vestibular dysfunction in childhood: an overlooked entity.

    Science.gov (United States)

    Weiss, Avery H; Phillips, James O

    2006-07-01

    We report five children with previously unrecognized vestibular dysfunction detected by clinical examination and confirmed by quantitative vestibular testing. Patient 1 presented with fluctuating visual acuity and intermittent nystagmus. Patient 2 had congenital hearing loss associated with imbalance, delayed motor development, and cyclic vomiting. Patient 3 had neurotrophic keratitis with an intermittent head tilt, imbalance, and motor delays. Patient 4 showed ataxia and eye movement abnormalities following traumatic brain injury and had reading difficulties. Patient 5 had episodic vertigo and eye movement abnormalities from infancy. Clinical vestibular testing emphasized spontaneous nystagmus, rapid head thrust, and assessment of post-rotatory nystagmus. Quantitative vestibular testing included the sinusoidal chair rotation and velocity step tests, measurement of dynamic visual acuity, post-head-shake nystagmus, and computerized platform posturography. Pediatric neurologists encounter children with congenital and compensated vestibular dysfunction, which can be recognized on the basis of relevant history and clinical abnormalities of the ocular-ocular reflex.

  17. [Preoperative determination of nerve of origin in patients with vestibular schwannoma. German version].

    Science.gov (United States)

    Rahne, T; Plößl, S; Plontke, S K; Strauss, C

    2017-09-25

    Vestibular schwannoma (VS) is a benign tumor that develops in the internal auditory canal and the cerebellopontine angle, potentially diminishing hearing or balance. Most VS tumors arise from one of two vestibular branches: the superior or inferior vestibular nerve. Determining the specific nerve of origin could improve patient management in terms of preoperative counseling, treatment selection, and surgical decision-making and planning. The aim of this study was to introduce a novel scoring system that was designed to determine the nerve of origin. The nerve of origin was predicted based on video head impulse assessments of all semicircular channels, together with cervical/ocular vestibular-evoked myogenic potential tests. The acquired data were entered into a scoring system developed to allocate the tumor origin. Finally, the nerve of origin was definitively determined intraoperatively. The novel scoring system was applied to 5 consecutive patients undergoing surgical VS treatment. In one case, no determination was possible. In all other cases, the preoperatively predicted tumor origin was the same as the origin determined during surgery. The scoring system predicts the nerve of origin and will be evaluated in a larger prospective cohort study of VS patients in the near future.

  18. Quality of Life in 807 Patients with Vestibular Schwannoma: Comparing Treatment Modalities.

    Science.gov (United States)

    Soulier, Géke; van Leeuwen, Bibian M; Putter, Hein; Jansen, Jeroen C; Malessy, Martijn J A; van Benthem, Peter Paul G; van der Mey, Andel G L; Stiggelbout, Anne M

    2017-07-01

    Objective In vestibular schwannoma treatment, the choice among treatment modalities is controversial. The first aim of this study was to examine the quality of life of patients with vestibular schwannoma having undergone observation, radiation therapy, or microsurgical resection. The second aim was to examine the relationship between perceived symptoms and quality of life. Last, the association between quality of life and time since treatment was studied. Study Design Cross-sectional study. Setting Tertiary referral center. Subjects and Methods A total of 1208 patients treated for sporadic vestibular schwannoma between 2004 and 2014 were mailed the disease-specific Penn Acoustic Neuroma Quality of Life (PANQOL) questionnaire and additional questions on symptoms associated with vestibular schwannoma. Total and domain scores were calculated and compared among treatment groups. Propensity scores were used, and results were stratified according to tumor size to control for potential confounders. Correlations were calculated to examine the relationship between self-reported symptoms and quality of life, as well as between quality of life and time since treatment. Results Patients with small tumors (≤10 mm) under observation showed a higher PANQOL score when compared with the radiation therapy and microsurgical resection groups. A strong negative correlation was found between self-reported symptoms and quality of life, with balance problems and vertigo having the largest impact. No correlation was found between PANQOL score and time since treatment. Conclusion This study suggests that patients with small vestibular schwannomas experience better quality of life when managed with observation than do patients who have undergone active treatment.

  19. Interactive wiimote gaze stabilization exercise training system for patients with vestibular hypofunction.

    Science.gov (United States)

    Chen, Po-Yin; Hsieh, Wan-Ling; Wei, Shun-Hwa; Kao, Chung-Lan

    2012-10-09

    Peripheral vestibular hypofunction is a major cause of dizziness. When complicated with postural imbalance, this condition can lead to an increased incidence of falls. In traditional clinical practice, gaze stabilization exercise is commonly used to rehabilitate patients. In this study, we established a computer-aided vestibular rehabilitation system by coupling infrared LEDs to an infrared receiver. This system enabled the subjects' head-turning actions to be quantified, and the training was performed using vestibular exercise combined with computer games and interactive video games that simulate daily life activities. Three unilateral and one bilateral vestibular hypofunction patients volunteered to participate in this study. The participants received 30 minutes of computer-aided vestibular rehabilitation training 2 days per week for 6 weeks. Pre-training and post-training assessments were completed, and a follow-up assessment was completed 1 month after the end of the training period. After 6 weeks of training, significant improvements in balance and dynamic visual acuity (DVA) were observed in the four participants. Self-reports of dizziness, anxiety and depressed mood all decreased significantly. Significant improvements in self-confidence and physical performance were also observed. The effectiveness of this training was maintained for at least 1 month after the end of the training period. Real-time monitoring of training performance can be achieved using this rehabilitation platform. Patients demonstrated a reduction in dizziness symptoms after 6 weeks of training with this short-term interactive game approach. This treatment paradigm also improved the patients' balance function. This system could provide a convenient, safe and affordable treatment option for clinical practitioners.

  20. A systematic review of patient-reported measures associated with vestibular dysfunction.

    Science.gov (United States)

    Stewart, Vicky M; Mendis, M Dilani; Low Choy, Nancy

    2017-05-23

    Use of clinical questionnaires to assist in the screening of vestibular disorders in the acute hospital setting is needed. The objective is to detail the clinimetric properties and clinical utility of patient-reported questionnaires for quantifying dizziness/vertigo symptoms associated with vestibular dysfunction, and to determine validity and utility for screening dizziness/vertigo in the emergency department. We performed a systematic review of PubMed, CINAHL, Embase, and Web of Science in May 2015. Two independent reviewers selected studies reporting clinimetric properties of patient-reported questionnaires that aim to evaluate symptomology of dizziness/vertigo associated with vestibular dysfunction. A third reviewer resolved disparities. Of 1,901 articles initially found in the database search, 58 articles and 9 patient-reported questionnaires were included. Clinimetric properties of content validity, criterion validity, internal consistency, inter-/intrarater reliability, test-retest reliability, and responsiveness to vestibular rehabilitation are reported, and methodological quality is rated using the COSMIN (Consensus-based Standards for the selection of health Measurement Instruments) checklist. Clinical utility is described in terms of target population, purpose, number of items, and whether the questionnaire was validated in the emergency department. The Vestibular Rehabilitation Benefit Questionnaire, a relatively new tool, scored an "excellent" rating on three COSMIN criteria, and may be the best measure to address treatment outcomes. Questions on respective tools ranged from nine to 36, and no questionnaire was validated in the emergency department. Due to the number of questions and lack of validity, none of the questionnaires was deemed appropriate as a screening tool for dizziness/vertigo in the emergency department. Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  1. Balance rehabilitation by moving platform and exercises in patients with neuropathy or vestibular deficit.

    Science.gov (United States)

    Nardone, Antonio; Godi, Marco; Artuso, Alessia; Schieppati, Marco

    2010-12-01

    To assess the efficacy of a balance rehabilitation treatment by using both a powered platform on which subjects stand and specific physical exercises (EXs). Crossover trial. Physical and rehabilitation medicine department in Italy. Patients (N=33) with balance disorders (14 vestibular origin, 19 peripheral neuropathy origin). Patients underwent powered platform then EX treatment (n=17); the other 16 received the same treatments in reverse order. powered platform consisted of balancing on a sinusoidally oscillating powered platform (in anteroposterior and laterolateral directions in separate trials) with eyes open and closed. A physical therapist administered Cawthorne-Cooksey EXs for patients with vestibular disorders and modified Frenkel EXs for patients with neuropathy. Treatment lasted 1 hour a day for 10 consecutive days, except for the weekend. Body sway area, subjective score of stability, balance and gait scores, and amplitude of head displacement while balancing on the oscillating powered platform were recorded before, (t0) after the first (t1), and after the second treatment (t2), regardless of the powered platform or EX order. On average, all participants improved balance regardless of the order of treatments, and more so at t2 than t1. Improvement was observed by using instrumental evaluations and balance and gait scales. In both patient groups, powered platform treatment proved to be as effective as EX in improving balance. This effect was stronger in patients with vestibular disorders, independently of order of treatment. Balance rehabilitation with either EX or powered platform is effective in patients with balance disorders of vestibular or neuropathic origin. These findings point to the value of either or both physical EXs and powered platform in increasing stability and potentially decrease the risk of falling in patients with neuropathy, for whom few results are documented in the literature. Copyright © 2010 American Congress of Rehabilitation

  2. Quality of life after gamma knife radiosurgery treatment in patients with a vestibular schwannoma: the patient's perspective.

    NARCIS (Netherlands)

    Timmer, F.C.A.; Haren, A.E. van; Mulder, J.J.S.; Hanssens, P.E.; Overbeeke, J.J. van; Cremers, C.W.R.J.; Graamans, K.

    2010-01-01

    This study evaluates the impact of gamma knife radiosurgery (GKRS) on the quality of life (QOL) of patients with a sporadic vestibular schwannoma (VS). This study pertains to 108 VS patients who had GKRS in the years 2003 through 2007. Two different QOL questionnaires were used: medical outcome

  3. Interaction between vestibular compensation mechanisms and vestibular rehabilitation therapy: ten recommendations for optimal functional recovery

    Directory of Open Access Journals (Sweden)

    LACOUR eMichel

    2015-01-01

    Full Text Available This review questions the relationships between the plastic events responsible for the recovery of vestibular function after a unilateral vestibular loss (vestibular compensation, which has been well described in animal models in the last decades, and the vestibular rehabilitation (VR therapy elaborated on a more empirical basis for vestibular loss patients. The main objective is not to propose a catalogue of results but to provide clinicians with an understandable view on when and how to perform VR therapy, and why VR may benefit from basic knowledge and may influence the recovery process. With this perspective, 10 major recommendations are proposed as ways to identify an optimal functional recovery. Among them are the crucial role of active and early VR therapy, coincidental with a post-lesion sensitive period for neuronal network remodelling, the instructive role that VR therapy may play in this functional reorganisation, the need for progression in the VR therapy protocol, which is based mainly on adaptation processes, the necessity to take into account the sensorimotor, cognitive and emotional profile of the patient to propose individual or à la carte VR therapies, and the importance of motivational and ecologic contexts. More than 10 general principles are very likely, but these principles seem crucial for the fast recovery of vestibular loss patients to ensure good quality of life.

  4. Interaction between Vestibular Compensation Mechanisms and Vestibular Rehabilitation Therapy: 10 Recommendations for Optimal Functional Recovery.

    Science.gov (United States)

    Lacour, Michel; Bernard-Demanze, Laurence

    2014-01-01

    This review questions the relationships between the plastic events responsible for the recovery of vestibular function after a unilateral vestibular loss (vestibular compensation), which has been well described in animal models in the last decades, and the vestibular rehabilitation (VR) therapy elaborated on a more empirical basis for vestibular loss patients. The main objective is not to propose a catalog of results but to provide clinicians with an understandable view on when and how to perform VR therapy, and why VR may benefit from basic knowledge and may influence the recovery process. With this perspective, 10 major recommendations are proposed as ways to identify an optimal functional recovery. Among them are the crucial role of active and early VR therapy, coincidental with a post-lesion sensitive period for neuronal network remodeling, the instructive role that VR therapy may play in this functional reorganization, the need for progression in the VR therapy protocol, which is based mainly on adaptation processes, the necessity to take into account the sensorimotor, cognitive, and emotional profile of the patient to propose individual or "à la carte" VR therapies, and the importance of motivational and ecologic contexts. More than 10 general principles are very likely, but these principles seem crucial for the fast recovery of vestibular loss patients to ensure good quality of life.

  5. Hearing outcomes of vestibular schwannoma patients managed with 'wait and scan': predictive value of hearing level at diagnosis

    DEFF Research Database (Denmark)

    Stangerup, S-E; Tos, M; Thomsen, J

    2010-01-01

    This study aimed to evaluate the predictive value of both hearing level (at various frequencies) and speech discrimination for forecasting hearing outcome after a period of observation, in patients with vestibular schwannoma.......This study aimed to evaluate the predictive value of both hearing level (at various frequencies) and speech discrimination for forecasting hearing outcome after a period of observation, in patients with vestibular schwannoma....

  6. Molecular aging of the mammalian vestibular system.

    Science.gov (United States)

    Brosel, Sonja; Laub, Christoph; Averdam, Anne; Bender, Andreas; Elstner, Matthias

    2016-03-01

    Dizziness and imbalance frequently affect the elderly and contribute to falls and frailty. In many geriatric patients, clinical testing uncovers a dysfunction of the vestibular system, but no specific etiology can be identified. Neuropathological studies have demonstrated age-related degeneration of peripheral and central vestibular neurons, but the molecular mechanisms are poorly understood. In contrast, recent studies into age-related hearing loss strongly implicate mitochondrial dysfunction, oxidative stress and apoptotic cell death of cochlear hair cells. While some data suggest that analogous biological pathomechanisms may underlie vestibular dysfunction, actual proof is missing. In this review, we summarize the available data on the molecular causes of vestibular dysfunction. Copyright © 2016 Elsevier B.V. All rights reserved.

  7. Drug therapy for peripheral vestibular vertigo

    Directory of Open Access Journals (Sweden)

    L. M. Antonenko

    2017-01-01

    Full Text Available The choice of effective treatments for vestibular vertigo is one of the important problems, by taking into account the high prevalence of peripheral vestibular diseases. Different drugs, such as vestibular suppressants for the relief of acute vertigo attacks and vestibular compensation stimulants for rehabilitation treatment, are used to treat vestibular vertigo. Drug therapy in combination with vestibular exercises is effective in patients with vestibular neuronitis, Meniere's disease, so is that with therapeutic maneuvers in patients with benign paroxysmal positional vertigo. The high therapeutic efficacy and safety of betahistines permit their extensive use for the treatment of various vestibular disorders.

  8. Assessing Readability and Reliability of Online Patient Information Regarding Vestibular Schwannoma.

    Science.gov (United States)

    Spiers, Harry; Amin, Nikul; Lakhani, Raj; Martin, Andrew J; Patel, Parag M

    2017-12-01

    The aim of this study is to objectively assess the quality and readability of websites related to vestibular schwannomas. Patients are increasingly seeking information on confirmed or suspected diagnoses through the Internet. Clinicians are often concerned regarding the accuracy, quality, and readability of web-based sites. Online information relating to vestibular schwannoma was searched using the three most popular search engines. The terms "acoustic neuroma" and "vestibular schwannoma" were used. The top 50 results from each site were assessed for readability using the Flesch-Kincaid Grade Level, Flesch Reading Ease Score, and the Gunning-Fog Index. Quality of website information was scored using the DISCERN tool. Of 300 search results analyzed, 58 separate appropriate websites were identified. The mean readability score using Flesch-Kincaid Grade Level was 10.27 (95% confidence interval [CI] 9.84-10.70). The mean Flesch Reading Ease Score was 48.75 (95% CI 46.57-50.92). The Gunning-Fog Index was 13.40 (95% CI 12.92-13.89). These scores equate to someone finishing secondary school/first year university student. DISCERN scores were highly variable but consistently demonstrated great variability in quality of information. Online patient information on vestibular schwannoma is highly variable in quality. Although there are a wide range of different websites easily available to patients on their condition and its treatment options, the information is written at a difficult level which may exceed the understanding level of many patients as it is written at a higher than average level of expected reading ability.

  9. Stereotactic radiosurgery vs. fractionated radiotherapy for tumor control in vestibular schwannoma patients: a systematic review.

    Science.gov (United States)

    Persson, Oscar; Bartek, Jiri; Shalom, Netanel Ben; Wangerid, Theresa; Jakola, Asgeir Store; Förander, Petter

    2017-06-01

    Repeated controlled studies have revealed that stereotactic radiosurgery is better than microsurgery for patients with vestibular schwannoma (VS) stereotactic radiosurgery (SRS) to fractionated stereotactic radiotherapy (FSRT) for patients with VS. We systematically searched MEDLINE, Web of Science, Embase and Cochrane and screened relevant articles for references. Publications from 1995 through 2014 with a minimum of 50 adult (>18 years) patients with unilateral VS, followed for a median of >5 years, were eligible for inclusion. After screening titles and abstracts of the 1094 identified articles and systematically reviewing 98 of these articles, 19 were included. Patients with unilateral VS treated with radiosurgery were compared to patients treated with fractionated stereotactic radiotherapy. No randomized controlled trial (RCT) was identified. None of the identified controlled studies comparing SRS with FSRT were eligible according to the inclusion criteria. Nineteen case series on SRS (n = 17) and FSRT (n = 2) were included in the systematic review. Loss of tumor control necessitating a new VS-targeted intervention was found in an average of 5.0% of the patients treated with SRS and in 4.8% treated with FSRT. Mean deterioration ratio for patients with serviceable hearing before treatment was 49% for SRS and 45% for FSRT, respectively. The risk for facial nerve deterioration was 3.6% for SRS and 11.2% for FSRT and for trigeminal nerve deterioration 6.0% for SRS and 8.4% for FSRT. Since these results were obtained from case series, a regular meta-analysis was not attempted. SRS and FSRT are both noninvasive treatment alternatives for patients with VS with low rates of treatment failure in need of rescue therapy. In this selection of patients, the progression-free survival rates were on the order of 92-100% for both treatment options. There is a lack of high-quality studies comparing radiation therapy alternatives for patients with VS. Finally, 19 articles

  10. Correlations between postural control and psychological factors in vestibular schwannoma patients.

    Science.gov (United States)

    Ribeyre, Laurence; Spitz, Elisabeth; Frère, Julien; Gauchard, Gerome; Parietti-Winkler, Cécile

    2016-11-03

    Various individual factors have been described to influence postural performances related to vestibular schwannoma. However, psychological factors may also be involved in postural variations. To identify relationships between postural performances, illness perceptions, coping, anxiety-depression and quality of life of patients with vestibular schwannoma. Twenty-six patients who were scheduled for a surgical removal of a vestibular schwannoma underwent posturography tests and were asked to complete psychological questionnaires three days prior to surgery.The Sensory Organization Test, the Illness Perceptions Questionnaire-Revised, the Brief-COPE, the Hospital Anxiety Depression Scale and the World Health Organization Quality of Life instrument were used for assessments. Correlations between posturography and psychological questionnaires were calculated. Balance disorders were associated with (i) impaired quality of life of patients, (ii) anxiety and depression affects, (iii) greater daily consequences, and with (iv) denial coping response. Given the association between balance disorders and psychological factors, health practitioners should be attentive to the deterioration of both aforementioned issues.

  11. Vestibulary rehabilitation--election treatment method for compensating vestibular impairment.

    Science.gov (United States)

    Georgescu, Mădălina; Stoian, Sorina; Mogoantă, Carmen Aurelia; Ciubotaru, Gh V

    2012-01-01

    This paper aims to reveal the actual benefit of vestibular rehabilitation (VR) in patients with unilateral vestibular loss. Case report of a young female patient with acute unilateral vestibular loss due to facial nerve schwannoma developed above the internal auditory canal (IAC) from where it seems to have entered the IAC. Betahistine associated to VR treatment was recommended due to persisting imbalance after tumor removal. The benefit of the combined therapy was evaluated objectively (sensory organization test) and subjectively (questionnaires regarding self-perception of the deficit in quality of life). Both evaluations revealed great improvement in stability (SOT scores) as well as in health-related quality of life (HRQoL)--improvement of self-perception scores of disequilibrium in all questionnaires used. Combined recommended treatment (betahistine and VR) improves HRQoL after acute unilateral vestibular loss. It reduces self-perceived disability and intensity of symptoms during usual activities.

  12. RECORDING OF VESTIBULAR EVOKED MYOGENIC POTENTIALS

    Directory of Open Access Journals (Sweden)

    A. A. Sazgar

    2006-05-01

    Full Text Available It has been shown recently that loud clicks evoke myogenic potentials in the tonically contracting sternocleidomastoid muscles. Studies have suggested that these potentials are of vestibular origin, especially of the saccule and inferior vestibular nerve. A pilot study was undertaken in our hospital to record vestibular evoked myogenic potentials (VEMP for the first time in Iran. Eighteen healthy volunteers (32 ears without history of otologic or vestibular disorders were subjected to the VEMP test. Twenty-one patients (26 ears with unilateral (6 patients and bilateral (5 patients high frequency sensorineural hearing loss with unknown etiology, acoustic neuroma (1 patient, Meniere’s disease (4 patients and unilateral low frequency sensorineural hearing loss without vestibular complaint (5 patients were also enrolled in this study. VEMP response to clicks was obtained from 84.4% of ears of healthy subjects. These subjects demonstrated short latency waves to click stimuli during tonic neck flexor activation. Mean latencies of first positive (p13 and first negative (n23 potentials in healthy subjects were 12.45 ± 1.9 ms and 20.8 ± 3.5 ms, respectively. Median latencies of these two potentials were 12.1 and 19.3 ms, respectively. We could record VEMP in 5 patients with unilateral and all patients with high and low frequency sensorineural hearing loss without vestibular complaint. In the patient with acoustic neuroma VEMP was absent on the affected side. This technique may offer a new method to evaluate otolith and sacculocollic pathways in human.

  13. Effect of Carbon Dioxide Laser on Increasing Vestibular Depth in Cleft Lip and Palate Patients.

    Science.gov (United States)

    Yassaei, Sogra; Aghili, Hossein; Azam, Alireza Navab; Moghadam, Mahjobeh Gholdani; Safari, Isa

    2017-09-01

    Shallow upper buccal sulcus deformity in cleft lip and palate patients is one of the common secondary deformities after primary cleft lip and palate repair; this deformity may prevent or complicate orthodontic and prosthodontic procedures causing aesthetic and functional problems. A number of methods are described to increase the anterior maxillary sulcus in these patients. This study assessed the use of a carbon dioxide laser (CO2) to increase the sulcus depth. Fifteen patients with cleft lip and palate (eight unilateral and seven bilateral) were studied. The surgical procedure was performed using CO2 laser. The vestibular depth and lip length were measured at three time points namely before surgery (T0), 1 week following surgery (T1), and 4 months following surgery (T2). After data collection, statistical analyses were done using PASW(®) version 18 SPSS. The mean values of vestibular depth were 9.46 ± 1.92, 13.83 ± 1.88, and 13.23 ± 1.76 mm for T0, T1, and T2, respectively. The vestibular depth significantly increased after 4 months of follow-up (p = 0.001). The mean amount of vestibular depth gain was not significantly different in unilateral and bilateral cleft groups (p = 0.908). The mean value of upper lip length increased by a mean of 1.23 mm and was statistically significant (p = 0.001). Upper buccal sulcus reconstruction with CO2 laser provides successful and stable results. CO2 laser application is suggested as an alternative to conventional vestibuloplasty.

  14. [Mutation analysis and prenatal diagnosis for 12 families affected with hereditary hearing loss and enlarged vestibular aqueduct].

    Science.gov (United States)

    Xiang, Yanbao; Li, Huanzheng; Xu, Xueqin; Xu, Chenyang; Chen, Chong; Lin, Xiaoling; Tang, Shaohua

    2017-06-10

    To carry out mutation analysis and prenatal diagnosis for 12 families affected with hearing loss and enlarged vestibular aqueduct from southern Zhejiang province. Clinical data and peripheral venous blood samples of 38 members from the 12 families were obtained. Mutations of 4 genes, namely SLC26A4, GJB2, c.538C to T and c.547G to A of GJB3, m.1555A to G and m.1494C to T of 12S rRNA, were detected by PCR and Sanger sequencing. Maternal contamination was excluded by application of STR detection during prenatal diagnosis. Among the probands from the 12 families, 11 were found to be compound heterozygotes or homozygotes and 25 were heterozygotes. All of the families were detected with IVS7-2A to G mutations, and 4 had a second heterozygous mutation (c.2168A to G of the SLC26A4 gene). Four rare pathogenic mutations, namely IVS5-1G to A, c.946G to T, c.1607A to G and c.2167C to G, were detected in another four families. In addition, the partner of proband from pedigree 3 was identified with compound heterozygous mutations of c.235delC and c.299-300delAT, and proband of pedigree 5 has carried a mutation of c.109G to A in GJB2. For SLC26A4 gene, prenatal diagnostic testing has revealed heterozygous mutations in 6 fetuses and compound heterozygous mutations in 2 fetuses. IVS7-2A to G and c.2168A to G of the SLC26A4 gene were the most common mutations in southern Zhejiang. Such mutations can be found in most families affected with hearing loss and enlarged vestibular aqueduct, which may facilitate genetic counseling and prenatal diagnosis for such families.

  15. Partial Aminoglycoside Lesions in Vestibular Epithelia Reveal Broad Sensory Dysfunction Associated with Modest Hair Cell Loss and Afferent Calyx Retraction.

    Science.gov (United States)

    Sultemeier, David R; Hoffman, Larry F

    2017-01-01

    Although the effects of aminoglycoside antibiotics on hair cells have been investigated for decades, their influences on the dendrites of primary afferent neurons have not been widely studied. This is undoubtedly due to the difficulty in disassociating pathology to dendritic processes from that resulting from loss of the presynaptic hair cell. This was overcome in the present investigation through development of a preparation using Chinchilla laniger that enabled direct perilymphatic infusion. Through this strategy we unmasked gentamicin's potential effects on afferent calyces. The pathophysiology of the vestibular neuroepithelia after post-administration durations of 0.5 through 6 months was assessed using single-neuron electrophysiology, immunohistochemistry, and confocal microscopy. Hair cell densities within cristae central zones (0.5-, 1-, 2-, and 6-months) and utricle peri- and extrastriola (6-months) regions were determined, and damage to calretinin-immunoreactive calyces was quantified. Gentamicin-induced hair cell loss exhibited a profile that reflected elimination of a most-sensitive group by 0.5-months post-administration (18.2%), followed by loss of a second group (20.6%) over the subsequent 5.5 months. The total hair cell loss with this gentamicin dose (approximately 38.8%) was less than the estimated fraction of type I hair cells in the chinchilla's crista central zone (approximately 60%), indicating that viable type I hair cells remained. Extensive lesions to afferent calyces were observed at 0.5-months, though stimulus-evoked modulation was intact at this post-administration time. Widespread compromise to calyx morphology and severe attenuation of stimulus-evoked afferent discharge modulation was found at 1 month post-administration, a condition that persisted in preparations examined through the 6-month post-administration interval. Spontaneous discharge was robust at all post-administration intervals. All calretinin-positive calyces had retracted

  16. Partial Aminoglycoside Lesions in Vestibular Epithelia Reveal Broad Sensory Dysfunction Associated with Modest Hair Cell Loss and Afferent Calyx Retraction

    Science.gov (United States)

    Sultemeier, David R.; Hoffman, Larry F.

    2017-01-01

    Although the effects of aminoglycoside antibiotics on hair cells have been investigated for decades, their influences on the dendrites of primary afferent neurons have not been widely studied. This is undoubtedly due to the difficulty in disassociating pathology to dendritic processes from that resulting from loss of the presynaptic hair cell. This was overcome in the present investigation through development of a preparation using Chinchilla laniger that enabled direct perilymphatic infusion. Through this strategy we unmasked gentamicin’s potential effects on afferent calyces. The pathophysiology of the vestibular neuroepithelia after post-administration durations of 0.5 through 6 months was assessed using single-neuron electrophysiology, immunohistochemistry, and confocal microscopy. Hair cell densities within cristae central zones (0.5-, 1-, 2-, and 6-months) and utricle peri- and extrastriola (6-months) regions were determined, and damage to calretinin-immunoreactive calyces was quantified. Gentamicin-induced hair cell loss exhibited a profile that reflected elimination of a most-sensitive group by 0.5-months post-administration (18.2%), followed by loss of a second group (20.6%) over the subsequent 5.5 months. The total hair cell loss with this gentamicin dose (approximately 38.8%) was less than the estimated fraction of type I hair cells in the chinchilla’s crista central zone (approximately 60%), indicating that viable type I hair cells remained. Extensive lesions to afferent calyces were observed at 0.5-months, though stimulus-evoked modulation was intact at this post-administration time. Widespread compromise to calyx morphology and severe attenuation of stimulus-evoked afferent discharge modulation was found at 1 month post-administration, a condition that persisted in preparations examined through the 6-month post-administration interval. Spontaneous discharge was robust at all post-administration intervals. All calretinin-positive calyces had

  17. The effect of virtual reality on visual vertigo symptoms in patients with peripheral vestibular dysfunction: a pilot study

    OpenAIRE

    Pavlou, M.; Kanegaonkar, R. G.; Swapp, D.; Bamiou, D. E.; Slater, Mel; Luxon. L. M.

    2012-01-01

    Individuals with vestibular dysfunction may experience visual vertigo (VV), in which symptoms are provoked or exacerbated by excessive or disorientating visual stimuli (e.g. supermarkets). VV can significantly improve when customized vestibular rehabilitation exercises are combined with exposure to optokinetic stimuli. Virtual reality (VR), which immerses patients in realistic, visually challenging environments, has also been suggested as an adjunct to VR to improve VV symptoms. This pilot st...

  18. [Clinical value of dynamic posturography in the evaluation and rehabilitation of vestibular function of patients with benign paroxysmal positional vertigo].

    Science.gov (United States)

    Zhang, Dao-gong; Fan, Zhao-min; Han, Yue-chen; Yu, Gang; Wang, Hai-bo

    2010-09-01

    To explore the clinical value of dynamic posturography in the evaluation and rehabilitation of vestibular function of patients with benign paroxysmal positional vertigo (BPPV). A total of 48 patients with BPPV of posterior semicircular canal in vertigo clinic of our hospital from May 2007 to December 2008 were retrospectively analyzed in this study. All patients underwent the inspection of caloric test, static posturography, and dynamic posturography. The vestibular tests were performed at two different time points: at onset when patients had typical nystagmus provoked by the Dix-Hallpike maneuver before treatment with the Epley maneuver (canalith repositioning maneuver, CRM), and at one week after treatment with CRM as their nystagmus disappeared. And results at theses two time points were compared. Eight patients whose dynamic balances were still abnormal after CRM accepted vestibular rehabilitation exercise using dynamic posturography, and re-examined 3 weeks later with dynamic posturography. Among 48 cases of BPPV, the abnormal rates of caloric test, static posturography, and dynamic posturography before CRM were 25.0%, 33.3% and 70.8%, respectively. The abnormal rate of dynamic posturography was much higher than that of caloric test or static posturography, and the differences were statistically significant (χ² = 4.84, 7.88; P 0.05). Eight patients whose dynamic balances were still abnormal after CRM, accepted vestibular rehabilitation exercise lasting 3 weeks using dynamic posturography. The dynamic balances were all improved to normal after vestibular rehabilitation. Dynamic posturography can quantitatively analyze postural balance, and is helpful in comprehensive evaluation of the vestibular function of BPPV patients. Impaired balance often presents in patients with BPPV. Treatment of BPPV using the canalith repositioning maneuver results in improved postural stability in static and dynamic posturography. However, not all patients have normal dynamic

  19. Recent Evidence About the Effectiveness of Vestibular Rehabilitation.

    Science.gov (United States)

    Whitney, Susan L; Alghadir, Ahmad H; Anwer, Shahnawaz

    2016-03-01

    Vestibular rehabilitation of persons with peripheral and central vestibular disorders requires a thorough evaluation and a customized plan of care. Collaboration of the various members of the treatment team optimizes outcomes. Early intervention appears to be better than referring patients who have developed chronic symptoms of balance loss, dizziness, anxiety, and depression. There is a body of emerging evidence that supports that the central nervous system has the capability to reweigh sensory inputs in order to improve function. There continues to be a dearth of knowledge related to how to treat persons with otolithic dysfunction as compared to those with semicircular canal damage. With the use of vestibular rehabilitation, patients are less likely to fall, are less dizzy, balance and gait improve, and quality of life is enhanced. Recent Cochrane reviews and a clinical practice guideline support the use of vestibular rehabilitation for persons with vestibular dysfunction. Typical symptoms and their management including dysregulated gait, falling, fear of falling, increased sway in standing, visual blurring, symptoms with complex visual scenes in the periphery, and weakness are all discussed with ideas for intervention. Any patient with a vestibular disorder may benefit from a trial of vestibular rehabilitation. A discussion of recent evidence and innovations related to vestibular rehabilitation is also included.

  20. Reabilitação vestibular em pacientes com esclerose múltipla remitente-recorrente Vestibular rehabilitation in patients with relapsing- remitting multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Karina Pavan

    2007-06-01

    Full Text Available A esclerose múltipla (EM é doença desmielinizante, inflamatória, que acomete a substância branca do sistema nervoso central, e sensações vestibulares anormais (vertigem, desequilíbrio são freqüentes. A reabilitação vestibular (RV é determinada por mecanismos de adaptações, substituições e compensações neurais. Este estudo avaliou a melhora da vertigem central ou periférica em pacientes com EM remitente-recorrente submetidos à RV (exercícios de Cawthorne-Cooksey, através da escala de Berg e Dizziness Handicap Inventory (DHI. Nesta amostra de 4 casos a RV, realizada em um período de 2 meses, demonstrou a melhora em 3 pacientes avaliados pela escala de Berg e em 2 pacientes quando avaliados pela DHI.Multiple sclerosis (MS is a demyelinating, inflammatory illness, that attack the white matter of the central nervous system, and abnormal vestibular sensations (vertigo, disequilibrium are frequent. The vestibular rehabilitation (VR is determined by mechanisms of adaptations, neural substitutions and compensations. This study evaluated the improvement of the central or peripheral vertigo in patients with relapsing-remitting MS submitted to the VR (exercises of Cawthorne-Cooksey, through the scale of Berg and Dizziness Handicap Inventory (DHI. In this sample of 4 cases the VR, carried through in a period of 2 months, demonstrated the improvement in 3 patients according to the Berg scale and in 2 patients considering that of the DHI.

  1. Electronystagmographic changes in patients with unilateral vestibular schwannomas in relation to tumor progression and central compensation.

    Science.gov (United States)

    Stipkovits, E M; Van Dijk, J E; Graamans, K

    1999-01-01

    Vestibular function was studied in a group of 121 patients with unilateral vestibular schwannomas who were referred to University Hospital Utrecht between 1986 and 1996. Testing included the caloric test, torsion test, saccade test, smooth pursuit test and the registration of spontaneous nystagmus. Each patient's symptoms were taken from a chart review. The size of the tumor was expressed as the maximum extrameatal diameter in the axial plane parallel to the petrous ridge as seen in magnetic resonance imaging or computed tomography. Large tumors were significantly more often accompanied by a more severe paresis on caloric testing, a smaller gain on torsion testing, spontaneous nystagmus, an abnormal saccade test and an abnormal smooth pursuit test. The presence of spontaneous nystagmus was significantly more frequently combined with an abnormal smooth pursuit and saccade test. There was a significant correlation between the slow component's velocity of the spontaneous nystagmus and the size and progression of tumor. However, a specific relation between tumor size and central vestibular compensation could not be demonstrated.

  2. SLC26A4 genotype, but not cochlear radiologic structure, is correlated with hearing loss in ears with an enlarged vestibular aqueduct.

    Science.gov (United States)

    King, Kelly A; Choi, Byung Yoon; Zalewski, Christopher; Madeo, Anne C; Manichaikul, Ani; Pryor, Shannon P; Ferruggiaro, Anne; Eisenman, David; Kim, H Jeffrey; Niparko, John; Thomsen, James; Butman, John A; Griffith, Andrew J; Brewer, Carmen C

    2010-02-01

    Identify correlations among SLC26A4 genotype, cochlear structural anomalies, and hearing loss associated with enlargement of the vestibular aqueduct (EVA). Prospective cohort survey, National Institutes of Health, Clinical Center, a federal biomedical research facility. Eighty-three individuals, 11 months to 59 years of age, with EVA in at least one ear were studied. Correlations among pure-tone hearing thresholds, number of mutant SLC26A4 alleles, and the presence of cochlear anomalies detected by computed tomography or magnetic resonance imaging were examined. Linear mixed-effects model indicated significantly poorer hearing in ears with EVA in individuals with two mutant alleles of SLC26A4 than in those with EVA and a single mutant allele (P = .012) or no mutant alleles (P = .007) in this gene. There was no detectable relationship between degree of hearing loss and the presence of structural cochlear anomalies. The number of mutant alleles of SLC26A4, but not the presence of cochlear anomalies, has a significant association with severity of hearing loss in ears with EVA. This information will be useful for prognostic counseling of patients and families with EVA.

  3. Vestibular migraine

    DEFF Research Database (Denmark)

    Lempert, Thomas; Olesen, Jes; Furman, Joseph

    2012-01-01

    This paper presents diagnostic criteria for vestibular migraine, jointly formulated by the Committee for Classification of Vestibular Disorders of the Bárány Society and the Migraine Classification Subcommittee of the International Headache Society (IHS). The classification includes vestibular...... migraine and probable vestibular migraine. Vestibular migraine will appear in an appendix of the third edition of the International Classification of Headache Disorders (ICHD) as a first step for new entities, in accordance with the usual IHS procedures. Probable vestibular migraine may be included...... in a later version of the ICHD, when further evidence has been accumulated. The diagnosis of vestibular migraine is based on recurrent vestibular symptoms, a history of migraine, a temporal association between vestibular symptoms and migraine symptoms and exclusion of other causes of vestibular symptoms...

  4. Vestibular rehabilitation with visual stimuli in peripheral vestibular disorders

    OpenAIRE

    Manso, Andréa; Ganança, Mauricio Malavasi; Caovilla, Heloisa Helena

    2016-01-01

    ABSTRACT INTRODUCTION: Visual stimuli can induce vestibular adaptation and recovery of body balance. OBJECTIVE: To verify the effect of visual stimuli by digital images on vestibular and body balance rehabilitation of peripheral vestibular disorders. METHODS: Clinical, randomized, prospective study. Forty patients aged between 23 and 63 years with chronic peripheral vestibular disorders underwent 12 sessions of rehabilitation with visual stimuli using digital video disk (DVD) (experimental...

  5. Mutations of KCNJ10 together with mutations of SLC26A4 cause digenic nonsyndromic hearing loss associated with enlarged vestibular aqueduct syndrome.

    Science.gov (United States)

    Yang, Tao; Gurrola, Jose G; Wu, Hao; Chiu, Sui M; Wangemann, Philine; Snyder, Peter M; Smith, Richard J H

    2009-05-01

    Mutations in SLC26A4 cause nonsyndromic hearing loss associated with an enlarged vestibular aqueduct (EVA, also known as DFNB4) and Pendred syndrome (PS), the most common type of autosomal-recessive syndromic deafness. In many patients with an EVA/PS phenotype, mutation screening of SLC26A4 fails to identify two disease-causing allele variants. That a sizable fraction of patients carry only one SLC26A4 mutation suggests that EVA/PS is a complex disease involving other genetic factors. Here, we show that mutations in the inwardly rectifying K(+) channel gene KCNJ10 are associated with nonsyndromic hearing loss in carriers of SLC26A4 mutations with an EVA/PS phenotype. In probands from two families, we identified double heterozygosity in affected individuals. These persons carried single mutations in both SLC26A4 and KCNJ10. The identified SLC26A4 mutations have been previously implicated in EVA/PS, and the KCNJ10 mutations reduce K(+) conductance activity, which is critical for generating and maintaining the endocochlear potential. In addition, we show that haploinsufficiency of Slc26a4 in the Slc26a4(+/-) mouse mutant results in reduced protein expression of Kcnj10 in the stria vascularis of the inner ear. Our results link KCNJ10 mutations with EVA/PS and provide further support for the model of EVA/PS as a multigenic complex disease.

  6. Characterizing Patients with Unilateral Vestibular Hypofunction Using Kinematic Variability and Local Dynamic Stability during Treadmill Walking

    Directory of Open Access Journals (Sweden)

    Peng Liu

    2017-01-01

    Full Text Available Here, we aimed to compare the unstable gait caused by unilateral vestibular hypofunction (UVH with the normal gait. Twelve patients with UVH and twelve age-matched control subjects were enrolled in the study. Thirty-four markers were attached to anatomical positions of each participant, and a three-dimensional (3D motion analysis system was used to capture marker coordinates as the participants walked on a treadmill. The mean standard deviation of the rotation angles was used to represent gait variability. To explore gait stability, local dynamic stability was calculated from the trunk trajectory. The UVH group had wider step width and greater variability of roll rotation at the hip than the control group (P<0.05. Also, the UVH group had lower local dynamic stability in the medial-lateral (ML direction than the control group (P<0.05. By linear regression analysis, we identified a linear relationship between the short-term Lyapunov exponent and vestibular functional asymmetry. The result implies that UVH-induced asymmetry can increase posture variability and gait instability. This study demonstrates the potential for using kinematic parameters to quantitatively evaluate the severity of vestibular functional asymmetry. Further studies will be needed to explore the clinical effectiveness of such approaches.

  7. Combined endoscopic-microscopic approach for vestibular schwannoma removal: outcomes in a cohort of 81 patients.

    Science.gov (United States)

    Presutti, L; Magnaguagno, F; Pavesi, G; Cunsolo, E; Pinna, G; Alicandri-Ciufelli, M; Marchioni, D; Prontera, A; Gioacchini, F M

    2014-12-01

    Patients affected by vestibular schwannomas typically report a number of symptoms and minor disabilities after surgery. Therefore, surgeons dealing with this pathology should also try to achieve a good QoL for patients who have undergone tumour removal. The aim of this study was to analyse QoL in subjects undergoing surgery for vestibular schwannomas and to try to establish a relationship with both the tumour size and post-surgical alterations (e.g. facial motor dysfunctions, difficulties in balance, persistence of headache and tinnitus). A retrospective analysis was performed on a consecutive series of 81 patients affected by vestibular schwannomas and treated by a combined microscopic-endoscopic approach. Three groups of patients were identified on the basis of tumour size. Group 1 (lesions 26 mm and 41 mm) with 11 patients (14%). Data obtained with the Short Form Questionnaire showed a statistically significant difference in QoL in those undergoing intervention compared with a control group of healthy subjects. The Glasgow Benefit Inventory Questionnaire showed that 25 (31%) patients felt better, 11 (14%) felt similarly, and 45 (55%) felt poorer health conditions in comparison to the pre-surgical period. Concerning the relationship between preservation of facial nerve function and QoL, using the Glasgow Health Status Inventory, it appeared that only 34% of subjects with good facial nerve function (RGS grade I-II) complained of worsening of QoL, while 45% of those with serious facial nerve injury (RGS grade IV-V) referred poorer QoL. Moreover, the possibility of recovery of facial nerve function during the months following surgery was clearly highlighted by our analysis. Our study confirmed the close relation between tumour size and post-surgical QoL, which is worse for patients affected by larger lesions.

  8. Significant vestibular system impairment is common in a cohort of elderly patients referred for assessment of falls risk.

    Science.gov (United States)

    Jacobson, Gary P; McCaslin, Devin L; Grantham, Sarah L; Piker, Erin G

    2008-01-01

    Falls in elderly patients are associated with morbidity, mortality, and cost to the healthcare system. The development of falls risk assessment programs have represented a method of responding to what is known about injurious falls. The multidimensional assessments involve the comparison against normative data of a patient's performance on metrics known to influence the likelihood of future falls. The factors assessed usually include falls and medication history, measures of mentation, depression, orthostatic hypotension, simple or choice reaction time, gait stability, postural stability, and the integrity of the patient's vision, somesthetic, and vestibular senses. This investigation was conducted to measure the proportion of patients referred for falls risk assessment who have evidence of vestibular system impairment. Qualitative, retrospective review of data collected from 2003 to 2007. The cohort was 185 consecutive patients referred for multidimensional assessments of falls risk. Patients underwent quantitative assessments of peripheral and central vestibular system function consisting of electro- or videonystagmography (i.e., ENG/VNG), and sinusoidal harmonic acceleration testing. Results of these tests were compared to normative data. We found that 73% of the sample who underwent vestibular system assessment had quantitative evidence of either peripheral or central vestibular system impairment. Our results suggest that quantitative assessments of the vestibulo-ocular reflex should be conducted on patients who are evaluated for falls risk. These examinations should include at least caloric testing and, where available, rotational testing.

  9. Artificial balance: restoration of the vestibulo-ocular reflex in humans with a prototype vestibular neuroprosthesis.

    Science.gov (United States)

    Perez Fornos, Angelica; Guinand, Nils; van de Berg, Raymond; Stokroos, Robert; Micera, Silvestro; Kingma, Herman; Pelizzone, Marco; Guyot, Jean-Philippe

    2014-01-01

    The vestibular system plays a crucial role in the multisensory control of balance. When vestibular function is lost, essential tasks such as postural control, gaze stabilization, and spatial orientation are limited and the quality of life of patients is significantly impaired. Currently, there is no effective treatment for bilateral vestibular deficits. Research efforts both in animals and humans during the last decade set a solid background to the concept of using electrical stimulation to restore vestibular function. Still, the potential clinical benefit of a vestibular neuroprosthesis has to be demonstrated to pave the way for a translation into clinical trials. An important parameter for the assessment of vestibular function is the vestibulo-ocular reflex (VOR), the primary mechanism responsible for maintaining the perception of a stable visual environment while moving. Here we show that the VOR can be artificially restored in humans using motion-controlled, amplitude modulated electrical stimulation of the ampullary branches of the vestibular nerve. Three patients received a vestibular neuroprosthesis prototype, consisting of a modified cochlear implant providing vestibular electrodes. Significantly higher VOR responses were observed when the prototype was turned ON. Furthermore, VOR responses increased significantly as the intensity of the stimulation increased, reaching on average 79% of those measured in healthy volunteers in the same experimental conditions. These results constitute a fundamental milestone and allow us to envision for the first time clinically useful rehabilitation of patients with bilateral vestibular loss.

  10. Artificial balance: restoration of the vestibulo-ocular reflex in humans with a prototype vestibular neuroprosthesis

    Directory of Open Access Journals (Sweden)

    Angelica ePerez Fornos

    2014-04-01

    Full Text Available The vestibular system plays a crucial role in the multisensory control of balance. When vestibular function is lost, essential tasks such as postural control, gaze stabilization, and spatial orientation are limited and the quality of life of patients is significantly impaired. Currently there is no effective treatment for bilateral vestibular deficits. Research efforts both in animals and humans during the last decade set a solid background to the concept of using electrical stimulation to restore vestibular function. Still, the potential clinical benefit of a vestibular neuroprosthesis has to be demonstrated to pave the way for a translation into clinical trials. An important parameter for the assessment of vestibular function is the Vestibulo-Ocular Reflex (VOR, the primary mechanism responsible for maintaining the perception of a stable visual environment while moving. Here we show that the VOR can be artificially restored in humans using motion-controlled, amplitude modulated electrical stimulation of the ampullary branches of the vestibular nerve. Three patients received a vestibular neuroprosthesis prototype, consisting of a modified cochlear implant providing vestibular electrodes. Significantly higher VOR responses were observed when the prototype was turned ON. Furthermore, VOR responses increased significantly as the intensity of the stimulation increased, reaching on average 79% of those measured in healthy volunteers in the same experimental conditions. These results constitute a fundamental milestone and allow us to envision for the first time clinically useful rehabilitation of patients with bilateral vestibular loss.

  11. The Effect of Vestibular Rehabilitation in the Treatment of Elderly Patients with Benign Paroxysmal Positional Vertigo

    Directory of Open Access Journals (Sweden)

    N. Saki

    2011-04-01

    Full Text Available Introduction & Objective: Vertigo in the elderly is relatively common, but only a few studies are available. Vestibular rehabilitation (VR therapy is an important therapeutic option in treating patients with significant balance deficits. The purpose of this study was to analyze the effect of vestibular rehabilitation on vertigo symptoms in elderly patients with benign paroxysmal positional vertigo (BPPV. Materials & Methods: In a cross sectional analytic design, 46 patients older than 60 years (aged 61 to 72 years with BPPV who referred to the ENT center of Imam Khomeini Hospital, Ahwaz, were studied. After an otologic evaluation, videonystagmography and dizziness handicap inventory (DHI evaluations were performed for each case. Then, vestibular rehabilitation (VR therapy was carried out by means of Epley maneuver. Efficacy of a VRT was tested by comparing pre-treatment with post-treatment VNG and DHI assessments. The data were analyzed by SPSS 16 software. Results: The average age of the patients was 67.28 ± 4.5 years. VR caused normal Hallpike findings in 31 (67.4 % and noticeable reduction in nystagmus amplitudes in 9 patients. We found a significant correlation between nystagmus amplitudes and DHI scores (r=0.77. The mean DHI scores decreased from 53.26±16.12 points to 15.36±9.23 points (p<0.001 at the end of the treatment course. Conclusion: Our investigation revealed that VR plays an important role in reducing vertigo in at-risk elderly patients. Lack of appropriate treatment in this population may cause a serious balance problem (such as bone fracture and long-term handicap that may interfere with their daily activities. (Sci J Hamadan Univ Med Sci 2011;18(1:33-36

  12. The challenge of vestibular migraine.

    Science.gov (United States)

    Sargent, Eric W

    2013-10-01

    Migraine is a common illness and migraine-related dizziness occurs in up to 3% of the population. Because the diagnosis is controversial and may be difficult, many patients go undiagnosed and untreated. This review summarizes current understanding of the taxonomy and diagnosis of vestibular migraine, the relation of vestibular migraine to labyrinthine disease, and the treatment of the condition in adults and children. The categories of migraine accepted by the International Headache Society do not reflect the complex presentations of patients suspected of having vestibular migraine. In clinical practice and research, criteria are increasingly accepted that divide patients suspected of vestibular migraine into 'definite vestibular migraine' and 'probable vestibular migraine.' Because vertigo itself may trigger migraine, patients with vestibular migraine should be suspected of having vestibular end-organ disease until proven otherwise. Treatment remains controversial because of a notable lack of randomized controlled studies of vestibular migraine treatment. For now, the best strategy for the treatment of suspected vestibular migraine patients is dietary/lifestyle modification, antinausea/antiemetics for acute vertigo, and preventive medication for patients who have continued disruptive symptoms. Patients with vestibular migraine should be monitored regularly for the development of latent audiovestibular end-organ disease.

  13. Comparing the vestibular evoked myogenic potentials in patients with type Ι diabetes mellitus and normal people

    Directory of Open Access Journals (Sweden)

    Behnoush Kamali

    2013-05-01

    Full Text Available Background and Aim: Patients with type I diabetes mellitus commonly complain about dizziness, floating sensation, tinnitus, weakness, and sweating. The aim of this study was comparing vestibular evoked myogenic potentials (VEMPs between these patients and normal people. Methods: Twenty-four patients with type I diabetes mellitus and twenty-four healthy volunteers with the age range of 15-40 years were enrolled in this study. A tone burst of 500 Hz, with the intensity of 95 dB nHL, was delivered through a insert earphone and vestibular evoked myogenic potential was recorded. The t-test was used to compare the results between the two groups. To investigate the effect of glycated hemoglobin (HbA1c on VEMP responses (latency, absolute and relative amplitude, the regression analysis was used. Results: The mean p13 and n23 latency were significantly more in patients with type Ι diabetes mellitus (for P13 latency, p=0.013 in right and p=0.010 in left ear, and for n23 latency, p0.050. There was no correlation between VEMPs and HbA1c in patients with type 1 diabetes mellitus (p>0.05. Conclusion: Prolonged latencies of the VEMP in patients with type 1 diabetes mellitus suggest lesions in the retrolabyrinthine, especially in the vestibulospinal tract. Nevertheless, due to the limited number of examined samples, further investigation with more patients should be performed.

  14. [Acute isolated vestibular paralysis. A clinical and electronystagmographic follow-up study in 28 patients].

    Science.gov (United States)

    Reker, U; Rudert, H

    1977-04-01

    Twenty-eight patients with unilateral acute vestibular paralysis (vestibular neuronitis) were examined after a period of 4-140 months. Seventeen of these patients were examined by electronystagmography with caloric stimuli at 44 degrees, 30 degrees, 17 degrees and 0 degrees C. Most were free of subjective symptoms only one-third had slight unsteadiness after sudden head movement. Subjective symptoms were independent of the presence of permanent canal paralysis or partial recovery of caloric excitability. Spontaneous nystagmus of 3-6,6% intensities was found in 11 of 17 patients. The normal limit for physiological spontaneous nystagmus should therefore be below 3 degrees/s. The most reliable parameter was the maximum velocity of the slow phase, as a mean value of the 4 caloric responses (values corrected for spontaneous nystagmus). The results were: 6 patients with persistent canal paralysis; 4 patients with considerable hypoexcitability; and 7 patients with moderate hypoexcitability. In no patient complete restoration of normal caloric response was found. This is attributed to the described method of caloric testing, which permits exact measurement of small side differences in excitability.

  15. 78 FR 53700 - Revised Medical Criteria for Evaluating Hearing Loss and Disturbances of Labyrinthine-Vestibular...

    Science.gov (United States)

    2013-08-30

    ... revise the criteria in our Listing of Impairments (listings) for evaluating hearing loss and disturbances... clarification? What types of testing should we consider when evaluating hearing loss in adults or children who... the requirements necessary for evaluation of hearing loss in adults or children? What word recognition...

  16. Responses evoked by a vestibular implant providing chronic stimulation.

    Science.gov (United States)

    Thompson, Lara A; Haburcakova, Csilla; Gong, Wangsong; Lee, Daniel J; Wall, Conrad; Merfeld, Daniel M; Lewis, Richard F

    2012-01-01

    Patients with bilateral vestibular loss experience dehabilitating visual, perceptual, and postural difficulties, and an implantable vestibular prosthesis that could improve these symptoms would be of great benefit to these patients. In previous work, we have shown that a one-dimensional, unilateral canal prosthesis can improve the vestibulooccular reflex (VOR) in canal-plugged squirrel monkeys. In addition to the VOR, the potential effects of a vestibular prosthesis on more complex, highly integrative behaviors, such as the perception of head orientation and posture have remained unclear. We tested a one-dimensional, unilateral prosthesis in a rhesus monkey with bilateral vestibular loss and found that chronic electrical stimulation partially restored the compensatory VOR and also that percepts of head orientation relative to gravity were improved. However, the one-dimensional prosthetic stimulation had no clear effect on postural stability during quiet stance, but sway evoked by head-turns was modestly reduced. These results suggest that not only can the implementation of a vestibular prosthesis provide partial restitution of VOR but may also improve perception and posture in the presence of bilateral vestibular hypofunction (BVH). In this review, we provide an overview of our previous and current work directed towards the eventual clinical implementation of an implantable vestibular prosthesis.

  17. [Comparison of caloric responses between vestibular migraine and Ménière disease patients].

    Science.gov (United States)

    Yang, Yuechang; Zhuang, Jianhua; Zhou, Lili; Tong, Bei; Zhou, Xiaowen; Gao, Bo

    2016-01-01

    To compare the features of caloric tests in vestibular migraine (VM) and Menière's disease (MD) patients, and provide objective evidence for differentiating the 2 groups of patients. This case-control study included 11 MD patients with left ear involved and mild to moderate impaired hearing, and 18 matched cases with VM. All participants received caloric tests. Maximum slow phase velocities (SPVmax) were used to describe horizontal and vertical nystagmus respectively and were compared between the 2 groups. Horizontal and vertical canal parasis(CP) were calculated according to respective SPVmax. Unilateral (UW-VR) or bilateral (BW-VR) weakness of vestibular response, and positive unilateral (UVR) or bilateral (BVR) vertical response or negative bilateral vertical response (NBVR) were judged by the boundary point of SPVmax of 5°/s respectively. Total left (LV) or right (RV) Vertical reactions were calculated accoeding to vertical SPVmax,and inter ears difference of vertical responses (IED-VR) calculated from LV minus RV. There were no significant differences in age and gender between the 2 groups. Horizontal SPVmax of all of caloric tests of VM group,except the left cold (LC), were statistically larger than that of MD group (P VR and BW-VR in VM group (5.56%, 0) were significantly lower than that in MD group (27.27%, 18.18%) (P VR in VM group (left intenser: 16.67%, right intenser: 83.33%) was statistically different from that in MD group (left intenser: 36.36%, right intenser: 9.09%, both no difference: 54.55%) (P Vestibular responses of caloric test are more sensitive, and vertical reactions are more easily induced in VM patients than in MD. Caloric test can be used to differentiate the 2 groups of diseases.

  18. The effect of virtual reality on visual vertigo symptoms in patients with peripheral vestibular dysfunction: a pilot study.

    Science.gov (United States)

    Pavlou, M; Kanegaonkar, R G; Swapp, D; Bamiou, D E; Slater, M; Luxon, L M

    2012-01-01

    Individuals with vestibular dysfunction may experience visual vertigo (VV), in which symptoms are provoked or exacerbated by excessive or disorientating visual stimuli (e.g. supermarkets). VV can significantly improve when customized vestibular rehabilitation exercises are combined with exposure to optokinetic stimuli. Virtual reality (VR), which immerses patients in realistic, visually challenging environments, has also been suggested as an adjunct to VR to improve VV symptoms. This pilot study compared the responses of sixteen patients with unilateral peripheral vestibular disorder randomly allocated to a VR regime incorporating exposure to a static (Group S) or dynamic (Group D) VR environment. Participants practiced vestibular exercises, twice weekly for four weeks, inside a static (Group S) or dynamic (Group D) virtual crowded square environment, presented in an immersive projection theatre (IPT), and received a vestibular exercise program to practice on days not attending clinic. A third Group D1 completed both the static and dynamic VR training. Treatment response was assessed with the Dynamic Gait Index and questionnaires concerning symptom triggers and psychological state. At final assessment, significant between-group differences were noted between Groups D (p=0.001) and D1 (p=0.03) compared to Group S for VV symptoms with the former two showing a significant 59.2% and 25.8% improvement respectively compared to 1.6% for the latter. Depression scores improved only for Group S (p=0.01) while a trend towards significance was noted for Group D regarding anxiety scores (p=0.07). Exposure to dynamic VR environments should be considered as a useful adjunct to vestibular rehabilitation programs for patients with peripheral vestibular disorders and VV symptoms.

  19. Audiometric results and cervical vestibular evoked myogenic potentials in patients with type I and II diabetes mellitus

    Directory of Open Access Journals (Sweden)

    Mojtaba Tavakoli

    2014-10-01

    Full Text Available Background and Aim: Diabetes mellitus is a metabolic disorder that affects multiple systems including the auditory and vestibular systems. Patients with diabetes mellitus complain of tinnitus and dizziness. The objective of this study is to assess the effects of diabetes mellitus types I and II on auditory and vestibular systems.Methods: We compared pure-tone audiometric results and cervical vestibular evoked myogenic potentials ( cVEMPs between 15 patients with diabetes mellitus type I (43.80 with SD 4.246, 15 patients with diabetes mellitus type II (48.13 with SD 2.973, and 10 normal volunteers (45.30 with SD 4.448. Age range of the participants was 40-50 years old.Results: Audiometric results showed normal hearing in both types of diabetes mellitus. In contrast, comparing amplitude of cVEMPs between diabetes mellitus and control groups showed statistically significant differences (p<0.05.Conclusion: In spite of normal audiometric results in patients with diabetes mellitus types I and II, there was abnormal vestibular responses involving vestibular end-organ and related central pathway.

  20. Vestibular dysfunction in patients with chronic pain or underlying neurologic disorders

    National Research Council Canada - National Science Library

    Gilbert, John W; Vogt, Manuel; Windsor, Robert E; Mick, Gregory E; Richardson, Gay B; Storey, Benjamin B; Herder, Stephanie L; Ledford, Susan; Abrams, Dee A; Theobald, Mary Katherine; Cunningham, Dana; Kelly, Louise; Herring, Kimberly V; Maddox, Michael L

    2014-01-01

    Individuals with vestibular dysfunction are at increased risk for falling. In addition, vestibular dysfunction is associated with chronic pain, which could present a serious public health concern as approximately 43...

  1. Função vestibular no acidente vascular cerebral do território carot��deo Vestibular function in carotid territory stroke patients

    Directory of Open Access Journals (Sweden)

    Anna Paula Batista de Ávila Pires

    2013-02-01

    Full Text Available Pacientes após Acidente Vascular Cerebral (AVC podem apresentar sintomas otoneurológicos. OBJETIVO: Avaliar a função vestibular de pacientes com antecedente pessoal de AVC no território carotídeo. Desenho científico: estudo de coorte histórica com corte transversal. MÉTODO: Quarenta pacientes foram submetidos à anamnese, exame otorrinolaringológico, Dizziness Handicap Inventory e vectoeletronistagmografia. RESULTADOS: Anormalidades discretas dos movimentos sacádicos foram encontradas em 20 pacientes (50,0%; nove referiram desequilíbrio e um tontura. O ganho do rastreio pendular foi anormal em 17 casos (42,5%; seis referiram desequilíbrio e um tontura. Preponderância direcional anormal do nistagmoperrotatório ocorreu em dois casos (5,0%, que referiram desequilíbrio. A prova calórica identificou três casos (7,5% com predomínio labiríntico anormal e dois (5,0% com preponderância direcional anormal do nistagmo; os cinco casos relataram desequilíbrio. Dos 11 pacientes que não referiram manifestações de alteração do equilíbrio corporal, 10 apresentaram alterações nos movimentos sacádicos e no rastreio pendular e um apresentou exame vestibular normal. CONCLUSÃO: Pacientes com antecedente pessoal de AVC no território carotídeo podem apresentar tontura ou desequilíbrio corporal e sinais de comprometimento da motilidade ocular e da função vestibular.Stroke patients may present otoneurological symptoms. OBJECTIVE: To assess the vestibular function of subjects with a history of carotid territory stroke. METHOD: This historical cohort cross sectional study enrolled 40 patients; subjects answered the Dizziness Handicap Inventory, were interviewed and submitted to ENT examination and vectorelectronystagmography. RESULTS: Mild saccadic movement anomalies were seen in 20 patients (50.0%; nine complained of imbalance and dizziness. Abnormal smooth pursuit gain was seen in 17 cases (42.5%; six subjects reported imbalance and

  2. Vestibular function testing.

    LENUS (Irish Health Repository)

    Lang, E E

    2010-06-01

    Vestibular symptoms of vertigo, dizziness and dysequilibrium are common complaints which can be disabling both physically and psychologically. Routine examination of the ear nose and throat and neurological system are often normal in these patients. An accurate history and thorough clinical examination can provide a diagnosis in the majority of patients. However, in a subgroup of patients, vestibular function testing may be invaluable in arriving at a correct diagnosis and ultimately in the optimal treatment of these patients.

  3. Vestibular information is necessary for maintaining metric properties of representational space: evidence from mental imagery.

    Science.gov (United States)

    Péruch, Patrick; Lopez, Christophe; Redon-Zouiteni, Christine; Escoffier, Guy; Zeitoun, Alain; Sanjuan, Mélanie; Devèze, Arnaud; Magnan, Jacques; Borel, Liliane

    2011-09-01

    The vestibular system contributes to a wide range of functions, from postural and oculomotor reflexes to spatial representation and cognition. Vestibular signals are important to maintain an internal, updated representation of the body position and movement in space. However, it is not clear to what extent they are also necessary to mentally simulate movement in situations that do not involve displacements of the body, as in mental imagery. The present study assessed how vestibular loss can affect object-based mental transformations (OMTs), i.e., imagined rotations or translations of objects relative to the environment. Participants performed one task of mental rotation of 3D-objects and two mental scanning tasks dealing with the ability to build and manipulate mental images that have metric properties. Menière's disease patients were tested before unilateral vestibular neurotomy and during the recovery period (1 week and 1 month). They were compared to healthy participants tested at similar time intervals and to bilateral vestibular-defective patients tested after the recovery period. Vestibular loss impaired all mental imagery tasks. Performance varied according to the extent of vestibular loss (bilateral patients were frequently the most impaired) and according to the time elapsed after unilateral vestibular neurotomy (deficits were stronger at the early stage after neurotomy and then gradually compensated). These findings indicate that vestibular signals are necessary to perform OMTs and provide the first demonstration of the critical role of vestibular signals in processing metric properties of mental representations. They suggest that vestibular loss disorganizes brain structures commonly involved in mental imagery, and more generally in mental representation. Copyright © 2011 Elsevier Ltd. All rights reserved.

  4. Recovery of Vestibular Ocular Reflex Function and Balance Control after a Unilateral Peripheral Vestibular Deficit

    OpenAIRE

    John eAllum

    2012-01-01

    This review describes the effect of unilateral peripheral vestibular deficit (UPVD) on balance control for stance and gait tests. Because a UPVD is normally defined based on vestibular ocular reflex (VOR) tests, we compared recovery observed in balance control with patterns of recovery in VOR function. Two general types of UPVD are considered; acute vestibular neuritis (AVN) and vestibular neurectomy. The latter was subdivided into vestibular loss after cerebellar pontine angle tumor surgery ...

  5. Influence of spontaneous nystagmus with eyes closed on computerized vestibular exam of patients with chronic peripheral

    Directory of Open Access Journals (Sweden)

    Shin, Elizabeth

    2010-06-01

    Full Text Available Introduction: The spontaneous nystagmus with eyes closed (NEOF can modify the results obtained during some evidence of vestibular, leading to erroneous conclusions. Objective: To characterize the patients and the type of influence on the evidence of NEOF vectonystagmography digital. Method: Retrospective study based on survey charts of patients with the presence of NEOF vectonystagmography digital, in the Outpatient Equilibriometria UNIFESP-EPM, in the years 2000 to 2007. Comparisons were made between genders, ages, direction, angular velocity of NEOF, completion of entrance examination and its influence on the results of caloric testing. Results: We found 73.7% of the population was female, mean age of 55.08 years; NEOF prevalence of horizontal and angular velocity smaller than 7o/s in 86.7%. 59% had some kind of influence caused by the caloric test NEOF as inversion, hyporeflexia, hyperreflexia, nystagmus directional preponderance (NDP and labyrinthine preponderance (LP changed. The most prevalent findings were normal vestibular tests (EVN and bilateral irritative peripheral vestibular syndrome (BIPVS. 38.7% caloric ice and realized these cases it was possible to reach a conclusion in 79%. Conclusion: The NEOF most common was the horizontal type, with VACL less than 7o/s, influencing the majority of examinations and only the results of caloric testing the air, with reversal of post-caloric nystagmus, hyperreflexia and hyporeflexia, NDP and PL altered; the findings were more prevalent and BIPVS EVN, and the caloric test the influence of ice withdrew NEOF in most individuals, enabling to reach a final conclusion.

  6. Paciente com cefaleia e síndrome vestibular periférica: relato de caso Patient with headache and peripheral vestibular dysfunction: case report

    OpenAIRE

    Tatiane Maria Rossi; Naonne Santos Camargo Luciano; Polliay Freire Oricoli; Luciana Lozza de Moraes Marchiori; Juliana Jandre Melo

    2009-01-01

    TEMA: a Reabilitação Vestibular constitui-se numa opção de tratamento para pacientes portadores de síndrome vestibular periférica e cefaleia. PROCEDIMENTOS: o paciente, do sexo feminino com 26 anos de idade apresentava síndrome vestibular periférica acompanhada de crises de cefaleia. Foi realizada avaliação e terapia fonoaudiológica com exercícios de habituação vestibular além de fisioterapia e dieta recomendada pelo nutricionista. RESULTADOS: no período de 3 meses com reabilitação vestibular...

  7. Vestibular Compensation in Unilateral Patients Often Causes Both Gain and Time Constant Asymmetries in The VOR

    Directory of Open Access Journals (Sweden)

    Mina eRanjbaran

    2016-03-01

    Full Text Available The vestibulo-ocular reflex (VOR is essential in our daily life to stabilize retinal images during head movements. Balanced vestibular functionality secures optimal reflex performance which can be distorted in case of peripheral vestibular lesions. Luckily, vestibular compensation in different neuronal sites restores VOR function to some extent over time. Studying vestibular compensation gives insight into the possible mechanisms for plasticity in the brain.In this work, novel experimental analysis tools are employed to reevaluate the VOR characteristics following unilateral vestibular lesions and compensation. Our results suggest that following vestibular lesions, asymmetric performance of the VOR is not only limited to its gain. Vestibular compensation also causes asymmetric dynamics, i.e. different time constants for the VOR during leftward or rightward passive head rotation. Potential mechanisms for these experimental observations are provided using simulation studies.

  8. Ipsilateral cochlear implantation after cochlear nerve preserving vestibular schwannoma surgery in patients with neurofibromatosis type 2.

    Science.gov (United States)

    Lloyd, Simon Kingsley Wickham; Glynn, Fergal John; Rutherford, Scott Alexander; King, Andrew Thomas; Mawman, Deborah Jane; O'Driscoll, Martin Paul; Evans, Dafydd Gareth Richard; Ramsden, Richard Thomas; Freeman, Simon Richard Mackenzie

    2014-01-01

    To investigate the outcomes from ipsilateral simultaneous or sequential cochlear implantation in patients with neurofibromatosis type 2 (NF2) after vestibular schwannoma removal with cochlear nerve preservation. Retrospective case series. Single tertiary referral NF2 center. Six patients with NF2. Removal of vestibular schwannoma (VS) with preservation of the cochlear nerve and cochlear implantation. Four patients had their surgery via a translabyrinthine approach. Two patients had a retrosigmoid approach. A cochlear implant was inserted at the same time as tumor removal in 4 cases and sequentially in 2 cases. Surgical and audiometric outcomes using Bamford-Kowal-Bench (BKB) and City of New York University (CUNY) sentence scores. The average age at implantation was 24 years (range, 15-36 yr). Follow-up ranged from 5 to 93 months, with an average of 38 months. All patients had useful hearing in the contralateral ear before surgery. One patient gained no benefit from cochlear implantation and proceeded to have an auditory brainstem implant. Of those that had functional cochlear nerves, the average BKB score in quiet was 64%, BKB score in noise was 42%, and CUNY score with lipreading was 97%. Results varied within the group, but all patients gained significant benefit and continue to use their CI at least intermittantly. The present series demonstrates that in selected cases, cochlear implantation can be successful after a translabyrinthine approach for VS removal and for restoring hearing after failed retrosigmoid hearing preservation surgery. All patients found the cochlear implant offered useful hearing even in the presence of contralateral hearing.

  9. Conservative management of bilateral vestibular schwannomas in neurofibromatosis type 2 patients: hearing and tumor growth results.

    Science.gov (United States)

    Peyre, Matthieu; Goutagny, Stéphane; Bah, Alpha; Bernardeschi, Daniele; Larroque, Béatrice; Sterkers, Olivier; Kalamarides, Michel

    2013-06-01

    As new treatment modalities develop for the management of vestibular schwannomas (VS) in patients with neurofibromatosis type 2, it remains crucial to ascertain the natural history of the disease. To determine the relationship between hearing and tumor growth in patients undergoing conservative VS management. Patients harboring bilateral VS with at least 1 year of radiological follow-up were selected. Conservative management was proposed based on the small tumor size and/or serviceable hearing at presentation. Tumor size was calculated by using the 2-component box model and reported as mean tumor diameter. Hearing was evaluated by using pure-tone average and the American Academy of Otololaryngologists and Head and Neck Surgery classification. Forty-six patients harboring 92 VS were included. The mean clinical and radiological follow-up times were 6.0 and 4.2 years, respectively. The mean tumor diameter was 13 mm at presentation and 20 mm at the end of follow-up. Mean tumor growth rate was 1.8 mm/year. During follow-up, 17 patients (37%) underwent surgery for VS. Surgery-free rate for VS was 88% at 5 years. The number of patients with at least 1 serviceable ear was 39 (85%) at presentation and 34 (74%) at the end of follow-up, including 22 (66%) with binaural serviceable hearing maintained. There was no statistical correlation between tumor growth rate and preservation of serviceable hearing. Tumor growth rates and age at presentation were inversely correlated. This study illustrates the high variability among neurofibromatosis type 2 patients regarding hearing status and VS growth rate and justifies the choice of initial conservative management in selected cases. : AAO-HNS, American Academy of Otololaryngologists and Head and Neck Surgery classificationMTD, mean tumor diameterNF2, neurofibromatosis type 2PTA, pure-tone averageSDS, speech discrimination scoreVS, vestibular schwannomas.

  10. [Presbyastasis and application of vestibular rehabilitation in geriatrics].

    Science.gov (United States)

    Costa de Araujo, P; Demanez, L; Lechien, J; Bauvir, P; Petermans, J

    2011-03-01

    Balance disorders can have a major functional impact among the elderly. The main risk is falling. Three elements are implicated in the loss of balance: vision, proprioception and the vestibular system. This article will discuss mainly vestibular damage and its implications. The assessment of balance disorders, particularly in geriatric patients, is based on validated scales composed of several items. These provide scores and are based on the results of chronometric measurements. They can be useful for the application of Vestibular Rehabilitation (VR), a technique improving the adaptation and autonomy of these patients. Vestibular rehabilitation is therefore part of an overall support, the goal of therapy being to improve daily life and to reduce the risk of falls.

  11. Alinhamento de cabeça e ombros em pacientes com hipofunção vestibular unilateral Head and shoulder alignment among patients with unilateral vestibular hypofunction

    Directory of Open Access Journals (Sweden)

    Adamar N. Coelho Júnior

    2010-08-01

    Full Text Available OBJETIVOS: Avaliar o alinhamento de cabeça e ombros de pacientes com hipofunção vestibular unilateral (HVU por meio da biofotogrametria computadorizada e associar esses dados com gênero, idade, tempo de evolução clínica, autopercepção da intensidade de tontura e ocorrência de quedas. MÉTODOS: Trata-se de estudo transversal em que 30 indivíduos com HVU e 30 indivíduos com função vestibular normal e sem queixa de tontura foram submetidos à biofotogrametria computadorizada. Foram registradas imagens em vistas anterior, posterior, laterais direita e esquerda em ortostatismo. O programa Alcimage® 2.0 foi usado para avaliar três ângulos que permitem verificar anteriorização e inclinação da cabeça e alinhamento dos ombros. Os grupos foram pareados por idade, gênero e estatura. Para a análise estatística, realizaram-se os testes de Mann-Whitney, Kruskal-Wallis, seguidos do teste de Dunn e Coeficiente de Correlação de Spearman. RESULTADOS: Pacientes com HVU apresentam maiores valores para os ângulos de anteriorização (55,44±16,33 e de inclinação lateral da cabeça (2,03±1,37 quando comparados aos indivíduos normais (34,3±44,60 e 1,34±1,05, respectivamente, com diferença estatisticamente significante (pOBJECTIVES: To investigate head and shoulder alignment among patients with unilateral vestibular hypofunction (UVH, using computerized biophotogrammetry (CB and to correlate these measurements with gender, age, duration of clinical evolution, self-perception of intensity of dizziness and occurrences of falls. METHODS: This was a cross-sectional study. Thirty individuals with UVH and 30 with normal vestibular function and without complaints of dizziness underwent CB in the anterior, right and left and posterior views, in an upright standing position. AlcimageTM 2.0 was used to evaluate three angles in order to verify the anterior deviation and inclination of the head, and the alignment of the shoulders. The groups were

  12. Treatment decision-making for sporadic small vestibular schwannoma in a pediatric patient: A case report and literature review.

    Science.gov (United States)

    Wang, Jun; Xu, Yajing; Lei, Ting; Zeng, Liang

    2015-05-01

    The current study reports the case of a 15-year-old male who presented with hearing loss due to a small left-sided vestibular schwannoma (VS) not associated with neurofibromatosis type 2 (NF2), which had been apparent for six months. Magnetic resonance imaging with gadolinium diethylenetriamine penta-acetic acid revealed a mass, 10 mm in diameter, located in the left inner auditory canal. The patient had no family history of NF2 and gene mutation analysis showed no signs of the condition. Small sporadic or non-NF2 VS is extremely rare and the treatment decision-making process is complicated in children when considering the implications for the impairment of childhood development and lifelong disability. Following careful consideration, the patient in the present study underwent treatment with stereotactic radiosurgery. The five-year post-operative follow-up examination showed tumor stability without additional neurological deficits and at the time of writing the patient was alive and well.

  13. Early Radiosurgery Improves Hearing Preservation in Vestibular Schwannoma Patients With Normal Hearing at the Time of Diagnosis

    Energy Technology Data Exchange (ETDEWEB)

    Akpinar, Berkcan [University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania (United States); Mousavi, Seyed H., E-mail: mousavish@upmc.edu [Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States); McDowell, Michael M.; Niranjan, Ajay; Faraji, Amir H. [Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States); Flickinger, John C. [Department of Radiation Oncology, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States); Lunsford, L. Dade [Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania (United States)

    2016-06-01

    Purpose: Vestibular schwannomas (VS) are increasingly diagnosed in patients with normal hearing because of advances in magnetic resonance imaging. We sought to evaluate whether stereotactic radiosurgery (SRS) performed earlier after diagnosis improved long-term hearing preservation in this population. Methods and Materials: We queried our quality assessment registry and found the records of 1134 acoustic neuroma patients who underwent SRS during a 15-year period (1997-2011). We identified 88 patients who had VS but normal hearing with no subjective hearing loss at the time of diagnosis. All patients were Gardner-Robertson (GR) class I at the time of SRS. Fifty-seven patients underwent early (≤2 years from diagnosis) SRS and 31 patients underwent late (>2 years after diagnosis) SRS. At a median follow-up time of 75 months, we evaluated patient outcomes. Results: Tumor control rates (decreased or stable in size) were similar in the early (95%) and late (90%) treatment groups (P=.73). Patients in the early treatment group retained serviceable (GR class I/II) hearing and normal (GR class I) hearing longer than did patients in the late treatment group (serviceable hearing, P=.006; normal hearing, P<.0001, respectively). At 5 years after SRS, an estimated 88% of the early treatment group retained serviceable hearing and 77% retained normal hearing, compared with 55% with serviceable hearing and 33% with normal hearing in the late treatment group. Conclusions: SRS within 2 years after diagnosis of VS in normal hearing patients resulted in improved retention of all hearing measures compared with later SRS.

  14. Audiovestibular Handicap and Quality of Life in Patients With Vestibular Schwannoma and "Excellent" Hearing.

    Science.gov (United States)

    Tveiten, Oystein Vesterli; Carlson, Matthew L; Link, Michael J; Lund-Johansen, Morten

    2017-03-01

    Studies examining patient-reported outcomes in subjects with vestibular schwannoma (VS) and "excellent" hearing are lacking. To assess patient-reported audiovestibular handicap and overall quality of life (QoL) in VS patients with class A hearing in both ears. Among 539 VS patients treated during 1998 to 2008, we identified 296 patients with either bilateral class A (AA) hearing or 1 good ear and 1 deaf ear (AD) according to the American Academy of Otolaryngology-Head and Neck Surgery classification. Patients responded to validated hearing, tinnitus, and dizziness handicap inventories and 2 QoL questionnaires, and the 2 groups were compared. A reference group of 103 adults filled out the same questionnaires. Forty-nine patients (16.6%) had class AA and 247 patients (83.4%) had class AD hearing. AA patients scored poorer than control subjects without tumor on all handicap questionnaires ( P handicap. Patients with VS and bilateral class A hearing report significantly poorer hearing handicap than control subjects without tumor but better hearing than those with unilateral deafness. When patients with bilateral class A hearing are counseled, it should be noted that one-third of patients experience self-perceived hearing handicap.

  15. The effect of bevacizumab on vestibular schwannoma tumour size and hearing in patients with neurofibromatosis type 2.

    Science.gov (United States)

    Alanin, Mikkel Christian; Klausen, Camilla; Caye-Thomasen, Per; Thomsen, Carsten; Fugleholm, Kaare; Poulsgaard, Lars; Lassen, Ulrik; Mau-Sorensen, Morten; Hofland, Kenneth Francis

    2015-12-01

    The hallmark of neurofibromatosis type 2 (NF2) is bilateral vestibular schwannomas (VS) and severe hearing loss is common in NF2 patients. Vascular endothelial growth factor (VEGF) expression level in NF2 correlates with tumour growth rate and bevacizumab, a VEGF-binding antibody, has previously been shown to induce tumour shrinkage and improve hearing. We retrospectively reviewed the effect of bevacizumab on hearing and VS tumour size in 12 consecutive NF2 patients. Bevacizumab 10 mg/kg was administered intravenously every second week for 6 months; hereafter, bevacizumab 15 mg/kg was administered every third week. Patients were evaluated with repeated audiometries, MR scans and clinical evaluations. Radiological response was defined as a 20 % or greater reduction in VS volume. A total of 398 treatments (median 36) were administered and the median duration on therapy was 22 months (range 7-34). We observed a radiological response (≥20 % tumour shrinkage) in seven out of 18 tumours (39 %) in six out of 12 patients (50 %). Sustained radiological responses were maintained in six tumours (33 %) for more than 2 months. Three patients had objectively improved hearing and five patients reported subjective benefit in neurological symptoms, including improved hearing. Toxicity was in general manageable; however, one patient died from cerebral haemorrhage which was possibly related to therapy. In conclusion, bevacizumab improved hearing and reduced the size of VS in some patients with progressive NF2 which corroborates previous findings; however, the risk of severe side effects should be carefully considered and discussed with the patients prior to treatment.

  16. Computer-assisted training as a complement in rehabilitation of patients with chronic vestibular dizziness

    DEFF Research Database (Denmark)

    Smaerup, Michael; Grönvall, Erik; Larsen, Simon B.

    2015-01-01

    Objective To compare a computer exercise program with conservative home-training following printed instructions in the rehabilitation of elderly patients with vestibular dysfunction. Design Single-blind, randomized, controlled trial. Setting Geriatric Department, Aarhus University Hospital...... instructions (control group: n=31). Intervention Patients in the intervention group received assisted rehabilitation by a computer program. Main outcome measures Measurements at baseline, 8 and 16 weeks were compared. These included the One Leg Stand Test, Dynamic Gait Index, Chair Stand Test, Motion...... Sensitivity Test, Short Form-12, Dizziness Handicap Inventory and Visual Analog Scale. Results Both groups improved significantly during 16 weeks of rehabilitation. However, neither t-tests nor repeated measurement ANOVA demonstrated any significant differences between the two groups. The overall compliance...

  17. Betahistine treatment in managing vertigo and improving vestibular compensation: clarification.

    Science.gov (United States)

    Lacour, Michel

    2013-01-01

    Betahistine dihydrochloride (betahistine) is currently used in the management of vertigo and vestibular pathologies with different aetiologies. The main goal of this review is to clarify the mechanisms of action of this drug, responsible for the symptomatic relief of vertigo and the improvement of vestibular compensation. The review starts with a brief summary recalling the role of histamine as a neuromodulator/neurotransmitter in the control of the vestibular functions, and the role of the histaminergic system in vestibular compensation. Then are presented data recorded in animal models demonstrating that betahistine efficacy can be explained by mechanisms targeting the histamine receptors (HRs) at three different levels: the vascular tree, with an increase of cochlear and vestibular blood flow involving the H1R; the central nervous system, with an increase of histamine turnover implicating the H3R, and the peripheral labyrinth, with a decrease of vestibular input implying the H3R/H4R. Clinical data from vestibular loss patients show the impact of betahistine treatment for the long-term control of vertigo, improvement of balance and quality of life that can be explained by these mechanisms of action. However, two conditions, at least, are required for reaching the betahistine therapeutic effect: the dose and the duration of treatment. Experimental and clinical data supporting these requirements are exposed in the last part of this review.

  18. Vestibular perception following acute unilateral vestibular lesions.

    Directory of Open Access Journals (Sweden)

    Sian Cousins

    Full Text Available Little is known about the vestibulo-perceptual (VP system, particularly after a unilateral vestibular lesion. We investigated vestibulo-ocular (VO and VP function in 25 patients with vestibular neuritis (VN acutely (2 days after onset and after compensation (recovery phase, 10 weeks. Since the effect of VN on reflex and perceptual function may differ at threshold and supra-threshold acceleration levels, we used two stimulus intensities, acceleration steps of 0.5°/s(2 and velocity steps of 90°/s (acceleration 180°/s(2. We hypothesised that the vestibular lesion or the compensatory processes could dissociate VO and VP function, particularly if the acute vertiginous sensation interferes with the perceptual tasks. Both in acute and recovery phases, VO and VP thresholds increased, particularly during ipsilesional rotations. In signal detection theory this indicates that signals from the healthy and affected side are still fused, but result in asymmetric thresholds due to a lesion-induced bias. The normal pattern whereby VP thresholds are higher than VO thresholds was preserved, indicating that any 'perceptual noise' added by the vertigo does not disrupt the cognitive decision-making processes inherent to the perceptual task. Overall, the parallel findings in VO and VP thresholds imply little or no additional cortical processing and suggest that vestibular thresholds essentially reflect the sensitivity of the fused peripheral receptors. In contrast, a significant VO-VP dissociation for supra-threshold stimuli was found. Acutely, time constants and duration of the VO and VP responses were reduced - asymmetrically for VO, as expected, but surprisingly symmetrical for perception. At recovery, VP responses normalised but VO responses remained shortened and asymmetric. Thus, unlike threshold data, supra-threshold responses show considerable VO-VP dissociation indicative of additional, higher-order processing of vestibular signals. We provide evidence of

  19. Caloric Vestibular Stimulation Reduces Pain and Somatoparaphrenia in a Severe Chronic Central Post-Stroke Pain Patient: A Case Study.

    Directory of Open Access Journals (Sweden)

    Grazia Fernanda Spitoni

    Full Text Available Central post-stroke pain is a neuropathic syndrome characterized by intolerable contralesional pain and, in rare cases, somatic delusions. To date, there is limited evidence for the effective treatments of this disease. Here we used caloric vestibular stimulation to reduce pain and somatoparaphrenia in a 57-year-old woman suffering from central post-stroke pain. Resting-state functional magnetic resonance imaging was used to assess the neurological effects of this treatment. Following vestibular stimulation we observed impressive improvements in motor skills, pain, and somatic delusions. In the functional connectivity study before the vestibular stimulation, we observed differences in the patient's left thalamus functional connectivity, with respect to the thalamus connectivity of a control group (N = 20, in the bilateral cingulate cortex and left insula. After the caloric stimulation, the left thalamus functional connectivity with these regions, which are known to be involved in the cortical response to pain, disappeared as in the control group. The beneficial use of vestibular stimulation in the reduction of pain and somatic delusion in a CPSP patient is now documented by behavioral and imaging data. This evidence can be applied to theoretical models of pain and body delusions.

  20. Genetics of peripheral vestibular dysfunction: lessons from mutant mouse strains.

    Science.gov (United States)

    Jones, Sherri M; Jones, Timothy A

    2014-03-01

    A considerable amount of research has been published about genetic hearing impairment. Fifty to sixty percent of hearing loss is thought to have a genetic cause. Genes may also play a significant role in acquired hearing loss due to aging, noise exposure, or ototoxic medications. Between 1995 and 2012, over 100 causative genes have been identified for syndromic and nonsyndromic forms of hereditary hearing loss. Mouse models have been extremely valuable in facilitating the discovery of hearing loss genes and in understanding inner ear pathology due to genetic mutations or elucidating fundamental mechanisms of inner ear development. Whereas much is being learned about hereditary hearing loss and the genetics of cochlear disorders, relatively little is known about the role genes may play in peripheral vestibular impairment. Here we review the literature with regard to genetics of vestibular dysfunction and discuss what we have learned from studies using mutant mouse models and direct measures of peripheral vestibular neural function. Several genes are considered that when mutated lead to varying degrees of inner ear vestibular dysfunction due to deficits in otoconia, stereocilia, hair cells, or neurons. Behavior often does not reveal the inner ear deficit. Many of the examples presented are also known to cause human disorders. Knowledge regarding the roles of particular genes in the operation of the vestibular sensory apparatus is growing, and it is clear that gene products co-expressed in the cochlea and vestibule may play different roles in the respective end organs. The discovery of new genes mediating critical inner ear vestibular function carries the promise of new strategies in diagnosing, treating, and managing patients as well as predicting the course and level of morbidity in human vestibular disease. American Academy of Audiology.

  1. The phosphorylation status of merlin in sporadic vestibular Schwannomas.

    Science.gov (United States)

    Wang, Zhaoyan; Lu, Yanjun; Tang, Juanjuan; Wang, Haojie; Wu, Hao

    2009-04-01

    The events leading to Schwannomas development are still largely unknown. Some studies have demonstrated that merlin acts as a tumor suppressor by blocking Ras-mediated signaling. In this study, we analyze the clinical and biological behaviors of seven randomly selected sporadic vestibular Schwannomas removed from the patients. We find that merlin was commonly lost in these Schwannomas, due to loss of merlin expression or phosphorylation status of merlin expression. Heightened CDKs/cyclins signal transduction concomitant with loss of p27 was well correlated with loss of functional merlin in Schwannomas. More, we show that phosphorylated merlin Schwannomas exhibited increased Ras/Rac/PAK signal transduction. That was in agreement with the severe clinical behaviors, i.e., phosphorylation status of merlin increased tumor size in sporadic vestibular Schwannomas. These results led us to suggest that phosphorylated merlin, a kind of type of mutation merlin, is involved in tumorigenesis of sporadic vestibular Schwannomas.

  2. Enlarged vestibular aqueduct (EVA) related with recurrent benign paroxysmal positional vertigo (BPPV).

    Science.gov (United States)

    Manzari, Leonardo

    2008-01-01

    The vestibular aqueduct is a bony canal related to the bony labyrinth of the inner ear and represents the non-sensory components of the endolymph-filled, closed, membranous labyrinth. The association of congenital sensorineural hearing loss with a large or enlarged vestibular aqueduct is well known as the large vestibular aqueduct syndrome (LVAS). The enlarged VA (EVA) comprises abnormalities not only in the structure of the inner ear, but also in the physiology of the auditory and vestibular systems. The clinical picture of this clinical entity is variable [Yetiser S, Kertment M, Ozkaptan Y. Vestibular disturbance in patients with Large Vestibular Aqueduct Syndrome (LVAS). Acta Otolaryngol (StochK) 1999;119: 641-646]. Signs and symptoms of the auditory impairment are more commonly described in the literature: hearing loss ranges from mild to profound, arising from fluctuating to stepwise progressive or sudden. Vestibular disturbances, ranging from mild imbalance to episodic vertigo, are rarely described in the literature. Benign paroxysmal positional vertigo (BPPV) is a labyrinthine disorder with a typical behavior: intense crises of rotational vertigo induced by postural changes of the head, with short duration and usually good responsiveness to rehabilitative maneuvers. These maneuvers are effective in about 80% of patients with BPPV. BPPV often recurs. About 1/3 of patients have a recurrence in the first year after treatment, and by five years, about half of all patients have a recurrence. Vestibular aqueduct has been demonstrated by conventional tomography and computed tomography (CT), however, CT scans cannot show the membranous labyrinth itself. On MR images it is not the vestibular aqueduct that is visualized but its contents, the endolymphatic duct and sac, and can show the abnormalities of the fluid spaces related to the membranous labyrinth. It is proposed that recurrent benign paroxysmal positional vertigo (BPPV) is related with volumetric abnormalities

  3. Laboratory-free measurement of gait rhythmicity in the assessment of the degree of impairment and the effectiveness of rehabilitation in patients with vertigo resulting from vestibular hypofunction.

    Science.gov (United States)

    Perring, S; Summers, T

    2007-06-01

    A portable system for measurement of stride time rhythmicity was developed using the technique of Hausdorff et al (2001a Arch. Phys. Med. Rehabil. 82 1050-6). Measurement was performed for an extended period of walking of 256 steps for each foot outside of the laboratory on 18 normal individuals and 20 patients referred with symptomatic vestibular impairment. Ten of the patients were reassessed following vestibular therapy. Gait rhythmicity measured by standard deviation (SD) stride time was found to be significantly higher in patients with vestibular impairment than in normal volunteers (mean +/- SD 60.3 +/- 39.8 ms versus 21.9 +/- 4.9 ms respectively, P measurement, specifically measurement of stride time variability, appears to be a powerful assessment tool for objective measurement of extent of impairment and response to therapy in patients with vestibular hypofunction.

  4. Analysis of Hearing Preservation and Facial Nerve Function for Patients Undergoing Vestibular Schwannoma Surgery: The Middle Cranial Fossa Approach versus the Retrosigmoid Approach - Personal Experience and Literature Review

    National Research Council Canada - National Science Library

    Rabelo de Freitas, Marcos; Russo, Alessandra; Sequino, Giuliano; Piccirillo, Enrico; Sanna, Mario

    2012-01-01

    ...) or the retrosigmoid approach (RSA). Materials and Methods: A review of the medical records of patients diagnosed with vestibular schwannoma who underwent surgical tumor removal in a single reference center via the MCFA or the RSA between January 1988...

  5. Influence of vestibular rehabilitation on neck pain and cervical range of motion among patients with whiplash-associated disorder: a randomized controlled trial

    National Research Council Canada - National Science Library

    Hansson, Eva Ekvall; Persson, Liselott; Malmström, Eva Maj

    2013-01-01

    To describe how vestibular rehabilitation influences pain and range of motion among patients with whiplash-associated disorder and dizziness, and to describe whether pain or range of motion correlated...

  6. Effects of acute altered gravity during parabolic flight and/or vestibular loss on cell proliferation in the rat dentate gyrus.

    Science.gov (United States)

    Zheng, Yiwen; Gliddon, Catherine M; Aitken, Phillip; Stiles, Lucy; Machado, Marie-Laure; Philoxene, Bruno; Denise, Pierre; Smith, Paul F; Besnard, Stephane

    2017-07-27

    Both parabolic flight, i.e. a condition of altered gravity, and loss of vestibular function, have been suggested to affect spatial learning and memory, which is known to be influenced by neurogenesis in the hippocampus. In this study we investigated whether short alternated micro- and hyper-gravity stimulations during parabolic flight and/or loss of vestibular function, would alter cell proliferation in the hippocampal dentate gyrus of rats, by measuring the number of bromodeoxyuridine (BrdU)-incorporated cells. Rats were randomly allocated to the following experimental groups: (1) sham transtympanic saline injection only (n=5); (2) bilateral vestibular deafferentation (BVD) by sodium arsanilate transtympanic injection only (n=5); (3) sham treatment and parabolic flight (n=5); (4) BVD and parabolic flight (n=6). Forty-two days following transtympanic injection, the animals were subjected to parabolic flight in an awake restrained condition after habituation. A modified Airbus A300 aircraft was flown on a parabolic path, creating 20s of 1.8G during both climbing and descending and 22s of 0G at the apex of each parabola. The no flight animals were subjected to the same housing for the same duration. Immediately after the parabolic flight or control ground condition, animals were injected with BrdU (300mg/kg, i.p). Twenty-four hs after BrdU injection, rats were sacrificed. BrdU immunolabelling was performed and the number of BrdU+ve cells in the dentate gyrus of the hippocampus was quantified using a modified fractionator method. BVD caused a large and significant reduction in the number of BrdU-positive cells compared to sham animals (P≤0.0001); however, flight and all interactions were non-significant. These results indicate that BVD significantly decreased cell proliferation irrespective of the short exposure to altered/modified gravity. Copyright © 2017 Elsevier B.V. All rights reserved.

  7. Out-of-Body Experiences and Other Complex Dissociation Experiences in a Patient with Unilateral Peripheral Vestibular Damage and Deficient Multisensory Integration.

    Science.gov (United States)

    Kaliuzhna, Mariia; Vibert, Dominique; Grivaz, Petr; Blanke, Olaf

    2015-01-01

    Out-of-body experiences (OBEs) are illusory perceptions of one's body from an elevated disembodied perspective. Recent theories postulate a double disintegration process in the personal (visual, proprioceptive and tactile disintegration) and extrapersonal (visual and vestibular disintegration) space as the basis of OBEs. Here we describe a case which corroborates and extends this hypothesis. The patient suffered from peripheral vestibular damage and presented with OBEs and lucid dreams. Analysis of the patient's behaviour revealed a failure of visuo-vestibular integration and abnormal sensitivity to visuo-tactile conflicts that have previously been shown to experimentally induce out-of-body illusions (in healthy subjects). In light of these experimental findings and the patient's symptomatology we extend an earlier model of the role of vestibular signals in OBEs. Our results advocate the involvement of subcortical bodily mechanisms in the occurrence of OBEs.

  8. Assessment of vestibular-evoked myogenic potentials and video head impulse test in type 2 diabetes mellitus patients with or without polyneuropathy.

    Science.gov (United States)

    Kalkan, Mehmet; Bayram, Ali; Gökay, Ferhat; Cura, Hasan Selçuk; Mutlu, Cemil

    2018-01-13

    This study aimed to compare cervical vestibular-evoked myogenic potentials (cVEMP), ocular vestibular-evoked myogenic potentials (oVEMP) and video head impulse test (vHIT) results between patients with type 2 diabetes mellitus (DM) or diabetic polyneuropathy (DPN) and healthy controls to determine vestibular end-organ pathologies. The participants in the present study consisted of three groups: the type 2 DM group (n = 33 patients), the DPN group (n = 33 patients), and the age- and sex-matched control group (n = 35). Cervical VEMP, oVEMP and vHIT were performed for each participant in the study and test results were compared between the groups. Peak-to-peak amplitudes of cVEMP (p13-n21) and oVEMP (n10-p15) were significantly lower in the DM and DPN groups than the control group. The values of vHIT were not statistically different between the groups. To our knowledge, the present study is the first report investigating oVEMP and cVEMP responses combined with vHIT findings in patients with DM and DPN. Vestibular end-organ pathologies can be determined via clinical vestibular diagnostic tools in spite of prominent vestibular symptoms in patients with type 2 DM as well as patients with DPN.

  9. Cervical kinematics in patients with vestibular pathology vs. patients with neck pain: A pilot study.

    Science.gov (United States)

    Williams, Grace; Sarig-Bahat, Hilla; Williams, Katrina; Tyrrell, Ryan; Treleaven, Julia

    2017-01-01

    Research has consistently shown cervical kinematic impairments in subjects with persistent neck pain (NP). It could be reasoned that those with vestibular pathology (VP) may also have altered kinematics since vestibular stimulation via head movement can cause dizziness and visual disturbances. However, this has not been examined to date. This pilot study investigated changes in cervical kinematics between asymptomatic control, NP and VP subjects using a Virtual Reality (VR) system. It was hypothesised that there would be altered kinematics in VP subjects, which might be associated with dizziness and visual symptoms. Pilot cross sectional observational study. Twenty control, 14 VP and 20 NP subjects. Not applicable. Measures included questionnaires (neck disability index, pain on movement, dizziness and pain intensity, visual disturbances) and cervical kinematics (range, peak and mean velocity, smoothness, symmetry, and accuracy of cervical motion) using a virtual reality system. Results revealed significantly decreased mean velocity and symmetry of motion in both planes in those with NP but no differences in accuracy or range of motion. No significant differences were seen between VP subjects and asymptomatic controls. However, correlation analysis showed some moderate correlations between dizziness to selected kinematics in both the NP and the VP groups. These results support that cervical kinematics are altered in NP patients, with velocity most affected. There is potential for VP subjects to also have altered kinematics, especially those who experience dizziness. More research is required.

  10. Vestibular rehabilitation: clinical benefits to patients with Parkinson's disease Reabilitação vestibular: utilidade clínica em pacientes com doença de Parkinson

    Directory of Open Access Journals (Sweden)

    Bianca Simone Zeigelboim

    2009-06-01

    Full Text Available OBJECTIVE: To evaluate the effectiveness of the vestibular rehabilitation (VR exercises by means of an assessment before and after the application of the Brazilian version of the Dizziness Handicap Inventory (DHI questionnaire. METHOD: Twelve patients were studied, the following procedures were carried out: anamnesis, otorhinolaryngological and vestibular evaluation, and the application of the DHI before and after the VR. RESULTS: Clinically resting tremors and subjective postural instability were the motor complaints most frequently associated with complaints of vertigo in 12 cases (100%; in the vestibular exam, all the patients presented abnormalities, frequently from the uni and bilateral peripheral vestibular deficiency syndromes in 10 cases (83.3%; there was significant improvement in the physical, functional and emotional aspects of the DHI after the completion of the VR. CONCLUSION: The VR following the Cawthorne and Cooksey protocol were shown to be useful in managing subjective complaints of several aspects evaluated in this protocol.OBJETIVO: Avaliar a eficácia dos exercícios de reabilitação vestibular (RV por meio de avaliação pré e pós-aplicação da versão brasileira do questionário Dizziness Handicap Inventory (DHI. MÉTODO: Estudou-se 12 pacientes e realizaram-se os seguintes procedimentos: anamnese, avaliação otorrinolaringológica, vestibular e aplicação do DHI pré e pós RV. RESULTADOS: Do ponto de vista clínico, o tremor de repouso e a instabilidade postural subjetiva foram às queixas motoras mais freqüentes associadas às queixas de vertigem em 12 casos (100%; no exame vestibular, todos os pacientes apresentaram anormalidades, com freqüência das síndromes vestibulares periféricas deficitárias uni e bilaterais em 10 casos (83,3%; houve melhora significativa dos aspectos físico, funcional e emocional do DHI após a realização da RV. CONCLUSÃO: A RV seguindo o protocolo de Cawthorne e Cooksey mostrou

  11. Influence of sensory information on static balance in older patients with vestibular disorder

    OpenAIRE

    Macedo, Camila; Gazzola,Juliana Maria; Ricci, Natalia Aquaroni [UNIFESP; Doná, Flávia; Ganança, Fernando Freitas

    2015-01-01

    Introduction: With aging, the sensory systems suffer an accumulation of degenerative, infectious and/or traumatic processes that may hinder the body balance maintenance. Objective: To assess the influence of sensory information on static body balance of elderly individuals with vestibular disorders. Methods: Cross-sectional study of elderly individuals with vestibular disorders. The Clinical Test of Sensory Interaction and Balance and posturography integrated with virtual reality (Balance Reh...

  12. Reabilitação Vestibular em portadores de Vertigem Posicional Paroxística Benigna Vestibular rehabilitation in patients with benign paroxysmal positional vertigo

    Directory of Open Access Journals (Sweden)

    João Simão de Melo Neto

    2012-01-01

    Full Text Available OBJETIVO: verificar, por meio do questionário handicap de tontura, o efeito de um protocolo de Reabilitação Vestibular (RV em portadores de Vertigem Posicional Paroxística Benigna (VPPB sete dias após primeira intervenção e seis meses após a segunda intervenção. MÉTODO: pacientes submetidos à confirmação diagnóstica de VPPB pela positividade da manobra Dix-Hallpike foram avaliados (coleta pelo questionário Dizziness Handicap Inventory - brasileiro (DHI-brasileiro, antes da primeira intervenção, após a segunda (intervalo de sete dias e seis meses após a segunda intervenção. As intervenções constavam de relaxamento cervical, manobra de Epley e restrições posturais e foram aplicadas logo após a primeira avaliação e antes da segunda avaliação, com intervalo de sete dias. Os resultados obtidos foram submetidos à análise estatística. RESULTADOS: nove mulheres com média de 63 anos (desvio padrão 4,6 fizeram parte da amostra. Foram encontradas as seguintes pontuações no DHI-brasileiro: Aspecto Físico - apresentou média na coleta 1 de 2,6a(±0,17; coleta 2 de 0,82b (±0,24; coleta 3 de 1,43b(±0,43 com pPURPOSE: to evaluate, by means of the dizziness handicap questionnaire, the effect of a Vestibular Rehabilitation (VR protocol in patients with benign paroxysmal positional vertigo (BPPV, seven days after the first intervention and six months after the second intervention. METHOD: patients undergoing BPPV diagnosis confirmation by a positive Dix-Hallpike maneuver were assessed (collection by the Dizziness Handicap Inventory - Brazilian (DHI-Brazilian before the first intervention, after the second (seven day interval and six months after the second one. The interventions consisted of cervical relaxation, Epley and postural restrictions were applied after the first assessment and before the second evaluation, with an interval of seven days. The results were statistically analyzed. RESULTS: nine women with an average

  13. Reabilitação vestibular: utilidade clínica em pacientes com esclerose múltipla Vestibular rehabilitation: clinical benefits to patients with multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Bianca Simone Zeigelboim

    2010-01-01

    Full Text Available O objetivo desse estudo foi analisar a eficácia do exercício de reabilitação vestibular em dois casos de esclerose múltipla remitente-recorrente. Ambos os casos foram encaminhados do Hospital de Clínicas para o Laboratório de Otoneurologia de uma instituição de ensino e foram submetidos aos seguintes procedimentos: anamnese, inspeção otológica, avaliação vestibular e aplicação do Dizziness Handicap Inventory pré e pós reabilitação vestibular utilizando-se o protocolo de Cawthorne e Cooksey. No primeiro caso, gênero feminino, 35 anos, tempo de doença de seis anos, referiu tontura há três anos, de intensidade moderada de ocorrência frequente, cefaléia, quedas, desvio de marcha à direita e sensação de desmaio (sic. Apresentou no exame labiríntico, síndrome vestibular periférica deficitária bilateral. No segundo caso, gênero feminino, 49 anos, tempo de doença de dois anos, referiu desvio de marcha à direita, dificuldade e/ou dor ao movimento do pescoço, formigamento de extremidade e alteração vocal. Apresentou no exame labiríntico, síndrome vestibular periférica deficitária à direita. Houve melhora significativa em ambos os casos dos aspectos físico, funcional e emocional do Dizziness Handicap Inventory após a realização da reabilitação vestibular. O protocolo utilizado promoveu melhora na qualidade de vida e auxiliou no processo de compensação vestibular.The aim of the present study was to analyze the effectiveness of vestibular rehabilitation exercises in two cases of remittent-recurrent multiple sclerosis. Both cases were referred from the Clinics Hospital to the Laboratory of Otoneurology of the same institution and were submitted to the following procedures: anamnesis, otological inspection, vestibular evaluation, and application of the Dizziness Handicap Inventory before and after vestibular rehabilitation using the Cawthorne and Cooksey protocol. The first case was a 35-year-old female

  14. The reliability and response stability of dynamic testing of the vestibulo-ocular reflex in patients with vestibular disease.

    Science.gov (United States)

    Mohammad, Maha T; Whitney, Susan L; Marchetti, Gregory F; Sparto, Patrick J; Ward, Bryan K; Furman, Joseph M

    2011-01-01

    The purpose of the study was to investigate the test-retest reliability and response stability of the Dynamic Visual Acuity (DVA) and Gaze Stabilization Test (GST) in patients with vestibular disorders. Twenty-nine patients with vestibular disease (16-78 years) participated. Subjects performed the GST and DVA in pitch and yaw planes, twice in one session and once after 7-10 days. The GST output is the maximum head velocity at which the patient was able to identify orientation of the letter E. The DVA output is the change in visual acuity when moving the head compared to static acuity. Subjects indicated their level of dizziness and visual blurring using a visual analog scale. Within- and between-sessions intraclass correlation coefficients ranged between 0-0.5 for the DVA and GST measures, with better correlations for within-session assessments. Response stability (standard error of measurement / mean) of the GST ranged between 21-32% and the DVA ranged between 25-69% with vertical DVA being most influenced by measurement error. Subjects' symptoms did not correlate with performance on either test. The current test protocol needs refinement to enhance reliability and stability in persons with vestibular disorders.

  15. Plasticity during vestibular compensation: the role of saccades

    Directory of Open Access Journals (Sweden)

    Hamish Gavin MacDougall

    2012-02-01

    Full Text Available This paper is focussed on one major aspect of compensation: the recent behavioural findings concerning oculomotor responses in human vestibular compensation and their possible implications for recovery after unilateral vestibular loss (UVL. New measurement techniques have provided new insights into how patients recover after UVL and have given clues for vestibular rehabilitation. Prior to this it has not been possible to quantify the level of function of all the peripheral vestibular sense organs. Now it is. By using vestibular-evoked myogenic potentials to measure utricular and saccular function and by new video head impulse testing to measure semicircular canal function to natural values of head accelerations. With these new video procedures it is now possible to measure both slow phase eye velocity and also saccades during natural head movements. The present evidence is that there is little or no recovery of slow phase eye velocity responses to natural head accelerations. It is doubtful as to whether the modest changes in slow phase eye velocity to small angular accelerations are functionally effective during compensation. On the other hand it is now clear that saccades can play a very important role in helping patients compensate and return to a normal lifestyle. Preliminary evidence suggests that different patterns of saccadic response may predict how well patients recover. It may be possible to train patients to produce more effective saccadic patterns in the first days after their unilateral loss. Some patients do learn new strategies, new behaviours, to conceal their inadequate VOR but when those strategies are prevented from operating by using passive, unpredictable, high acceleration natural head movements, as in the head impulse test, their vestibular loss can be demonstrated. It is those very strategies which the tests exclude, which may be the cause of their successful compensation.

  16. Is customized vestibular rehabilitation effective in patients with multiple sclerosis? A randomized controlled trial.

    Science.gov (United States)

    Ozgen, Gulnur; Karapolat, Hale; Akkoc, Yesim; Yuceyar, Nur

    2016-08-01

    Balance disorders are among the most common problems encountered by patients diagnosed with multiple sclerosis (MS). The purpose of this randomized, controlled trial was to investigate the effects of customized vestibular rehabilitation (VR) on balance, functional capacity, quality of life, and depression in patients with MS. This study was designed as a prospective, randomized, controlled trial. The study was carried out in a single tertiary referral center. Forty consecutive patients referred with a diagnosis of MS were randomized into two groups: an exercise group (N.=20) and a control group (N.=20). The experimental group underwent customized VR and the wait-listed control group received the usual medical care. All of the patients were assessed with objective balance tests (Romberg Test, Tandem Romberg Test, Foam Romberg Test, Static Posturography, Six-Meter Walk Test, Five Times Sit-to-Stand Test, Berg Balance Scale, Timed Up and Go Test, Functional Gait Assessment, and Dynamic Gait Index), subjective balance parameters (Activities-Specific Balance Confidence Scale and Dizziness Handicap Inventory), and functional capacity (Six-Minute Walking Test), quality of life (Multiple Sclerosis Quality of Life-54), and depression (Beck Depression Inventory) scales. At the end of the trial, the exercise group exhibited significant changes in most of the evaluated parameters compared to the control group [except the Tandem Romberg with eyes closed and the Foam Romberg, standing with eyes open (P0.05). The intergroup comparisons of differences indicated significant recoveries in favor of the exercise group in all of the evaluated parameters (P<0.05). This study confirms the effects of customized VR programs on balance, quality of life, and functional capacity in patients with MS. Customized VR is an effective method for treating balance disorders in patients with MS.

  17. Vestibular mechanisms.

    Science.gov (United States)

    Precht, W

    1979-01-01

    It is apparent from this and other reviews of the subject that our knowledge of vestibular function is most complete for the primary canal and otolithic afferents. Relatively little progress has been made in the understanding of receptor mechanisms and the functional importance of the efferent vestibular system. Since most of it has been summarized previously the latter were not considered here. Considerably more knowledge has accumulated in the field of central vestibular mechanisms, particularly those related to eye movements. Recent advances in functional synaptology of direct and indirect vestibuloocular pathways are described. It appears that the indirect pathways are essential for the central integration of the peripheral head velocity into a central eye position signal. Candidates for the neural integrator are presented and discussed and their connectivity described both for the horizontal and the relatively poorly studied vertical eye movement system. This field will certainly be studied extensively during the next years. Another interesting field is the role of the cerebellum in the control the vestibuloocular reflex. Recent data and hypotheses, including the problem of cerebellar plasticity, are summarized and evaluated. That the vestibular nuclei are by no means a simple relay system for specific vestibular signals destined for other sensory or motor centers is evidenced in this review by the description of multiple canal-canal, canalotolith, and visual-vestibular convergence at the nuclear level. Canal-otolith and polysensory convergence in vestibular neurons enables them to correct for the inherent inadequacies of the peripheral canal system in the low frequency range. The mechanisms of polysensory interaction in the central vestibular system will undoubtedly be an important and interesting field for future research.

  18. Vestibular rehabilitation outcomes in the elderly with chronic vestibular dysfunction.

    Science.gov (United States)

    Bayat, Arash; Pourbakht, Akram; Saki, Nader; Zainun, Zuraida; Nikakhlagh, Soheila; Mirmomeni, Golshan

    2012-11-01

    Chronic vestibular dysfunction is a frustrating problem in the elderly and can have a tremendous impact on their life, but only a few studies are available. Vestibular rehabilitation therapy (VRT) is an important therapeutic option for the neuro-otologist in treating patients with significant balance deficits. The purpose of this study was to assess the effect of vestibular rehabilitation on dizziness in elderly patients with chronic vestibular dysfunction. A total of 33 patients older than 60 years with chronic vestibular dysfunction were studied. Clinical and objective vestibular tests including videonystagmography (VNG) and dizziness handicap inventory (DHI) were carried out at their first visit, 2 weeks, and 8 weeks post-VRT. The VRT exercises were performed according to Cawthorne and Cooksey protocols. Oculomotor assessments were within normal limits in all patients. Nineteen patients (57.57%) showed abnormal canal paralysis on caloric testing which at follow-up sessions; CP values were decreased remarkably after VRT exercises. We found a significant improvement between pre-VRT and post-VRT total DHI scores (P < 0.001). This improvement was most prominent in functional subscore. Our study demonstrated that VRT is an effective therapeutic method for elderly patients with chronic vestibular dysfunction.

  19. Patient- versus physician-reported facial disability in vestibular schwannoma: an international cross-sectional study.

    Science.gov (United States)

    Tveiten, Øystein Vesterli; Carlson, Matthew L; Goplen, Frederik; Myrseth, Erling; Driscoll, Colin L W; Mahesparan, Rupavathana; Link, Michael J; Lund-Johansen, Morten

    2017-11-01

    OBJECTIVE Patient-reported outcomes are increasingly used in studies of vestibular schwannoma (VS); however, few studies have examined self-evaluated facial nerve function and its relation to physician-reported outcomes. The primary objective of this study was to compare patient self-evaluations of facial disability with physician-evaluated facial nerve status and with self-evaluations of a healthy control group. The second objective was to provide insight into the controversial subject of the optimal initial management of small- and medium-sized VSs; consequently, the authors compared patient-reported facial nerve disability following treatment via observation (OBS), Gamma Knife surgery (GKS), or microsurgery (MS). Lastly, the authors sought to identify risk factors for facial nerve dysfunction following treatment for small- and medium-sized VSs. METHODS All patients with a VS 3 cm or smaller that was singly treated with OBS, GKS, or MS at either of 2 independent treatment centers between 1998 and 2008 were retrospectively identified. Longitudinal facial nerve measures and clinical data, including facial nerve evaluation according to the House-Brackmann (HB) grading system, were extracted from existing VS databases. Supplementing the objective data were Facial Disability Index (FDI) scores, which were obtained via survey of patients a mean of 7.7 years after initial treatment. RESULTS The response rate among the 682 eligible patients was 79%; thus, data from a total of 539 patients were analyzed. One hundred forty-eight patients had been managed by OBS, 247 with GKS, and 144 with MS. Patients who underwent microsurgery had larger tumors and were younger than those who underwent OBS or GKS. Overall, facial nerve outcomes were satisfactory following treatment, with more than 90% of patients having HB Grade I function at the last clinical follow-up. Treatment was the major risk factor for facial nerve dysfunction. Almost one-fifth of the patients treated with MS had

  20. Contribuição do potencial evocado auditivo em pacientes com vertigem Results of brainstem evoked response in patients with vestibular complaints

    Directory of Open Access Journals (Sweden)

    Gisiane Munaro

    2010-06-01

    Full Text Available A avaliação otoneurológica consiste em exames para investigação de patologias auditivas e vestibulares, incluindo o potencial evocado de tronco encefálico e a vectoeletronistagmografia. OBJETIVO: Descrever os resultados da avaliação otoneurológica em pacientes com queixas vestibulococleares, normo-ouvintes e com perda auditiva, comparados a grupo-controle. MATERIAL E MÉTODOS: Estudo transversal, retrospectivo, observacional, realizado com 56 pacientes vertiginosos avaliados por audiometria, vectoeletronistagmografia e potencial evocado auditivo de tronco encefálico, divididos em grupo A, 31 pacientes normo-ouvintes, e grupo B, 25 pacientes com perda auditiva, comparados ao grupo-controle constituído por dez voluntários normo-ouvintes assintomáticos. RESULTADOS: Os pacientes dos grupos A e B apresentaram aumento em monobloco das latências absolutas das ondas I, III e V estatisticamente significante, quando comparados ao grupo-controle, embora com valores dentro da normalidade. A ausência da onda I a 80 dBNA foi um achado comum para ambos os grupos e ocorreu em quatro (12,9% sujeitos bilateralmente e em três (9,6% unilateralmente no grupo A e em oito (32% pacientes no grupo B bilateralmente. Nos dois casos em que a vectoeletronistagmografia acusou alteração vestibular central não ocorreram alterações nos parâmetros dos potenciais evocados. CONCLUSÃO: Os pacientes com vertigem, normo-ouvintes e com perda auditiva, apresentaram latências absolutas aumentadas quando comparados a grupo-controleOtoneurological evaluations are based on tests which investigate auditory and vestibular disorders, including brainstem evoked auditory potentials and vecto-electronystagmography. AIM: to describe the results from the otoneurological assessment of patients with vestibulocochlear complaints, normal hearing individuals and patients with hearing loss, and we will compare them to a control group. MATERIALS AND METHODS: Cross

  1. [Timed balance test and static posturography in the patients with unilateral vestibular hypofunction].

    Science.gov (United States)

    Liu, Bo; Kong, Wei-Jia; Lai, Chang-Qin; Hu, Yu-Juan

    2007-03-01

    To investigate the balance function of the patients with unilateral vestibular hypofunction (UVH) by timed balance tests and static posturography (SPG). Sixty-five subjects with UVH and 92 healthy subjects were taken the timed balance tests under differential stance including (1) standard Romberg test, (2) feet apart stance test, (3) tandem and (4) unilateral standing tests with eyes open and eyes closed. The average timing that subjects kept balance before falling in each standing conditions was recorded by stopwatch as the timed result. The body sway velocity during the test (1) and (2) were also recorded by the SPG. The timed results of the tandem and unilateral standing with eyes open and eyes closed in the UVH group were decreased (P Romberg test and foot apart stance with eyes open was not different between the UVH group and control group (P-value was 0.118 and 0.110 for the two tests respectively), and the difference was significant in the eyes closed condition (P Romberg test with eyes open and eyes closed (P 0.05). According to clinical assessment of balance function in UVH, the tandem and unilateral stance test could provide the additional information about the upright stance to the SPG measurement. The effect of foot position on the results of SPG should been considered in clinic.

  2. A quantitative analysis of gait patterns in vestibular neuritis patients using gyroscope sensor and a continuous walking protocol.

    Science.gov (United States)

    Kim, Soo Chan; Kim, Joo Yeon; Lee, Hwan Nyeong; Lee, Hwan Ho; Kwon, Jae Hwan; Kim, Nam Beom; Kim, Mi Joo; Hwang, Jong Hyun; Han, Gyu Cheol

    2014-04-11

    Locomotion involves an integration of vision, proprioception, and vestibular information. The parieto-insular vestibular cortex is known to affect the supra-spinal rhythm generators, and the vestibular system regulates anti-gravity muscle tone of the lower leg in the same side to maintain an upright posture through the extra-pyramidal track. To demonstrate the relationship between locomotion and vestibular function, we evaluated the differences in gait patterns between vestibular neuritis (VN) patients and normal subjects using a gyroscope sensor and long-way walking protocol. Gyroscope sensors were attached to both shanks of healthy controls (n=10) and age-matched VN patients (n = 10). We then asked the participants to walk 88.8 m along a corridor. Through the summation of gait cycle data, we measured gait frequency (Hz), normalized angular velocity (NAV) of each axis for legs, maximum and minimum NAV, up-slope and down-slope of NAV in swing phase, stride-swing-stance time (s), and stance to stride ratio (%). The most dominant walking frequency in the VN group was not different compared to normal control. The NAVs of z-axis (pitch motion) were significantly larger than the others (x-, y-axis) and the values in VN patients tended to decrease in both legs and the difference of NAV between both group was significant in the ipsi-lesion side in the VN group only (p=0.03). Additionally, the gait velocity of these individuals was decreased relatively to controls (1.11 ± 0.120 and 0.84 ± 0.061 m/s in control and VN group respectively, p<0.01), which seems to be related to the significantly increased stance and stride time of the ipsi-lesion side. Moreover, in the VN group, the maximum NAV of the lesion side was less, and the minimum one was higher than control group. Furthermore, the down-slope and up-slope of NAV decreased on the impaired side. The walking pattern of VN patients was highly phase-dependent, and NAV of pitch motion was significantly decreased in the ipsi

  3. Ten-Year Follow-up on Tumor Growth and Hearing in Patients Observed With an Intracanalicular Vestibular Schwannoma

    DEFF Research Database (Denmark)

    Kirchmann, Malene; Karnov, Kirstine; Hansen, Søren

    2017-01-01

    BACKGROUND: Reports on the natural history of tumor growth and hearing in patients with a vestibular schwannoma (VS) are almost exclusively short-term data. Long-term data are needed for comparison with results of surgery and radiotherapy.  OBJECTIVE: To report the long-term occurrence of tumor...... in 37% and growth into the cerebellopontine angle had occurred in 23% of patients. Conservative treatment failed in 15%. The pure tone average had increased from 51- to 72-dB hearing level, and the speech discrimination score (SDS) had decreased from 60% to 34%. The number of patients with good hearing...

  4. Signal intensity change of the labyrinth in patients with surgically confirmed or radiologically diagnosed vestibular schwannoma on isotropic 3D fluid-attenuated inversion recovery MR imaging at 3 T

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    Lee, In Ho; Kim, Hyung-Jin; Kim, Eunhee; Moon, Jung Won; Kim, Sung Tae; Kim, Keon Ha; Jeon, Pyoung; Byun, Hong Sik [Sungkyunkwan University School of Medicine, Department of Radiology, Samsung Medical Center, Seoul (Korea); Chung, Won Ho [Sungkyunkwan University School of Medicine, Department of Otorhinolaryngology-Head and Neck Surgery, Samsung Medical Center, Seoul (Korea)

    2010-04-15

    The purpose of this study was to evaluate the signal intensity (SI) change of the labyrinth in patients with vestibular schwannoma on isotropic 3D fluid-attenuated inversion recovery (FLAIR) imaging at 3 T. Thirty-four patients with surgically confirmed or radiologically diagnosed vestibular schwannoma were included in this study. Retrospectively, we visually and quantitatively compared the SIs of the cochlea and vestibule on the affected side with those on the unaffected side. We also investigated whether there was correlation between the SI ratios (SIRs) of the labyrinth and the audiometric findings. On 3D FLAIR images, the SI of the cochlea and vestibule on the affected side was significantly increased in 97% (33/34) and 91% (31/34), respectively. While the SI of the cochlea was diffusely increased, that of the vestibule was only partially increased. Quantitative study also revealed statistically significantly higher SIRs of the cochlea (0.99 {+-} 0.29) and vestibule (0.73 {+-} 0.31) on the affected side, compared with the cochlea (0.47 {+-} 0.20) and vestibule (0.19 {+-} 0.10) on the unaffected side. There was no significant correlation of the SIRs of the labyrinth with the degree of hearing loss. In patients with vestibular schwannoma, isotropic 3D FLAIR imaging is a useful method for the evaluation of the SI changes of the labyrinth. (orig.)

  5. From ear to uncertainty: Vestibular contributions to cognitive function.

    OpenAIRE

    Paul eSmith; Yiwen eZheng

    2013-01-01

    In addition to the deficits in the vestibulo-ocular and vestibulo-spinal reflexes that occur following vestibular dysfunction, there is substantial evidence that vestibular loss also causes cognitive disorders, some of which may be due to the reflexive deficits and some of which are related to the role that ascending vestibular pathways to the limbic system and neocortex play in spatial orientation. In this review we summarize the evidence that vestibular loss causes cognitive disorders, espe...

  6. The vestibular implant: Quo vadis?

    Directory of Open Access Journals (Sweden)

    Raymond eVan De Berg

    2011-08-01

    Full Text Available AbstractObjective: to assess the progress of the development of the vestibular implant and its feasibility short-term. Data sources: a search was performed in Pubmed, Medline and Embase. Key words used were vestibular prosth* and vestibular implant. The only search limit was language: English or Dutch. Additional sources were medical books, conference lectures and our personal experience with per-operative vestibular stimulation in patients selected for cochlear implantation.Study selection: all studies about the vestibular implant and related topics were included and evaluated by two reviewers. No study was excluded since every study investigated different aspects of the vestibular implant. Data extraction and synthesis: data was extracted by the first author from selected reports, supplemented by additional information, medical books conference lectures. Since each study had its own point of interest with its own outcomes, it was not possible to compare data of different studies. Conclusion: to use a basic vestibular implant in humans seems feasible in the very near future. Investigations show that electric stimulation of the canal nerves induces a nystagmus which corresponds to the plane of the canal which is innervated by the stimulated nerve branch. The brain is able to adapt to a higher baseline stimulation, while still reacting on a dynamic component. The best response will be achieved by a combination of the optimal stimulus (stimulus profile, stimulus location, precompensation, complemented by central vestibular adaptation. The degree of response will probably vary between individuals, depending on pathology and their ability to adapt.

  7. Dyscalculia and vestibular function.

    Science.gov (United States)

    Smith, P F

    2012-10-01

    A few studies in humans suggest that changes in stimulation of the balance organs of the inner ear (the 'vestibular system') can disrupt numerical cognition, resulting in 'dyscalculia', the inability to manipulate numbers. Many studies have also demonstrated that patients with vestibular dysfunction exhibit deficits in spatial memory. It is suggested that there may be a connection between spatial memory deficits resulting from vestibular dysfunction and the occurrence of dyscalculia, given the evidence that numerosity is coupled to the processing of spatial information (e.g., the 'spatial numerical association of response codes ('SNARC') effect'). The evidence supporting this hypothesis is summarised and potential experiments to test it are proposed. Copyright © 2012 Elsevier Ltd. All rights reserved.

  8. Deficient recovery response and adaptive feedback potential in dynamic gait stability in unilateral peripheral vestibular disorder patients.

    Science.gov (United States)

    McCrum, Christopher; Eysel-Gosepath, Katrin; Epro, Gaspar; Meijer, Kenneth; Savelberg, Hans H C M; Brüggemann, Gert-Peter; Karamanidis, Kiros

    2014-12-01

    Unilateral peripheral vestibular disorder (UPVD) causes deficient locomotor responses to novel environments due to a lack of accurate vestibular sensory information, increasing fall risk. This study aimed to examine recovery response (stability recovery actions) and adaptive feedback potential in dynamic stability of UPVD-patients and healthy control subjects during perturbed walking. 17 UPVD-patients (>6 months since onset) and 17 matched healthy control participants walked on a treadmill and were subjected to eight unexpected perturbations during the swing phase of the right leg. For each perturbation, the margin of stability (MS; state of body's centre of mass in relation to the base of support), was determined at touchdown of the perturbed leg and during the following six recovery steps. The first perturbation caused a reduced MS at touchdown for the perturbed leg compared to baseline, indicating an unstable position, with controls requiring five recovery steps to return to MS baseline and UPVD-patients not returning to baseline level within the analyzed six recovery steps. By the eighth perturbation, control subjects needed two steps, and UPVD-patients required three recovery steps, both thereby improving their recovery response with practice. However, MS at touchdown of the perturbed leg increased only for the controls after repeated perturbations, indicating adaptive feedback-driven locomotor improvements for the controls, but not for the UPVD-patients. We concluded that UPVD-patients have a diminished ability to control dynamic gait stability during unexpected perturbations, increasing their fall risk, and that vestibular dysfunction may inhibit the neuromotor system adapting the reactive motor response to perturbations. © 2014 The Authors. Physiological Reports published by Wiley Periodicals, Inc. on behalf of the American Physiological Society and The Physiological Society.

  9. Long-term dizziness handicap in patients with vestibular schwannoma: a multicenter cross-sectional study.

    Science.gov (United States)

    Carlson, Matthew L; Tveiten, Øystein Vesterli; Driscoll, Colin L; Neff, Brian A; Shepard, Neil T; Eggers, Scott D; Staab, Jeffrey P; Tombers, Nicole M; Goplen, Frederik K; Lund-Johansen, Morten; Link, Michael J

    2014-12-01

    (1) To characterize long-term dizziness following observation, microsurgery, and stereotactic radiosurgery (SRS) for small to medium-sized vestibular schwannoma (VS) using a validated self-assessment inventory; and (2) to identify clinical variables associated with long-term dizziness handicap. Cross-sectional observational study. Two independent tertiary academic referral centers: one located in the United States and one in Norway. All patients with sporadic VS of less than 3 cm who underwent primary microsurgery, SRS, or observation between 1998 and 2008 were identified. Subjects were surveyed via a postal questionnaire using the Dizziness Handicap Inventory (DHI) and a VS symptom questionnaire. The overall survey response rate was 79%. A total of 538 respondents (mean age, 64 years; 56% female) were analyzed, and the mean time interval between treatment and survey was 7.7 years. Pretreatment variables associated with greater dizziness handicap included female sex, older age, larger tumor size, preexisting diagnosis of headache or migraine, and symptoms of dizziness predating treatment. Significant posttreatment features strongly associated with poor long-term DHI scores included frequency and severity of ongoing headache. On multivariable analysis, treatment modality did not influence long-term dizziness handicap. At a mean of approximately 8 years following treatment, over half of patients with VS reported ongoing dizziness. The authors have identified several baseline features that may help predict the risk of lasting dizziness. Treatment modality does not appear to influence long-term DHI score. We found a strong association between posttreatment headache and poor dizziness handicap. Future study is needed to further define this relationship. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2014.

  10. Hyperventilation-induced nystagmus in patients with vestibular neuritis in the acute and follow-up stages.

    Science.gov (United States)

    Park, Hong Ju; Shin, Jung Eun; Lee, Yeo Jin; Park, Mun Su; Kim, Jae Myung; Na, Bo Ra

    2011-01-01

    Our purposes were to characterize hyperventilation-induced nystagmus (HVIN) in patients with unilateral vestibular neuritis (VN) through follow-up examinations and to determine the effects of hyperventilation on vestibular imbalance in patients with VN. The horizontal eye movements in 35 patients with acute VN were recorded. The eye movements were analyzed and the maximum value of slow-phase eye velocity (SPV) was obtained during and after hyperventilation. Nineteen of 35 patients underwent follow-up examinations around 7 weeks later. When spontaneous nystagmus was present, the SPV of spontaneous nystagmus was subtracted from that of HVIN. A maximum SPV of HVIN of ≥4°/s was considered abnormal. The direction and SPV of HVIN were analyzed. The incidence of HVIN in patients with VN was significantly higher in the acute stage (18 of 35; 51%) than the follow-up stage (4 of 19; 21%). The direction of HVIN present in the follow-up stage was entirely towards the contralesional side (contralesional HVIN). However, the direction of HVIN in the acute stage was mixed, towards the contralesional side (10 of 35; 28%) and towards the ipsilesional side (8 of 35; 23%). The SPVs (49 ± 56°/s) of ipsilesional HVIN were significantly greater than the contralesional HVIN in the acute stage (8 ± 3°/s). Robust nystagmus (SPV ≥ 25°/s) was entirely ipsilesional HVIN, which was observed only in the acute stage. Our findings indicate that hyperventilation can result in aggravation of vestibular imbalance in the acute and follow-up stages in different ways. Hyperventilation resulted in contralesional HVIN in both the acute and follow-up stages, each in approximately a fourth of the patients, which suggests a disruption of central static compensatory mechanisms. However, ipsilesional HVIN was elicited only in the acute stage (in approximately a fourth of the patients). About half of the patients with ipsilesional HVIN showed robust responses, which is a characteristic finding

  11. The cognitive neurology of the vestibular system.

    Science.gov (United States)

    Seemungal, Barry M

    2014-02-01

    The aim is to reappraise the current state about what we know of vestibular cognition. The review focuses on cognition and perception, and hence the stress on human studies. In addition, the cerebral cortex is the main but not exclusive brain region of interest. There is a brief mention of vestibular ocular function if only to demonstrate the differential processing between reflex and perception. The effect of vestibular activation on some aspects of cognition, for example neglect, is not reviewed, as there have been no recent landmark findings in this area. The vestibular cerebellum is pivotal in the differential gating of vestibular perceptual and ocular signals to the cerebral cortex. The neuroanatomical correlates mediating vestibular sensations of self-motion ('am I moving?') and spatial orientation ('where am I now?') are distinct. Vestibular-motion perception is supported by a widespread white matter network. Vestibular activation specifically reduces visual motion cortical excitability, whereas other visual cortical regions show an increase in excitability. As the vestibular ocular reflex (VOR) and self-motion perception can be uncoupled both behaviourally and in neural correlate, deficits underlying vestibular patients' symptoms may not be revealed by simple VOR assessment. Given the pivotal cerebellar role in gating vestibular signals to perceptual regions, modulating mechanisms of cerebellar plasticity, for example by combining training with medication or brain stimulation, may prove fruitful in treating the symptoms of chronic dizzy patients.

  12. Achados vestibulares em usuários de aparelho de amplificação sonora individual Vestibular findings in hearing aid users

    Directory of Open Access Journals (Sweden)

    Fabiane Paulin

    2009-01-01

    Full Text Available OBJETIVO: verificar os achados vestibulares em pacientes com perda auditiva neurossenssorial usuários de aparelho de amplificação sonora individual. MÉTODOS: vinte pacientes, 11 do sexo feminino e nove do sexo masculino, com idades entre 39 e 85 anos, com perda auditiva neurossenssorial bilateral de grau moderado e severo foram atendidos em uma Instituição de Ensino Superior e submetidos a uma anamnese, inspeção otológica, avaliação audiológica, imitanciometria e ao exame vestibular por meio da vectoeletronistagmografia. RESULTADOS: a dos 20 pacientes avaliados, 18 (90% apresentaram queixa de zumbido, 15 (75% queixa de tontura e oito (40% queixa de cefaléia; b houve predomínio de alteração na prova calórica e no sistema vestibular periférico; c o resultado do exame vestibular esteve alterado em 14 pacientes (70%, sendo, oito casos (40% de síndrome vestibular periférica irritativa e seis casos (30% de síndrome vestibular periférica deficitária; d verificou-se diferença significativa entre o resultado do exame vestibular e o tempo de uso do aparelho de amplificação sonora individual; e dos cinco pacientes que não referiram nenhum sintoma vestibular, quatro (80% apresentaram alteração no exame. CONCLUSÃO: ressalta-se a sensibilidade e importância do estudo funcional do sistema do equilíbrio neste tipo de população, uma vez que podem ocorrer alterações na avaliação labiríntica independente da presença de sintomas.PURPOSE: to check vestibular findings in patients with sensoneural hearing loss, hearing aid users. METHODS: 20 patients (eleven females and nine males aging from 39 to 85-year-old with bilateral sensorineural hearing loss, from moderate to severe degrees, were attended in a higher education institution evaluated by medical history, otological inspections, complete basic conventional audiological evaluations, acoustic impedance tests and vectoeletronystagmography. RESULTS: a from the 20 evaluated

  13. Vestibular rehabilitation with biofeedback in patients with central imbalance Reabilitação vestibular por biofeedback no desequilíbrio corporal de origem central

    Directory of Open Access Journals (Sweden)

    Roseli Saraiva Moreira Bittar

    2011-06-01

    Full Text Available Central Nervous System disorders may cause important functional unbalance in the maintenance of balance and posture. There is no effective rehabilitation for these symptoms until now. OBJECTIVE: The aim of this paper is to evaluate the use of tongue electrotactile stimulation on patients with central imbalance using BrainPort. MATERIALS AND METHODS: This is a prospective case series study. We evaluated 8 patients with central imbalance, 6 men and 2 women, with mean age of 67.75 years. The patients were submitted to Computed Dynamic Posturography (CDP and then received 18 sessions of electrotactile stimulation by BrainPort® device for 20 minutes, twice a day. Then they were submitted to a new CDP test and to a self-perception scale to assess symptom remission, partial improvement and no improvement at all. RESULTS: 75% of the patients reported being more stable. There was no improvement in the balance control of the mass center in these patients. CONCLUSION: The patients were able to use the electrotactile stimulus to improve their balance control.As lesões do Sistema Nervoso Central (SNC determinam importantes prejuízos funcionais na manutenção do equilíbrio e da postura. A reabilitação vestibular e a fisioterapia oferecem benefícios limitados nesses casos. OBJETIVO: Avaliar a resposta de pacientes portadores de desequilíbrio de origem central à estimulação eletrotáctil da língua por meio do BrainPort®. CASUÍSTICA E MÉTODO: O estudo é prospectivo e configura uma série de casos. Foram avaliados 8 pacientes portadores de desequilíbrio de origem central, 6 homens e 2 mulheres com média de idade de 67,75 anos. Os pacientes foram submetidos à posturografia dinâmica computadorizada (PDC e submetidos ao treinamento pelo BrainPort®. em duas sessões diárias de 20 minutos, perfazendo um total de 18 sessões. Foram então reavaliados pela PDC e a uma escala análogo visual, que compreendeu remissão dos sintomas, melhora parcial

  14. Influence of sensory information on static balance in older patients with vestibular disorder

    Directory of Open Access Journals (Sweden)

    Camila Macedo

    2015-02-01

    Full Text Available Introduction: With aging, the sensory systems suffer an accumulation of degenerative, infectious and/or traumatic processes that may hinder the body balance maintenance. Objective: To assess the influence of sensory information on static body balance of elderly individuals with vestibular disorders. Methods: Cross-sectional study of elderly individuals with vestibular disorders. The Clinical Test of Sensory Interaction and Balance and posturography integrated with virtual reality (Balance Rehabilitation UnitTM were used. Posturography parameters analyzed included center of pressure and velocity of body sway. Results: 123 individuals with mean age of 73.11 were assessed. Worst performance was observed in the Clinical Test of Sensory Interaction and Balance condition of visual dome-unstable surface. Differences between conditions were: firm surface-open eyes/firm surface-closed eyes, unstable surface-open eyes/unstable surface-closed eyes (p < 0.001, and unstable surface-closed eyes/unstable surface-visual dome. Considering center of pressure and velocity of body sway, significant differences were observed between the following conditions: firm surface-open eyes/firm surface-closed eyes: firm surface-saccadic stimulus/firm surfacevertical optokinetic stimulus; firm surface-optokinetic stimuli/firm surface-visual-vestibular interaction; and firm surface-visual-vestibular interaction/unstable surface. Worse performances were observed in conditions firm surface-closed eyes, firm surface-vertical optokinetic stimulus, F-visual-vestibular interaction, and unstable surface-closed eyes. There was a difference in the center of pressure between firm surface-closed eyes/firm surface-saccadic stimulus, with a worse performance in the condition of firm surface-closed eyes, and of velocity of body sway, between firm surface-saccadic stimulus/firm surface-horizontal optokinetic stimulus (p < 0.001. Conclusion: Static body balance in elderly individuals with

  15. Presbivértigo: ejercicios vestibulares Presbivertigo: vestibular exercises

    OpenAIRE

    Esther Bernal Valls; Víctor Faus Cuñat; Raquel Bernal Valls

    2006-01-01

    El uso de ejercicios en el tratamiento de pacientes con déficit vestibular crónico está incrementándose de forma notable, lo que evidencia que se trata de un procedimiento que resulta beneficioso para este tipo de pacientes. Los buenos resultados que se obtienen sugieren que los ejercicios vestibulares dan lugar a una estabilidad postural y a una disminución de la sensación de desequilibrio.The use of exercises in the treatment of patients with vestibular deficits is increasing in a represent...

  16. Influence of sensory information on static balance in older patients with vestibular disorder.

    Science.gov (United States)

    Macedo, Camila; Gazzola, Juliana Maria; Ricci, Natalia Aquaroni; Doná, Flávia; Ganança, Fernando Freitas

    2015-01-01

    With aging, the sensory systems suffer an accumulation of degenerative, infectious and/or traumatic processes that may hinder the body balance maintenance. To assess the influence of sensory information on static body balance of elderly individuals with vestibular disorders. Cross-sectional study of elderly individuals with vestibular disorders. The Clinical Test of Sensory Interaction and Balance and posturography integrated with virtual reality (Balance Rehabilitation Unit) were used. Posturography parameters analyzed included center of pressure and velocity of body sway. 123 individuals with mean age of 73.11 were assessed. Worst performance was observed in the Clinical Test of Sensory Interaction and Balance condition of visual dome-unstable surface. Differences between conditions were: firm surface-open eyes/firm surface-closed eyes, unstable surface-open eyes/unstable surface-closed eyes (pvestibular interaction; and firm surface-visual-vestibular interaction/unstable surface. Worse performances were observed in conditions firm surface-closed eyes, firm surface-vertical optokinetic stimulus, F-visual-vestibular interaction, and unstable surface-closed eyes. There was a difference in the center of pressure between firm surface-closed eyes/firm surface-saccadic stimulus, with a worse performance in the condition of firm surface-closed eyes, and of velocity of body sway, between firm surface-saccadic stimulus/firm surface-horizontal optokinetic stimulus (pvestibular disorders is worse when the sensory conditions are more challenging, i.e. stable and unstable surfaces, visual stimuli, such as optokinetic and visual-vestibular interaction, and with the eyes closed. Copyright © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  17. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on the Role of Imaging in the Diagnosis and Management of Patients With Vestibular Schwannomas.

    Science.gov (United States)

    Dunn, Ian F; Bi, Wenya Linda; Mukundan, Srinivasan; Delman, Bradley N; Parish, John; Atkins, Tyler; Asher, Anthony L; Olson, Jeffrey J

    2017-12-20

    associated with rapid growth, lower rates of complete resection, and facial nerve outcomes that may be inferior in the immediate postoperative period but similar to noncystic schwannomas over time. Should the extent of lateral internal auditory canal involvement be considered by treating physicians? Adult patients with vestibular schwannomas. Level 3: The degree of lateral internal auditory canal involvement by tumor adversely affects facial nerve and hearing outcomes and should be emphasized when interpreting imaging for preoperative planning. How should patients with neurofibromatosis type 2 (NF2) and vestibular schwannoma be imaged and over what follow-up period? Adult patients with NF2 and vestibular schwannomas. Level 3: In general, vestibular schwannomas associated with NF2 should be imaged (similar to sporadic schwannomas) with the following caveats: 1. More frequent imaging may be adopted in NF2 patients because of a more variable growth rate for vestibular schwannomas, and annual imaging may ensue once the growth rate is established. 2. In NF2 patients with bilateral vestibular schwannomas, growth rate of a vestibular schwannoma may increase after resection of the contralateral tumor, and therefore, more frequent imaging may be indicated, based on the nonoperated tumor's historical rate of growth. 3. Careful consideration should be given to whether contrast is necessary in follow-up studies or if high-resolution T2 (including CISS or FIESTA-type sequences) MRI may adequately characterize changes in lesion size instead. How long should vestibular schwannomas be imaged after surgery, including after gross-total, near-total, and subtotal resection? Adult patients with vestibular schwannomas followed after surgery. Level 3: For patients receiving gross total resection, a postoperative MRI may be considered to document the surgical impression and may occur as late as 1 yr after surgery. For patients not receiving gross total resection, more frequent surveillance scans

  18. The role of the vestibular assessment.

    Science.gov (United States)

    Phillips, J S; FitzGerald, J E; Bath, A P

    2009-11-01

    To evaluate the role of vestibular assessment in the management of the dizzy patient. A retrospective review of case notes and vestibular assessment reports of 100 consecutive patients referred for vestibular assessment. Sixty of the 100 patients had an abnormal vestibular assessment. Eleven patients had benign paroxysmal positional vertigo as the sole diagnosis, of whom nine had not had a Dix-Hallpike manoeuvre performed before referral. Of patients referred for vestibular rehabilitation, 76 per cent had an abnormal electrophysiological assessment. After vestibular assessment, 35 patients were discharged with no further follow-up appointments in the ENT department. All patients should have a Dix-Hallpike manoeuvre performed prior to referral for vestibular assessment. The majority of our patients undergoing vestibular rehabilitation had abnormal test results, although a significant number did not. Prior to referral, it is worth considering the implication of a 'normal' and 'abnormal' result for the management of the patient. Careful consideration should be given to the development of dedicated dizziness clinics run by practitioners with a specialist interest in balance disorders, in order to ensure appropriate requests for vestibular assessment.

  19. Gamma Knife radiosurgery for treatment of growing vestibular schwannomas in patients with neurofibromatosis Type 2: a matched cohort study with sporadic vestibular schwannomas.

    Science.gov (United States)

    Kruyt, Ivo J; Verheul, Jeroen B; Hanssens, Patrick E J; Kunst, Henricus P M

    2018-01-01

    OBJECTIVE Neurofibromatosis Type 2 (NF2) is a tumor syndrome characterized by an autosomal dominant pattern of inheritance. The hallmark of NF2 is the development of bilateral vestibular schwannomas (VSs), generally by 30 years of age. One of the first-line treatment options for small to medium-large VSs is radiosurgery. Although radiosurgery shows excellent results in sporadic VS, its use in NF2-related VS is still a topic of dispute. The aim of this study was to evaluate long-term tumor control, hearing preservation rates, and factors influencing outcome of optimally dosed, contemporary Gamma Knife radiosurgery (GKRS) for growing VSs in patients with NF2 and compare the findings to data obtained in patients with sporadic VS also treated by means of GKRS. METHODS The authors performed a retrospective analysis of 47 growing VSs in 34 NF2 patients who underwent GKRS treatment performed with either the Model C or Perfexion Leksell Gamma Knife, with a median margin dose of 11 Gy. Actuarial tumor control rates were estimated using the Kaplan-Meier method. For patient- and treatment-related factors, a Cox proportional hazards model was used to identify predictors of outcome. Trigeminal, facial, and vestibulocochlear nerve function were assessed before and after treatment. NF2-related VS patients were matched 1:1 with sporadic VS patients who were treated in the same institute, and the same indications for treatment, definitions, and dosimetry were used in order to compare outcomes. RESULTS Actuarial tumor control rates in NF2 patients after 1, 3, 5, and 8 years were 98%, 89%, 87%, and 87%, respectively. Phenotype and tumor volume had significant hazard rates of 0.086 and 22.99, respectively, showing that Feiling-Gardner phenotype and a tumor volume not exceeding 6 cm3 both were associated with significantly better outcome. Actuarial rates of serviceable hearing preservation after 1, 3, 5, and 7 years were 95%, 82%, 59%, and 33%, respectively. None of the patients

  20. Adverse effects of health anxiety on management of a patient with benign paroxysmal positional vertigo, vestibular migraine and chronic subjective dizziness.

    Science.gov (United States)

    Honaker, Julie A; Gilbert, Jane M; Shepard, Neil T; Blum, Daniel J; Staab, Jeffrey P

    2013-01-01

    Care of patients with vestibular symptoms focuses primarily on physical otoneurologic disorders; however, psychological factors can sustain symptoms, confound assessment, and adversely affect treatment. Health anxiety is a particularly pernicious process that simultaneously magnifies physical symptoms and inhibits medical care. To demonstrate the excess morbidity caused by vestibular health anxiety and its successful management in a patient with otoneurologic disease. Report of a 41-year-old woman with recurrent benign paroxysmal positional vertigo, vestibular migraine, and chronic subjective dizziness, who expressed grave concerns about her health, repeatedly questioned her otoneurologic diagnoses, and failed physical therapy and medication treatment until her health anxiety and otoneurologic illnesses were addressed simultaneously. Health anxiety is an empirically validated concept that explains troublesome health-related beliefs and behaviors. It is frustrating for patients and health care teams, but can be treated successfully in otoneurology practice, thereby reducing physical symptoms, emotional distress, functional impairment, and health care overutilization. Copyright © 2013 Elsevier Inc. All rights reserved.

  1. Efeito da reabilitação vestibular sobre a qualidade de vida de idosos labirintopatas Vestibular rehabilitation's effect over the quality of life of geriatric patients with labyrinth disease

    Directory of Open Access Journals (Sweden)

    Erika Barioni Mantello

    2008-04-01

    Full Text Available A tontura é um sintoma que acomete a população mundial, sendo observado maior prevalência em idosos devido ao processo de deterioração funcional dos sistemas auditivo e vestibular com o envelhecimento. OBJETIVO: O objetivo deste trabalho foi avaliar prospectivamente o efeito da Reabilitação Vestibular (RV como tratamento das labirintopatias de origem vascular e metabólica sobre a qualidade de vida de idosos. MATERIAL E MÉTODO: O estudo foi delineado como um ensaio clínico prospectivo, longitudinal, com a participação de 40 idosos de ambos os gêneros, divididos em 2 grupos, tontura de origem vascular ou metabólica. Os pacientes passaram por avaliações, orientações e a RV, que se baseou no protocolo de Cawthorne e Cooksey. A análise estatística dos dados foi feita através do teste t-Student e dos coeficientes de Pearson e Spearman. RESULTADOS: Pelas escalas de qualidade de vida utilizadas podemos observar que os aspectos avaliados melhoraram após a Reabilitação Vestibular. CONCLUSÃO: Conclui-se que a RV baseada nos protocolos de Cawthorne e Cooksey pode ser utilizada de modo benéfico nesta população.Dizziness is a symptom that affects the population world over, being more prevalent in the elderly due to the process of functional deterioration of the hearing and vestibular systems with aging. AIM: The objective of this study was to evaluate prospectively the effect of Vestibular Rehabilitation (VR as treatment for labyrinth disease of vascular and metabolic origin in the quality of life of geriatric patients. METHODS: The study was outlined as clinical-prospective, longitudinal, and observed, with the participation of 40 elder citizens of both genders, divided in 2 groups, dizziness of vascular or metabolic origin. The patients were evaluated and underwent VR - based on Cawthorne and Cooksey's protocol. The statistical analysis from the data was done through the t-Student test, the coefficients of Pearson and Spearman

  2. Mutation spectrum and genotype-phenotype correlation of hearing loss patients caused by SLC26A4 mutations in the Japanese: a large cohort study.

    Science.gov (United States)

    Miyagawa, Maiko; Nishio, Shin-Ya; Usami, Shin-Ichi

    2014-05-01

    Mutations in SLC26A4 cause a broad phenotypic spectrum, from typical Pendred syndrome to nonsyndromic hearing loss associated with enlarged vestibular aqueduct. Identification of these mutations is important for accurate diagnosis, proper medical management and appropriate genetic counseling and requires updated information regarding spectrum, clinical characteristics and genotype-phenotype correlations, based on a large cohort. In 100 patients with bilateral enlarged vestibular aqueduct among 1511 Japanese hearing loss probands registered in our gene bank, goiter data were available for 79, of whom 15 had Pendred syndrome and 64 had nonsyndromic hearing loss. We clarified the mutation spectrum for the SLC26A4 mutations and also summarized hearing levels, progression, fluctuation and existence of genotype-phenotype correlation. SLC26A4 mutations were identified in 82 of the 100 patients (82.0%). Of the Pendred syndrome patients, 93% (14/15) were carriers, as were 77% (49/64) of the nonsyndromic hearing loss patients. Clinical characteristics of patients with SLC26A4 mutations were congenital, fluctuating and progressive hearing loss usually associated with vertigo and/or goiter. We found no genotype-phenotype correlations, indicating that, unlike in the case of GJB2 mutations, the phenotype cannot be predicted from the genotype. Our mutation analysis confirmed the importance of mutations in the SLC26A4 gene among hearing loss patients with enlarged vestibular aqueduct and revealed the mutation spectrum, essential information when performing genetic testing.

  3. Presbivértigo: ejercicios vestibulares Presbivertigo: vestibular exercises

    Directory of Open Access Journals (Sweden)

    Esther Bernal Valls

    2006-12-01

    Full Text Available El uso de ejercicios en el tratamiento de pacientes con déficit vestibular crónico está incrementándose de forma notable, lo que evidencia que se trata de un procedimiento que resulta beneficioso para este tipo de pacientes. Los buenos resultados que se obtienen sugieren que los ejercicios vestibulares dan lugar a una estabilidad postural y a una disminución de la sensación de desequilibrio.The use of exercises in the treatment of patients with vestibular deficits is increasing in a representative way, what evidences this is a profitable process for this kind of patients. The good results suggest that vestibular exercises permit a postural stability and a decrease in the perception of disequilibrium.

  4. A review of the interrelationship between vestibular dysfunction ...

    African Journals Online (AJOL)

    problems and dyslexia were also associated with dysfunction of the vestibular system. Different tests evaluating vestibular loss were identified of which some can be used successfully by practitionars. Various programmes and activities were identified to successfully rehabilitate vestibular function. For better understanding ...

  5. The vestibular system and cognition.

    Science.gov (United States)

    Smith, Paul F

    2017-02-01

    The last year has seen a great deal of new information published relating vestibular dysfunction to cognitive impairment in humans, especially in the elderly. The objective of this review is to summarize and critically evaluate this new evidence in the context of the previous literature. This review will address the recent epidemiological/survey studies that link vestibular dysfunction with cognitive impairment in the elderly; recent clinical investigations into cognitive impairment in the context of vestibular dysfunction, both in the elderly and in the cases of otic capsule dehiscence and partial bilateral vestibulopathy; recent evidence that vestibular impairment is associated with hippocampal atrophy; and finally recent evidence relating to the hypothesis that vestibular dysfunction could be a risk factor for dementia. The main implication of these recent studies is that vestibular dysfunction, possibly of any type, may result in cognitive impairment, and this could be especially so for the elderly. Such symptoms will need to be considered in the treatment of patients with vestibular disorders.

  6. Anatomy, physiology, and physics of the peripheral vestibular system.

    Science.gov (United States)

    Kingma, H; van de Berg, R

    2016-01-01

    Many medical doctors consider vertigo and dizziness as the major, almost obligatory complaints in patients with vestibular disorders. In this chapter, we will explain that vestibular disorders result in much more diverse and complex complaints. Many of these other complaints are unfortunately often misinterpreted and incorrectly classified as psychogenic. When we really understand the function of the vestibular system, it becomes quite obvious why patients with vestibular disorders complain about a loss of visual acuity, imbalance, fear of falling, cognitive and attentional problems, fatigue that persists even when the vertigo attacks and dizziness decreases or even disappears. Another interesting new aspect in this chapter is that we explain why the function of the otolith system is so important, and that it is a mistake to focus on the function of the semicircular canals only, especially when we want to understand why some patients seem to suffer more than others from the loss of canal function as objectified by reduced caloric responses. © 2016 Elsevier B.V. All rights reserved.

  7. Vestibular activation, smooth pursuit tracking, and psychosis.

    Science.gov (United States)

    Jones, A M; Pivik, R T

    1985-04-01

    Pursuit tracking and vestibular activation procedures were combined in an investigation to determine if smooth pursuit tracking deficits could be related to abnormalities of visual-vestibular interaction in psychiatric patients. In actively psychotic patients, but not in comparison groups of schizophrenic outpatients with remitted symptomatology or normal controls, a significant failure of visual fixation to suppress caloric nystagmus was related to a higher incidence of disordered tracking during both baseline and postirrigation conditions. Other vestibular irregularities including dysrhythmia and reduced fast phase velocity were observed in these same patients. The results are supportive of a central deficit in visual-vestibular interaction that may contribute to pursuit tracking deficits in psychosis.

  8. Image-guided stereotactic radiotherapy for patients with vestibular schwannoma. A clinical study

    Energy Technology Data Exchange (ETDEWEB)

    Badakhshi, H.; Muellner, S.; Budach, V. [Charite School of Medicine and University Hospital of Berlin, Departments for Radiation Oncology, Berlin (Germany); Wiener, E. [School of Medicine and University Hospital of Berlin, Institute for Neuroradiology, Berlin (Germany)

    2014-06-15

    Local tumor control and functional outcome after linac-based stereotactic radiosurgery (SRS) and fractionated stereotactic radiotherapy (FSRT) for vestibular schwannoma (VS) were assessed. In all, 250 patients with VS were treated: 190 patients with tumors < 2 cm diameter underwent SRS and 60 patients with tumors >2 to 3.5 cm underwent FSRT. Dose prescription for all cases with SRS (n = 190, 76 %) was 13.5 Gy. For FSRT, mainly two hypofractionated schedules (n = 60, 24 %) with either 7 fractions of 5 Gy (total dose: 35 Gy; n = 35) or 11 fractions of 3.8 Gy (total dose: 41.8 Gy; n = 16) were used. The primary endpoint was local tumor control. Secondary endpoints were symptomatic control and morbidity. The median follow-up was 33.8 months. The 3-year local tumor control was 88.9 %. Local control for SRS and FSRT was 88 and 92 %, respectively. For FSRT with 35 and 41.8 Gy, local control was 90 and 100 %, respectively. There were no acute reactions exceeding grade I. In 61 cases (24.4 % of the entire cohort), trigeminal neuralgia was reported prior to treatment. At last follow-up, 16.3 % (10/61) of those patients reported relief of pain. Regarding facial nerve dysfunction, 45 patients (18 %) presented with symptoms prior to RT. At the last follow-up, 13.3% (6/45) of those patients reported a relief of dysesthesia. Using SRS to treat small VS results in good local control rates. FSRT for larger lesions also seems effective. Severe treatment-related complications are not frequent. Therefore, image-guided stereotactic radiotherapy is an appropriate alternative to microsurgery for patients with VS. (orig.) [German] Wir analysierten die lokale Kontrolle und die funktionellen Verlaeufe bei Patienten mit einem Vestibularisschwannom (VS), die sich einer linacbasierten stereotaktischen Radiochirurgie (SRS) oder einer fraktionierten stereotaktischen Radiotherapie (FSRT) unterzogen. Zwischen 1998 und 2008 wurden 250 Patienten mit einem VS behandelt. In dieser Kohorte wurden 190

  9. Gamma Knife radiosurgery for vestibular schwannomas: evaluation of tumor control and its predictors in a large patient cohort in The Netherlands

    NARCIS (Netherlands)

    Klijn, S.; Verheul, J.B.; Beute, G.N.; Leenstra, S.; Mulder, J.J.S.; Kunst, H.P.M.; Hanssens, P.E.

    2016-01-01

    OBJECT The authors of this study sought to assess tumor control and complication rates in a large cohort of patients who underwent Gamma Knife radiosurgery (GKRS) for vestibular schwannoma (VS) and to identify predictors of tumor control. METHODS The records of 420 patients treated with GKRS for VS

  10. Auditory and Vestibular Issues Related to Human Spaceflight

    Science.gov (United States)

    Danielson, Richard W.; Wood, Scott J.

    2009-01-01

    Human spaceflight provides unique opportunities to study human vestibular and auditory systems. This session will discuss 1) vestibular adaptive processes reflected by pronounced perceptual and motor coordination problems during, and after, space missions; 2) vestibular diagnostic and rehabilitative techniques (used to promote recovery after living in altered gravity environments) that may be relevant to treatment of vestibular disorders on earth; and 3) unique acoustical challenges to hearing loss prevention and crew performance during spaceflight missions.

  11. Vestibular Schwannoma or acoustic neuroma

    Directory of Open Access Journals (Sweden)

    Hekmatara M

    1997-04-01

    Full Text Available Vestibular schwannoma is the most common tumor of the posterior fossa of the skull. Patients referred with the primary otologic symptoms such as hearing loss, tinnitus, vertigo, imbalance, and the cranial nerve palsy. Thirty-three patients were operated and treated by a team of otolaryngologist and neurosurgeon, anudiometrist, and internist. Patients'chiefcomplaint was due to 94% hearing loss and 27% tinnitus. They scarcely complain of vertigo. If a patient refers with the palsy or paralysis of facial nerve preoperation, we must think of the facial nerve schwannoma or hemangioma or congential cholestoma or malignant metastases rather than acoustic neuroma. The best way for preoperative diagnosis is audiometry, ABR (Auditory Brain Response, and SDS (speech discrimination score with 90% success, but computer Tomography (CT scan and MRI (Magnetic Resonance Image are the valuable anatomic diagnostic radiographic devices. The best method of operation is translabirynthine approach (TLA, since it has the advantages such as an easy access to nerve paths and being the nearest path to CPA (Cerebellopontine Angle. Physicians ought to talk to patients about the importance of the microscopic surgery, surgical methods, and their probable diverse effects such as hearing loss, facial nerve palsy, and intracranial problems.

  12. Unilateral vestibular schwannoma and meningiomas in a patient with PIK3CA-related segmental overgrowth: Co-occurrence of mosaicism for 2 rare disorders.

    Science.gov (United States)

    Mills, J R; Moyer, A M; Kipp, B R; Poplawski, A B; Messiaen, L M; Babovic-Vuksanovic, D

    2018-01-01

    A 28-year-old female with PIK3CA-related segmental overgrowth presented with headaches. She also had a unilateral vestibular schwannoma (VS), as well as 3 small (A (p.Gly914Arg) mutation, confirming the diagnosis of PIK3CA-related overgrowth, but no mutations in NF2 were detected. Although VS has not previously been reported in PIK3CA-related segmental overgrowth, meningiomas have, raising the question of whether this patient's VS and meningiomas represent coincidental NF2 or phenotypic extension of her overgrowth syndrome. Genetic analysis of the VS revealed a heterozygous NF2 mutation c.784C>T (p.Arg262Ter) and loss of a portion of 22q, including NF2, SMARCB1, and LZTR1 genes. These results suggest that the patient has 2 different mosaic disorders, NF2 and PIK3CA-related overgrowth. The PIK3CA mutation was also present in the VS. Confirmation of the clinical diagnosis of mosaic NF2 in this patient has implications for monitoring and highlights the possibility of co-occurrence of mosaicism for multiple rare disorders in a single patient. © 2017 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

  13. Gamma Knife radiosurgery for vestibular schwannoma: case report and review of the literature

    Directory of Open Access Journals (Sweden)

    Fairbanks Robert K

    2009-12-01

    Full Text Available Abstract Vestibular schwannomas, also called acoustic neuromas, are benign tumors of the vestibulocochlear nerve. Patients with these tumours almost always present with signs of hearing loss, and many also experience tinnitus, vertigo, and equilibrium problems. Following diagnosis with contrast enhanced MRI, patients may choose to observe the tumour with subsequent scans or seek active treatment in the form of microsurgery, radiosurgery, or radiotherapy. Unfortunately, definitive guidelines for treating vestibular schwannomas are lacking, because of insufficient evidence comparing the outcomes of therapeutic modalities. We present a contemporary case report, describing the finding of a vestibular schwannoma in a patient who presented with dizziness and a "clicking" sensation in the ear, but no hearing deficit. Audible clicking is a symptom that, to our knowledge, has not been associated with vestibular schwannoma in the literature. We discuss the diagnosis and patient's decision-making process, which led to treatment with Gamma Knife radiosurgery. Treatment resulted in an excellent radiographic response and complete hearing preservation. This case highlights an atypical presentation of vestibular schwannoma, associated with audible "clicks" and normal hearing. We also provide a concise review of the available literature on modern vestibular schwannoma treatment, which may be useful in guiding treatment decisions.

  14. Physical therapy for persons with vestibular disorders.

    Science.gov (United States)

    Whitney, Susan L; Alghwiri, Alia; Alghadir, Ahmad

    2015-02-01

    Persons with vestibular disorders experience symptoms of dizziness and balance dysfunction, resulting in falls, as well as impairments of daily life. Various interventions provided by physical therapists have been shown to decrease dizziness and improve postural control. In the present review, we will focus on the role of physical therapy in the management of vestibular symptoms in patients with peripheral and central vestibular disorders. Persons with both acute and chronic central and peripheral vestibular disorders improve with vestibular rehabilitation. New interventions during the past 5 years have been designed to enhance recovery from problems with balance and dizziness. Examples include the use of virtual reality, vibrotactile feedback, optokinetic flow, YouTube videos, and innovative methods to change the gain of the vestibulo-ocular reflex (VOR). Patients with central and peripheral vestibular disorders benefit from physical therapy interventions. Advances in physical therapy interventions include new methods to stimulate adaptation of the VOR and the vestibulospinal systems.

  15. Unilateral Enlarged Vestibular Aqueduct Syndrome and Bilateral Endolymphatic Hydrops

    Science.gov (United States)

    Nola, Giuseppe; Sparvoli, Luca; Ralli, Giovanni

    2017-01-01

    Enlarged vestibular aqueduct (EVA) syndrome is a common congenital inner ear malformation characterized by a vestibular aqueduct with a diameter larger than 1.5 mm, mixed or sensorineural hearing loss that ranges from mild to profound, and vestibular disorders that may be present with a range from mild imbalance to episodic objective vertigo. In our study, we present the case of a patient with unilateral enlarged vestibular aqueduct and bilateral endolymphatic hydrops (EH). EH was confirmed through anamnestic history and audiological exams; EVA was diagnosed using high-resolution CT scans and MRI images. Therapy included intratympanic infusion of corticosteroids with a significant hearing improvement, more evident in the ear contralateral to EVA. Although most probably unrelated, EVA and EH may present with similar symptoms and therefore the diagnostic workup should always include the proper steps to perform a correct diagnosis. Association between progression of hearing loss and head trauma in patients with a diagnosis of EVA syndrome is still uncertain; however, these individuals should be advised to avoid activities that increase intracranial pressure to prevent further hearing deterioration. Intratympanic treatment with steroids is a safe and well-tolerated procedure that has demonstrated its efficacy in hearing, tinnitus, and vertigo control in EH. PMID:28607789

  16. Unilateral Enlarged Vestibular Aqueduct Syndrome and Bilateral Endolymphatic Hydrops

    Directory of Open Access Journals (Sweden)

    Massimo Ralli

    2017-01-01

    Full Text Available Enlarged vestibular aqueduct (EVA syndrome is a common congenital inner ear malformation characterized by a vestibular aqueduct with a diameter larger than 1.5 mm, mixed or sensorineural hearing loss that ranges from mild to profound, and vestibular disorders that may be present with a range from mild imbalance to episodic objective vertigo. In our study, we present the case of a patient with unilateral enlarged vestibular aqueduct and bilateral endolymphatic hydrops (EH. EH was confirmed through anamnestic history and audiological exams; EVA was diagnosed using high-resolution CT scans and MRI images. Therapy included intratympanic infusion of corticosteroids with a significant hearing improvement, more evident in the ear contralateral to EVA. Although most probably unrelated, EVA and EH may present with similar symptoms and therefore the diagnostic workup should always include the proper steps to perform a correct diagnosis. Association between progression of hearing loss and head trauma in patients with a diagnosis of EVA syndrome is still uncertain; however, these individuals should be advised to avoid activities that increase intracranial pressure to prevent further hearing deterioration. Intratympanic treatment with steroids is a safe and well-tolerated procedure that has demonstrated its efficacy in hearing, tinnitus, and vertigo control in EH.

  17. Progress toward development of a multichannel vestibular prosthesis for treatment of bilateral vestibular deficiency.

    Science.gov (United States)

    Fridman, Gene Y; Della Santina, Charles C

    2012-11-01

    This article reviews vestibular pathology and the requirements and progress made in the design and construction of a vestibular prosthesis. Bilateral loss of vestibular sensation is disabling. When vestibular hair cells are injured by ototoxic medications or other insults to the labyrinth, the resulting loss of sensory input disrupts vestibulo-ocular reflexes (VORs) and vestibulo-spinal reflexes that normally stabilize the eyes and body. Affected individuals suffer poor vision during head movement, postural instability, chronic disequilibrium, and cognitive distraction. Although most individuals with residual sensation compensate for their loss over time, others fail to do so and have no adequate treatment options. A vestibular prosthesis analogous to cochlear implants but designed to modulate vestibular nerve activity during head movement should improve quality of life for these chronically dizzy individuals. We describe the impact of bilateral loss of vestibular sensation, animal studies supporting feasibility of prosthetic vestibular stimulation, the current status of multichannel vestibular sensory replacement prosthesis development, and challenges to successfully realizing this approach in clinical practice. In bilaterally vestibular-deficient rodents and rhesus monkeys, the Johns Hopkins multichannel vestibular prosthesis (MVP) partially restores the three-dimensional (3D) VOR for head rotations about any axis. Attempts at prosthetic vestibular stimulation of humans have not yet included the 3D eye movement assays necessary to accurately evaluate VOR alignment, but these initial forays have revealed responses that are otherwise comparable to observations in animals. Current efforts now focus on refining electrode design and surgical technique to enhance stimulus selectivity and preserve cochlear function, optimizing stimulus protocols to improve dynamic range and reduce excitation-inhibition asymmetry, and adapting laboratory MVP prototypes into devices

  18. From ear to uncertainty: Vestibular contributions to cognitive function.

    Directory of Open Access Journals (Sweden)

    Paul eSmith

    2013-11-01

    Full Text Available In addition to the deficits in the vestibulo-ocular and vestibulo-spinal reflexes that occur following vestibular dysfunction, there is substantial evidence that vestibular loss also causes cognitive disorders, some of which may be due to the reflexive deficits and some of which are related to the role that ascending vestibular pathways to the limbic system and cortex play in spatial orientation. In this review we summarise the evidence that vestibular loss causes cognitive disorders, especially spatial memory deficits, in animals and humans and critically evaluate the evidence that these deficits are not due to hearing loss, problems with motor control, oscillopsia or anxiety and depression. We review the evidence that vestibular lesions affect head direction and place cells as well as the emerging evidence that artificial activation of the vestibular system, using galvanic vestibular stimulation, can modulate cognitive function.

  19. From ear to uncertainty: vestibular contributions to cognitive function.

    Science.gov (United States)

    Smith, Paul F; Zheng, Yiwen

    2013-11-26

    In addition to the deficits in the vestibulo-ocular and vestibulo-spinal reflexes that occur following vestibular dysfunction, there is substantial evidence that vestibular loss also causes cognitive disorders, some of which may be due to the reflexive deficits and some of which are related to the role that ascending vestibular pathways to the limbic system and neocortex play in spatial orientation. In this review we summarize the evidence that vestibular loss causes cognitive disorders, especially spatial memory deficits, in animals and humans and critically evaluate the evidence that these deficits are not due to hearing loss, problems with motor control, oscillopsia or anxiety and depression. We review the evidence that vestibular lesions affect head direction and place cells as well as the emerging evidence that artificial activation of the vestibular system, using galvanic vestibular stimulation (GVS), can modulate cognitive function.

  20. Mechanisms of vestibular compensation: recent advances.

    Science.gov (United States)

    Dutia, Mayank B

    2010-10-01

    This article reviews recent studies that have provided experimental evidence for mechanisms of neural and synaptic plasticity in the brain during vestibular compensation, the behavioural recovery that takes place following peripheral vestibular lesions. First, experimental evidence from animal studies indicates that an unbalanced vestibular commissural system is a fundamental cause of the syndrome of oculomotor and postural deficits after unilateral labyrinthectomy. Second, recent studies suggest the involvement of both GABAergic and glycinergic commissural neurons. In addition gliosis and reactive neurogenesis in the ipsilesional vestibular nuclei appear to be involved in compensation. Third, evidence from cerebellar-deficient mutant mice demonstrates an important role for cerebellum-dependent motor learning in the longer term. Factors such as stress steroids and neuromodulators such as histamine influence these plasticity mechanisms and may thus contribute to the development of compensation in patients. Vestibular compensation involves multiple, parallel plastic processes at various sites in the brain. Experimental evidence suggests that adaptive changes in the sensitivity of ipsilesional vestibular neurons to the inhibitory neurotransmitters GABA and glycine, changes in the electrophysiological excitability of vestibular neurons, changes in the inhibitory control of the brainstem vestibular networks by the cerebellum, gliosis and neurogenesis in the ipsilesional vestibular nuclei, and activity-dependent reorganization of the synaptic connectivity of the vestibular pathways are mechanisms involved in compensation.

  1. Ethical, anatomical and physiological issues in developing vestibular implants for human use.

    Science.gov (United States)

    Guyot, Jean-Philippe; Gay, Annietta; Kos, Maria Izabel; Pelizzone, Marco

    2012-01-01

    Effort towards the development of a vestibular implant for human use are being made. This paper will summarize the first important steps conducted in Geneva towards this ambitious goal. Basically, we have faced three major issues. First, an ethical issue. While it was clear that such development would require the collaboration of human volunteers, it was also clear that stimulation of the vestibular system may produce periods of significant incomfort. We know today how to minimize (and potentially eliminate) this type of incomfort. The second issue was anatomical. The anatomical topology of the vestibular system is complex, and of potentially dangerous access (i.e. facial nerve damage). We choose not to place the electrodes inside the ampullae but close the vestibular nerve branches, to avoid any opening of the inner ear and limit the risk of hearing loss. Work on cadaver heads, confirmed by acute stimulations trials on patients undergoing ear surgery under local anesthesia, demonstrated that it is possible to stimulate selectively both the posterior and lateral ampullary nerves, and elicit the expected vertical and horizontal nystagmic responses. The third issue was physiological. One of the goal of a vestibular implant will be to produce smooth eye movements to stabilize gaze direction when the head is moving. Indeed, after restoring a baseline or "rest" activity in the vestibular pathways with steady-state electrical stimulation, we demonstrated that modulation of this stimulation is producing smooth eye movements. In conclusion, humans can adapt to electrical stimulation of the vestibular system without too much discomfort. Surgical access to the posterior and lateral ampullary nerves have been developed and, electrical stimulation of the vestibular system can be used to artificially elicit smooth eye movements of different speeds and directions, once the system is in adapted state. Therefore, the major prerequisites to develop a prototype vestibular implant

  2. Origin of vestibular dysfunction in Usher syndrome type 1B.

    NARCIS (Netherlands)

    Sun, J.; Alphen, A.M. van; Wagenaar, M.; Huygen, P.L.M.; Hoogenraad, C.C.; Hasson, T.; Koekkoek, S.K.; Bohne, B.A.; Zeeuw, C.I. de

    2001-01-01

    It is still debated to what extent the vestibular deficits in Usher patients are due to either central vestibulocerebellar or peripheral vestibular problems. Here, we determined the origin of the vestibular symptoms in Usher 1B patients by subjecting them to compensatory eye movement tests and by

  3. Objective vestibular testing of children with dizziness and balance complaints following sports-related concussions.

    Science.gov (United States)

    Zhou, Guangwei; Brodsky, Jacob R

    2015-06-01

    To conduct objective assessment of children with balance and vestibular complaints following sports-related concussions and identify the underlying deficits by analyzing laboratory test outcomes. Case series with chart review. Pediatric tertiary care facility. Medical records were reviewed of 42 pediatric patients with balance and/or vestibular complaints following sports-related concussions who underwent comprehensive laboratory testing on their balance and vestibular function. Patients' characteristics were summarized and results analyzed. More than 90% of the children with protracted dizziness or imbalance following sports-related concussion had at least 1 abnormal finding from the comprehensive balance and vestibular evaluation. The most frequent deficit was found in dynamic visual acuity test, followed by Sensory Organization Test and rotational test. Patient's balance problem associated with concussion seemed to be primarily instigated by vestibular dysfunction. Furthermore, semicircular canal dysfunction was involved more often than dysfunction of otolith organs. Yet, children experienced a hearing loss following sports-related concussion. Vestibular impairment is common among children with protracted dizziness or imbalance following sports-related concussion. Our study demonstrated that proper and thorough evaluation is imperative to identify these underlying deficits and laboratory tests were helpful in the diagnosis and recommendation of following rehabilitations. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  4. Isolated cochlear neuritis from varicella reactivation mimicking a vestibular schwannoma

    Directory of Open Access Journals (Sweden)

    Adam D. Goodale

    2016-09-01

    Full Text Available We present a case of a patient with progressive unilateral sensorineural hearing loss and tinnitus with internal auditory canal enhancement on magnetic resonance imaging (MRI secondary to isolated cochlear neuritis from varicella reactivation. MRI following antiviral treatment showed resolution of enhancement. Varicella reactivation is commonly seen in the form of Ramsay Hunt syndrome, which is known to produce abnormal MRI enhancement from facial and vestibulocochlear neuritis; however, its characteristic clinical signs aid the diagnosis. This case is unique in that the only manifestation of varicella infection was unilateral hearing loss. This case outlines the importance of maintaining a broad differential diagnosis in the evaluation of unilateral hearing loss as well as recognizing the limited specificity of MRI. Keywords: Vestibular schwannoma, Acoustic neuroma, Vestibular neuritis, Ramsay Hunt syndrome, Varicella zoster virus

  5. [Emergency diagnosis of the acute vestibular syndrome].

    Science.gov (United States)

    Tamás, T László; Garai, Tibor; Király, István; Mike, Andrea; Nagy, Csaba; Paukovics, Ágnes; Schmidt, Péter; Szatmári, Ferenc; Tompos, Tamás; Vadvári, Árpád; Szirmai, Ágnes

    2017-12-01

    To diagnose acute vestibular syndrome (AVS) in a prospective study by a new bedside test (providing 1A evidence) based on oculomotor analysis and assessment of hearing loss. To assess the frequency of central and peripheral causes of acute vestibular syndrome in the emergency room. To establish the diagnostic accuracy of acute cranial computed tomography as compared to oculomotor analysis done by video oculography goggles and audiometry. Between 1st March 2016 and 1st March 2017 we documented 125 patients (62 women, 63 men, average age 53 years) in the emergency room of the Petz Aladár County Teaching Hospital using the above bedside and instrumental testing. Diagnosis was verified by cranial magnetic resonance imaging. According to the results of the instrumental examination in AVS in 67% we found a peripheral cause and in 33% a central pathology. In 62% isolated posterior circulation stroke manifested itself by isolated vertigo without additional focal signs and the acute cranial computed tomography showed negative results in 96%. The instrumental examination increased diagnostic accuracy by making the diagnosis of isolated inferior semicircular canal vestibular neuritis possible. The new bedside oculomotor test is suitable for the diagnosis of posterior circulation stroke manifesting with isolated vertigo in early cases, when the routine neuroradiologic methods have a lower sensitivity or are not available. Orv Hetil. 2017; 158(51): 2029-2040.

  6. Vestibular rehabilitation with visual stimuli in peripheral vestibular disorders.

    Science.gov (United States)

    Manso, Andréa; Ganança, Mauricio Malavasi; Caovilla, Heloisa Helena

    2016-01-01

    Visual stimuli can induce vestibular adaptation and recovery of body balance. To verify the effect of visual stimuli by digital images on vestibular and body balance rehabilitation of peripheral vestibular disorders. Clinical, randomized, prospective study. Forty patients aged between 23 and 63 years with chronic peripheral vestibular disorders underwent 12 sessions of rehabilitation with visual stimuli using digital video disk (DVD) (experimental group) or Cawthorne-Cooksey exercises (control group). The Dizziness Handicap Inventory (DHI), dizziness analog scale, and the sensitized Romberg static balance and one-leg stance tests were applied before and after the intervention. Before and after the intervention, there was no difference between the experimental and control groups (p>0.005) regarding the findings of DHI, dizziness analog scale, and static balance tests. After the intervention, the experimental and control groups showed lower values (p<0.05) in the DHI and the dizziness analog scale, and higher values (p<0.05) in the static balance tests in some of the assessed conditions. The inclusion of visual stimuli by digital images on vestibular and body balance rehabilitation is effective in reducing dizziness and improving quality of life and postural control in individuals with peripheral vestibular disorders. Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  7. Vestibular rehabilitation with visual stimuli in peripheral vestibular disorders

    Directory of Open Access Journals (Sweden)

    Andréa Manso

    2016-04-01

    Full Text Available ABSTRACT INTRODUCTION: Visual stimuli can induce vestibular adaptation and recovery of body balance. OBJECTIVE: To verify the effect of visual stimuli by digital images on vestibular and body balance rehabilitation of peripheral vestibular disorders. METHODS: Clinical, randomized, prospective study. Forty patients aged between 23 and 63 years with chronic peripheral vestibular disorders underwent 12 sessions of rehabilitation with visual stimuli using digital video disk (DVD (experimental group or Cawthorne-Cooksey exercises (control group. The Dizziness Handicap Inventory (DHI, dizziness analog scale, and the sensitized Romberg static balance and one-leg stance tests were applied before and after the intervention. RESULTS: Before and after the intervention, there was no difference between the experimental and control groups (p > 0.005 regarding the findings of DHI, dizziness analog scale, and static balance tests. After the intervention, the experimental and control groups showed lower values (p < 0.05 in the DHI and the dizziness analog scale, and higher values (p < 0.05 in the static balance tests in some of the assessed conditions. CONCLUSION: The inclusion of visual stimuli by digital images on vestibular and body balance rehabilitation is effective in reducing dizziness and improving quality of life and postural control in individuals with peripheral vestibular disorders.

  8. Can vestibular rehabilitation exercises help patients with concussion? A systematic review of efficacy, prescription and progression patterns.

    Science.gov (United States)

    Murray, Drew A; Meldrum, Dara; Lennon, Olive

    2017-03-01

    Concussion symptoms normally resolve within 7-10 days but vertigo, dizziness and balance dysfunction persist in 10-30% of cases causing significant morbidity. This study systematically evaluated the evidence supporting the efficacy, prescription and progression patterns of vestibular rehabilitation therapy (VRT) in patients with concussion. Systematic Review, guided by PRISMA guidelines and presenting a best evidence synthesis. Electronic databases PubMed (1949 to May 2015), CINAHL (1982 to May 2015), EMBASE (1947 to May 2015), SPORTDiscus (1985 to May 2015), Web of Science (1945 to May 2015) and PEDRO (1999 to May 2015), supplemented by manual searches and grey literature. Article or abstract of original research, population of patients with concussion/mild traumatic brain injury (mTBI) with vestibular symptoms, interventions detailing VRT, measurement of outcomes pre-VRT/post-VRT. Study type was not specified. Following a double review of abstract and full-text articles, 10 studies met the inclusion criteria: randomised controlled trial (n=2), uncontrolled studies (n=3) and case studies (n=5). 4 studies evaluated VRT as a single intervention. 6 studies incorporated VRT in multimodal interventions (including manual therapy, strength training, occupational tasks, counselling or medication). 9 studies reported improvement in outcomes but level I evidence from only 1 study was found that demonstrated increased rates (OR 3.91; 95% CI 1.34 to 11.34; p=0.002) of medical clearance for return to sport within 8 weeks, when VRT (combined with cervical therapy) was compared with usual care. Heterogeneity in study type and outcomes precluded meta-analysis. Habituation and adaptation exercises were employed in 8 studies and balance exercises in 9 studies. Prescription and progression patterns lacked standardisation. Current evidence for optimal prescription and efficacy of VRT in patients with mTBI/concussion is limited. Available evidence, although weak, shows promise in

  9. Tooth loss: Are the patients prepared?

    African Journals Online (AJOL)

    The emotional effects following teeth loss were sadness 22. (12.9%) cases, depression in 11 (6.4%), feeling of losing body part in 24 (14%), feeling of aging in 4 (2.3%), while 13. (7.6%) respondents felt unconcerned. Conclusion: We observed that emotional effects of tooth loss are also experienced among our patients with ...

  10. Vestibular Restoration and Adaptation in Vestibular Neuritis and Ramsay Hunt Syndrome With Vertigo.

    Science.gov (United States)

    Martin-Sanz, Eduardo; Rueda, Almudena; Esteban-Sanchez, Jonathan; Yanes, Joaquin; Rey-Martinez, Jorge; Sanz-Fernandez, Ricardo

    2017-08-01

    To evaluate vestibular restoration and the evolution of the compensatory saccades in acute severe inflammatory vestibular nerve paralysis, including vestibular neuritis and Ramsay Hunt syndrome with vertigo. Prospective. Tertiary referral center. Vestibular neuritis (n = 18) and Ramsay Hunt syndrome patients with vertigo (n = 13) were enrolled. After treatment with oral corticosteroids, patients were followed up for 6 months. Functional recovery of the facial nerve was scored according to the House-Brackman grading system. Caloric and video head impulse tests were performed in every patient at the time of enrolment. Subsequently, successive video head impulse test (vHIT) exploration was performed at the 1, 3, and 6-month follow-up. Eighteen patients with vestibular neuritis and 13 with Ramsay Hunt syndrome and associated vertigo were included. Vestibular function was significantly worse in patients with Ramsay Hunt syndrome than in those with vestibular neuritis. Similar compensatory saccades velocity and latency values were observed in both groups, in both the caloric and initial vHIT tests. Successive vHIT results showed a significantly higher vestibulo-ocular reflex gain recovery in vestibular neuritis patients than in Ramsay Hunt syndrome patients. A significantly faster reduction in the latency, velocity, and organization of the compensatory saccades was observed in neuritis than in Ramsay Hunt syndrome patients. In addition to the recovery of the vestibulo-ocular reflex, the reduction of latency, velocity and the organization of compensatory saccades play a role in vestibular compensation.

  11. Counselling patients with sudden, irreversible sight loss

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    Jasmine Thombs

    2017-03-01

    Full Text Available Sudden loss of vision is devastating to the patient and close relatives. This article discusses how to talk with someone who has lost their vision and how to help them with their concerns and questions.

  12. Vestibular end organ injury induced by middle ear treatment with ferric chloride in rats.

    Science.gov (United States)

    Lee, J H; Kim, M S; Park, B R

    2017-02-01

    Sensorineural hearing loss, ataxia, pyramidal signs, and vestibular deficits characterize superficial siderosis of the central nervous system. This study investigated changes in vestibular function, free radical formation, and phosphorylated cJun expression in the vestibular end organs after middle ear treatment with a ferric chloride (FeCl3) solution. A single injection of 70% FeCl3 solution into the unilateral middle ear cavity caused static vestibular symptoms, such as spontaneous nystagmus and head tilt. Asymmetric expression of c-Fos protein was observed in the bilateral vestibular nuclei and prepositus hypoglossal nuclei within 6 h after injection. Histopathologic examinations revealed partial hair cell loss, degeneration of the supporting stroma, and terminal deoxynucleotidyl transferase dUTP nick end labeling-positive cells in the neuroepithelial layer of the crista ampullaris in FeCl3-treated animals. 5-(And-6)-chloromethyl-2',7'-dichlorodihydrofluorescein diacetate, acetyl ester and diaminofluorescein-2 diacetate fluorescence and immunoreactivity for nitrotyrosine increased markedly in the sensory neuroepithelial layer and nerve bundles of the crista ampullaris after 2 h. Strong immunoreactivity for phospho-cJun and cJun was observed in the type I hair cells of the crista ampullaris 120 h after injection. Thus, a single short-term treatment with a high concentration of FeCl3 in the unilateral middle ear cavity can induce activation of intracellular signals for cJun protein and oxidative stress through the formation of reactive oxygen species and nitric oxide in vestibular sensory receptors, resulting in vestibular dysfunction. These results suggest that activation of intracellular signals for cJun protein and oxidative stress may be a key component of the pathogenesis of vestibular deficits in patients with superficial siderosis.

  13. Eye movements in vestibular disorders.

    Science.gov (United States)

    Kheradmand, A; Colpak, A I; Zee, D S

    2016-01-01

    The differential diagnosis of patients with vestibular symptoms usually begins with the question: is the lesion central or is it peripheral? The answer commonly emerges from a careful examination of eye movements, especially when the lesion is located in otherwise clinically silent areas of the brain such as the vestibular portions of the cerebellum (flocculus, paraflocculus which is called the tonsils in humans, nodulus, and uvula) and the vestibular nuclei as well as immediately adjacent areas (the perihypoglossal nuclei and the paramedian nuclei and tracts). The neural circuitry that controls vestibular eye movements is intertwined with a larger network within the brainstem and cerebellum that also controls other types of conjugate eye movements. These include saccades and pursuit as well as the mechanisms that enable steady fixation, both straight ahead and in eccentric gaze positions. Navigating through this complex network requires a thorough knowledge about all classes of eye movements to help localize lesions causing a vestibular disorder. Here we review the different classes of eye movements and how to examine them, and then describe common ocular motor findings associated with central vestibular lesions from both a topographic and functional perspective. © 2016 Elsevier B.V. All rights reserved.

  14. Preoperative vestibular assessment protocol of cochlear implant surgery: an analytical descriptive study.

    Science.gov (United States)

    Bittar, Roseli Saraiva Moreira; Sato, Eduardo Setsuo; Ribeiro, Douglas Jósimo Silva; Tsuji, Robinson Koji

    Cochlear implants are undeniably an effective method for the recovery of hearing function in patients with hearing loss. To describe the preoperative vestibular assessment protocol in subjects who will be submitted to cochlear implants. Our institutional protocol provides the vestibular diagnosis through six simple tests: Romberg and Fukuda tests, assessment for spontaneous nystagmus, Head Impulse Test, evaluation for Head Shaking Nystagmus and caloric test. 21 patients were evaluated with a mean age of 42.75±14.38 years. Only 28% of the sample had all normal test results. The presence of asymmetric vestibular information was documented through the caloric test in 32% of the sample and spontaneous nystagmus was an important clue for the diagnosis. Bilateral vestibular areflexia was present in four subjects, unilateral arreflexia in three and bilateral hyporeflexia in two. The Head Impulse Test was a significant indicator for the diagnosis of areflexia in the tested ear (p=0.0001). The sensitized Romberg test using a foam pad was able to diagnose severe vestibular function impairment (p=0.003). The six clinical tests were able to identify the presence or absence of vestibular function and function asymmetry between the ears of the same individual. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  15. Preoperative vestibular assessment protocol of cochlear implant surgery: an analytical descriptive study

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    Roseli Saraiva Moreira Bittar

    Full Text Available Abstract Introduction: Cochlear implants are undeniably an effective method for the recovery of hearing function in patients with hearing loss. Objective: To describe the preoperative vestibular assessment protocol in subjects who will be submitted to cochlear implants. Methods: Our institutional protocol provides the vestibular diagnosis through six simple tests: Romberg and Fukuda tests, assessment for spontaneous nystagmus, Head Impulse Test, evaluation for Head Shaking Nystagmus and caloric test. Results: 21 patients were evaluated with a mean age of 42.75 ± 14.38 years. Only 28% of the sample had all normal test results. The presence of asymmetric vestibular information was documented through the caloric test in 32% of the sample and spontaneous nystagmus was an important clue for the diagnosis. Bilateral vestibular areflexia was present in four subjects, unilateral arreflexia in three and bilateral hyporeflexia in two. The Head Impulse Test was a significant indicator for the diagnosis of areflexia in the tested ear (p = 0.0001. The sensitized Romberg test using a foam pad was able to diagnose severe vestibular function impairment (p = 0.003. Conclusion: The six clinical tests were able to identify the presence or absence of vestibular function and function asymmetry between the ears of the same individual.

  16. Hearing loss in geriatric hemodialysis patients

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    Caner Sahin

    2015-01-01

    Full Text Available Introduction: The aim of the study was to evaluate the hearing loss in geriatric hemodialysis patients. Materials and Methods: The study was performed on 16 geriatric hemodialysis patients (age minimum: 65, maximum: 86 years and 16 volunteers (age minimum: 65, maximum: 86 years as a control group. The patients′ pure tone audiometry values between 250 and 8000 Hz frequencies were analyzed. Results: In our study, statistical significance was found between hearing loss and serum urea levels (P = 0.001. Hearing loss values were not statistically significantly different between the study and control groups (P = 0.786. High frequency hearing thresholds were found to be significantly higher in the geriatric hemodialysis patients (P = 0.032. Normal hearing levels at all levels were found in 5 patients in the study group. Mild to moderate hearing loss was found in 11 patients. Conclusions: In our preliminary study, we found statistically significant differences between the increase in hearing thresholds and uremia. Statistically significant changes in hearing thresholds at high frequencies were found between the two groups. Long-term hemodialysis treatment of 10 years or more is a risk factor for hearing loss. Hemodialysis treatment is a risk factor for hearing loss in geriatric patients who are at a risk of presbyacusis.

  17. Effects of Vestibular Rehabilitation Interventions in the Elderly with Chronic Unilateral Vestibular Hypofunction

    OpenAIRE

    Arash Bayat; Nader Saki

    2017-01-01

    Introduction: Although vestibular rehabilitation therapy (VRT) methods are relatively popular in treating patients with body balance deficits of vestibular origin, only limited studies have been conducted into customized exercises for unilateral vestibular hypofunction (UVH). Furthermore, very little evidence is available on the outcomes of VRT in the elderly population with chronic UVH. Materials and Methods: A total of 21 patients, aged 61 to 74 years, with UVH participated in this study. T...

  18. Head–Eye Vestibular Motion Therapy Affects the Mental and Physical Health of Severe Chronic Postconcussion Patients

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    Frederick Robert Carrick

    2017-08-01

    Full Text Available ContextApproximately 1.8–3.6 million annual traumatic brain injuries occur in the United States. An evidence-based treatment for concussions that is reliable and effective has not been available.ObjectiveThe objective of this study is to test whether head–eye vestibular motion (HEVM therapy is associated with decreased symptoms and increased function in postconcussive syndrome (PCS patients that have been severely impaired for greater than 6 months after a mild traumatic brain injury.DesignRetrospective clinical chart review.Setting and participantsTertiary Specialist Brain Rehabilitation Center.InterventionsAll subjects underwent comprehensive neurological examinations including measurement of eye and head movement. The seven modules of the C3 Logix Comprehensive Concussion Management System were used for pre- and postmeasurements of outcome of HEVM therapy.Materials and methodsWe utilized an objective validated measurement of physical and mental health characteristics of our patients before and after a 1-week HEVM rehabilitation program. We included only PCS patients that were disabled from work or school for a period of time exceeding 6 months after suffering a sports concussion. These subjects all were enrolled in a 5-day HEVM rehabilitation program at our Institutional Brain Center with pre- and post-C3 Logix testing outcomes.ResultsThere were statistical and substantive significant decreases in PCS symptom severity after treatment and statistical and substantive significant increases in standardized assessment of concussion scores. The outcomes were associated with positive changes in mental and physical health issues. This is a retrospective review and no control group has been included in this study. These are major limitations with retrospective reviews and further investigations with prospective designs including a randomized controlled study are necessary to further our understanding.ConclusionHead–eye vestibular motion

  19. Recovery of vestibular ocular reflex function and balance control after a unilateral peripheral vestibular deficit.

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    John eAllum

    2012-05-01

    Full Text Available This review describes the effect of unilateral peripheral vestibular deficit (UPVD on balance control as observed in stance and gait tests. Normally, a UPVD is defined based on vestibular ocular reflex (VOR function. Therefore, we compare recovery observed in balance control over time with similar patterns of recovery or lack thereof in VOR function. Three types of UPVD are considered; acute vestibular neuritis, vestibular loss prior to and after cerebellar pontine angle tumor (CPAT surgery during which a vestibular neurectomy was performed, and vestibular loss following neurectomy to eliminate disabling Ménière’s disease.To measure balance control, body-worn gyroscopes, mounted near the body’s centre of mass, were used for stance and gait tests. Measurement variables were the pitch (anterior-posterior and roll (lateral sway angles and angular velocities of the lower trunk-pelvis. All three groups showed balance deficits during stance tasks on foam, especially with eyes closed when stable control is highly dependent on vestibular inputs. Deficits in balance control during gait were present but were more profound for complex gait tasks such as tandem gait. Differences emerged between the groups concerning the severity of the deficit and its recovery. Generally, the effects of acute neuritis were more severe but recovered rapidly, deficits due to vestibular neurectomy were less severe but longer lasting. These results paralleled deficits in VOR function and raise questions about two modes of neural plasticity occurring in the vestibular system following vestibular loss: one mode being the limited central compensation for the loss, and the second mode being some restoration of peripheral vestibular function. Future work will need to correlate deficits in balance control during stance and gait more exactly with VOR deficits and carefully consider the differences between insufficient central compensation compared to inadequate peripheral

  20. Lateral medullary syndrome following injury of the vestibular pathway to the core vestibular cortex: Diffusion tensor imaging study.

    Science.gov (United States)

    Yeo, Sang Seok; Jang, Sung Ho; Kwon, Jung Won

    2017-12-05

    The parieto-insular vestibular cortex (PIVC) is a core region of vestibular input into regions of the cortex. The vestibular nuclei have reciprocal connections with the PIVC. However, little is known about injury of the core vestibular pathway to the PIVC in patients with dorsolateral medullary infarctions. In this study, using diffusion tensor tractography (DTT), we investigated injury of the neural connections between the vestibular nuclei and the PIVC in patients with typical central vestibular disorder. Eight consecutive patients with lateral medullary syndrome and 10 control subjects were recruited for this study. To reconstruct the core vestibular pathway to the PIVC, we defined the seed region of interest (ROI) as the vestibular nuclei of the pons and the target ROI as the PIVC. Fractional anisotropy (FA), mean diffusivity (MD), and tract volume were measured. The core vestibular pathway to the PIVC showed significantly lower tract volume in patients compared with the control group (p0.05). In conclusion, injury of the core vestibular pathway to the PIVC was demonstrated in patients with lateral vestibular syndrome following dorsolateral medullary infarcts. We believe that analysis of the core vestibular pathway to the PIVC using DTT would be helpful in evaluating patients with lateral medullary syndrome. Copyright © 2017. Published by Elsevier B.V.

  1. Radiological, clinical and audiological evaluation of jugular bulb-vestibular aqueduct dehiscence.

    Science.gov (United States)

    Tanrivermis Sayit, Asli; Elmali, Muzaffer; Kemal, Ozgur; Terzi, Yuksel

    2017-12-01

    The aim of this study is to determine the prevalence of jugular bulb-vestibular aqueduct dehiscence (JBVAD) in patients undergoing temporal bone multidetector computed tomography (MDCT) and assess the relationship between JBVAD and hearing loss with the findings of audiometry. About 1503 temporal bone MDCT scans were evaluated for the prevalence of JBVAD. Correlation of the imaging findings and audiometric data was performed. Patients were divided into two groups, those with and those without hearing loss, and were statistically compared. Jugular bulb-vestibular aqueduct dehiscence was detected in 124 of the 1503 patients with a prevalence of 8.2%. MDCT images of 56 of the 124 patients were normal except for JBVAD (n = 38) and close proximity of the jugular bulb (JB) and vestibular aqueduct (VA) (n = 18). A total of 23 of 38 patients with JBVAD and 7 of 18 patients with close proximity of the JB and VA had hearing loss detected by audiometric evaluation. The most common hearing loss was detected as sensorineural hearing loss in patients with JBVAD. Also, median air and bone conduction and air bone gap values were found statistically higher in patients with hearing loss versus those without hearing loss.

  2. Immersive Virtual Environment for Visuo-Vestibular Therapy: Preliminary Results

    OpenAIRE

    Gascuel, Jean-Dominique; Payno, Henri; Schmerber, Sébastien,; Martin, Olivier

    2012-01-01

    International audience; The sense of equilibrium aggregates several interacting cues. On patients with vestibular loss, vision plays a major role. In this study, the goal is to propose a new immersive therapy based on 3D opto-kinetic stimulation. We propose to demonstrate that 3D monoscopic optical flows are an efficient tool to stimulate adaptive postural adjustment. We developed an immersive therapeutic platform that enables to tune the balance task difficulty by managing optic flow speed a...

  3. Variations in the vestibular cortical bone of permanent canine teeth in orthodontic patients. a comparative study: linear tomography vs. cbct (3d accuitomo).

    Science.gov (United States)

    Mateu, María E; Martínez, M E; Dagum, H; Benítez Rogé, Sandra C; Bruno, Gabriela I; Hecht, Pedro; Folco, Alejandra A

    2014-01-01

    The aim of this study was to compare the results of measuring the height of the vestibular cortical bone of canine teeth by linear tomography (LT) and 3-D Accuitomo cone beam computed tomography (CBCT) before and after aligning dental arches by orthodontic treatment. LT and CBCT were performed before and after orthodontic alignment on 12 canines in three patients undergoing orthodontic treatment, and the height of the canine vestibular cortical bones measured in mm. Measurements were taken by double-blinded operators. The mean variation in height of the vestibular cortical bone with orthodontic treatment was - 0,33 mm} 0.233 standard error using CBCT and -0,08mm } 0.55 standard error using LT. Analysis of variance (ANOVA) was performed to compare the techniques, the patients and upper and lower canines. No significant difference was found for any of the cases. Using LT to evaluate vestibular crest cortical bone in canines is comparable in efficiency to using CBCT. Height in millimeters is less in LT because image resolution is lower and when it is very thin it is not appreciable by this method.

  4. An adaptive vestibular rehabilitation technique.

    Science.gov (United States)

    Crane, Benjamin T; Schubert, Michael C

    2017-05-23

    There is a large variation in vestibular rehabilitation (VR) results depending on type of therapy, adherence, and the appropriateness for the patient's level of function. A novel adaptive vestibular rehabilitation (AVR) program was developed and evaluated. Technology and procedure development, and prospective multicenter trial. Those with complete unilateral vestibular hypofunction and symptomatic at least 3 months with a Dizziness Handicap Inventory (DHI) >30 were eligible. Patients were given a device to use with their own computer. They were instructed to use the program daily, with each session lasting about 10 minutes. The task consisted of reporting orientation of the letter C, which appeared when their angular head velocity exceeded a threshold. The letter size and head velocity required were adjusted based on prior performance. Performance on the task was remotely collected by the investigator as well as a weekly DHI score. Four patients aged 31 to 74 years (mean = 51 years) were enrolled in this feasibility study to demonstrate efficacy. Two had treated vestibular schwannomas and two had vestibular neuritis. Starting DHI was 32 to 56 (mean = 42), which was reduced to 0 to 16 (mean = 11.5) after a month of therapy, a clinically and statistically significant (P VR in terms of cost and customization for patient ability and obtained a major improvement in symptoms. This study demonstrated a clinically and statistically significant decrease in symptoms after 4 weeks of therapy. 2b Laryngoscope, 2017. © 2017 The American Laryngological, Rhinological and Otological Society, Inc.

  5. International Clinical Protocol on Vestibular Disorders (Dizziness).

    Science.gov (United States)

    Trinus, Kostiantyn; Claussen, Claus-Frenz

    2017-12-01

    26-28 May at 43 Congress of Neurootological and Equilibriometric Society (Budapest, Hungary) International Clinical Protocol on Vestibular Disorders (Dizziness) being discussed and accepted as Consensus Document. Cochrane reports estimates that dizziness has prevalence of 22.9% in the last 12 months and an incidence of 3.1%. Only 1.8% of adults consulted a physician in the last 12 months. Cochrane reviews suggest that the evidence base for dizziness evaluation is weak, thus necessitates the creation of evidence-based document. Protocol is based at the new concept of vestibular system, which involves the vestibular peripheral sensors, space orientation tetrad, vestibular presentations in the brain cortex and vestibular effectory projections in the brain. Labyrinth consists of sensors, for which six modalities are adequate: 1. acceleration, 2. gravitation, 3. low frequency whole-body vibration, 4. Infrasound, 5. magnetic impulse, 6. metabolic changes. Vestibular system from rhomboid fosse gets the inputs from visual, acoustic, somatosensory organs, integrating them and forming space perception and orientation. Interaction with space is realized through sensory, motor, vegetative and limbic projections. So, vestibular disturbances may manifest as paropsia, tinnitus, numbness. Vestibular evoked potentials (not VEMP) and craniocorpography have highest sensitivity (90% and more). As vestibular dysfunction has recurrent character patients need monitoring.

  6. SLC26A4 gene copy number variations in Chinese patients with non-syndromic enlarged vestibular aqueduct

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    Zhao Jiandong

    2012-05-01

    Full Text Available Abstract Background Many patients with enlarged vestibular aqueduct (EVA have either only one allelic mutant of the SLC26A4 gene or lack any detectable mutation. In this study, multiplex ligation-dependent probe amplification (MLPA was used to screen for copy number variations (CNVs of SLC26A4 and to reveal the pathogenic mechanisms of non-syndromic EVA (NSEVA. Methods Between January 2003 and March 2010, 923 Chinese patients (481 males, 442 females with NSEVA were recruited. Among these, 68 patients (7.4% were found to carry only one mutant allele of SLC26A4 and 39 patients (4.2% lacked any detectable mutation in SLC26A4; these 107 patients without double mutant alleles were assigned to the patient group. Possible copy number variations in SLC26A4 were detected by SALSA MLPA. Results Using GeneMapper, no significant difference was observed between the groups, as compared with the standard probe provided in the assay. The results of the capillary electrophoresis showed no significant difference between the patients and controls. Conclusion Our results suggest that CNVs and the exon deletion in SLC26A4 are not important factors in NSEVA. However, it would be premature to conclude that CNVs have no role in EVA. Genome-wide studies to explore CNVs within non-coding regions of the SLC26A4 gene and neighboring regions are warranted, to elucidate their roles in NSEVA etiology.

  7. Neurogenic vestibular evoked potentials using a tone pip auditory stimulus.

    Science.gov (United States)

    Papathanasiou, E S; Zamba-Papanicolaou, E; Pantziaris, M; Kleopas, K; Kyriakides, T; Papacostas, S; Pattichis, C; Iliopoulos, I; Piperidou, C

    2004-01-01

    To obtain neurogenic vestibular evoked potentials (NVESTEPs) with surface scalp recording using a tone pip auditory stimulus. Fourteen neurologically normal volunteers (Age range 26-45 years, 10 females and 4 males), and two patients with sensorineural hearing loss and possible multiple sclerosis respectively, were examined. Two channel recordings were obtained, the first channel being P3 referred to Fpz, and the second channel being P4 referred to Fpz. A 1 kHz tone pip stimulus with two cycles was delivered via headphones monoaurally with contralateral masking noise. A consistent negative wave with a mean absolute latency of 4.72 msec was obtained, which we have named N5. 25% of the ears tested had better responses at the ipsilateral parietal electrode. In the patient with bilateral sensorineural hearing loss, NVESTEPs was present, suggesting that the NVESTEP is not a cochlear response. In the patient with possible multiple sclerosis, an abnormal NVESTEP response and a normal BAEP response were found. Use of a tone-pip rather than a click auditory stimulus allows a lower click intensity to be used in the production of NVESTEP responses, leads to a shorter testing time, and is therefore more comfortable for the patient. This study adds to our impression that the NVESTEP may be a physiological response that can be used to assess the vestibular system and is different from the BAEP response. Further testing in patients with symptoms of dizziness and with disorders specific for the vestibular nerve is required.

  8. Pathogenic substitution of IVS15 + 5G > A in SLC26A4 in patients of Okinawa Islands with enlarged vestibular aqueduct syndrome or Pendred syndrome.

    Science.gov (United States)

    Ganaha, Akira; Kaname, Tadashi; Yanagi, Kumiko; Naritomi, Kenji; Tono, Tetsuya; Usami, Shin-ichi; Suzuki, Mikio

    2013-05-24

    Pendred syndrome (PS) and nonsyndromic hearing loss associated with enlarged vestibular aqueduct (EVA) are caused by SLC26A4 mutations. The Okinawa Islands are the southwestern-most islands of the Japanese archipelago. And ancestral differences have been reported between people from Okinawa Island and those from the main islands of Japan. To confirm the ethnic variation of the spectrum of SLC26A4 mutations, we investigated the frequencies of SLC26A4 mutations and clinical manifestations of patients with EVA or PS living in the Okinawa Islands. We examined 22 patients with EVA or PS from 21 unrelated families in Okinawa Islands. The patient's clinical history, findings of physical and otoscopic examinations, hearing test, and computed tomography (CT) scan of the temporal bones were recorded. To detect mutations, all 21 exons and the exon-intron junctions of SLC26A4 were sequenced for all subjects. Quantitative reverse-transcription polymerase chain reaction (qRT-PCR) for SLC26A4 and calculations using the comparative CT (2(-ΔΔCT)) method were used to determine the pathogenicity associated with gene substitutions. SLC26A4 mutations were identified in 21 of the 22 patients. We found a compound heterozygous mutation for IVS15 + 5G > A/H723R in nine patients (41%), a homozygous substitution of IVS15 + 5G > A in six patients (27%), and homozygous mutation for H723R in five patients (23%). The most prevalent types of SLC26A4 alleles were IVS15 + 5G > A and H723R, which both accounted for 15/22 (68%) of the patients. There were no significant correlations between the types of SLC26A4 mutation and clinical manifestations. Based on qRT-PCR results, expression of SLC26A4 was not identified in patients with the homozygous substitution of IVS15 + 5G > A. The substitution of IVS15 + 5G > A in SLC26A4 was the most common mutation in uniquely found in patients with PS and EVA in Okinawa Islands. This suggested that the spectrum of SLC26A4 mutation differed

  9. Effects of primary caregiver participation in vestibular rehabilitation for unilateral neglect patients with right hemispheric stroke: a randomized controlled trial.

    Science.gov (United States)

    Dai, Chin-Ying; Huang, Yu-Hui; Chou, Li-Wei; Wu, Shiao-Chi; Wang, Ray-Yau; Lin, Li-Chan

    2013-01-01

    The current study aims to investigate the effects of primary caregiver participation in vestibular rehabilitation (VR) on improving the measures of neglect, activities of daily living (ADL), balance, and falls of unilateral neglect (UN) patients. This study is a single-blind randomized controlled trial. Both experimental (n = 24) and control groups (n = 24) received conventional rehabilitation. The experimental group undertook VR for a month. During the first and second weeks, a registered nurse trained the experimental group in VR. The primary caregivers in the experimental group supervised and guided their patients in VR during the third and fourth weeks. The outcome measures were neglect, ADL, balance, and falls. The two groups of UN patients showed a significant improvement in neglect, ADL, and balance over time. Based on the generalized estimating equations model, an interaction was observed between groups and times. Significant interactions were observed between the VR group at days 14 and 28 in the areas of neglect, ADL, and balance. No significant difference was observed between the two groups in the number of falls. Neglect, ADL, and balance among UN patients with right hemispheric stroke can be improved through the participation of primary caregivers in VR. Trained informal caregivers were recommended to provide VR guidance and supervision to patients who suffer from UN.

  10. Effects of primary caregiver participation in vestibular rehabilitation for unilateral neglect patients with right hemispheric stroke: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Dai CY

    2013-04-01

    Full Text Available Chin-Ying Dai,1,2 Yu-Hui Huang,3,4 Li-Wei Chou,5,6 Shiao-Chi Wu,7 Ray-Yau Wang,8 Li-Chan Lin9 1School of Nursing, National Yang Ming University, Taipei, Taiwan; 2Department of Nursing, Central Taiwan University of Science and Technology, Taichung, Taiwan; 3Department of Physical Medicine and Rehabilitation, Chung Shan Medical University Hospital, Taichung, Taiwan; 4School of Medicine, Chung Shan Medical University, Taichung, Taiwan; 5Department of Physical Medicine and Rehabilitation, China Medical University Hospital, Taichung, Taiwan; 6School of Chinese Medicine, College of Chinese Medicine, China Medical University, Taichung, Taiwan; 7Institute of Health and Welfare Policy, National Yang-Ming University, Taipei, Taiwan; 8Department of Physical Therapy and Assistive Technology, National Yang-Ming University, Taipei, Taiwan; 9Institute of Clinical and Community Health Nursing, National Yang-Ming University, Taipei, Taiwan, Republic of China Introduction: The current study aims to investigate the effects of primary caregiver participation in vestibular rehabilitation (VR on improving the measures of neglect, activities of daily living (ADL, balance, and falls of unilateral neglect (UN patients. Methods: This study is a single-blind randomized controlled trial. Both experimental (n = 24 and control groups (n = 24 received conventional rehabilitation. The experimental group undertook VR for a month. During the first and second weeks, a registered nurse trained the experimental group in VR. The primary caregivers in the experimental group supervised and guided their patients in VR during the third and fourth weeks. The outcome measures were neglect, ADL, balance, and falls. Results: The two groups of UN patients showed a significant improvement in neglect, ADL, and balance over time. Based on the generalized estimating equations model, an interaction was observed between groups and times. Significant interactions were observed between the VR group

  11. Comparison of Cawthorne-Cooksey exercises and sinusoidal support surface translations to improve balance in patients with unilateral vestibular deficit.

    Science.gov (United States)

    Corna, Stefano; Nardone, Antonio; Prestinari, Alessandro; Galante, Massimo; Grasso, Margherita; Schieppati, Marco

    2003-08-01

    To compare the effectiveness of vestibular rehabilitation by using Cawthorne-Cooksey exercises with that of instrumental rehabilitation. The main study (n=32) used a pre-post rehabilitation (A-B) design; the ancillary studies used a subset of 11 patients 1 month before rehabilitation versus pre-post rehabilitation (A-A-B design) and 9 patients pre-post rehabilitation versus 1 month after (A-B-B design). Division of physical therapy and rehabilitation at a scientific institute in Italy. Patients (Cawthorne-Cooksey, n=17; instrumental rehabilitation, n=15) with a complete or incomplete unilateral vestibular lesion due to ischemic, inflammatory, cranial nerve VIII sectioning, or unknown cause. Cawthorne-Cooksey exercises or instrumental rehabilitation training consisting of standing with eyes open (EO) or closed (EC) on a platform moving, relative to the subjects, in the anteroposterior (AP) or mediolateral direction, at a sinusoidal translation frequency of 0.2 or 0.6Hz; training sessions for both interventions were twice daily, 30 minutes per session, for 5 days. Body sway and subjective score of sway during quiet stance with EO or EC, with feet 10cm apart (FA) or together (FT); the standard deviation of the AP displacement of the malleolus, hip, and head during AP platform translations; the Dizziness Handicap Inventory (DHI); and performance-oriented evaluation of balance and gait (according to Tinetti). Both interventions improved patients' balance. Under each postural and visual condition, both groups showed reduction in body sway, and the post rehabilitation sway values approached those observed in normal subjects; improvement was significantly better for instrumental rehabilitation under FA EO, FA EC, and FT EC conditions. All patients reported a subjective feeling of increased steadiness. Sway recorded 1 month before treatment did not differ from that at the start of treatment. The follow-up evaluation showed persistence of effect. Parallel to the improved

  12. Ocular Vestibular Evoked Myogenic Potentials

    Directory of Open Access Journals (Sweden)

    Felipe, Lilian

    2014-01-01

    Full Text Available Introduction Diagnostic testing of the vestibular system is an essential component of treating patients with balance dysfunction. Until recently, testing methods primarily evaluated the integrity of the horizontal semicircular canal, which is only a portion of the vestibular system. Recent advances in technology have afforded clinicians the ability to assess otolith function through vestibular evoked myogenic potential (VEMP testing. VEMP testing from the inferior extraocular muscles of the eye has been the subject of interest of recent research. Objective To summarize recent developments in ocular VEMP testing. Results Recent studies suggest that the ocular VEMP is produced by otolith afferents in the superior division of the vestibular nerve. The ocular VEMP is a short latency potential, composed of extraocular myogenic responses activated by sound stimulation and registered by surface electromyography via ipsilateral otolithic and contralateral extraocular muscle activation. The inferior oblique muscle is the most superficial of the six extraocular muscles responsible for eye movement. Therefore, measurement of ocular VEMPs can be performed easily by using surface electrodes on the skin below the eyes contralateral to the stimulated side. Conclusion This new variation of the VEMP procedure may supplement conventional testing in difficult to test populations. It may also be possible to use this technique to evaluate previously inaccessible information on the vestibular system.

  13. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Surgical Resection for the Treatment of Patients With Vestibular Schwannomas.

    Science.gov (United States)

    Hadjipanayis, Constantinos G; Carlson, Matthew L; Link, Michael J; Rayan, Tarek A; Parish, John; Atkins, Tyler; Asher, Anthony L; Dunn, Ian F; Corrales, C Eduardo; Van Gompel, Jamie J; Sughrue, Michael; Olson, Jeffrey J

    2017-12-20

    What surgical approaches for vestibular schwannomas (VS) are best for complete resection and facial nerve (FN) preservation when serviceable hearing is present? There is insufficient evidence to support the superiority of either the middle fossa (MF) or the retrosigmoid (RS) approach for complete VS resection and FN preservation when serviceable hearing is present. Which surgical approach (RS or translabyrinthine [TL]) for VS is best for complete resection and FN preservation when serviceable hearing is not present? There is insufficient evidence to support the superiority of either the RS or the TL approach for complete VS resection and FN preservation when serviceable hearing is not present. Does VS size matter for facial and vestibulocochlear nerve preservation with surgical resection? Level 3: Patients with larger VS tumor size should be counseled about the greater than average risk of loss of serviceable hearing. Should small intracanalicular tumors (<1.5 cm) be surgically resected? There are insufficient data to support a firm recommendation that surgery be the primary treatment for this subclass of VSs. Is hearing preservation routinely possible with VS surgical resection when serviceable hearing is present? Level 3: Hearing preservation surgery via the MF or the RS approach may be attempted in patients with small tumor size (<1.5 cm) and good preoperative hearing. When should surgical resection be the initial treatment in patients with neurofibromatosis type 2 (NF2)? There is insufficient evidence that surgical resection should be the initial treatment in patients with NF2. Does a multidisciplinary team, consisting of neurosurgery and neurotology, provides the best outcomes of complete resection and facial/vestibulocochlear nerve preservation for patients undergoing resection of VSs? There is insufficient evidence to support stating that a multidisciplinary team, usually consisting of a neurosurgeon and a neurotologist, provides superior outcomes compared

  14. Vestibular Function and Depersonalization/Derealization Symptoms.

    Science.gov (United States)

    Jáuregui Renaud, Kathrine

    2015-01-01

    Patients with an acquired sensory dysfunction may experience symptoms of detachment from self or from the environment, which are related primarily to nonspecific symptoms of common mental disorders and secondarily, to the specific sensory dysfunction. This is consistent with the proposal that sensory dysfunction could provoke distress and a discrepancy between the multi-sensory frame given by experience and the actual perception. Both vestibular stimuli and vestibular dysfunction can underlie unreal experiences. Vestibular afferents provide a frame of reference (linear and angular head acceleration) within which spatial information from other senses is interpreted. This paper reviews evidence that symptoms of depersonalization/derealization associated with vestibular dysfunction are a consequence of a sensory mismatch between disordered vestibular input and other sensory signals of orientation.

  15. The Skull Vibration-Induced Nystagmus Test of Vestibular Function—A Review

    Science.gov (United States)

    Dumas, Georges; Curthoys, Ian S.; Lion, Alexis; Perrin, Philippe; Schmerber, Sébastien

    2017-01-01

    A 100-Hz bone-conducted vibration applied to either mastoid induces instantaneously a predominantly horizontal nystagmus, with quick phases beating away from the affected side in patients with a unilateral vestibular loss (UVL). The same stimulus in healthy asymptomatic subjects has little or no effect. This is skull vibration-induced nystagmus (SVIN), and it is a useful, simple, non-invasive, robust indicator of asymmetry of vestibular function and the side of the vestibular loss. The nystagmus is precisely stimulus-locked: it starts with stimulation onset and stops at stimulation offset, with no post-stimulation reversal. It is sustained during long stimulus durations; it is reproducible; it beats in the same direction irrespective of which mastoid is stimulated; it shows little or no habituation; and it is permanent—even well-compensated UVL patients show SVIN. A SVIN is observed under Frenzel goggles or videonystagmoscopy and recorded under videonystagmography in absence of visual-fixation and strong sedative drugs. Stimulus frequency, location, and intensity modify the results, and a large variability in skull morphology between people can modify the stimulus. SVIN to 100 Hz mastoid stimulation is a robust response. We describe the optimum method of stimulation on the basis of the literature data and testing more than 18,500 patients. Recent neural evidence clarifies which vestibular receptors are stimulated, how they cause the nystagmus, and why the same vibration in patients with semicircular canal dehiscence (SCD) causes a nystagmus beating toward the affected ear. This review focuses not only on the optimal parameters of the stimulus and response of UVL and SCD patients but also shows how other vestibular dysfunctions affect SVIN. We conclude that the presence of SVIN is a useful indicator of the asymmetry of vestibular function between the two ears, but in order to identify which is the affected ear, other information and careful clinical judgment are

  16. Caloric Vestibular Stimulation Reduces Pain and Somatoparaphrenia in a Severe Chronic Central Post-Stroke Pain Patient: A Case Study

    National Research Council Canada - National Science Library

    Spitoni, Grazia Fernanda; Pireddu, Giorgio; Galati, Gaspare; Sulpizio, Valentina; Paolucci, Stefano; Pizzamiglio, Luigi

    2016-01-01

    .... To date, there is limited evidence for the effective treatments of this disease. Here we used caloric vestibular stimulation to reduce pain and somatoparaphrenia in a 57-year-old woman suffering from central post-stroke pain...

  17. Vestibular implants studied in animal models: clinical and scientific implications.

    Science.gov (United States)

    Lewis, Richard F

    2016-12-01

    Damage to the peripheral vestibular system can result in debilitating postural, perceptual, and visual symptoms. A potential new treatment for this clinical problem is to replace some aspects of peripheral vestibular function with an implant that senses head motion and provides this information to the brain by stimulating branches of the vestibular nerve. In this review I consider animal studies performed at our institution over the past 15 years, which have helped elucidate how the brain processes information provided by a vestibular (semicircular canal) implant and how this information could be used to improve the problems experienced by patients with peripheral vestibular damage. Copyright © 2016 the American Physiological Society.

  18. Influence of vestibular rehabilitation on neck pain and cervical range of motion among patients with whiplash-associated disorder: a randomized controlled trial.

    Science.gov (United States)

    Hansson, Eva Ekvall; Persson, Liselott; Malmström, Eva Maj

    2013-09-01

    To describe how vestibular rehabilitation influences pain and range of motion among patients with whiplash-associated disorder and dizziness, and to describe whether pain or range of motion correlated with balance performance or self-perceived dizziness handicap. A total of 29 patients, 20 women and 9 men, age range 22-76 years. Patients with whiplash-associated disorder and dizziness were randomized to either intervention (vestibular rehabilitation) or control. Neck pain intensity, cervical range of motion (CROM), balance and self-perceived dizziness handicap were measured at baseline, 6 weeks and 3 months. There were no differences in neck pain intensity or CROM between the 2 groups either at baseline, 6 weeks or 3 months (p = 0.10-0.89). At baseline, neck pain intensity correlated with CROM (-0.406) and self-perceived dizziness handicap (0.492). CROM correlated with self-perceived dizziness handicap and with 1 balance measure (-0.432). Neck pain intensity did not correlate with balance performance (-0.188-0.049). Neck pain intensity and CROM was not influenced by vestibular rehabilitation. Importantly, the programme did not appear to increase pain or decrease neck motion, as initially thought. Neck pain intensity and CROM correlated with self-perceived dizziness handicap. CROM also correlated with 1 balance measure.

  19. Hearing preservation in the resection of vestibular schwannomas: patterns of hearing preservation and patient-assessed hearing function.

    Science.gov (United States)

    Wind, Joshua J; Leonetti, John P; Raffin, Michael J M; Pisansky, Marc T; Herr, Brian; Triemstra, Justin D; Anderson, Douglas E

    2011-05-01

    No extant literature documents the analysis of patient perceptions of hearing as a corollary to objective audiometric measures in patients with vestibular schwannoma (VS), or acoustic neuroma. Therefore, using objective audiometric data and patient perceptions of hearing function as outlined on a questionnaire, the authors evaluated the hearing of patients who underwent VS resection. This investigation involved a retrospective review of 176 patients who had undergone VS resections in which hearing preservation was a goal. Both pre- and postoperative audiometry, expressed as a speech discrimination score (SDS) and pure tone threshold average (PTA), were performed, and the results were analyzed. Intraoperative auditory brainstem responses were also recorded. Eighty-seven of the patients (49.4%) completed a postoperative questionnaire designed to assess hearing function in a variety of social and auditory situations. Multiple linear regression analyses were completed to compare available audiometric results with questionnaire responses for each patient. One hundred forty-two patients (80.7%) had PTA and SDS audiometric data pertaining to the surgically treated ear; 94 of these patients (66.2%) had measurable postoperative hearing, as defined by a PTA 0%. Eighty-seven patients (49.4%) completed the retrospective questionnaire, and 74 of them had complete audiometric data and thus were included in a comparative analysis. Questionnaire data showed major postoperative subjective hearing decrements, even among patients with the same pre- and postoperative objective audiometric hearing status. Moreover, the subscore reflecting hearing while exposed to background noise, or the "cocktail party effect," characterized the most significant patient-perceived hearing deficit following VS resection. The authors' analysis of a patient-perceived hearing questionnaire showed that hearing during exposure to background noise, or the cocktail party effect, represents a significant

  20. Clinical features of otolith organ-specific vestibular dysfunction.

    Science.gov (United States)

    Fujimoto, Chisato; Suzuki, Sayaka; Kinoshita, Makoto; Egami, Naoya; Sugasawa, Keiko; Iwasaki, Shinichi

    2018-01-01

    To elucidate the clinical features and vestibular symptoms of patients with otolith organ dysfunction in the presence of normal function of the semicircular canals. We reviewed the clinical records of 277 consecutive new patients with balance disorders who underwent testing of cervical and ocular vestibular evoked myogenic potentials (cVEMPs and oVEMPs) as well as caloric testing and video head impulse testing (vHIT). We identified 76 patients who showed normal caloric responses and normal vHIT findings in each SCC plane, but abnormal responses in cVEMP and/or oVEMP testing. Benign paroxysmal positional vertigo (BPPV) was the most common diagnosis. 37% of patients could not be categorized into any of the established clinical entities that could cause a balance disorder and did not show sensorineural hearing loss. The most common clinical manifestation in the idiopathic cases was recurrent rotatory vertigo with a duration of 1-12 h. The most common diagnosis of otolith organ-specific vestibular dysfunction was BPPV. The most common clinical manifestation in the idiopathic cases was recurrent rotatory vertigo. Specific dysfunction of the otolith organs occurs in association with some of the undiagnosed patients with recurrent rotatory vertigo. Copyright © 2017 International Federation of Clinical Neurophysiology. Published by Elsevier B.V. All rights reserved.

  1. Phase II study of mTORC1 inhibition by everolimus in neurofibromatosis type 2 patients with growing vestibular schwannomas.

    Science.gov (United States)

    Goutagny, Stéphane; Raymond, Eric; Esposito-Farese, Marina; Trunet, Stéphanie; Mawrin, Christian; Bernardeschi, Daniele; Larroque, Béatrice; Sterkers, Olivier; Giovannini, Marco; Kalamarides, Michel

    2015-04-01

    Neurofibromatosis type 2 (NF2) is a genetic disorder with bilateral vestibular schwannomas (VS) as the most frequent manifestation. Merlin, the NF2 tumor suppressor, was identified as a negative regulator of mammalian target of rapamycin complex 1. Pre-clinical data in mice showed that mTORC1 inhibition delayed growth of NF2-schwannomas. We conducted a prospective single-institution open-label phase II study to evaluate the effects of everolimus in ten NF2 patients with progressive VS. Drug activity was monitored every 3 months. Everolimus was administered orally for 12 months and, if the decrease in tumor volume was >20 % from baseline, treatment was continued for 12 additional months. Other patients stopped when completed 12 months of everolimus but were allowed to resume treatment when VS volume was >20 % during 1 year follow-up. Nine patients were evaluable. Safety was evaluated using CTCAE 3.0 criteria. After 12 months of everolimus, no reduction in volume ≥20 % was observed. Four patients had progressive disease, and five patients had stable disease with a median annual growth rate decreasing from 67 %/year before treatment to 0.5 %/year during treatment. In these patients, tumor growth resumed within 3-6 months after treatment discontinuation. Everolimus was then reintroduced and VS decreased by a median 6.8 % at 24 months. Time to tumor progression increased threefold from 4.2 months before treatment to > 12 months. Hearing was stable under treatment. The safety of everolimus was manageable. Although the primary endpoint was not reached, further studies are required to confirm the potential for stabilization of everolimus.

  2. Vestibular evoked myogenic potential (VEMP) in patients with Ménière's disease with drop attacks.

    Science.gov (United States)

    Timmer, Ferdinand C A; Zhou, Guangwei; Guinan, John J; Kujawa, Sharon G; Herrmann, Barbara S; Rauch, Steven D

    2006-05-01

    In this retrospective study, we tested the hypothesis that vestibular evoked myogenic potential (VEMP) thresholds are more often elevated or absent in patients with Ménière's disease experiencing Tumarkin drop attacks than in other patients with Ménière's disease. Subjects included normal subjects (n = 14) and patients with unilateral Ménière's disease by AAO-HNS (1995) diagnostic criteria with (n = 12) and without (n = 82) Tumarkin drop attacks at a large specialty hospital otology service. VEMP threshold testing was conducted using 250, 500, and 1,000 Hz tone burst stimuli. VEMP responses were present in at all frequencies in both ears of all normal subjects. In unaffected ears of patients with unilateral Ménière's disease, VEMPs were undetectable in 13% of measurements attempted. This number rose to 18% in affected ears of patients with unilateral Ménière's disease and to 41% in Meniere ears with Tumarkin drop attacks. Frequency tuning of the VEMP response in normal subjects showed lowest thresholds at 500 Hz. In Meniere ears, the tuning was altered such that the 500-Hz thresholds were higher than the 1,000-Hz thresholds. There was a gradient of threshold elevation and altered tuning that corresponded to the gradient of worsening disease. Our findings support the hypothesis that Tumarkin drop attacks arise from advanced disease involving the saccule and that VEMP may be a clinically valuable metric of disease severity or progression in patients with Ménière's disease.

  3. Genetic disorders of the vestibular system.

    Science.gov (United States)

    Eppsteiner, Robert W; Smith, Richard J H

    2011-10-01

    This review highlights the current body of literature related to the genetics of inherited vestibular disorders and provides a framework for the characterization of these disorders. We emphasize peripheral causes of vestibular dysfunction and highlight recent advances in the field, point out gaps in understanding, and focus on key areas for future investigation. The discovery of a modifier gene that leads to a more severe Usher syndrome phenotype calls into question the assumption that Usher syndrome is universally a monogenic disorder. Despite the use of several investigational approaches, the genetic basis of Menière's disease remains poorly understood. Evidence for a vestibular phenotype associated with DFNB1 suggests that mutations in other genes causally related to nonsyndromic hearing loss also may have an unrecognized vestibular phenotype. Our understanding of the genetic basis for vestibular disorders is superficial. Significant challenges include defining the genetics of inherited isolated vestibular dysfunction and understanding the pathological basis of Menière's disease. However, improved characterization of inherited vestibular dysfunction, coupled with advanced genetic techniques such as targeted genome capture and massively parallel sequencing, provides an opportunity to investigate these diseases at the genetic level.

  4. Embryological development and large vestibular aqueduct syndrome.

    Science.gov (United States)

    Pyle, G M

    2000-11-01

    Large vestibular aqueduct syndrome (LVAS) is a significant cause of hearing loss in early childhood. Many theories on the origins and causes of LVAS have been proposed, including arrest or maldevelopment of the vestibular labyrinth in embryonic life. Prior studies have described postnatal and adult vestibular aqueduct anatomy, but none has analyzed aqueduct growth throughout embryonic life. This study was undertaken to characterize the growth of the developing vestibular aqueduct to gain a better understanding of the possible origins of LVAS. Basic science, temporal bone histopathological study. Serial sections from 48 temporal bones from human embryos ranging in age from 5 weeks' gestation to full term were studied with computer image analysis. Measurements of vestibular aqueduct internal and external aperture, midportion diameter, and length were analyzed to obtain a growth model of development. The vestibular aqueduct grows in a nonlinear fashion throughout embryonic life. All parameters fit a similar growth curve and never reached a maximum or began narrowing during development. Growth in one parameter correlated well with growth of another. There was good side-to-side correlation with all but the external aperture. Most of the membranous labyrinth reaches adult size by 20 weeks' gestation, but the vestibular aqueduct grows throughout embryonic life. The measurements and growth model obtained in this study are not consistent with the theory that LVAS results from an arrest in development early in fetal life. The data suggest that LVAS may result from postnatal and early childhood maldevelopment.

  5. Transdermal fluid loss in severely burned patients

    Directory of Open Access Journals (Sweden)

    Lange, Thomas

    2010-01-01

    Full Text Available Introduction: The skin protects against fluid and electrolyte loss. Burn injury does affect skin integrity and protection against fluid loss is lost. Thus, a systemic dehydration can be provoked by underestimation of fluid loss through burn wounds. Purpose: We wanted to quantify transdermal fluid loss in burn wounds. Method: Retrospective study. 40 patients admitted to a specialized burn unit were analyzed and separated in two groups without (Group A or with (Group B hypernatremia. Means of daily infusion-diuresis-ratio (IDR and the relationship to totally burned surface area (TBSA were analyzed. Results: In Group A 25 patients with a mean age of 47±18 years, a mean TBSA of 23±11%, and a mean abbreviated burned severity index (ABSI score of 6.9±2.1 were summarized. In Group B 15 patients with a mean age of 47±22 years, a mean TBSA of 30±13%, and a mean ABSI score of 8.1±1.7 were included. Statistical analysis of the period from day 3 to day 6 showed a significant higher daily IDR-amount in Group A (Group A vs. Group B: 786±1029 ml vs. –181±1021 ml; p<0.001 and for daily IDR-TBSA-ratio (Group A vs. Group B: 40±41 ml/% vs. –4±36 ml/%; p<0.001. Conclusions: There is a systemic relevant transdermal fluid loss in burn wounds after severe burn injury. Serum sodium concentration can be used to calculate need of fluid resuscitation for fluid maintenance. There is a need of an established fluid removal strategy to avoid water and electrolyte imbalances.

  6. Long-term course and relapses of vestibular and balance disorders.

    Science.gov (United States)

    Brandt, Thomas; Huppert, Tdoreen; Hüfner, Katharina; Zingler, Vera C; Dieterich, Marianne; Strupp, Michael

    2010-01-01

    The long-term course and the frequency of relapses for various peripheral vestibular disorders and somatoform phobic postural vertigo are discussed with respect to the clinically most important questions for thus afflicted patients. This review is mainly based on our own long-term follow-up studies and takes into consideration the most relevant literature. The following syndromes are discussed in detail. Vestibular neuritis: the recovery rate of peripheral vestibular function lies between 40-63% depending on early-onset treatment with corticosteroids; the recurrence rate within 10 years is 2%. Menière's disease} loss of auditory and vestibular function occurs mainly in the first 5 to 10 years; frequency of vertigo attacks may decline after 5 to 10 years; bilateral involvement increases with increasing duration of the condition in up to 30-50%; vestibular drop attacks may occur early or late within the course, mostly with spontaneous remission; high-dose and long-term treatment with betahistine significantly reduces attack frequency in Menière's disease, Benign paroxysmal positioning vertigo: the recurrence rate is 50% within 10 years (in females 58%, in males 39%), most recurrences (80%) being observed within the first year after initial relief; recurrence rate in the seventh decade is half of that in the sixth decade. Vestibular paroxysmia: medical treatment with carbamazepine or oxcarbazepine leads to a continuous significant reduction in attack frequency, intensity, and duration of 10-15% of baseline. Bilateral vestibulopathy: recovery of vestibular function is limited to single cases depending on their etiology. Phobic postural vertigo: within 5 to 16 years 27% of the patients are symptom-free, 48% improve, 22% remain unchanged, and 3% worsen; a detailed explanation of the mechanisms that cause and the factors that provoke attacks is imperative, as well as instructions for self-controlled desensitization within the context of behavioral therapy.

  7. Move it or lose it--is stimulation of the vestibular system necessary for normal spatial memory?

    Science.gov (United States)

    Smith, Paul F; Darlington, Cynthia L; Zheng, Yiwen

    2010-01-01

    Studies in both experimental animals and human patients have demonstrated that peripheral vestibular lesions, especially bilateral lesions, are associated with spatial memory impairment that is long-lasting and may even be permanent. Electrophysiological evidence from animals indicates that bilateral vestibular loss causes place cells and theta activity to become dysfunctional; the most recent human evidence suggests that the hippocampus may cause atrophy in patients with bilateral vestibular lesions. Taken together, these studies suggest that self-motion information provided by the vestibular system is important for the development of spatial memory by areas of the brain such as the hippocampus, and when it is lost, spatial memory is impaired. This naturally suggests the converse possibility that activation of the vestibular system may enhance memory. Surprisingly, there is some human evidence that this may be the case. This review considers the relationship between the vestibular system and memory and suggests that the evolutionary age of this primitive sensory system as well as how it detects self-motion (i.e., detection of acceleration vs. velocity) may be the reasons for its unique contribution to spatial memory. Copyright 2009 Wiley-Liss, Inc.

  8. Evaluation of postural control in unilateral vestibular hypofunction

    Directory of Open Access Journals (Sweden)

    Rafaela Maia Quitschal

    2014-07-01

    Full Text Available INTRODUCTION: Patients with vestibular hypofunction, a typical finding in peripheral vestibular disorders, show body balance alterations. OBJECTIVE: To evaluate the postural control of patients with vertigo and unilateral vestibular hypofunction. METHOD: This is a clinical cross-sectional study. Twenty-five patients with vertigo and unilateral vestibular hypofunction and a homogeneous control group consisting of 32 healthy individuals were submitted to a neurotological evaluation including the Tetrax Interactive Balance System posturography in eight different sensory conditions. RESULTS: For different positions, vertiginous patients with unilateral vestibular hypofunction showed significantly higher values of general stability index, weight distribution index, right/left and tool/heel synchronizations, Fourier transformation index and fall index than controls. CONCLUSION: Increased values in the indices of weight distribution, right/left and tool/heel synchronizations, Fourier transformation and fall risk characterize the impairment of postural control in patients with vertigo and unilateral vestibular hypofunction.

  9. The value of close monitoring in vestibular rehabilitation therapy.

    Science.gov (United States)

    Itani, M; Koaik, Y; Sabri, A

    2017-03-01

    Vestibular rehabilitation therapy is a well-established treatment modality for patients with vestibular problems. Performing vestibular rehabilitation therapy in a closely monitored setting may result in a better outcome than a home exercise programme. A retrospective study was conducted of patients undergoing vestibular rehabilitation therapy between June 2005 and November 2012 in a tertiary university hospital. The Dynamic Gait Index, the main outcome measure, was utilised before and after the rehabilitation programme. The magnitude of improvement for all patients was analysed, mainly to compare the home exercise group with the closely monitored therapy group. Only 32 patients underwent the vestibular rehabilitation therapy programme. In all patients, there was significant improvement in the mean Dynamic Gait Index score (from 11.75 to 17.38; p rehabilitation therapy resulted in improved performance status. More studies are needed to establish the efficiency of vestibular rehabilitation therapy and compare closely monitored therapy with tailored home exercise rehabilitation.

  10. Sinais e sintomas associados a alterações otoneurológicas diagnoticadas ao exame vestibular computadorizado em pacientes com esclerose múltipla Signs and symptoms associated to otoneurologic alterations diagnosed on computerized vestibular exam of patients with multiple sclerosis

    Directory of Open Access Journals (Sweden)

    Andreza Tomaz

    2005-09-01

    Full Text Available OBJETIVO: Descrever os principais sintomas e sinais ao exame vestibular computadorizado em pacientes com diagnóstico de esclerose múltipla. MÉTODO:Foram examinados 30 pacientes com diagnóstico de esclerose múltipla. Analisaram-se os dados relativos à sintomatologia e achados ao exame vestibular computadorizado realizado no ambulatório de otoneurologia da Irmandade Santa Casa de Misericórdia de São Paulo, em 2003. RESULTADOS: Em relação aos sintomas relatados, observamos desequilíbrio (60%, formigamento de extremidades (43,3%, vertigem (40%, cefaléia e ansiedade (36,7%, zumbido (30%, depressão (26,7%. Ao exame vestibular encontramos alterações do nistagmo de posicionamento (6,7%, nistagmo espontâneo de olhos fechados (30%, nistagmo semi-espontâneo (13,3%, rastreio pendular (3,3% e prova calórica (63,3%. Na conclusão do exame tivemos prevalência de síndrome vestibular periférica irritativa (60% e síndrome central (13,4%. CONCLUÇÃO: Concluimos que a realização do exame otoneurológico torna-se imprescindível nos pacientes com esclerose múltipla devido a elevada prevalência de alterações à vectonistagmografia computadorizada e elevada prevalência de sintomas otoneurológicos.OBJETIVE: To identify main symptoms and signs on computerized vestibular testing in patients diagnosed with multiple sclerosis. METHOD: Thirty patients with the diagnosis of multiple sclerosis were studied. We analyzed data related to presented symptoms and the findings from a computerized vestibular testing realized in the otoneurological ambulatory in Santa Casa de Misericórdia de São Paulo in 2003. RESULTS: Reported symptoms consisted mainly of disequilibrium (60%, tingling of limbs (43.3%, vertigo (40%, headache and anxiety (36.7%, tinnitus (30%, depression (26.7%. In vestibular testing we found alterations in positional nystagmus (6.7%, spontaneous nystagmus with the eyes shut (30%, directional nystagmus (13.3% and caloric testing (63

  11. Weight loss and skin manifestations in obese patients with psoriasis

    DEFF Research Database (Denmark)

    Geiker, Nina Rica Wium; Jensen, Peter; Kirchner Larsson, Lena

    Objective To examine if psoriatic patients can achieve a weight loss to the same extent as non-psoriatic patients To describe the effect of weight loss on the cutaneous manifestations. Conclusion Patients with psoriasis achieved a weight loss, similar to non-psoriatic patients, of 12 % of their b......Objective To examine if psoriatic patients can achieve a weight loss to the same extent as non-psoriatic patients To describe the effect of weight loss on the cutaneous manifestations. Conclusion Patients with psoriasis achieved a weight loss, similar to non-psoriatic patients, of 12...

  12. CONTRIBUTION OF THE AUDIOLOGICAL AND VESTIBULAR ASSESSMENT TO THE DIFFERENTIAL AND ETIOLOGICAL DIAGNOSIS OF PERIPHERIC VESTIBULAR SYNDROMES

    Directory of Open Access Journals (Sweden)

    Loreta Ungureanu

    2012-09-01

    Full Text Available Scope of the study: Vestibular pathology is a complex one, requiring a minute clinical evaluation, as well as numerous paraclinical investigations. The present study analyzes the contribution of the modern methods of vestibular and auditive investigation to the diagnosis of dizziness. Materials and method: The results of the investigations performed on 84 patients with peripheric vestibular syndrome, on whom a complete audiological and vestibular assessment had been also made, have been retrospectively analyzed. Results: Anamnestic data and the results of evaluation permitted classification of peripheric vestibular pathology according to topo-lesional and etiological criteria. The most frequently diagnosed diseases were: benign paroxysmal positional vertigo, Ménière syndrome and vestibular neuronitis. Conclusions: Testing of the vestibulo-ocular and vestibulo-spinal reflexes through videonystagmoscopy and, respectively, computerized dynamic posturography, besides tonal vocal audiometry and precocious auditive potentials, is especially important for a positive diagnosis and etiological differentiation of vestibular syndromes.

  13. Increased signal intensity of the cochlea on pre- and post-contrast enhanced 3D-FLAIR in patients with vestibular schwannoma

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    Yamazaki, Masahiro; Naganawa, Shinji; Kawai, Hisashi; Nihashi, Takashi [Nagoya University, Department of Radiology, Graduate School of Medicine, Nagoya (Japan); Fukatsu, Hiroshi [Aichi Medical University Hospital, Department of Medical Informatics, Nagakute (Japan); Nakashima, Tsutomu [Nagoya University, Department of Otorhinolaryngology, Graduate School of Medicine, Nagoya (Japan)

    2009-12-15

    In the vestibular schwannoma patients, the pathophysiologic mechanism of inner ear involvement is still unclear. We investigated the status of the cochleae in patients with vestibular schwannoma by evaluating the signal intensity of cochlear fluid on pre- and post-contrast enhanced thin section three-dimensional fluid-attenuated inversion recovery (3D-FLAIR). Twenty-eight patients were retrospectively analyzed. Post-contrast images were obtained in 18 patients, and 20 patients had the records of their pure-tone audiometry. Regions of interest of both cochleae (C) and of the medulla oblongata (M) were determined on 3D-FLAIR images by referring to 3D heavily T2-weighted images on a workstation. The signal intensity ratio between C and M on the 3D-FLAIR images (CM ratio) was then evaluated. In addition, correlation between the CM ratio and the hearing level was also evaluated. The CM ratio of the affected side was significantly higher than that of the unaffected side (p < 0.001). In the affected side, post-contrast signal elevation was observed (p < 0.005). In 13 patients (26 cochleae) who underwent both gadolinium injection and the pure-tone audiometry, the post-contrast CM ratio correlated with hearing level (p < 0.05). The results of the present study suggest that alteration of cochlear fluid composition and increased permeability of the blood-labyrinthine barrier exist in the affected side in patients with vestibular schwannoma. Furthermore, although weak, positive correlation between post-contrast cochlear signal intensity on 3D-FLAIR and hearing level warrants further study to clarify the relationship between 3D-FLAIR findings and prognosis of hearing preservation surgery. (orig.)

  14. Vestibular schwannoma: negative growth and audiovestibular features.

    Science.gov (United States)

    Stipkovits, E M; Graamans, K; Van Dijk, J E

    2001-11-01

    At the University Medical Center Utrecht, non-operative management was used for 44 patients with a unilateral vestibular schwannoma between 1990 and 1997. During that period, consecutive tumor sizes were determined by magnetic resonance imaging. Three of the 44 patients showed an average decrease in tumor size of 16.7% according to American Academy of Otolaryngology-Head and Neck Surgery standards. This study describes the initial vestibular status and audiometric changes measured over up to 10 years in these three patients. Vestibular function was determined once, by means of the bithermal caloric test, the torsion test, the saccade test, the smooth pursuit test, and the registration of spontaneous nystagmus. The three patients had severe vestibular paresis on the affected side. Pure-tone and speech audiometry were performed at regular intervals. Although the size of their tumors decreased, their hearing gradually deteriorated, just as it does in the majority of patients with a growing or stable vestibular schwannoma. The observations presented here suggest that the development of symptoms in a vestibular schwannoma does not differentiate between patients with a stable, growing or shrinking tumor. The development of symptoms may be the result of the same pathogenetic mechanism.

  15. Patients' psychological well-being and resilient coping protect from secondary somatoform vertigo and dizziness (SVD) 1 year after vestibular disease.

    Science.gov (United States)

    Tschan, Regine; Best, Christoph; Beutel, Manfred E; Knebel, Achim; Wiltink, Jörg; Dieterich, Marianne; Eckhardt-Henn, Annegret

    2011-01-01

    Secondary somatoform dizziness and vertigo (SVD) is an underdiagnosed and handicapping psychosomatic disorder, leading to extensive utilization of health care and maladaptive coping. Few long-term follow-up studies have focused on the assessment of risk factors and little is known about protective factors. The aim of this 1-year follow-up study was to identify neurootological patients at risk for the development of secondary SVD with respect to individual psychopathological disposition, subjective well-being and resilient coping. In a prospective interdisciplinary study, we assessed mental disorders in n=59 patients with peripheral and central vestibular disorders (n=15 benign paroxysmal positional vertigo, n=15 vestibular neuritis, n=8 Menière's disease, n=24 vestibular migraine) at baseline (T0) and 1 year after admission (T1). Psychosomatic examinations included the structured clinical interview for DSM-IV, the Vertigo Symptom Scale (VSS), and a psychometric test battery measuring resilience (RS), sense of coherence (SOC), and satisfaction with life (SWLS). Subjective well-being significantly predicted the development of secondary SVD: Patients with higher scores of RS, SOC, and SWLS at T0 were less likely to acquire secondary SVD at T1. Lifetime mental disorders correlated with a reduced subjective well-being at T0. Patients with mental comorbidity at T0 were generally more at risk for developing secondary SVD at T1. Patients' dispositional psychopathology and subjective well-being play a major predictive role for the long-term prognosis of dizziness and vertigo. To prevent secondary SVD, patients should be screened for risk and preventive factors, and offered psychotherapeutic treatment in case of insufficient coping capacity.

  16. Biobehavioural analysis of the vestibular system and posture control in patients with cervicogenic dizziness. A cross-sectional study.

    Science.gov (United States)

    Grande-Alonso, M; Moral Saiz, B; Mínguez Zuazo, A; Lerma Lara, S; La Touche, R

    2016-07-21

    Cervicogenic dizziness is a musculoskeletal disorder mainly characterised by dizziness and disequilibrium associated with neck pain. The pathophysiology is unclear and the neurophysiological basis remains to be ascertained. The aim of this study is to compare the vestibulo-ocular reflex and postural control between patients with cervicogenic dizziness and asymptomatic subjects, and to assess the association between debilitating dizziness and other psychosocial variables. A total of 20 patients and 22 asymptomatic subjects were selected. Vestibulo-ocular reflex was assessed by performing the head impulse test. Computerised dynamic posturography was used to evaluate the postural control by means of the sensory organisation test. In addition, subjects self-reported their degree of disability due to dizziness, cervical disability, kinesiophobia, and state of anxiety and depression. There were no differences in the vestibulo-ocular reflex (P>.05). However, we found differences with a medium-to-large effect size (d>0.60) in variables related to proprioception and visual information integration; the former variable set was related to disability due to dizziness. Disability due to dizziness presents strong-to-moderate associations with cervical disability, kinesiophobia, and anxiety. Our data rule out changes in the vestibular system in cervicogenic dizziness, but they do point to proprioceptive impairment. According to our results, the association between dizziness-related disability and other psychosocial factors in cervicogenic dizziness is very relevant for clinical medicine and for future research projects. Copyright © 2016 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  17. Vestibular ablation and a semicircular canal prosthesis affect postural stability during head turns

    Science.gov (United States)

    Thompson, Lara A.; Haburcakova, Csilla; Lewis, Richard F.

    2016-01-01

    In our study, we examined postural stability during head turns for two rhesus monkeys: one, single animal study contrasted normal and mild bilateral vestibular ablation and a second animal study contrasted severe bilateral vestibular ablation with and without prosthetic stimulation. The monkeys freely stood, unrestrained on a balance platform and made voluntary head turns between visual targets. To quantify each animals’ posture, motions of the head and trunk, as well as torque about the body’s center-of-mass, were measured. In the mildly ablated animal, we observed less foretrunk sway in comparison to the normal state. When the canal prosthesis provided electric stimulation to the severely ablated animal, it showed a decrease in trunk sway during head turns. Because the rhesus monkey with severe bilateral vestibular loss exhibited a decrease in trunk sway when receiving vestibular prosthetic stimulation, we propose that the prosthetic electrical stimulation partially restored head velocity information. Our results provide an indication that a semicircular canal prosthesis may be an effective way to improve postural stability in patients with severe peripheral vestibular dysfunction. PMID:27405997

  18. Clinical Evaluation of the Vestibular Nerve Using Vestibular Evoked Myogenic Potentials.

    Science.gov (United States)

    Bogle, Jamie M

    2018-01-01

    Vestibular evoked myogenic potentials are currently the most clinically accessible method to evaluate the otolith reflex pathways. These responses provide unique information regarding the status of the utriculo-ocular and sacculo-collic reflex pathways, information that has previously been unavailable. Vestibular evoked myogenic potentials are recorded from tonically contracted target muscles known to be innervated by these respective otolith organs. Diagnosticians can use vestibular evoked myogenic potentials to better evaluate the overall integrity of the inner ear and neural pathways; however, there are specific considerations for each otolith reflex protocol. In addition, specific patient populations may require protocol variations to better evaluate atypical function of the inner ear organs, vestibular nerve transmission, or subsequent reflex pathways. This is a review of the clinical application and interpretation of cervical and ocular vestibular evoked myogenic potentials.

  19. Can a finding of cervical vestibular evoked myogenic potentials contribute to vestibular migraine diagnostics?

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    Tihana Vešligaj

    2016-02-01

    Full Text Available Aim To investigate differences in vestibular evoked myogenic potentials (VEMP results with patients suffering from vestibular migraine and healthy people, taking into consideration values of threshold and latency of occurrence of the characteristic wave complex, size of amplitude, and interaural amplitude ratio. According to the results, determine the importance and usefulness of VEMP in vestibular migraine diagnostics. Methods A total number of 62 subjects were included in the study, 32 of them belonging to a group of patients suffering from vestibular migraine (VM, while other 30 were in a control group of healthy subjects. Information was collected during the diagnostic evaluation. General and otoneurological history of patients and bedside tests, audiological results, videonystagmography and cervical vestibular evoked myogenic potentials (cVEMP were made. Results There was a difference in an interaural ratio of amplitudes in the experimental and control groups, but it was not found to be clinically significant. By ToneBurst 500 Hz method, the interaural amplitude ratio higher than 35% was measured in 46.97% subjects, while the response was totally unilaterally missing in 28.8% patients. Conclusion Even the sophisticated method as cVEMP does not give the ultimate result confirming the vestibular migraine diagnosis, and neither do other diagnostic methods. cVEMP result can contribute to the completion of full mosaic of vestibular migraine diagnostics.

  20. Common Vestibular Disorders

    OpenAIRE

    Balatsouras, Dimitrios G

    2017-01-01

    The three most common vestibular diseases, benign paroxysmal positional vertigo (BPPV), Meniere's disease (MD) and vestibular neuritis (VN), are presented in this paper. BPPV, which is the most common peripheral vestibular disorder, can be defined as transient vertigo induced by a rapid head position change, associated with a characteristic paroxysmal positional nystagmus. Canalolithiasis of the posterior semicircular canal is considered the most convincing theory of its pathogenesis and the ...

  1. Efficacy of vestibular rehabilitation on chronic unilateral vestibular dysfunction.

    Science.gov (United States)

    Topuz, Oya; Topuz, Bülent; Ardiç, F Necdet; Sarhuş, Merih; Ogmen, Gülsen; Ardiç, Füsun

    2004-02-01

    To assess the efficacy of vestibular rehabilitation exercises on patients with chronic unilateral vestibular dysfunction. Prospective study. Physical Medicine and Rehabilitation Clinic and Otolaryngology Clinic of a tertiary referral hospital. One-hundred and twenty-five patients with unilateral chronic vestibular dysfunction were included in the study. Eight-week, two-staged (clinic and home) vestibular rehabilitation programme with components of Cawthorne-Cooksey and Norre exercises was applied. Dizziness Handicap Inventory (DHI) and visual analogue scale (VAS) were completed three times (at the beginning, end of the second week and end of the treatment). Data for 112 patients in the first stage and 93 patients in the second stage were evaluated because of insufficient compliance of the other patients. The mean DHI score was decreased from 50.42 +/- 24.12 points to 21.21 +/- 15.97 points (p < 0.001) at the end of first two weeks, and to 19.93 +/- 19.33 points at the end of the whole treatment. The mean VAS score was decreased from 5.87 +/- 2.27 to 2.02 +/- 1.75 (p < 0.001) at the end of second week, and to 1.51 +/- 1.29 at the end of eighth week. In respect to both VAS and DHI scores, improvement was noted in 67 patients (77.4%). Age, gender and disability level had no predictive value about therapy outcome. There was a fast recovery in the supervised exercise session, whereas there was no significant difference in the home exercise session. These findings suggest that either supervised exercise is better than home exercise or that 10 supervised sessions are sufficient to get the end result.

  2. Clinical vestibular testing assessed with machine-learning algorithms.

    Science.gov (United States)

    Priesol, Adrian J; Cao, Mengfei; Brodley, Carla E; Lewis, Richard F

    2015-04-01

    Dizziness and imbalance are common clinical problems, and accurate diagnosis depends on determining whether damage is localized to the peripheral vestibular system. Vestibular testing guides this determination, but the accuracy of the different tests is not known. To determine how well each element of the vestibular test battery segregates patients with normal peripheral vestibular function from those with unilateral reductions in vestibular function. Retrospective analysis of vestibular test batteries in 8080 patients. Clinical medical records were reviewed for a subset of individuals with the reviewers blinded to the vestibular test data. A group of machine-learning classifiers were trained using vestibular test data from persons who were "manually" labeled as having normal vestibular function or unilateral vestibular damage based on a review of their medical records. The optimal trained classifier was then used to categorize patients whose diagnoses were unknown, allowing us to determine the information content of each element of the vestibular test battery. The information provided by each element of the vestibular test battery to segregate individuals with normal vestibular function from those with unilateral vestibular damage. The time constant calculated from the rotational test ranked first in information content, and measures that were related physiologically to the rotational time constant were 10 of the top 12 highest-ranked variables. The caloric canal paresis ranked eighth, and the other elements of the test battery provided minimal additional information. The sensitivity of the rotational time constant was 77.2%, and the sensitivity of the caloric canal paresis was 59.6%; the specificity of the rotational time constant was 89.0%, and the specificity of the caloric canal paresis was 64.9%. The diagnostic accuracy of the vestibular test battery increased from 72.4% to 93.4% when the data were analyzed with the optimal machine-learning classifier

  3. Need for facial reanimation after operations for vestibular schwannoma: patients perspective

    DEFF Research Database (Denmark)

    Tos, Tina; Caye-Thomasen, Per; Stangerup, Sven-Eric

    2003-01-01

    (15%) of 779 patients considered their facial palsy to be a big problem and 125 patients (16%) were interested in surgical treatment for the sequelae of facial palsy. Seventy-eight (10%) had already had some kind of operation, usually the VII-XII coaptation. Thirty-three of 61 patients who had already...... been operated on for facial palsy were interested in further surgical treatment. One hundred and ninety-five patients (25%) had some kind of operation on the eye, mostly (88%) a tarsorrhaphy. Reanimation procedures such as a palpebral gold weight or a spring, apparently still have a small place...

  4. Need for facial reanimation after operations for vestibular schwannoma: patients perspective

    DEFF Research Database (Denmark)

    Tos, Tina; Caye-Thomasen, Per; Stangerup, Sven-Eric

    2003-01-01

    year postoperatively and self-evaluated by each patient according to the House-Brackmann scale at the time of the questionnaire. The patients' self-evaluation was more pessimistic than that of the professionals with 26% reporting House-Brackmann grade IV-VI, compared with 20%. One hundred and seventeen...

  5. Understanding the links between vestibular and limbic systems regulating emotions.

    Science.gov (United States)

    Rajagopalan, Archana; Jinu, K V; Sailesh, Kumar Sai; Mishra, Soumya; Reddy, Udaya Kumar; Mukkadan, Joseph Kurien

    2017-01-01

    Vestibular system, which consists of structures in the inner ear and brainstem, plays a vital role is body balance and patient well-being. In recent years, modulating this system by vestibular stimulation techniques are reported to be effective in stress relief and possibly patient's emotional well-being. Emotions refer to an aroused state involving intense feeling, autonomic activation, and related change in behavior, which accompany many of our conscious experiences. The limbic system is primarily involved in the regulation of emotions. Considering the extensive networks between vestibular and limbic system, it is likely that vestibular stimulation techniques may be useful in influencing emotions. Hence, we review here, the possible mechanisms through which vestibular system can influence emotions and highlight the necessary knowledge gaps, which warrants further research to develop vestibular stimulation techniques as a means to treat health conditions associated with emotional disturbances.

  6. Vestibular rehabilitation: clinical benefits to patients with Parkinson's disease Reabilitação vestibular: utilidade clínica em pacientes com doença de Parkinson

    National Research Council Canada - National Science Library

    Bianca Simone Zeigelboim; Karlin Fabianne Klagenberg; Hélio A. Ghizoni Teive; Renato Puppi Munhoz; Jackeline Martins-Bassetto

    2009-01-01

    OBJECTIVE: To evaluate the effectiveness of the vestibular rehabilitation (VR) exercises by means of an assessment before and after the application of the Brazilian version of the Dizziness Handicap Inventory (DHI) questionnaire. METHOD...

  7. Stereotactic radiosurgery vs. fractionated radiotherapy for tumor control in vestibular schwannoma patients

    DEFF Research Database (Denmark)

    Persson, Oscar; Bartek, Jiri; Shalom, Netanel Ben

    2017-01-01

    ) to fractionated stereotactic radiotherapy (FSRT) for patients with VS. DATA SOURCES AND ELIGIBILITY CRITERIA: We systematically searched MEDLINE, Web of Science, Embase and Cochrane and screened relevant articles for references. Publications from 1995 through 2014 with a minimum of 50 adult (>18 years) patients...... to patients treated with fractionated stereotactic radiotherapy. RESULTS: No randomized controlled trial (RCT) was identified. None of the identified controlled studies comparing SRS with FSRT were eligible according to the inclusion criteria. Nineteen case series on SRS (n = 17) and FSRT (n = 2) were...... alternatives for patients with VS. Finally, 19 articles reported long-term tumor control after SRS, while only 2 articles reported long-term FSRT results, making effect estimates more uncertain for FSRT....

  8. Bedside examination for vestibular screening in occupational medicine

    Directory of Open Access Journals (Sweden)

    Ewa Zamysłowska-Szmytke

    2015-04-01

    Full Text Available Objectives: The aim of the study was to assess the usefulness of bedside examination for screening of vestibular and balance system for occupational medicine purposes. Study group comprised 165 patients referred to Audiology and Phoniatric Clinic due to vestibular and/or balance problems. Caloric canal paresis of 19% was the cut off value to divide patients into 43 caloric-positive vestibular subjects and 122 caloric-negative patients. The latter group comprised 79 subjects revealing abnormalities of videonystagmographic (VNG oculomotor tests (central group and 43 subjects with normal VNG. Material and Methods: Vestibular and balance symptoms were collected. Five tests were included to bedside examination: Romberg and Unterberger tests, Head Impulse Test (HIT, Dynamic Visual Acuity (DVA and gaze nystagmus assessment. Results: Vestibular and balance symptoms were reported by 82% of vestibular, 73% of central and 40% of VNG-normal patients. Thirteen out of 18 VNG-normal but symptomatic subjects (73% had abnormal tests in clinical assessment. The sensitivity of bedside test set for vestibular pathology was 88% as compared to caloric test and 68% for central pathology as compared to VNG oculomotor tests. Conclusions: The combination of 5 bedside tests reveal satisfactory sensitivity to detect vestibular abnormalities. Bedside examination abnormalities are highly correlated with vestibular/balance symptoms, regardless the normal results of VNG. Thus, this method should be recommended for occupational medicine purposes.

  9. Bedside examination for vestibular screening in occupational medicine.

    Science.gov (United States)

    Zamysłowska-Szmytke, Ewa; Szostek-Rogula, Sylwia; Śliwińska-Kowalska, Mariola

    2015-01-01

    The aim of the study was to assess the usefulness of bedside examination for screening of vestibular and balance system for occupational medicine purposes. Study group comprised 165 patients referred to Audiology and Phoniatric Clinic due to vestibular and/or balance problems. Caloric canal paresis of 19% was the cut off value to divide patients into 43 caloric-positive vestibular subjects and 122 caloric-negative patients. The latter group comprised 79 subjects revealing abnormalities of videonystagmographic (VNG) oculomotor tests (central group) and 43 subjects with normal VNG. Vestibular and balance symptoms were collected. Five tests were included to bedside examination: Romberg and Unterberger tests, Head Impulse Test (HIT), Dynamic Visual Acuity (DVA) and gaze nystagmus assessment. Vestibular and balance symptoms were reported by 82% of vestibular, 73% of central and 40% of VNG-normal patients. Thirteen out of 18 VNG-normal but symptomatic subjects (73%) had abnormal tests in clinical assessment. The sensitivity of bedside test set for vestibular pathology was 88% as compared to caloric test and 68% for central pathology as compared to VNG oculomotor tests. The combination of 5 bedside tests reveal satisfactory sensitivity to detect vestibular abnormalities. Bedside examination abnormalities are highly correlated with vestibular/balance symptoms, regardless the normal results of VNG. Thus, this method should be recommended for occupational medicine purposes. This work is available in Open Access model and licensed under a CC BY-NC 3.0 PL license.

  10. Mechanism-based modeling of the clinical effects of bevacizumab and everolimus on vestibular schwannomas of patients with neurofibromatosis type 2.

    Science.gov (United States)

    Ouerdani, Aziz; Goutagny, Stéphane; Kalamarides, Michel; Trocóniz, Iñaki F; Ribba, Benjamin

    2016-06-01

    To describe the natural growth of vestibular schwannoma in patients with neurofibromatosis type 2 and to predict tumor volume evolution in patients treated with bevacizumab and everolimus. Clinical data, including longitudinal tumor volumes in patients treated by bevacizumab (n = 13), everolimus (n = 7) or both (n = 2), were analyzed by means of mathematical modeling techniques. Together with clinical data, data from the literature were also integrated to account for drugs mechanisms of action. We developed a model of vestibular schwannoma growth that takes into account the effect of vascular endothelial growth factors and mammalian target of rapamycin complex 1 on tumor growth. Behaviors, such as tumor growth rebound following everolimus treatment stops, was correctly described with the model. Preliminary results indicate that the model can be used to predict, based on early tumor volume dynamic, tumor response to variation in treatment dose and regimen. The developed model successfully describes tumor volume growth before and during bevacizumab and/or everolimus treatment. It might constitute a rational tool to predict patients' response to these drugs, thus potentially improving management of this disease.

  11. Caracterização clínica de idosos com disfunção vestibular crônica Clinical evaluation of elderly people with chronic vestibular disorder

    Directory of Open Access Journals (Sweden)

    Juliana Maria Gazzola

    2006-08-01

    patients were taking on average 3.86±2.27 different medications. The most prevalent diagnosis on the vestibular exam was unilateral vestibular loss (29.8% and the most prevalent etiology was metabolic vestibulopathy (40.0% followed by benign paroxysmal positional vertigo (36.7%. Fifty-two patients (43.3% had experienced dizziness for 5 years or more. Sixty-four patients (53.3% had at least one fall in the last year and thirty-five (29.2% had recurrent falls. CONCLUSIONS: Most of the sample included females with associated diseases, and using many different drugs. The most prevalent vestibular diseases were metabolic and vascular labyrinth conditions. Dizziness is a chronic symptom in elderly patients. The association of two vestibular diseases is common. Falls are prevalent in chronic dizzy elderly patients.

  12. Enhancing vestibular function in the elderly with imperceptible electrical stimulation.

    Science.gov (United States)

    Serrador, Jorge M; Deegan, Brian M; Geraghty, Maria C; Wood, Scott J

    2018-01-10

    Age-related loss of vestibular function can result in decrements in gaze stabilization and increased fall risk in the elderly. This study was designed to see if low levels of electrical stochastic noise applied transcutaneously to the vestibular system can improve a gaze stabilization reflex in young and elderly subject groups. Ocular counter-rolling (OCR) using a video-based technique was obtained in 16 subjects during low frequency passive roll tilts. Consistent with previous studies, there was a significant reduction in OCR gains in the elderly compared to the young group. Imperceptible stochastic noise significantly increased OCR in the elderly (Mean 23%, CI: 17-35%). Increases in OCR gain were greatest for those with lowest baseline gain and were negligible in those with normal gain. Since stimulation was effective at low levels undetectable to subjects, stochastic noise may provide a new treatment alternative to enhance vestibular function, specifically otolith-ocular reflexes, in the elderly or patient populations with reduced otolith-ocular function.

  13. Central Vestibular Dysfunction in an Otorhinolaryngological Vestibular Unit: Incidence and Diagnostic Strategy

    Directory of Open Access Journals (Sweden)

    Mostafa, Badr E.

    2014-03-01

    Full Text Available Introduction Vertigo can be due to a variety of central and peripheral causes. The relative incidence of central causes is underestimated. This may have an important impact of the patients' management and prognosis. Objective The objective of this work is to determine the incidence of central vestibular disorders in patients presenting to a vestibular unit in a tertiary referral academic center. It also aims at determining the best strategy to increase the diagnostic yield of the patients' visit. Methods This is a prospective observational study on 100 consecutive patients with symptoms suggestive of vestibular dysfunction. All patients completed a structured questionnaire and received bedside and vestibular examination and neuroimaging as required. Results There were 69 women and 31 men. Their ages ranged between 28 and 73 (mean 42.48 years. Provisional videonystagmography (VNG results were: 40% benign paroxysmal positional vertigo (BPPV, 23% suspicious of central causes, 18% undiagnosed, 15% Meniere disease, and 4% vestibular neuronitis. Patients with an unclear diagnosis or central features (41 had magnetic resonance imaging (MRI and Doppler studies. Combining data from history, VNG, and imaging studies, 23 patients (23% were diagnosed as having a central vestibular lesion (10 with generalized ischemia/vertebra basilar insufficiency, 4 with multiple sclerosis, 4 with migraine vestibulopathy, 4 with phobic postural vertigo, and 1 with hyperventilation-induced nystagmus. Conclusions Combining a careful history with clinical examination, VNG, MRI, and Doppler studies decreases the number of undiagnosed cases and increases the detection of possible central lesions.

  14. Visual dependency and dizziness after vestibular neuritis.

    Directory of Open Access Journals (Sweden)

    Sian Cousins

    Full Text Available Symptomatic recovery after acute vestibular neuritis (VN is variable, with around 50% of patients reporting long term vestibular symptoms; hence, it is essential to identify factors related to poor clinical outcome. Here we investigated whether excessive reliance on visual input for spatial orientation (visual dependence was associated with long term vestibular symptoms following acute VN. Twenty-eight patients with VN and 25 normal control subjects were included. Patients were enrolled at least 6 months after acute illness. Recovery status was not a criterion for study entry, allowing recruitment of patients with a full range of persistent symptoms. We measured visual dependence with a laptop-based Rod-and-Disk Test and severity of symptoms with the Dizziness Handicap Inventory (DHI. The third of patients showing the worst clinical outcomes (mean DHI score 36-80 had significantly greater visual dependence than normal subjects (6.35° error vs. 3.39° respectively, p = 0.03. Asymptomatic patients and those with minor residual symptoms did not differ from controls. Visual dependence was associated with high levels of persistent vestibular symptoms after acute VN. Over-reliance on visual information for spatial orientation is one characteristic of poorly recovered vestibular neuritis patients. The finding may be clinically useful given that visual dependence may be modified through rehabilitation desensitization techniques.

  15. Weight loss and skin manifestations in obese patients with psoriasis

    DEFF Research Database (Denmark)

    Geiker, Nina Rica Wium; Jensen, Peter; Kirchner Larsson, Lena

    % of their body weight following calorie restriction for 12 weeks. Taken together with recent literature the findings suggest that weight loss has a potential to reduce skin manifestations. Weight loss might also attenuate the increased cardiovascular and diabetes risks posed by obese psoriatric patients.......Objective To examine if psoriatic patients can achieve a weight loss to the same extent as non-psoriatic patients To describe the effect of weight loss on the cutaneous manifestations. Conclusion Patients with psoriasis achieved a weight loss, similar to non-psoriatic patients, of 12...

  16. Visualization of inner ear dysplasias in patients with sensorineural hearing loss.

    Science.gov (United States)

    Klingebiel, R; Bockmühl, U; Werbs, M; Freigang, B; Vorwerk, W; Thieme, N; Lehmann, R

    2001-11-01

    We evaluated a data acquisition and post-processing protocol for inner ear (IE) assessment by MR imaging in patients, suffering from various labyrinth malformations. MR IE studies of 158 consecutive patients (316 IEs) suffering from sensorineural hearing loss without evidence of an acoustic neurinoma were reviewed for pathologies of the IE and internal acoustic meatus. High-resolution MR data of all abnormal IE studies (n=45) were post-processed to previously standardized 3D volume rendered (VR) reconstructions. In 9 patients (5.7%) the following IE dysplasias were detected: malformation of the cochlea (6 IEs), vestibulum (4 IEs), semicircular canals (12 IEs) and vestibular aqueduct/endolymphatic sac (10 IEs). One patient showed evidence of an aplasia of the vestibulocochlear nerve. In 4 patients multiple IE dysplasias were encountered. Comprehensive 3D visualization of all labyrinthine dysplasias was achieved by the use of two VR reconstructions. The overall time for bilateral IE assessment amounted to 30-35 min. The imaging protocol allows for rapid and comprehensive visualization of various IE dysplasias, based on a limited number of VR reconstructions.

  17. Hearing loss without overt metabolic acidosis in ATP6V1B1 deficient MRL mice, a new genetic model for non-syndromic deafness with enlarged vestibular aqueducts.

    Science.gov (United States)

    Tian, Cong; Gagnon, Leona H; Longo-Guess, Chantal; Korstanje, Ron; Sheehan, Susan M; Ohlemiller, Kevin K; Schrader, Angela D; Lett, Jaclynn M; Johnson, Kenneth R

    2017-10-01

    Mutations of the human ATP6V1B1 gene cause distal renal tubular acidosis (dRTA; OMIM #267300) often associated with sensorineural hearing impairment; however, mice with a knockout mutation of Atp6v1b1 were reported to exhibit a compensated acidosis and normal hearing. We discovered a new spontaneous mutation (vortex, symbol vtx) of Atp6v1b1 in an MRL/MpJ (MRL) colony of mice. In contrast to the reported phenotype of the knockout mouse, which was developed on a primarily C57BL/6 (B6) strain background, MRL-Atp6v1b1vtx/vtx mutant mice exhibit profound hearing impairment, which is associated with enlarged endolymphatic compartments of the inner ear. Mutant mice have alkaline urine but do not exhibit overt metabolic acidosis, a renal phenotype similar to that of the Atpbv1b1 knockout mouse. The abnormal inner ear phenotype of MRL- Atp6v1b1vtx/vtx mice was lost when the mutation was transferred onto the C57BL/6J (B6) background, indicating the influence of strain-specific genetic modifiers. To genetically map modifier loci in Atp6v1b1vtx/vtx mice, we analysed ABR thresholds of progeny from a backcross segregating MRL and B6 alleles. We found statistically significant linkage with a locus on Chr 13 that accounts for about 20% of the hearing threshold variation in the backcross mice. The important effect that genetic background has on the inner ear phenotype of Atp6v1b1 mutant mice provides insight into the hearing loss variability associated with dRTA caused by ATP6V1B1 mutations. Because MRL-Atp6v1b1vxt/vtx mice do not recapitulate the metabolic acidosis of dRTA patients, they provide a new genetic model for nonsyndromic deafness with enlarged vestibular aqueduct (EVA; OMIM #600791). © The Author 2017. Published by Oxford University Press. All rights reserved. For Permissions, please email: journals.permissions@oup.com.

  18. Vestibular evoked myogenic potential

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    Felipe, Lilian

    2012-01-01

    Full Text Available Introduction: The Vestibular Evoked Myogenic Potential (VEMP is a promising test for the evaluation of the cholic descending vestibular system. This reflex depends of the integrity from the saccular macula, from the inferior vestibular nerve, the vestibular nuclei, the vestibule-spinal tract and effectors muscles. Objective: Perform a systematic review of the pertinent literature by means of database (COCHRANE, MEDLINE, LILACS, CAPES. Conclusion: The clinical application of the VEMP has expanded in the last years, as goal that this exam is used as complementary in the otoneurological evaluation currently used. But, methodological issues must be clarified. This way, this method when combined with the standard protocol, can provide a more widely evaluation from the vestibular system. The standardization of the methodology is fundamental criterion for the replicability and sensibility of the exam.

  19. Avaliação vestibular no tremor essencial Vestibular evaluation in the essential tremor

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    Bianca Simone Zeigelboim

    2008-01-01

    Full Text Available TEMA: o tremor essencial é familial em cerca de 50% dos casos, com uma herança autossômica, possui início insidioso e é lentamente progressivo. PROCEDIMENTOS: avaliou-se no Setor de Otoneurologia de um Hospital Particular em fevereiro de 2007, uma paciente do sexo feminino, branca, 59 anos, casada, artista plástica, com história de tremor na cabeça desde os dois anos de idade (sic. A paciente relata queixa de tontura há vários meses de origem súbita sem acompanhamento de náusea e/ou queda. Nega perda de força muscular e formigamento em membros superiores e inferiores, rebaixamento da acuidade auditiva e zumbido. A paciente relata que um de seus filhos possuiu tremor nas mãos há dois anos e avós maternos e paternos com Parkinson. Realizaram-se os seguintes procedimentos: anamnese, inspeção otológica e avaliação vestibular por meio da vectoeletronistagmografia. RESULTADOS: observaram-se os seguintes achados ao exame vestibular: nistagmo de posicionamento com características centrais, nistagmo espontâneo presente com os olhos abertos, nistagmo semi-espontâneo do tipo múltiplo e hiper-reflexia em valor absoluto à prova calórica 20ºC (OD e OE. CONCLUSÃO: o exame vestibular mostrou-se sensível e importante para captar alterações em provas que sugerissem envolvimento do sistema nervoso central.BACKGROUND: essential tremors are family-related in about 50% of the cases with an autosomal inheritance and they register an insidious beginning with a slow progression. PROCEDURE: a 59 year old, white female patient, married and whose occupation is a plastic artist with a history of head tremors since she was two years (sic old was evaluated in the Otoneurology sector of a private hospital, during the period from February 2007. The patient had been complaining of dizziness from unknown origin for several months without accompanying nausea and/or falls. She denied any loss of muscular strength or tingling in her upper and lower

  20. The vestibular system: balancing more than just the body.

    Science.gov (United States)

    Lopez, Christophe

    2016-02-01

    The review presents a selection of recent studies in the field of vestibular neuroscience, including how vestibular stimulation modulates space and body perception. Recent neuroimaging studies identified the operculo-insular/retroinsular cortex as the core vestibular cortex and showed how it is reorganized after vestibular dysfunctions. Subliminal galvanic vestibular stimulation (GVS) induces long-term reduction of hemispatial neglect and improves vertical perception in stroke patients, but the underlying mechanisms remain to be identified. Healthy volunteer research suggests that GVS and caloric vestibular stimulation (CVS) modulate visual and somatosensory processing and that beneficial effects of GVS/CVS in stroke patients are not limited to merely rebalancing brain hemispheric activity. Another mechanism would be that GVS/CVS anchors the self to the body, thus promoting an egocentric frame of reference. In addition to 'balancing the body', the vestibular cortical network contributes to modulate space, body and self-awareness. Emerging evidence suggests that the vestibular network expands into dimensions of emotion processing, mental health, and social cognition. Here, the importance of connecting vestibular physiology, affective neuroscience, and social neuroscience to better understand the psychological aspects of vertigo in otoneurology is discussed.

  1. Deregulated genes in sporadic vestibular schwannomas

    DEFF Research Database (Denmark)

    Cayé-Thomasen, Per; Helweg-Larsen, Rehannah Holga Andrea; Stangerup, Sven-Eric

    2010-01-01

    In search of genes associated with vestibular schwannoma tumorigenesis, this study examines the gene expression in human vestibular nerve versus vestibular schwannoma tissue samples using microarray technology....

  2. Histopathology of the Human Inner Ear in a Patient With Sensorineural Hearing Loss Caused by a Variant in DFNA5.

    Science.gov (United States)

    Nadol, Joseph B; Handzel, Ophir; Amr, Sami

    2015-12-01

    Describe the histopathology of the inner ear in a patient with hearing loss caused by a pathogenic variant of the DFNA5 gene. Variants in DFNA5 have been described as causing an autosomal dominant nonsyndromic sensorineural hearing loss. To date, there has been no description of the histopathology of the inner ear in humans with hearing loss because of pathogenic variants in DFNA5. Temporal bone histopathology by light microscopy, next-generation sequencing (NGS) of DNA obtained from blood, and Sanger sequencing of DNA obtained from formalin fixed temporal bone sections. Both the temporal bone donor and her daughter were shown to have the same pathogenic variant in the DFNA5 gene. The principal histopathologic correlates of the hearing loss were loss of the inner and outer hair cells and severe degeneration of the stria vascularis and spiral ligament throughout the cochlea. In addition, there was severe degeneration of spiral ganglion cells, particularly in the basal turn, and degeneration of vestibular neuroepithelium and neurons. The donor had undergone unilateral cochlear implantation during life. Histopathology demonstrated that the cochlear implant was inserted into the scala vestibuli with considerable new bone formation around the track of the implanted electrode. This is the first report of the histopathology of the inner ear in a patient with hearing loss caused by a pathogenic variant in the DFNA5 gene.

  3. Pathogenesis of vestibular schwannoma in ring chromosome 22

    Directory of Open Access Journals (Sweden)

    Debiec-Rychter Maria

    2009-09-01

    Full Text Available Abstract Background Ring chromosome 22 is a rare human constitutional cytogenetic abnormality. Clinical features of neurofibromatosis type 1 and 2 as well as different tumour types have been reported in patients with ring chromosome 22. The pathogenesis of these tumours is not always clear yet. Methods We report on a female patient with a ring chromosome 22 presenting with severe mental retardation, autistic behaviour, café-au-lait macules and facial dysmorphism. Peripheral blood lymphocytes were karyotyped and array CGH was performed on extracted DNA. At the age of 20 years she was diagnosed with a unilateral vestibular schwannoma. Tumour cells were analyzed by karyotyping, array CGH and NF2 mutation analysis. Results Karyotype on peripheral blood lymphocytes revealed a ring chromosome 22 in all analyzed cells. A 1 Mb array CGH experiment on peripheral blood DNA showed a deletion of 5 terminal clones on the long arm of chromosome 22. Genetic analysis of vestibular schwannoma tissue revealed loss of the ring chromosome 22 and a somatic second hit in the NF2 gene on the remaining chromosome 22. Conclusion We conclude that tumours can arise by the combination of loss of the ring chromosome and a pathogenic NF2 mutation on the remaining chromosome 22 in patients with ring chromosome 22. Our findings indicate that patients with a ring 22 should be monitored for NF2-related tumours starting in adolescence.

  4. Evaluation of the Effectiveness of a Novel Brain and Vestibular Rehabilitation Treatment Modality in PTSD Patients Who have Suffered Combat-Related Traumatic Brain Injuries.

    Science.gov (United States)

    Carrick, Frederick R; McLellan, Kate; Brock, J Brandon; Randall, Cagan; Oggero, Elena

    2015-01-01

    Blast-related head injuries are among the most prevalent injuries suffered by military personnel deployed in combat and mild traumatic brain injury (mTBI) or concussion on the battlefield in Iraq/Afghanistan has resulted in its designation as a "signature injury." Vestibular complaints are the most frequent sequelae of mTBI, and vestibular rehabilitation (VR) has been established as the most important treatment modality for this group of patients. We studied the effectiveness of a novel brain and VR treatment post-traumatic stress disorder (PTSD) in subjects who had suffered combat-related traumatic brain injuries in terms of PTSD symptom reduction. The trial was registered as ClinicalTrials.gov Identifier: NCT02003352. (http://clinicaltrials.gov/ct2/show/NCT02003352?term=carrick&rank=6). We analyzed the difference in the Clinician Administered DSM-IV PTSD Scale (CAPS) scores pre- and post-treatment using our subjects as their own matched controls. The study population consisted of 98 combat veterans maintaining an alpha of VR with a potential decrease in suffering of patients, family, and society.

  5. Patients with chronic peripheral vestibular hypofunction compared to healthy subjects exhibit differences in gaze and gait behaviour when walking on stairs and ramps.

    Science.gov (United States)

    Swanenburg, Jaap; Bäbler, Edith; Adelsberger, Rolf; Straumann, Dominik; de Bruin, Eling D

    2017-01-01

    The aim of this study was to compare gaze behaviour during stair and ramp walking between patients with chronic peripheral vestibular hypofunction and healthy human subjects. Twenty four (24) patients with chronic peripheral vestibular hypofunction (14 unilateral and 10 bilateral) and 24 healthy subjects performed stair and ramp up and down walks at self-selected speed. The walks were repeated five times. A mobile eye tracker was used to record gaze behaviour (defined as time directed to pre-defined areas) and an insole measurement device assessed gait (speed, step time, step length). During each walk gaze behaviour relative to i) detection of first transition area "First TA", ii) detection of steps of the mid-staircase area and the handrail "Structure", iii) detection of second transition area "Second TA", and iv) looking elsewhere "Elsewhere" was assessed and expressed as a percentage of the walk duration. For all variables, a one-way ANOVA followed by contrast tests was conducted. Patients looked significantly longer at the "Structure" (p<0.001) and "Elsewhere" (p<0.001) while walking upstairs compared to walking downstairs (p<0.013). Patients looked significantly longer at the "Structure" (p<0.001) and "Elsewhere" (p<0.001) while walking upstairs compared to walking downstairs (p<0.013). No differences between groups were observed for the transition areas with exception of stair ascending. Patients were also slower going downstairs (p = 0.002) and presented with an increased step time (p = 0.003). Patients were walking faster up the ramp (p = 0.014) with longer step length (p = 0.008) compared to walking down the ramp (p = 0.050) with shorter step length (p = 0.024). Patients with chronic peripheral vestibular hypofunction differed in time directed to pre-defined areas during stair and ramp walking and looked longer at stair and ramp areas of interest during walking compared to healthy subjects. Patients did not differ in time directed to pre-defined areas

  6. Regeneration of hair cells in the mammalian vestibular system.

    Science.gov (United States)

    Li, Wenyan; You, Dan; Chen, Yan; Chai, Renjie; Li, Huawei

    2016-06-01

    Hair cells regenerate throughout the lifetime of non-mammalian vertebrates, allowing these animals to recover from hearing and balance deficits. Such regeneration does not occur efficiently in humans and other mammals. Thus, balance deficits become permanent and is a common sensory disorder all over the world. Since Forge and Warchol discovered the limited spontaneous regeneration of vestibular hair cells after gentamicininduced damage in mature mammals, significant efforts have been exerted to trace the origin of the limited vestibular regeneration in mammals after hair cell loss. Moreover, recently many strategies have been developed to promote the hair cell regeneration and subsequent functional recovery of the vestibular system, including manipulating the Wnt, Notch and Atoh1. This article provides an overview of the recent advances in hair cell regeneration in mammalian vestibular epithelia. Furthermore, this review highlights the current limitations of hair cell regeneration and provides the possible solutions to regenerate functional hair cells and to partially restore vestibular function.

  7. Otolith-Canal Convergence in Vestibular Nuclei Neurons

    Science.gov (United States)

    Dickman, J. David

    1996-01-01

    During manned spaceflight, acute vestibular disturbances often occur, leading to physical duress and a loss of performance. Vestibular adaptation to the weightless environment follows within two to three days yet the mechanisms responsible for the disturbance and subsequent adaptation are still unknown In order to understand vestibular system function in space and normal earth conditions the basic physiological mechanisms of vestibular information co coding must be determined. Information processing regarding head movement and head position with respect to gravity takes place in the vestibular nuclei neurons that receive signals From the semicircular canals and otolith organs in the vestibular labyrinth. These neurons must synthesize the information into a coded output signal that provides for the head and eye movement reflexes as well as the conscious perception of the body in three-dimensional space The current investigation will for the first time. determine how the vestibular nuclei neurons quantitatively synthesize afferent information from the different linear and angular acceleration receptors in the vestibular labyrinths into an integrated output signal. During the second year of funding, progress on the current project has been focused on the anatomical orientation of semicircular canals and the spatial orientation of the innervating afferent responses. This information is necessary in order to understand how vestibular nuclei neurons process the incoming afferent spatial signals particularly with the convergent otolith afferent signals that are also spatially distributed Since information from the vestibular nuclei is presented to different brain regions associated with differing reflexive and sensory functions it is important to understand the computational mechanisms used by vestibular neurons to produce the appropriate output signal.

  8. Vestibular rehabilitation following surgical repair for Superior Canal Dehiscence Syndrome: A complicated case report.

    Science.gov (United States)

    Carender, Wendy J; Grzesiak, Melissa

    2018-02-01

    Superior Canal Dehiscence Syndrome (SCDS) causes auditory and vestibular symptoms. Following surgical repair of the dehiscence, patients often experience dizziness and imbalance. This case report describes a postoperative vestibular exercise program, focusing on the principles of central compensation and habituation, and how it was modified for a patient with delayed progress secondary to strabismus and visual vertigo. A 63-year-old male with history of strabismus eye surgery, right hearing loss, aural fullness, and sensitivity to loud sounds was referred for vestibular rehabilitation (VR). He was seen for one preoperative and six postoperative PT visits over eight months. Outcome measures two weeks postoperative were as follows: Dizziness Handicap Inventory (DHI) 38/100; Timed Up & Go (TUG) 9.92 seconds; Dynamic Gait Index (DGI) 16/24; and a 3-line difference in Dynamic Visual Acuity (DVA). Improved outcomes at discharge included: DHI 18/100; TUG 6.87 seconds; DGI 23/24; and 1-line difference in DVA. He was able to return to work and previously enjoyed recreational activities. Postoperative vestibular rehabilitation programs are functionally and symptomatically beneficial following surgical repair for SCDS. Deviations from expected recovery should be addressed to achieve optimal outcomes as demonstrated in this complicated case report.

  9. Longitudinal performance of an implantable vestibular prosthesis.

    Science.gov (United States)

    Phillips, Christopher; Ling, Leo; Oxford, Trey; Nowack, Amy; Nie, Kaibao; Rubinstein, Jay T; Phillips, James O

    2015-04-01

    Loss of vestibular function may be treatable with an implantable vestibular prosthesis that stimulates semicircular canal afferents with biphasic pulse trains. Several studies have demonstrated short-term activation of the vestibulo-ocular reflex (VOR) with electrical stimulation. Fewer long-term studies have been restricted to small numbers of animals and stimulation designed to produce adaptive changes in the electrically elicited response. This study is the first large consecutive series of implanted rhesus macaque to be studied longitudinally using brief stimuli designed to limit adaptive changes in response, so that the efficacy of electrical activation can be studied over time, across surgeries, canals and animals. The implantation of a vestibular prosthesis in animals with intact vestibular end organs produces variable responses to electrical stimulation across canals and animals, which change in threshold for electrical activation of eye movements and in elicited slow phase velocities over time. These thresholds are consistently lower, and the slow phase velocities higher, than those obtained in human subjects. The changes do not appear to be correlated with changes in electrode impedance. The variability in response suggests that empirically derived transfer functions may be required to optimize the response of individual canals to a vestibular prosthesis, and that this function may need to be remapped over time. This article is part of a Special Issue entitled . Copyright © 2014 Elsevier B.V. All rights reserved.

  10. Vestibular vertigo in emergency neurology and cervical osteochondrosis

    Directory of Open Access Journals (Sweden)

    T S Barykova

    2010-01-01

    had acute peripheral vestibular pathology that required cerebral stroke or hemorrhage to be ruled out according to clinical data in most cases. Intermittent, recurrent, short-term vestibular crisis in the examined group of patients is temporarily or clinically unrelated to an exacerbation of cervical osteochondrosis.

  11. Vestibular rehabilitation for unilateral peripheral vestibular dysfunction.

    Science.gov (United States)

    Hillier, Susan L; McDonnell, Michelle

    2011-02-16

    This is an update of a Cochrane Review first published in The Cochrane Library in Issue 4, 2007.Unilateral peripheral vestibular dysfunction (UPVD) can occur as a result of disease, trauma or postoperatively. The dysfunction is characterised by complaints of dizziness, visual or gaze disturbances and balance impairment. Current management includes medication, physical manoeuvres and exercise regimes, the latter known collectively as vestibular rehabilitation (VR). To assess the effectiveness of vestibular rehabilitation in the adult, community-dwelling population of people with symptomatic unilateral peripheral vestibular dysfunction. We searched the Cochrane Ear, Nose and Throat Disorders Group Trials Register; the Cochrane Central Register of Controlled Trials (CENTRAL); PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ISRCTN and additional sources for published and unpublished trials. The most recent search was 1 July 2010, following a previous search in March 2007. Randomised trials of adults living in the community, diagnosed with symptomatic unilateral peripheral vestibular dysfunction. We sought comparisons of VR versus control (placebo etc.), other treatment (non-VR, e.g. pharmacological) or another form of VR. We considered the outcome measures of frequency and severity of dizziness or visual disturbance; changes in balance impairment, function or quality of life; and measure/s of physiological status with known functional correlation. Both authors independently extracted data and assessed trials for risk of bias. We included 27 trials, involving 1668 participants, in the review. Trials addressed the effectiveness of VR against control/sham interventions, medical interventions or other forms of VR. Individual and pooled data showed a statistically significant effect in favour of VR over control or no intervention. The exception to this was when movement-based VR was compared to physical manoeuvres for benign

  12. Central vestibular system: vestibular nuclei and posterior cerebellum.

    Science.gov (United States)

    Barmack, Neal H

    2003-06-15

    The vestibular nuclei and posterior cerebellum are the destination of vestibular primary afferents and the subject of this review. The vestibular nuclei include four major nuclei (medial, descending, superior and lateral). In addition, smaller vestibular nuclei include: Y-group, parasolitary nucleus, and nucleus intercalatus. Each of the major nuclei can be subdivided further based primarily on cytological and immunohistochemical histological criteria or differences in afferent and/or efferent projections. The primary afferent projections of vestibular end organs are distributed to several ipsilateral vestibular nuclei. Vestibular nuclei communicate bilaterally through a commissural system that is predominantly inhibitory. Secondary vestibular neurons also receive convergent sensory information from optokinetic circuitry, central visual system and neck proprioceptive systems. Secondary vestibular neurons cannot distinguish between sources of afferent activity. However, the discharge of secondary vestibular neurons can distinguish between "active" and "passive" movements. The posterior cerebellum has extensive afferent and efferent connections with vestibular nuclei. Vestibular primary afferents are distributed to the ipsilateral uvula-nodulus as mossy fibers. Vestibular secondary afferents are distributed bilaterally. Climbing fibers to the cerebellum originate from two subnuclei of the contralateral inferior olive; the dorsomedial cell column and beta-nucleus. Vestibular climbing fibers carry information only from the vertical semicircular canals and otoliths. They establish a coordinate map, arrayed in sagittal zones on the surface of the uvula-nodulus. Purkinje cells respond to vestibular stimulation with antiphasic modulation of climbing fiber responses (CFRs) and simple spikes (SSs). The modulation of SSs is out of phase with the modulation of vestibular primary afferents. Modulation of SSs persists, even after vestibular primary afferents are destroyed by a

  13. Vestibular rehabilitation: useful but not universally so.

    Science.gov (United States)

    Krebs, David E; Gill-Body, Kathleen M; Parker, Stephen W; Ramirez, Jose V; Wernick-Robinson, Mara

    2003-02-01

    Although vestibular rehabilitation (VR) is gaining popularity, few data support its utility in improving locomotor stability, and no good predictors exist of whom will benefit most. A double-blind, placebo-controlled randomized trial of vestibular rehabilitation was conducted at a large tertiary care hospital on 124 patients (59 +/- 18 years old) with unilateral (n = 51) or bilateral (n = 73) vestibular hypofunction, of whom 86 completed a 12-week intervention. Of these 86, 27 returned for long-term (1-year) follow-up testing. The primary outcome measure was locomotor stability. Group A (6 weeks of VR) significantly (P VR; there were no group differences at 1 year. Of the 86 who completed the intervention, 52 (61%) had clear locomotor gains. VR is helpful for most patients in providing locomotor stability, but further work is needed to determine the factors that prevent VR from being effective for all patients with vestibulopathy.

  14. State Anxiety Subjective Imbalance and Handicap in Vestibular Schwannoma.

    Science.gov (United States)

    Saman, Yougan; Mclellan, Lucie; Mckenna, Laurence; Dutia, Mayank B; Obholzer, Rupert; Libby, Gerald; Gleeson, Michael; Bamiou, Doris-Eva

    2016-01-01

    Evidence is emerging for a significant clinical and neuroanatomical relationship between balance and anxiety. Research has suggested a potentially priming effect with anxiety symptoms predicting a worsening of balance function in patients with underlying balance dysfunction. We propose to show that a vestibular stimulus is responsible for an increase in state anxiety, and there is a relationship between increased state anxiety and worsening balance function. (1) To quantify state anxiety following a vestibular stimulus in patients with a chronic vestibular deficit. (2) To determine if state anxiety during a vestibular stimulus would correlate with the severity of chronic balance symptoms and handicap. Two separate cohorts of vestibular schwannoma (VS) patients underwent vestibular tests (electronystagmography, cervical and ocular vestibular evoked myogenic potentials, and caloric responses) and questionnaire assessments [vertigo handicap questionnaire (VHQ), vertigo symptom scale (VSS), and state-trait anxiety inventory (STAIY)]. Fifteen post-resection VS patients, with complete unilateral vestibular deafferentation, were assessed at a minimum of 6 months after surgery in Experiment 1 (Aim 1). Forty-five patients with VS in situ formed the cohort for Experiment 2 (Aim 2). Experiment 1: VS subjects (N = 15) with a complete post-resection unilateral vestibular deafferentation completed a state anxiety questionnaire before caloric assessment and again afterward with the point of maximal vertigo as the reference (Aim 1). Experiment 2: state anxiety measured at the point of maximal vertigo following a caloric assessment was compared between two groups of patients with VS in situ presenting with balance symptoms (Group 1, N = 26) and without balance symptoms (Group 2, N = 11) (Aim 2). The presence of balance symptoms was defined as having a positive score on the VSS-VER. In Experiment 1, a significant difference (p handicap (p < 0.001). Anxiety

  15. [Therapy of vestibular vertigo].

    Science.gov (United States)

    Hamann, K F

    1993-05-01

    The non-surgical treatment of vestibular disorders must be based on current knowledge of vestibular pathophysiology. It is generally accepted that after vestibular lesions a self-repair mechanism exists that allows a more or less complete recovery. In cases of persisting vestibular complaints the physician's duty consists in stimulation of these pre-existing mechanisms. This can be done by physical exercises, as has been recommended since the work of Cawthorne and Cooksey in 1946. This concept is meanwhile supported by modern neurophysiological research. This article describes a short training program consisting of exercises for fixation during rotations, smooth pursuit, optokinetic nystagmus and motor learning mechanisms. Physical exercises can be reinforced by nootropic drugs.

  16. Angiogenesis in vestibular schwannomas

    DEFF Research Database (Denmark)

    Møller, Martin Nue; Werther, Kim; Nalla, Amarnadh

    2010-01-01

    Vascular endothelial growth factor (VEGF) and matrix metalloproteinases (MMPs) are potent mediators of tumor angiogenesis. It has been demonstrated that vestibular schwannoma VEGF expression correlates with tumor growth pattern, whereas knowledge on the expression of MMPs is lacking. This study...

  17. Complications of Microsurgery of Vestibular Schwannoma

    Directory of Open Access Journals (Sweden)

    Jan Betka

    2014-01-01

    Full Text Available Background. The aim of this study was to analyze complications of vestibular schwannoma (VS microsurgery. Material and Methods. A retrospective study was performed in 333 patients with unilateral vestibular schwannoma indicated for surgical treatment between January 1997 and December 2012. Postoperative complications were assessed immediately after VS surgery as well as during outpatient followup. Results. In all 333 patients microsurgical vestibular schwannoma (Koos grade 1: 12, grade 2: 34, grade 3: 62, and grade 4: 225 removal was performed. The main neurological complication was facial nerve dysfunction. The intermediate and poor function (HB III–VI was observed in 124 cases (45% immediately after surgery and in 104 cases (33% on the last followup. We encountered disordered vestibular compensation in 13%, permanent trigeminal nerve dysfunction in 1%, and transient lower cranial nerves (IX–XI deficit in 6%. Nonneurological complications included CSF leakage in 63% (lateral/medial variant: 99/1%, headache in 9%, and intracerebral hemorrhage in 5%. We did not encounter any case of meningitis. Conclusions. Our study demonstrates that despite the benefits of advanced high-tech equipment, refined microsurgical instruments, and highly developed neuroimaging technologies, there are still various and significant complications associated with vestibular schwannomas microsurgery.

  18. Deregulated genes in sporadic vestibular schwannomas

    DEFF Research Database (Denmark)

    Cayé-Thomasen, Per; Helweg-Larsen, Rehannah Holga Andrea; Stangerup, Sven-Eric

    2010-01-01

    In search of genes associated with vestibular schwannoma tumorigenesis, this study examines the gene expression in human vestibular nerve versus vestibular schwannoma tissue samples using microarray technology.......In search of genes associated with vestibular schwannoma tumorigenesis, this study examines the gene expression in human vestibular nerve versus vestibular schwannoma tissue samples using microarray technology....

  19. Molecular pathogenesis of vestibular schwannomas: insights for the development of novel medical therapies.

    Science.gov (United States)

    Miller, Craig; Igarashi, Suzu; Jacob, Abraham

    2012-01-01

    Vestibular schwannomas (VS), benign intracranial tumors originating from the vestibulocochlear nerve, usually present with hearing loss, tinnitus, and balance dysfunction. Rarely, however, if untreated, these neoplasms can cause significant patient compromise - resulting in facial paralysis, brainstem compression, and even death. Those with vestibular schwannomas currently choose between surgery and stereotactic radiation therapy as available treatment options. Unfortunately, no medical therapies are presently U.S. Food & Drug Administration approved, representing an urgent and unmet clinical need. Recent breakthroughs in research have discovered key cell surface receptors and intracellular signaling pathways that drive vestibular schwannoma tumorigenesis, proliferation, and survival. A number of promising inhibitors targeting these signaling molecules have also now shown efficacy in preclinical VS cell culture models and animal experiments, with some recently entering human clinical trials. In this review, we summarize ErbB receptor signaling, PDGF receptors, MAP kinase signaling, AKT, p21-activated kinase signaling, mTOR, and VEGF signaling in the context of vestibular schwannoma drug development efforts worldwide. Today, it is truly an exciting time as our specialty stands on the verge of major breakthroughs in the development of medical therapies for VS. Copyright © 2012 Polish Otolaryngology Society. Published by Elsevier Urban & Partner Sp. z.o.o. All rights reserved.

  20. STATE ANXIETY, SUBJECTIVE IMBALANCE AND HANDICAP IN VESTIBULAR SCHWANNOMA

    Directory of Open Access Journals (Sweden)

    Yougan Saman

    2016-07-01

    Full Text Available ABSTRACTEvidence is emerging of a significant clinical and neuro-anatomical relationship between balance and anxiety. Research has suggested a potentially priming effect with anxiety symptoms predicting a worsening of balance function in patients with underlying balance dysfunction. We propose to show that a vestibular stimulus is responsible for an increase in state anxiety and there is a relationship between increased state anxiety and worsening balance function. Aims1.To quantify state anxiety following a vestibular stimulus in patients with a chronic vestibular deficit.2.To determine if state anxiety during a vestibular stimulus would correlate with the severity of chronic balance symptoms and handicap. MethodsTwo separate cohorts Vestibular Schwannoma (VS patients underwent vestibular tests (electronystagmography, cervical and ocular vestibular evoked myogenic potentials and caloric responses and questionnaire assessment (Vertigo handicap Questionnaire, Vertigo Symptom Scale, State Trait Anxiety InventoryFifteen post resection Vestibular schwannoma patients, with complete unilateral vestibular deafferentation, were assessed at a minimum of 6 months after surgery in Experiment 1 (Aim 1. Forty-five patients with VS in-situ and with preserved vestibular function formed the cohort for Experiment 2 (Aim 2. Experiment 1: VS subjects (N=15 with a complete post-resection unilateral vestibular deafferentation completed a State anxiety questionnaire before caloric assessment and again afterwards with the point of maximal vertigo as the reference (Aim 1. Experiment 2: State anxiety measured at the point of maximal vertigo following a caloric assessment was compared between two groups of presenting with balance symptoms (Group 1 N=26 and without balance symptoms (Group 2 N=11 (Aim 2. The presence of balance symptoms was defined as having a positive score on the VSS-VER.ResultsIn experiment 1, a significant difference (p<0.01 was found when comparing

  1. Prevalência das alterações metabólicas em pacientes portadores de queixas vestibulares Prevalency of metabolic disorders in dizzy patients

    Directory of Open Access Journals (Sweden)

    Roseli Saraiva Moreira Bittar

    2003-01-01

    Full Text Available FORMA DE ESTUDO: Clínico prospectivo. MATERIAL E MÉTODO: Os autores avaliam a prevalência de alterações metabólicas em 325 pacientes que procuraram o Setor de Otoneurologia do Hospital das Clínicas da FMUSP com queixas vestibulares. Os pacientes foram consecutivamente atendidos entre janeiro de 1997 e janeiro de 2002. Foram avaliados os primeiros exames referentes ao protocolo clássico de investigação das tonturas, que compreende a dosagem de LDL colesterol, TSH, T3 e T4 e glicemia de jejum. As alterações encontradas foram então comparadas às observadas na população geral. As alterações mais significativas encontradas foram a elevação dos níveis de LDL colesterol, a presença de níveis alterados de hormônios tireoideanos e a maior freqüência do diabetes mellitus na população estudada. CONCLUSÃO: Conclui-se que é válida a investigação destes dados, visto que são mais freqüentes na população de risco e que a correta abordagem dessas alterações melhora o prognóstico e o controle da tontura.STUDY DESIGN: Clinical prospective. MATERIAL AND METHOD:The authors evaluated the prevalence of metabolic disorders among 325 patients with vestibular symptoms investigated by the Otoneurology Section, Otolaryngology Department of Hospital das Clínicas, Medical School, University of São Paulo. The patients were evaluated from January 1997 to January 2002, by a standard protocol which included, among other items, fast glucose levels, cholesterol, triglycerides and thyroid hormones, performed in the same laboratory. The results were compared to a standard population. Results showed higher levels of fast glucose, alteration in the thyroid hormones and also higher prevalence of diabetes in the studied population. CONCLUSION: The otolaryngologist should include the investigation of such medical problems in the routine evaluation in order to reverse them and to obtain better results in management of vestibular disorders.

  2. Recovery of dynamic visual acuity in bilateral vestibular hypofunction.

    Science.gov (United States)

    Herdman, Susan J; Hall, Courtney D; Schubert, Michael C; Das, Vallabh E; Tusa, Ronald J

    2007-04-01

    To determine the effect of vestibular exercises on the recovery of visual acuity during head movement in patients with bilateral vestibular hypofunction (BVH). Prospective, randomized, double-blinded study. Outpatient clinic, academic setting. Thirteen patients with BVH, aged 47 to 73 years. One group (8 patients) performed vestibular exercises designed to enhance remaining vestibular function, and the other (5 patients) performed placebo exercises. Measurements of dynamic visual acuity (DVA) during predictable head movements using a computerized test; measurement of intensity of oscillopsia using a visual analog scale. As a group, patients who performed vestibular exercises showed a significant improvement in DVA (P = .001), whereas those performing placebo exercises did not (P = .07). Only type of exercise (ie, vestibular vs placebo) was significantly correlated with change in DVA. Other factors examined, including age, time from onset, initial DVA, and complaints of oscillopsia and disequilibrium, were not significantly correlated with change in DVA. Change in oscillopsia did not correlate with change in DVA. Use of vestibular exercises is the main factor involved in recovery of DVA in patients with BVH. We theorize that exercises may foster the use of centrally programmed eye movements that could substitute for the vestibulo-ocular reflex. clinicaltrials.gov Identifier: NCT00411216.

  3. Vestibular migraine: clinical and epidemiological aspects

    Directory of Open Access Journals (Sweden)

    Ligia Oliveira Gonçalves Morganti

    Full Text Available ABSTRACT INTRODUCTION: Vestibular migraine (VM is one of the most often common diagnoses in neurotology, but only recently has been recognized as a disease. OBJECTIVE: To analyze the clinical and epidemiological profile of patients with VM. METHODS: This was a retrospective, observational, and descriptive study, with analysis of patients' records from an outpatient VM clinic. RESULTS: 94.1% of patients were females and 5.9% were males. The mean age was 46.1 years; 65.6% of patients had had headache for a longer period than dizziness. A correlation was detected between VM symptoms and the menstrual period. 61.53% of patients had auditory symptoms, with tinnitus the most common, although tonal audiometry was normal in 68.51%. Vectoelectronystagmography was normal in 67.34%, 10.20% had hyporeflexia, and 22.44% had vestibular hyperreflexia. Electrophysiological assessment showed no abnormalities in most patients. Fasting plasma glucose and glycemic curve were normal in most patients, while the insulin curve was abnormal in 75%. 82% of individuals with MV showed abnormalities on the metabolism of carbohydrates. CONCLUSION: VM affects predominantly middle-aged women, with migraine headache representing the first symptom, several years before vertigo. Physical, auditory, and vestibular evaluations are usually normal. The most frequent vestibular abnormality was hyperreflexia. Most individuals showed abnormality related to carbohydrate metabolism.

  4. The molecular biology and novel treatments of vestibular schwannomas.

    Science.gov (United States)

    Fong, Brendan; Barkhoudarian, Garni; Pezeshkian, Patrick; Parsa, Andrew T; Gopen, Quinton; Yang, Isaac

    2011-11-01

    Vestibular schwannomas are histopathologically benign tumors arising from the Schwann cell sheath surrounding the vestibular branch of cranial nerve VIII and are related to the NF2 gene and its product merlin. Merlin acts as a tumor suppressor and as a mediator of contact inhibition. Thus, deficiencies in both NF2 genes lead to vestibular schwannoma development. Recently, there have been major advances in our knowledge of the molecular biology of vestibular schwannomas as well as the development of novel therapies for its treatment. In this article the authors comprehensively review the recent advances in the molecular biology and characterization of vestibular schwannomas as well as the development of modern treatments for vestibular schwannoma. For instance, merlin is involved with a number of receptors including the CD44 receptor, EGFR, and signaling pathways, such as the Ras/raf pathway and the canonical Wnt pathway. Recently, merlin was also shown to interact in the nucleus with E3 ubiquitin ligase CRL4(DCAF1). A greater understanding of the molecular mechanisms behind vestibular schwannoma tumorigenesis has begun to yield novel therapies. Some authors have shown that Avastin induces regression of progressive schwannomas by over 40% and improves hearing. An inhibitor of VEGF synthesis, PTC299, is currently in Phase II trials as a potential agent to treat vestibular schwannoma. Furthermore, in vitro studies have shown that trastuzumab (an ERBB2 inhibitor) reduces vestibular schwannoma cell proliferation. With further research it may be possible to significantly reduce morbidity and mortality rates by decreasing tumor burden, tumor volume, hearing loss, and cranial nerve deficits seen in vestibular schwannomas.

  5. Vestibular dysfunction in a child with embryonic exposure to accutane.

    Science.gov (United States)

    Westerman, S T; Gilbert, L M; Schondel, L

    1994-05-01

    Children with a history of embryonic exposure to Accutane (isotretinoin) are at great risk for major physical malformations, brain malformations, and decreased intelligence. A case is presented of a 4-year 7-month-old black male with a history of embryonic exposure to Accutane who was born with embryopathy that includes bilateral major ear deformities. The child has a significant bilateral conductive hearing loss, and, in addition, a left sided sensorineural loss. Vestibular function testing revealed evidence of peripheral and central vestibular dysfunction. A course of diphenhydramine hydrochloride and Donnatal (phenobarbital, hyoscyamine sulfate, atropine sulfate, and scopolamine hydrobromide) significantly alleviated the symptoms of vestibular dysfunction. Otologic management of these children should include clinical documentation of the external deformities, evaluation of cochlear function, and early auditory habilitation. Vestibular function should also be evaluated in all children with a history of embryonic exposure to isotretinoin.

  6. Grief and loss for patients before and after heart transplant.

    Science.gov (United States)

    Poole, Jennifer; Ward, Jennifer; DeLuca, Enza; Shildrick, Margrit; Abbey, Susan; Mauthner, Oliver; Ross, Heather

    2016-01-01

    The purpose of the study was to examine the loss and grief experiences of patients waiting for and living with new hearts. There is much scholarship on loss and grief. Less attention has been paid to these issues in clinical transplantation, and even less on the patient experience. Part of a qualitative inquiry oriented to the work of Merleau-Ponty, a secondary analysis was carried out on audiovisual data from interviews with thirty participants. Patients experience loss and three forms of grief. Pre-transplant patients waiting for transplant experience loss and anticipatory grief related to their own death and the future death of their donor. Transplanted patients experience long-lasting complicated grief with respect to the donor and disenfranchised grief which may not be sanctioned. Loss as well as anticipatory, complicated and disenfranchised grief may have been inadvertently disregarded or downplayed. More research and attention is needed. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Symptomatic recovery in Miller Fisher Syndrome parallels vestibular-perceptual and not vestibular-ocular reflex function

    Directory of Open Access Journals (Sweden)

    Barry M Seemungal

    2011-02-01

    Full Text Available Unpleasant visual symptoms including oscillopsia and dizziness may occur when there is unexpected motion of the visual world across the subject’s retina (‘retinal-slip’ as in an acute spontaneous nystagmus or on head movement with an acute ophthalmoplegia. In contrast, subjects with chronic ocular dysmotility, e.g. congenital nystagmus or CPEO (chronic progressive external ophthalmoplegia, are typically symptom free. The adaptive processes that render chronic patients asymptomatic are obscure but may include a suppression of oscillopsia perception as well as an increased tolerance to perceived oscillopsia. Such chronic asymptomatic patients display an attenuation of vestibular-mediated angular velocity perception, implying a possible contributory role in the adaptive process. In order to assess causality between symptoms, signs (i.e. eye-movements and vestibular perceptual function, we prospectively assessed symptom ratings and ocular-motor and perceptual vestibular function, in a patient with acute but transient ophthalmoplegia due to Miller Fisher Syndrome (as a model of visuo-vestibular adaptation. The data show that perceptual measures of vestibular function display a significant attenuation as compared to ocularmotor measures during the acute, symptomatic period. Perhaps significantly, both symptomatic recovery and normalisation of vestibular perceptual function were delayed and then occurred in a parallel fashion. This is the first report showing that symptomatic recovery of visuo-vestibular symptoms is better paralleled by vestibular-perceptual testing than VOR (vestibular ocular reflex measures. The findings may have implications for the understanding of patients with chronic vestibular symptoms where VOR testing is often unhelpful.

  8. Comparison of the Prevalence and Latency of Vestibular Evoked Myogenic Potentials in Normal Participants and Symptomatic and Asymptomatic Meniere's disease Patients

    Directory of Open Access Journals (Sweden)

    Mandana Zarei

    2010-06-01

    Full Text Available Background and Aim: Vestibular evoked myogenic potentials (VEMP originate from the saccule and the inferior vestibular nerve. In this study, the prevalence of VEMP and latency of the p13 and n23 were compared between three groups of individuals, including symptomatic and asymptomatic Meniere's disease cases and normal participants.Methods: This study was conducted on 42 cases with the mean age of 40.48 years; thirty were Meniere's disease patients, of which 19 were symptomatic and 11 were asymptomatic; twelve were normal participants. The VEMP were recorded with 500 Hz tone bursts at 120 dBpeSPL. Then the prevalence and latency of the waves were analyzed and compared in the three above mentioned groups.Results: The prevalence of VEMP in symptomatic Meniere's disease patients (52.6% was significantly less than asymptomatic individuals (90.9% and also normal subjects (100%(p0.05. The latency of p13 for symptomatic, asymptomatic and normal participants was 16.41, 15.20 and 14.14 ms, respectively and the latency of n23 for these groups was 20.25, 18.77 and 18.50 ms, respectively.Conclusion: In Meniere's disease, after medical management, the succule probably regains normal function resulting in re-existence of VEMP. It seems that there is no change in the latency of the waves, most likely due to involvement of the inner ear and intactness of the nerve. VEMP may be a useful test for diagnosis of Meniere's disease and additionally for monitoring the trend of medical management.

  9. Evaluation of the effectiveness of a novel brain and vestibular rehabilitation treatment modality in PTSD patients who have suffered combat related traumatic brain injuries

    Directory of Open Access Journals (Sweden)

    Frederick Robert Carrick

    2015-02-01

    Full Text Available Introduction: Blast-related head injuries are among the most prevalent injuries suffered by military personnel deployed in combat and mild traumatic brain injury (mTBI or concussion on the battlefield in Iraq/Afghanistan has resulted in its designation as a signature injury. Vestibular complaints are the most frequent sequelae of mTBI and vestibular rehabilitation (VR has been established as the most important treatment modality for this group of patients. Material and Methods:We studied the effectiveness of a novel brain and VR treatment PTSD in subjects who had suffered combat related traumatic brain injuries in terms of PTSD symptom reduction. The trial was registered as ClinicalTrials.gov Identifier: NCT02003352. (http://clinicaltrials.gov/ct2/show/NCT02003352?term=carrick&rank=6. We analyzed the difference in the Clinician Administered DSM-IV PTSD Scale (CAPS scores pre and post treatment using our subjects as their own matched controls. The study population consisted of 98 combat veterans maintaining an alpha of <0.05 and power of 80%. Results:Prior to treatment, 75 subjects representing 76.53 % of the sample were classified in the 2 most severe categories of PTSD. 41 subjects, representing 41.80 % of the total sample, were classified in the extreme category of PTSD and 34 subjects, representing 34.70 % of the total sample, were classified in the severe category of PTSD. After treatment we observed a large reduction in CAPS severity scores with both statistical and substantive significance. Discussion:Treatment of PTSD as a physical injury rather than a psychiatric disorder is associated with strong statistical and substantive significant outcomes associated with a decrease of PTSD classification. The stigma associated with neuropsychiatric disorders may be lessened when PTSD is treated with brain and VR with a potential decrease in suffering of patients, family and society.

  10. Galvanic vestibular stimulation improves the results of vestibular rehabilitation.

    Science.gov (United States)

    Carmona, Sergio; Ferrero, Antonela; Pianetti, Guillermina; Escolá, Natalia; Arteaga, María Victoria; Frankel, Lilian

    2011-09-01

    Here, we present findings from a three-step investigation of the effect of galvanic vestibular stimulation (GVS) in normal subjects and in subjects undergoing vestibular rehabilitation (VR). In an initial study, we examined the body sway of 10 normal subjects after one minute of 2 mA GVS. The effect of the stimulation lasted for at least 20 minutes in all subjects and up to two hours in 70% of the subjects. We then compared a group of patients who received conventional VR (40 patients) with a group that received a combination of VR and GVS. Results suggest a significant improvement in the second group. Finally, we attempted to establish the optimal number of GVS sessions and to rule out a placebo effect. Fifteen patients received "systematic" GVS: five sessions, once a week. Five patients received "nonsystematic" galvanic stimulation in a sham protocol, which included two stimulations of the clavicle. These data were analyzed with Fisher's exact test and indicated that the best results were obtained after three sessions of GVS and no placebo effect was observed. © 2011 New York Academy of Sciences.

  11. Perspectives on Aging Vestibular Function

    National Research Council Canada - National Science Library

    Anson, Eric; Jeka, John

    2016-01-01

    Much is known about age related anatomical changes in the vestibular system. Knowledge regarding how vestibular anatomical changes impact behavior for older adults continues to grow, in line with advancements in diagnostic testing...

  12. Neurotransmitters in the vestibular system.

    Science.gov (United States)

    Balaban, C D

    2016-01-01

    Neuronal networks that are linked to the peripheral vestibular system contribute to gravitoinertial sensation, balance control, eye movement control, and autonomic function. Ascending connections to the limbic system and cerebral cortex are also important for motion perception and threat recognition, and play a role in comorbid balance and anxiety disorders. The vestibular system also shows remarkable plasticity, termed vestibular compensation. Activity in these networks is regulated by an interaction between: (1) intrinsic neurotransmitters of the inner ear, vestibular nerve, and vestibular nuclei; (2) neurotransmitters associated with thalamocortical and limbic pathways that receive projections originating in the vestibular nuclei; and (3) locus coeruleus and raphe (serotonergic and nonserotonergic) projections that influence the latter components. Because the ascending vestibular interoceptive and thalamocortical pathways include networks that influence a broad range of stress responses (endocrine and autonomic), memory consolidation, and cognitive functions, common transmitter substrates provide a basis for understanding features of acute and chronic vestibular disorders. © 2016 Elsevier B.V. All rights reserved.

  13. Vestibular schwannoma with contralateral facial pain – case report

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    Ghodsi Mohammad

    2003-03-01

    Full Text Available Abstract Background Vestibular schwannoma (acoustic neuroma most commonly presents with ipsilateral disturbances of acoustic, vestibular, trigeminal and facial nerves. Presentation of vestibular schwannoma with contralateral facial pain is quite uncommon. Case presentation Among 156 cases of operated vestibular schwannoma, we found one case with unusual presentation of contralateral hemifacial pain. Conclusion The presentation of contralateral facial pain in the vestibular schwannoma is rare. It seems that displacement and distortion of the brainstem and compression of the contralateral trigeminal nerve in Meckel's cave by the large mass lesion may lead to this atypical presentation. The best practice in these patients is removal of the tumour, although persistent contralateral pain after operation has been reported.

  14. Adjustment of the dynamic weight distribution as a sensitive parameter for diagnosis of postural alteration in a rodent model of vestibular deficit

    Science.gov (United States)

    Tighilet, Brahim; Péricat, David; Frelat, Alais; Cazals, Yves; Rastoldo, Guillaume; Boyer, Florent; Dumas, Olivier

    2017-01-01

    Vestibular disorders, by inducing significant posturo-locomotor and cognitive disorders, can significantly impair the most basic tasks of everyday life. Their precise diagnosis is essential to implement appropriate therapeutic countermeasures. Monitoring their evolution is also very important to validate or, on the contrary, to adapt the undertaken therapeutic actions. To date, the diagnosis methods of posturo-locomotor impairments are restricted to examinations that most often lack sensitivity and precision. In the present work we studied the alterations of the dynamic weight distribution in a rodent model of sudden and complete unilateral vestibular loss. We used a system of force sensors connected to a data analysis system to quantify in real time and in an automated way the weight bearing of the animal on the ground. We show here that sudden, unilateral, complete and permanent loss of the vestibular inputs causes a severe alteration of the dynamic ground weight distribution of vestibulo lesioned rodents. Characteristics of alterations in the dynamic weight distribution vary over time and follow the sequence of appearance and disappearance of the various symptoms that compose the vestibular syndrome. This study reveals for the first time that dynamic weight bearing is a very sensitive parameter for evaluating posturo-locomotor function impairment. Associated with more classical vestibular examinations, this paradigm can considerably enrich the methods for assessing and monitoring vestibular disorders. Systematic application of this type of evaluation to the dizzy or unstable patient could improve the detection of vestibular deficits and allow predicting better their impact on posture and walk. Thus it could also allow a better follow-up of the therapeutic approaches for rehabilitating gait and balance. PMID:29112981

  15. Vestibular syndrome: a change in internal spatial representation.

    Science.gov (United States)

    Borel, L; Lopez, C; Péruch, P; Lacour, M

    2008-12-01

    The vestibular system contributes to a wide range of functions from reflexes to spatial representation. This paper reviews behavioral, perceptive, and cognitive data that highlight the role of changes in internal spatial representation on the vestibular syndrome. Firstly, we review how visual vertical perception and postural orientation depend on multiple reference frames and multisensory integration and how reference frames are selected according to the status of the peripheral vestibular system (i.e., unilateral or bilateral hyporeflexia), the environmental constraints (i.e., sensory cues), and the postural constraints (i.e., balance control). We show how changes in reference frames are able to modify vestibular lesion-induced postural and locomotor deficits and propose that fast changes in reference frame may be considered as fast-adaptive processes after vestibular loss. Secondly, we review data dealing with the influence of vestibular loss on higher levels of internal representation sustaining spatial orientation and navigation. Particular emphasis is placed on spatial performance according to task complexity (i.e., the required level of spatial knowledge) and to the sensory cues available to define the position and orientation within the environment (i.e., real navigation in darkness or visual virtual navigation without any actual self-motion). We suggest that vestibular signals are necessary for other sensory cues to be properly integrated and that vestibular cues are involved in extrapersonal space representation. In this respect, vestibular-induced changes would be based on a dynamic mental representation of space that is continuously updated and that supports fast-adaptive processes.

  16. Vestibular Deficits in Neurodegenerative Disorders: Balance, Dizziness, and Spatial Disorientation.

    Science.gov (United States)

    Cronin, Thomas; Arshad, Qadeer; Seemungal, Barry M

    2017-01-01

    The vestibular system consists of the peripheral vestibular organs in the inner ear and the associated extensive central nervous system projections-from the cerebellum and brainstem to the thalamic relays to cortical projections. This system is important for spatial orientation and balance, both of critical ecological importance, particularly for successful navigation in our environment. Balance disorders and spatial disorientation are common presenting features of neurodegenerative diseases; however, little is known regarding central vestibular processing in these diseases. A ubiquitous aspect of central vestibular processing is its promiscuity given that vestibular signals are commonly found in combination with other sensory signals. This review discusses how impaired central processing of vestibular signals-typically in combination with other sensory and motor systems-may account for the impaired balance and spatial disorientation in common neurodegenerative conditions. Such an understanding may provide for new diagnostic tests, potentially useful in detecting early disease while a mechanistic understanding of imbalance and spatial disorientation in these patients may enable a vestibular-targeted therapy for such problems in neurodegenerative diseases. Studies with state of the art central vestibular testing are now much needed to tackle this important topic.

  17. Vestibular Deficits in Neurodegenerative Disorders: Balance, Dizziness, and Spatial Disorientation

    Directory of Open Access Journals (Sweden)

    Thomas Cronin

    2017-10-01

    Full Text Available The vestibular system consists of the peripheral vestibular organs in the inner ear and the associated extensive central nervous system projections—from the cerebellum and brainstem to the thalamic relays to cortical projections. This system is important for spatial orientation and balance, both of critical ecological importance, particularly for successful navigation in our environment. Balance disorders and spatial disorientation are common presenting features of neurodegenerative diseases; however, little is known regarding central vestibular processing in these diseases. A ubiquitous aspect of central vestibular processing is its promiscuity given that vestibular signals are commonly found in combination with other sensory signals. This review discusses how impaired central processing of vestibular signals—typically in combination with other sensory and motor systems—may account for the impaired balance and spatial disorientation in common neurodegenerative conditions. Such an understanding may provide for new diagnostic tests, potentially useful in detecting early disease while a mechanistic understanding of imbalance and spatial disorientation in these patients may enable a vestibular-targeted therapy for such problems in neurodegenerative diseases. Studies with state of the art central vestibular testing are now much needed to tackle this important topic.

  18. The impact of weight loss on patients with cancer.

    Science.gov (United States)

    Escamilla, Danilo Macasa; Jarrett, Patricia

    Weight loss due to cachexia is a common symptom in patients with advanced cancer and often affects their quality of life. This article outlines a literature review conducted to better understand the effects of weight loss on patients with cancer. Five themes were identified that encompassed patients' experiences, including personal response, physical effects, emotions and moods, changes in eating habits and effects on social life. The review suggests strategies that health professionals can implement to ensure patients' and their families' feelings about weight loss are taken into consideration.

  19. Weight loss goals of patients in a health maintenance organization.

    Science.gov (United States)

    Dutton, Gareth R; Perri, Michael G; Dancer-Brown, Melissa; Goble, Mary; Van Vessem, Nancy

    2010-04-01

    Individuals seeking weight loss treatment endorse unrealistic expectations regarding their goals for weight loss, although these conclusions are primarily based on research conducted in obesity specialty clinics and/or controlled clinical trials. This study examined the weight loss goals and predictors of these goals among patients participating in obesity treatment in an applied, clinical setting (i.e., managed care organization). Managed care patients enrolled in a behavioral weight loss program (N=143; mean age=46.8 years; mean BMI=36.9 kg/m(2); 89.5% female; 64.5% Caucasian) completed a self-report survey during an initial weight loss session. The survey included items assessing patients' weight loss expectations, including goals for dream, happy, acceptable, and disappointed weights. Participants completed questions regarding contacts with their primary care physician and physician provision of weight loss counseling and/or referrals. They also provided values for current height and weight. BMI's and weight loss associated with dream, happy, acceptable, and disappointed weight goals were 24.8 kg/m(2) (30.9% loss), 27.1 kg/m(2) (25.2% loss), 29.3 kg/m(2) (19.7% loss), and 33.0 kg/m(2) (10.4% loss), respectively. There were significant gender differences in weight loss goals, with women endorsing more unrealistic goals than men for dream and happy weights, psgoals included baseline BMI, gender, ethnicity, and frequency of visits with one's primary care physician, pssetting endorsed unrealistic expectations for weight loss. However, more frequent contact with one's primary care physician was associated with more realistic goals. Future, longitudinal research is needed to document the discrepancy between these goals and actual weight loss achieved in such settings as well as to determine whether excessive goals are associated with diminished treatment outcomes. Copyright 2009 Elsevier Ltd. All rights reserved.

  20. Loss of HIV-infected patients on potent antiretroviral therapy ...

    African Journals Online (AJOL)

    Of the 1004 patients whose phone number was listed, 802 patients (79.9%) were not reachable on the recorded number, 114 patients (11.4%) were alive and 88 patients (8.8%) had died. In multivariate analysis, factors associated with loss to follow-up during the first 6 months of ART were: age below 35 years (OR=1.6; ...

  1. Effects of Vestibular Rehabilitation Interventions in the Elderly with Chronic Unilateral Vestibular Hypofunction

    Science.gov (United States)

    Bayat, Arash; Saki, Nader

    2017-01-01

    Introduction: Although vestibular rehabilitation therapy (VRT) methods are relatively popular in treating patients with body balance deficits of vestibular origin, only limited studies have been conducted into customized exercises for unilateral vestibular hypofunction (UVH). Furthermore, very little evidence is available on the outcomes of VRT in the elderly population with chronic UVH. Materials and Methods: A total of 21 patients, aged 61 to 74 years, with UVH participated in this study. The dizziness handicap inventory (DHI) was performed immediately before, and 2 and 8 weeks after treatment. Results: All patients showed a reduction in DHI scores during the study. The average decrease in DHI score was 25.98 points after 2 weeks’ intervention (P0.05). There were no relationships between the scores and gender. Conclusion: Our study demonstrates that VRT is an effective method for the management of elderly patients with UVH, and shows maximal effect on functional aspects. PMID:28819615

  2. Effects of vibrotactile vestibular substitution on vestibular rehabilitation - preliminary study,

    Directory of Open Access Journals (Sweden)

    Cibele Brugnera

    2015-12-01

    Full Text Available ABSTRACT INTRODUCTION: Some patients with severe impairment of body balance do not obtain adequate improvement from vestibular rehabilitation (VR. OBJECTIVE: To evaluate the effectiveness of Vertiguard(tm biofeedback equipment as a sensory substitution (SS of the vestibular system in patients who did not obtain sufficient improvement from VR. METHODS: This was a randomized prospective clinical study. Thirteen patients without satisfactory response to conventional VR were randomized into a study group (SG, which received the vibrotactile stimulus from Vertiguard(tm for ten days, and a control group (CG, which used equipment without the stimulus. For pre- and post-treatment assessment, the Sensory Organization Test (SOT protocol of the Computerized Dynamic Posturography (CDP and two scales of balance self-perception, Activities-specific Balance Confidence (ABC and Dizziness Handicap Inventory (DHI, were used. RESULTS: After treatment, only the SG showed statistically significant improvement in C5 (p = 0.007 and C6 (p = 0.01. On the ABC scale, there was a significant difference in the SG (p= 0.04. The DHI showed a significant difference in CG and SG with regard to the physical aspect, and only in the SG for the functional aspect (p = 0.04. CONCLUSION: The present findings show that sensory substitution using the vibrotactile stimulus of the Vertiguard(tm system helped with the integration of neural networks involved in maintaining posture, improving the strategies used in the recovery of body balance.

  3. Effects of vibrotactile vestibular substitution on vestibular rehabilitation - preliminary study.

    Science.gov (United States)

    Brugnera, Cibele; Bittar, Roseli Saraiva Moreira; Greters, Mário Edvin; Basta, Dietmar

    2015-01-01

    Some patients with severe impairment of body balance do not obtain adequate improvement from vestibular rehabilitation (VR). To evaluate the effectiveness of Vertiguard™ biofeedback equipment as a sensory substitution (SS) of the vestibular system in patients who did not obtain sufficient improvement from VR. This was a randomized prospective clinical study. Thirteen patients without satisfactory response to conventional VR were randomized into a study group (SG), which received the vibrotactile stimulus from Vertiguard™ for ten days, and a control group (CG), which used equipment without the stimulus. For pre- and post-treatment assessment, the Sensory Organization Test (SOT) protocol of the Computerized Dynamic Posturography (CDP) and two scales of balance self-perception, Activities-specific Balance Confidence (ABC) and Dizziness Handicap Inventory (DHI), were used. After treatment, only the SG showed statistically significant improvement in C5 (p=0.007) and C6 (p=0.01). On the ABC scale, there was a significant difference in the SG (p=0.04). The DHI showed a significant difference in CG and SG with regard to the physical aspect, and only in the SG for the functional aspect (p=0.04). The present findings show that sensory substitution using the vibrotactile stimulus of the Vertiguard™ system helped with the integration of neural networks involved in maintaining posture, improving the strategies used in the recovery of body balance. Copyright © 2015 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  4. Evaluation of quality of life pre- and post-vestibular rehabilitation in patients with benign paroxysmal positional vertigo associated with Meniere's disease.

    Science.gov (United States)

    Socher, Dayra Dill; Socher, Jan Alessandro; Azzi, Viviane Jacintha Bolfe

    2012-10-01

     Vertigo is a symptom that impacts the patients' quality of life and may force them to cease performing activities of daily living. Here, we discuss benign paroxysmal positional vertigo (BPPV) and Meniere's disease (MD), which show exacerbated symptoms when they appear in association. Vestibular rehabilitation (VR) is an effective treatment in reducing vertigo, especially in conjunction with other therapies.  To evaluate the quality of life of patients with BPPV and MD before and after VR.  We conducted a descriptive observational qualitative and quantitative case study with 12 patients aged 35 to 86 years. All patients diagnosed with BPPV and MD received treatment in the ENT clinic. The Brazilian DHI questionnaire, which assesses the quality of life with a focus on physical, emotional, and functional aspects, was used for data collection, and was completed by patients before the first session and after the fifth session of VR. Data were tested using the Shapiro-Wilk normality test, followed by Wilcoxon, Friedman, and Spearman correlation tests (p VR was an effective method for the treatment of patients with BPPV and MD; it improves quality of life and shows the maximal influence on physical aspect scores, regardless of age or gender.

  5. Evaluation of quality of life pre- and post-vestibular rehabilitation in patients with benign paroxysmal positional vertigo associated with Meniere's disease

    Directory of Open Access Journals (Sweden)

    Azzi, Viviane Jacintha Bolfe

    2012-01-01

    Full Text Available Introduction: Vertigo is a symptom that impacts the patients' quality of life and may force them to cease performing activities of daily living. Here, we discuss benign paroxysmal positional vertigo (BPPV and Meniere's disease (MD, which show exacerbated symptoms when they appear in association. Vestibular rehabilitation (VR is an effective treatment in reducing vertigo, especially in conjunction with other therapies. Aim: To evaluate the quality of life of patients with BPPV and MD before and after VR. Method: We conducted a descriptive observational qualitative and quantitative case study with 12 patients aged 35 to 86 years. All patients diagnosed with BPPV and MD received treatment in the ENT clinic. The Brazilian DHI questionnaire, which assesses the quality of life with a focus on physical, emotional, and functional aspects, was used for data collection, and was completed by patients before the first session and after the fifth session of VR. Data were tested using the Shapiro-Wilk normality test, followed by Wilcoxon, Friedman, and Spearman correlation tests (p < 0.05. Results: There were significant improvements in scores for all aspects, with median changes ranging from 12 to 0 in the physical, 6 to 1 in the emotional, and 11 to 1 in the functional aspect. There were no correlations between the scores and sample characteristics. Conclusion: VR was an effective method for the treatment of patients with BPPV and MD; it improves quality of life and shows the maximal influence on physical aspect scores, regardless of age or gender.

  6. Adaptive plasticity in vestibular influences on cardiovascular control

    Science.gov (United States)

    Yates, B. J.; Holmes, M. J.; Jian, B. J.

    2000-01-01

    Data collected in both human subjects and animal models indicate that the vestibular system influences the control of blood pressure. In animals, peripheral vestibular lesions diminish the capacity to rapidly and accurately make cardiovascular adjustments to changes in posture. Thus, one role of vestibulo-cardiovascular influences is to elicit changes in blood distribution in the body so that stable blood pressure is maintained during movement. However, deficits in correcting blood pressure following vestibular lesions diminish over time, and are less severe when non-labyrinthine sensory cues regarding body position in space are provided. These observations show that pathways that mediate vestibulo-sympathetic reflexes can be subject to plastic changes. This review considers the adaptive plasticity in cardiovascular responses elicited by the central vestibular system. Recent data indicate that the posterior cerebellar vermis may play an important role in adaptation of these responses, such that ablation of the posterior vermis impairs recovery of orthostatic tolerance following subsequent vestibular lesions. Furthermore, recent experiments suggest that non-labyrinthine inputs to the central vestibular system may be important in controlling blood pressure during movement, particularly following vestibular dysfunction. A number of sensory inputs appear to be integrated to produce cardiovascular adjustments during changes in posture. Although loss of any one of these inputs does not induce lability in blood pressure, it is likely that maximal blood pressure stability is achieved by the integration of a variety of sensory cues signaling body position in space.

  7. Ocular vestibular evoked myogenic potentials: skull taps can cause a stimulus direction dependent double-peak.

    Science.gov (United States)

    Holmeslet, Berit; Westin, Magnus; Brantberg, Krister

    2011-02-01

    To explore the mechanisms for skull tap induced ocular vestibular evoked myogenic potentials (oVEMP). An electro-mechanical "skull tapper" was used to test oVEMP in response to four different stimulus sites (forehead, occiput and above each ear) in healthy subjects (n=20) and in patients with unilateral loss of vestibular function (n=10). In normals, the oVEMP in response to forehead taps and the contra-lateral oVEMP to taps above the ears were similar. These responses had typical oVEMP features, i.e. a short-latency negative peak (n10) followed by a positive peak (p15). In contrast, the ipsi-lateral oVEMP to the laterally directed skull taps, as well as the oVEMP to occiput taps, had an initial double negative peak (n10+n10b). In patients with unilateral loss of vestibular function, the crossed responses from the functioning labyrinth were very similar to the corresponding oVEMP in normals. The present data support a theory that skull tapping may cause both a response that is more stimulus direction dependent and one that is less so. Whereas the stimulus direction dependent occurrence of the negative double-peak might reveal the functional status of one part of the labyrinth, the rather stimulus direction-independent response might reveal the functional status of other parts. Copyright © 2010 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

  8. Diagnosis of acute unilateral vestibular deficit by virtual reality.

    Science.gov (United States)

    Mora, Renzo; Cesarani, Antonio; Meloni, Francesco; Passali, Francesco Maria; Mora, Francesco; Passali, Giulio Cesare; Barbieri, Marco

    2004-01-01

    The aim of our study was to establish a new diagnostic approach, through the use of virtual reality, to the study of the subjective vertical bar in unilateral peripheral vestibular dysfunction. We subjected 174 patients with unilateral peripheral vestibular dysfunction (ages 18-82 years) to vestibular diagnosis with the virtual reality system. We changed the classic configuration of the subjective visual vertical into a subjective visual horizontal bar. This technique revealed values of the subjective visual horizontal outside the normal range in 91% of patients.

  9. Vestibular tributaries to the vein of the vestibular aqueduct

    DEFF Research Database (Denmark)

    Hansen, Jesper Marsner; Qvortrup, Klaus; Friis, Morten

    2010-01-01

    CONCLUSION: The vein of the vestibular aqueduct drains blood from areas extensively lined by vestibular dark cells (VDCs). A possible involvement in the pathogenesis of an impaired endolymphatic homeostasis can be envisioned at the level of the dark cells area. OBJECTIVES: The aim of this study...... was to investigate the vascular relationship between the vein of the vestibular aqueduct and the vestibular apparatus, with focus on the VDCs. METHODS: Sixteen male Wistar rats were divided into groups of 6 and 10. In the first group, 2 µm thick sections including the vein of the vestibular aqueduct, utricle...... relation to the VDCs in the utricle and the crista ampullaris of the lateral semicircular canal in the vestibular apparatus. One major vein emanated from these networks, which emptied into the vein of the vestibular aqueduct. Veins draining the saccule and the common crus of the superior and posterior...

  10. Stereotactic radiation therapy for large vestibular schwannomas

    NARCIS (Netherlands)

    Mandl, Ellen S.; Meijer, Otto W. M.; Slotman, Ben J.; Vandertop, W. Peter; Peerdeman, Saskia M.

    2010-01-01

    Background and purpose: To evaluate the morbidity and tumor-control rate in the treatment of large vestibular schwannomas (VS) after stereotactic radiation therapy in our institution. Material and methods: Twenty-five consecutive patients (17 men, 8 women) with large VS (diameter 3.0 cm or larger),

  11. Congenital sensorineural hearing loss

    Energy Technology Data Exchange (ETDEWEB)

    Mafee, M.F.; Selis, J.E.; Yannias, D.A.; Valvassori, G.E.; Pruzansky, S.; Applebaum, E.L.; Capek, V.

    1984-02-01

    The ears of 47 selected patients with congenital sensorineural hearing loss were examined with complex-motion tomography. The patients were divided into 3 general categories: those with a recognized syndrome, those with sensorineural hearing loss unrelated to any known syndrome, and those with microtia. A great variety of inner ear anomalies was detected, but rarely were these characteristic of a particular clinical entity. The most common finding was the Mondini malformation or one of its variants. Isolated dysplasia of the internal auditory canal or the vestibular aqueduct may be responsible for sensorineural hearing loss in some patients. Patients with microtia may also have severe inner ear abnormalities despite the fact that the outer and inner ears develop embryologically from completely separate systems.

  12. Systematic review of vestibular disorders related to human immunodeficiency virus and acquired immunodeficiency syndrome.

    Science.gov (United States)

    Heinze, B; Swanepoel, D W; Hofmeyr, L M

    2011-09-01

    Disorders of the auditory and vestibular system are often associated with human immunodeficiency virus infection and acquired immunodeficiency syndrome. However, the extent and nature of these vestibular manifestations are unclear. To systematically review the current peer-reviewed literature on vestibular manifestations and pathology related to human immunodeficiency virus and acquired immunodeficiency syndrome. Systematic review of peer-reviewed articles related to vestibular findings in individuals with human immunodeficiency virus infection and acquired immunodeficiency syndrome. Several electronic databases were searched. We identified 442 records, reduced to 210 after excluding duplicates and reviews. These were reviewed for relevance to the scope of the study. We identified only 13 reports investigating vestibular functioning and pathology in individuals affected by human immunodeficiency virus and acquired immunodeficiency syndrome. This condition can affect both the peripheral and central vestibular system, irrespective of age and viral disease stage. Peripheral vestibular involvement may affect up to 50 per cent of patients, and central vestibular involvement may be even more prevalent. Post-mortem studies suggest direct involvement of the entire vestibular system, while opportunistic infections such as oto- and neurosyphilis and encephalitis cause secondary vestibular dysfunction resulting in vertigo, dizziness and imbalance. Patients with human immunodeficiency virus and acquired immunodeficiency syndrome should routinely be monitored for vestibular involvement, to minimise functional limitations of quality of life.

  13. Reabilitação vestibular personalizada: levantamento de prontuários dos pacientes atendidos no ambulatório de otoneurologia da I.S.C.M.S.P. Personalized vestibular rehabilitation: medical chart survey with patients seen at the ambulatory of otoneurology of I.S.C.M.S.P.

    Directory of Open Access Journals (Sweden)

    Lucia Kazuko Nishino

    2005-08-01

    Full Text Available O OBJETIVO: o objetivo deste trabalho foi verificar a eficácia da reabilitação vestibular personalizada (RVP em diferentes quadros otoneurológicos. FORMA DE ESTUDO: clínico retrospectivo. MATERIAL E MÉTODO: Foi realizado um estudo retrospectivo que constou de uma descrição do programa de reabilitação vestibular de 37 pacientes, com idade entre 21 a 87 anos, vinte e seis do sexo feminino, onze do sexo masculino, com quadros otoneurológicos variados, atendidos no Ambulatório de Otoneurologia do Departamento de Otorrinolaringologia da Irmandade da Santa Casa de Misericórdia de São Paulo, no período de 2002 a 2003. Estes foram submetidos à avaliação otoneurológica e depois de realizado o diagnóstico pelo otorrinolaringologista, encaminhados para a reabilitação vestibular, realizada semanalmente no ambulatório, e em casa diariamente. Cada paciente seguiu programas específicos de exercícios, considerando-se os achados ao exame vestibular, o quadro clínico e, principalmente, os sintomas apresentados. Os exercícios foram baseados em diferentes protocolos descritos na literatura. Foi realizada uma análise individual da evolução clínica e em conjunto, a fim de verificar a eficácia da RVP em diferentes quadros clínicos. CONCLUSÃO: Pudemos concluir que o programa de RVP mostrou-se um recurso terapêutico efetivo na diminuição e extinção dos sintomas e conseqüente melhora na qualidade de vida de pacientes portadores de diferentes quadros clínicos.The objective of this research study was to verify the efficiency of the personalized vestibular rehabilitation (PVR in different otoneurologic clinical diseases, as well as set the best protocol option in each case. STUDY DESIGN: clinical retrospective. MATERIAL AND METHOD: A retrospective study was conducted based on the description of the vestibular rehabilitation program of 37 patients aged 21 to 87 years, twenty-six females and eleven males, with different clinical

  14. Vestibular syncope: A disorder associated with drop attack in Ménière's disease.

    Science.gov (United States)

    Pyykkö, Ilmari; Manchaiah, Vinaya; Zou, Jing; Levo, Hilla; Kentala, Erna

    2017-05-03

    Experiments in humans and animals indicate that vestibular influx through vestibular sympathetic reflex is an important and vital part of the regulatory system of circulation. The otolith organ adjusts the circulatory responses through the vestibular sympathetic reflex during an upright stance and may trigger a vasovagal attack of syncope. The aim of the present study was to evaluate the prevalence and association of syncope attacks among patients with Ménière's disease (MD). Vestibular syncope was defined as a sudden and transient loss of consciousness, which subsides spontaneously in people with vestibular disorders and without localizing neurological deficit. During clinical interactions, we encountered 5 patients with syncope during a Tumarkin attack of MD. Thereafter we evaluated data from 952 patients collected with a questionnaire from the Finnish Ménière Association (FMA). The data contained case histories with special attention to Tumarkin attacks, participation restriction, migraines, and syncope attacks. The mean age of the subjects participating in the study was 60.6 years (range 25-75 years). The duration of the disease was on average 9.8 years (range 0.5-35 years). In the current study sample, attacks of syncope were reported by 38 patients (4%) in association with the vertigo attack. Syncope was associated with Tumarkin attacks (X2=16.7, pdisease (X2=6.0, pdisease (X2=11.7, p<0.004). Duration of MD was correlated with syncope. Syncope was provoked by physical strain and environmental pressure, and was associated with impairment of the visual field (i.e., visual blurring). In logistic regression analysis, syncope was significantly associated with Tumarkin attacks (odds ratio 3.2), migraines (odds ratio 2.3) and nausea (odds ratio 1.3). The attack of syncope was experienced as frightening, and general health related quality of life (HRQoL) was significantly worsened. Also, the patients suffered more from fatigue. The current study indicates that

  15. Weight loss and skin manifestations in obese patients with psoriasis

    DEFF Research Database (Denmark)

    Geiker, Nina Rica Wium; Jensen, Peter; Kirchner Larsson, Lena

    % of their body weight following calorie restriction for 12 weeks. Taken together with recent literature the findings suggest that weight loss has a potential to reduce skin manifestations. Weight loss might also attenuate the increased cardiovascular and diabetes risks posed by obese psoriatric patients....

  16. Weight loss and skin manifestations in obese patients with psoriasis

    DEFF Research Database (Denmark)

    Geiker, Nina Rica Wium; Jensen, Peter; Kirchner Larsson, Lena

    2010-01-01

    % of their body weight following calorie restriction for 12 weeks. Taken together with recent literature the findings suggest that weight loss has a potential to reduce skin manifestations. Weight loss might also attenuate the increased cardiovascular and diabetes risks posed by obese psoriatric patients....

  17. Tooth loss: Are the patients prepared? | Okoje | Nigerian Journal of ...

    African Journals Online (AJOL)

    The emotional effects following teeth loss were sadness 22 (12.9%) cases, depression in 11 (6.4%), feeling of losing body part in 24 (14%), feeling of aging in 4 (2.3%), while 13 (7.6%) respondents felt unconcerned. Conclusion: We observed that emotional effects of tooth loss are also experienced among our patients with ...

  18. Biochemical parameters response to weight loss in patients with non ...

    African Journals Online (AJOL)

    al. who reported that weight loss reduces TNF- α in the obese22. Also, Sandoval and Davis approved that patients who had bariatric surgery gained reduction in. IL-6 concentration and improved insulin sensitivity in parallel to weight loss23. However, Chu and colleagues confirmed that serum leptin level was reduced after.

  19. Congress of Neurological Surgeons Systematic Review and Evidence-Based Guidelines on Hearing Preservation Outcomes in Patients With Sporadic Vestibular Schwannomas.

    Science.gov (United States)

    Carlson, Matthew L; Vivas, Esther X; McCracken, D Jay; Sweeney, Alex D; Neff, Brian A; Shepard, Neil T; Olson, Jeffrey J

    2018-02-01

    serviceable hearing following microsurgical resection of small to medium-sized sporadic vestibular schwannomas early after surgery, at 2, 5, and 10 yr following treatment? Level 3: Individuals who meet these criteria and are considering microsurgical resection should be counseled that there is a moderately low probability (>25%-50%) of hearing preservation immediately following surgery, moderately low probability (>25%-50%) of hearing preservation at 2 yr, moderately low probability (>25%-50%) of hearing preservation at 5 yr, and moderately low probability (>25%-50%) of hearing preservation at 10 yr. Among patients with AAO-HNS class A or GR grade I hearing at baseline, what is the overall probability of maintaining serviceable hearing following microsurgical resection of small to medium-sized sporadic vestibular schwannomas early after surgery, at 2, 5, and 10 yr following treatment? Level 3: Individuals who meet these criteria and are considering microsurgical resection should be counseled that there is a moderately high probability (>50%-75%) of hearing preservation immediately following surgery, moderately high probability (>50%-75%) of hearing preservation at 2 yr, moderately high probability (>50%-75%) of hearing preservation at 5 yr, and moderately low probability (>25%-50%) of hearing preservation at 10 yr. What patient- and tumor-related factors influence progression to nonserviceable hearing following microsurgical resection of small to medium-sized sporadic vestibular schwannomas? Level 3: Individuals who meet these criteria and are considering microsurgical resection should be counseled regarding the probability of successful hearing preservation based on the following prognostic data: the most consistent prognostic features associated with maintenance of serviceable hearing are good preoperative word recognition and/or pure tone thresholds with variable cut-points reported, smaller tumor size commonly less than 1 cm, and presence of a distal internal auditory

  20. Reabilitação vestibular na criança: estudo preliminar Vestibular rehabilitation in children: preliminary study

    Directory of Open Access Journals (Sweden)

    Roseli S. M. Bittar

    2002-08-01

    Full Text Available Forma de estudo: Clínico prospectivo. Objetivo: O estudo analisa prospectivamente os resultados da Reabilitação Vestibular pelo método de Cawtorne & Cooksey em 22 crianças, portadoras de vestibulopatia periférica, associada ou não a sintomas centrais, com idade média de 8,6 anos. Material e método: Os exames quantitativos da função vestibular utilizados para quantificar a vestibulopatia foram a eletronistagmografia e a prova rotatória pendular decrescente (PRPD, mas a história clínica altamente sugestiva de processo vestibular foi considerada diagnóstica mesmo na presença de exames normais. Resultado: Os resultados apontam a Reabilitação Vestibular como uma opção válida no tratamento das vestibulopatias na infância, uma vez que não houve casos não responsivos ao tratamento.Study design: Clinical prospective. Aim: The authors analyze prospectively 22 children (mean age 8,6 years with vestibulopathy treated with Vestibular Rehabilitation in order to verify its results. Material and methody: Twenty two children with peripheral vestibular disorders associated or not to central symptoms were submitted to vestibular stimulation by the method of Cawthorne & Cooksey. The methods used to quantify the vestibular abnormalities were the electronystagmography and rotational chair testing, but a suggestive history of vestibular disorder was accepted even the exams were normal. Results: All the patients improved and our results suggest that VR is a therapeutic alternative for the treatment of vestibular disorders in the children.

  1. Vestibular Rehabilitation Therapy: Review of Indications, Mechanisms, and Key Exercises

    Science.gov (United States)

    Song, Hyun Seok; Kim, Ji Soo

    2011-01-01

    Vestibular rehabilitation therapy (VRT) is an exercise-based treatment program designed to promote vestibular adaptation and substitution. The goals of VRT are 1) to enhance gaze stability, 2) to enhance postural stability, 3) to improve vertigo, and 4) to improve activities of daily living. VRT facilitates vestibular recovery mechanisms: vestibular adaptation, substitution by the other eye-movement systems, substitution by vision, somatosensory cues, other postural strategies, and habituation. The key exercises for VRT are head-eye movements with various body postures and activities, and maintaining balance with a reduced support base with various orientations of the head and trunk, while performing various upper-extremity tasks, repeating the movements provoking vertigo, and exposing patients gradually to various sensory and motor environments. VRT is indicated for any stable but poorly compensated vestibular lesion, regardless of the patient's age, the cause, and symptom duration and intensity. Vestibular suppressants, visual and somatosensory deprivation, immobilization, old age, concurrent central lesions, and long recovery from symptoms, but there is no difference in the final outcome. As long as exercises are performed several times every day, even brief periods of exercise are sufficient to facilitate vestibular recovery. Here the authors review the mechanisms and the key exercises for each of the VRT goals. PMID:22259614

  2. Fractionated vs. single-fraction stereotactic radiotherapy in patients with vestibular schwannoma. Hearing preservation and patients' self-reported outcome based on an established questionnaire

    Energy Technology Data Exchange (ETDEWEB)

    Kessel, Kerstin A.; Fischer, Hanna; Vogel, Marco M.E.; Combs, Stephanie E. [Technical University of Munich (TUM), Department of Radiation Oncology, Munich (Germany); Helmholtz Zentrum Muenchen, Institute of Innovative Radiotherapy (iRT), Neuherberg (Germany); Oechsner, Markus [Technical University of Munich (TUM), Department of Radiation Oncology, Munich (Germany); Bier, Henning [Technical University of Munich (TUM), Department of Otorhinolaryngology, Munich (Germany); Meyer, Bernhard [Technical University of Munich (TUM), Department of Neurosurgery, Munich (Germany)

    2017-03-15

    Stereotactic radiotherapy (RT) has been established as a valid treatment alternative in patients with vestibular schwannoma (VS). There is ongoing controversy regarding the optimal fractionation. Hearing preservation may be the primary goal for patients with VS, followed by maintenance of quality of life (QoL). From 2002 to 2015, 184 patients with VS were treated with radiosurgery (RS) or fractionated stereotactic radiotherapy (FSRT). A survey on current symptoms and QoL was conducted between February and June 2016. Median follow-up after RT was 7.5 years (range 0-14.4 years). Mean overall survival (OS) after RT was 31.1 years, with 94 and 87% survival at 5 and 10 years, respectively. Mean progression-free survival (PFS) was 13.3 years, with 5- and 10-year PFS of 92%. Hearing could be preserved in RS patients for a median of 36.3 months (range 2.3-13.7 years). Hearing worsened in 17 (30%) cases. Median hearing preservation for FSRT was 48.7 months (range 0.0-13.8 years); 29 (23%) showed hearing deterioration. The difference in hearing preservation was not significant between RS and FSRT (p = 0.3). A total of 123/162 patients participated in the patient survey (return rate 76%). The results correlate well with the information documented in the patient files for tinnitus and facial and trigeminal nerve toxicity. Significant differences appeared regarding hearing impairment, gait uncertainty, and imbalance. These data confirm that RS and FSRT are comparable in terms of local control for VS. RS should be reserved for smaller lesions, while FSRT can be offered independently of tumor size. Patient self-reported outcome during follow-up is of high value. The established questionnaire could be validated in the independent cohort. (orig.) [German] Die stereotaktische Radiotherapie (RT) wurde als gueltige Behandlungsalternative bei Patienten mit Vestibularisschwannom (VS) etabliert. Diskussionen ueber die optimale Fraktionierung laufen jedoch. Der Erhalt von Hoervermoegen

  3. Vestibular telemedicine and rehabilitation. Applications for virtual reality.

    Science.gov (United States)

    Viirre, E

    1996-01-01

    This paper will discuss the use of Virtual Reality (VR) technologies in the rehabilitation of patients with vestibular disorders and in the provision of remote medical consultations for those patients. Patients with a vestibular problem are very common (vertigo is the second most common neurological complaint after headache) and yet there are very few vestibular neurotologists: specialists in their diagnosis and treatment. New treatments for various disorders causing vertigo now exist. This means that appropriate diagnosis can significantly improve patients' well-being. Remote medical diagnosis and treatment facilities could make the few vestibular disorder specialists much more available to patients. An analysis of the technological and economic factors influencing the provision of this service is necessary. The main long term effect of many vestibular disorders is damage to the sensing apparatus of the inner ear. The damage can lead to inappropriate interaction between visually driven orientation sensing and sensing of orientation by the inner ear. The consequence for the patient is vertigo (a sensation of turning), motion sickness and imbalance. Current rehabilitation efforts are intended to drive the nervous system to adapt to the disordered vestibular input. Adaptation appears to occur slowly in many subjects, even those within rehabilitation programs. An appropriately designed VR experience could greatly increase the rate of adaptation in these patients.

  4. Hearing loss in mild OSAS and simple snoring patients.

    Science.gov (United States)

    Spinosi, Maria Carla; D'Amico, Francesca; Passali, Giulio; Cingi, Cemal; Rodriguez, Hugo; Passali, Desiderio

    2017-04-30

    Introduction Obstructive Sleep Apnea Syndrome (OSAS) is characterized by recurrent episodes of prolonged partial or complete obstruction of the upper airways. Several study groups studied the effect of snoring and OSAS on auditory function, showing an increase in the incidence of hearing loss in apneic patients, an earlier onset and/or a degree of hearing loss deeper than in peers. The aim of our study is to evaluate the audiological performance of a population of simple-snoring patients and patients suffering from mild OSAS, and the impact that such pathological condition can have on the auditory function, considering the significant levels of chronic noise. Materials and Methods Data was collected by analyzing audiometric exams on snoring patients and a control group of non-snoring patients. Our study included simple snoring patients without OSAS (AHI < 5) or with low level of OSAS (5< AHI < 15). Possible hearing loss was classified in a crescent scale (A-B-C-D-E), from greater to minor auditory performance, according to the indications of the national protocol of occupational medicine for evaluation of hearing loss in patients exposed to chronic noise. Results We have found independence between simple snorers, mild-OSAS snorers and non-snoring patients compared to the scale of hearing performance classification. Conclusions Our results show a distribution of hearing loss in the different groups that appear independent of the presence or absence of snoring, complicated or uncomplicated by mild OSAS.

  5. Intentional Weight Loss Improved Performance in Obese Ischaemic Heart Patient

    DEFF Research Database (Denmark)

    Geiker, Nina; Myint, Khin Swe; Heck, Patrick

    2014-01-01

    ) on physical performance and cardiovascular risk factors in obese patients with moderate-to-severe HF and/or ischaemic heart disease (IHD). Methods and Results: Results from two weight loss interventions at two centres, one in Denmark (DK - 12 week intervention in 21 subjects (14 LED, 7 controls)) and one......Aims: The risk of heart failure (HF) increases with BMI, but paradoxically obesity has been associated with reduced mortality in patients with HF. The effect of intentional or therapeutic weight loss on HF is not well known. We examined the effect of weight loss induced by low energy diet (LED...... improvement in physical performance and cardiovascular risk markers....

  6. VESTIBULAR SCHWANNOMA (ACOUSTIC NEUROMA) MIMICKING TEMPOROMANDIBULAR DISORDERS: A CASE REPORT

    Science.gov (United States)

    Bisi, Maurício A.; Selaimen, Caio M. P.; Chaves, Karen D.; Bisi, Melissa C.; Grossi, Márcio L.

    2006-01-01

    Approximately 6 to 16% of patients with trigeminal neuralgia symptoms present intracranial tumors, the most common being the vestibular schwannoma (acoustic neuroma). Some symptoms reported by patients include hearing loss, tinnitus, headaches, vertigo and trigeminal disturbances. An increased muscle response in the surrounding head and neck musculature may also be observed, which mimics signs and symptoms of temporomandibular disorders. In these cases, magnetic resonance imaging (MRI) has proved to be a useful tool in tumor diagnosis. The differential diagnosis between myofascial and neuralgic pain is important, as both may present similar characteristics, while being of different origin, and demanding special treatment approaches. The purpose of this paper is to demonstrate the relationship among trigeminal neuralgia symptoms, intracranial tumors and temporomandibular dysfunction by presenting a clinical case. PMID:19089251

  7. Effects and safety profile of betahistine in patients in the Russian contingent of OSVaLD, an open-label observational study in vestibular vertigo

    Directory of Open Access Journals (Sweden)

    Morozova SV

    2015-01-01

    Full Text Available Svetlana Vyacheslavovna Morozova,1 Natalia Stepanovna Alekseeva,2 Sergey Vasilyevich Lilenko,3 Eduard Ivanovich Matsnev,4 Oleg Anatol'evich Melnikov51Department of Ear, Nose, and Throat, State Budgetary Educational Institution of Higher Professional Training, IM Sechenov First Moscow State Medical University of the Ministry of Healthcare and Social Development of the Russian Federation, Moscow, 2Federal State Budgetary Institution, Scientific Neurology Center of the Russian Academy of Medical Sciences, Moscow, 3St Petersburg Research Institute of Ear, Throat, Nose and Speech, St Petersburg, 4Department of Physiology and Pathology of Auditory and Vestibular Systems, Federal Scientific Center (FSC, Institute for Biomedical Problems, Russian Academy of Sciences (RAS, Moscow, 5ANO Guta Clinic, Moscow, Russian Federation Background: We report here data from the >200 patients recruited in Russia to take part in OSVaLD, a 12-week, open-label, post-marketing surveillance study of the response to betahistine 48 mg/day in vertigo of peripheral vestibular origin carried out in a total of 13 countries.Methods: The primary efficacy endpoint was change in the Dizziness Handicap Inventory (DHI; 100-point scale. Changes in Hospital Anxiety and Depression Scale (HADS and Medical Outcomes Study Short-Form 36, version 2 (SF-36v2® scores were a priori secondary Outcomes.Results: Total DHI score improved by 43 points during betahistine treatment. This aggregate improvement was equally distributed across the three domains of the DHI (physical, emotional, and functional; P<0.0001 for main and subscore changes from baseline. Statistically significant improvements versus baseline were also observed in mean HADS scores for anxiety and depression (both P<0.0001, and in the Physical Component Summary and Mental Component Summary scores of the SF-36v2 (both P<0.0001 versus baseline. Only one suspected adverse drug reaction was recorded in the Russian safety population (n

  8. Optimal duration of therapy in the recovery period of vestibular diseases

    Directory of Open Access Journals (Sweden)

    M. V. Zamergrad

    2014-01-01

    Full Text Available Dizziness is a common symptom in neurological and general medical practice. In most cases it is caused by diseases of the central or peripheral vestibular system. The most common vestibular system diseases include benign paroxysmal postural vertigo, dizziness, Meniere's disease, vestibular neuronitis, and cerebrovascular diseases. One of the main treatments for the diseases accompanied by dizziness is vestibular rehabilitation that is a complex of exercises, the goal of which is to stimulate vestibular compensation. Adequate vestibular compensation allows a patient to get rid of dizziness and unsteadiness even though vestibular system injury is irreversible. Some medications are able to enhance the efficiency of vestibular rehabilitation. At the same time, the optimal duration of treatment for the most common vestibular disorders has not beenadequately explored. The paper gives the results of an observational program, whose purpose was to determine the optimal duration of vestibular rehabilitation in combination with the use of tanakan in patients with non-progressive unilateral peripheral vestibular disorder.Patients and methods. Data on 46 patients aged 19 to 70 years who underwent vestibular rehabilitation and took tanakan for vertigo caused by vestibular neuronitis (n = 44, labyrinthitis (n =1, or Ramsay Hunt syndrome (n = 1 were analyzed. All the patients were examined four times. The symptoms were recorded and the histories of disease were considered. The degree of vestibular disorders, including vertigo, was assessed when collecting complaints. The symptoms of vertigo were objectivized using its vertigo rating scale and five-point subjective rating scale for vertigo. All the patients underwent standard somatic and neurological examinations and videonystagmography. During the first visit after diagnosis, vestibular exercises were chosen for the patients and tanakan was used in a dose of 40 mg thrice daily to accelerate

  9. Caloric Vestibular Stimulation Reduces Pain and Somatoparaphrenia in a Severe Chronic Central Post-Stroke Pain Patient: A Case Study: e0151213

    National Research Council Canada - National Science Library

    Grazia Fernanda Spitoni; Giorgio Pireddu; Gaspare Galati; Valentina Sulpizio; Stefano Paolucci; Luigi Pizzamiglio

    2016-01-01

    .... To date, there is limited evidence for the effective treatments of this disease. Here we used caloric vestibular stimulation to reduce pain and somatoparaphrenia in a 57-year-old woman suffering from central post-stroke pain...

  10. Is hippocampal neurogenesis modulated by the sensation of self-motion encoded by the vestibular system?

    Science.gov (United States)

    Smith, Paul F

    2017-12-01

    It is now well accepted that physical exercise stimulates hippocampal neurogenesis and may promote cognitive ability. Less clear are the mechanisms by which this process occurs. One potential contributing influence, that is usually neglected, is the vestibular system, which by its very nature must be activated during physical exercise and which essentially cannot be turned off without complete bilateral vestibular lesions. This paper reviews a small literature that demonstrates that bilateral vestibular loss (BVL) in rats modulates cell proliferation in the dentate gyrus (DG) and that artificial electrical activation of the vestibular system, using galvanic vestibular stimulation, does also. Although there are only a few piecemeal studies of this subject, because of the way that they were controlled, it is likely that the vestibular system has a regulatory role in cell proliferation in the DG and therefore possibly in neurogenesis, which needs to be taken into account in the interpretation of neurogenesis studies. Copyright © 2017 Elsevier Ltd. All rights reserved.

  11. The vestibular body: Vestibular contributions to bodily representations.

    Science.gov (United States)

    Ferrè, Elisa Raffaella; Haggard, Patrick

    2016-01-01

    Vestibular signals are integrated with signals from other sensory modalities. This convergence could reflect an important mechanism for maintaining the perception of the body. Here we review the current literature in order to develop a framework for understanding how the vestibular system contributes to body representation. According to recent models, we distinguish between three processes for body representation, and we look at whether vestibular signals might influence each process. These are (i) somatosensation, the primary sensory processing of somatic stimuli, (ii) somatoperception, the processes of constructing percepts and experiences of somatic objects and events and (iii) somatorepresentation, the knowledge about the body as a physical object in the world. Vestibular signals appear to contribute to all three levels in this model of body processing. Thus, the traditional view of the vestibular system as a low-level, dedicated orienting module tends to underestimate the pervasive role of vestibular input in bodily self-awareness.

  12. Vestibular animal models: contributions to understanding physiology and disease.

    Science.gov (United States)

    Straka, Hans; Zwergal, Andreas; Cullen, Kathleen E

    2016-04-01

    Our knowledge of the vestibular sensory system, its functional significance for gaze and posture stabilization, and its capability to ensure accurate spatial orientation perception and spatial navigation has greatly benefitted from experimental approaches using a variety of vertebrate species. This review summarizes the attempts to establish the roles of semicircular canal and otolith endorgans in these functions followed by an overview of the most relevant fields of vestibular research including major findings that have advanced our understanding of how this system exerts its influence on reflexive and cognitive challenges encountered during daily life. In particular, we highlight the contributions of different animal models and the advantage of using a comparative research approach. Cross-species comparisons have established that the morpho-physiological properties underlying vestibular signal processing are evolutionarily inherent, thereby disclosing general principles. Based on the documented success of this approach, we suggest that future research employing a balanced spectrum of standard animal models such as fish/frog, mouse and primate will optimize our progress in understanding vestibular processing in health and disease. Moreover, we propose that this should be further supplemented by research employing more "exotic" species that offer unique experimental access and/or have specific vestibular adaptations due to unusual locomotor capabilities or lifestyles. Taken together this strategy will expedite our understanding of the basic principles underlying vestibular computations to reveal relevant translational aspects. Accordingly, studies employing animal models are indispensible and even mandatory for the development of new treatments, medication and technical aids (implants) for patients with vestibular pathologies.

  13. Evaluation of postural control in unilateral vestibular hypofunction.

    Science.gov (United States)

    Quitschal, Rafaela Maia; Fukunaga, Jackeline Yumi; Ganança, Maurício Malavasi; Caovilla, Heloísa Helena

    2014-01-01

    Patients with vestibular hypofunction, a typical finding in peripheral vestibular disorders, show body balance alterations. To evaluate the postural control of patients with vertigo and unilateral vestibular hypofunction. This is a clinical cross-sectional study. Twenty-five patients with vertigo and unilateral vestibular hypofunction and a homogeneous control group consisting of 32 healthy individuals were submitted to a neurotological evaluation including the Tetrax Interactive Balance System posturography in eight different sensory conditions. For different positions, vertiginous patients with unilateral vestibular hypofunction showed significantly higher values of general stability index, weight distribution index, right/left and tool/heel synchronizations, Fourier transformation index and fall index than controls. Increased values in the indices of weight distribution, right/left and tool/heel synchronizations, Fourier transformation and fall risk characterize the impairment of postural control in patients with vertigo and unilateral vestibular hypofunction. Copyright © 2014 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  14. Effects and tolerability of betahistine in patients with vestibular vertigo: results from the Romanian contingent of the OSVaLD study

    Directory of Open Access Journals (Sweden)

    Băjenaru O

    2014-12-01

    Full Text Available Ovidiu Băjenaru,1 Adina Maria Roceanu,2 Silviu Albu,3 Viorel Zainea,4 Alexandru Pascu,4 Mădălina Gabriela Georgescu,4 Sebastian Cozma,5 Luigi Mărceanu,6 Dafin Fior Mureşanu7 1Department of Neurology, Carol Davila University of Medicine and Pharmacy, 2Department of Neurology, University Hospital, Bucharest, 3IInd Department of Otolaryngology, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, 4Institute of Phono-Audiology and ENT Functional Surgery Prof Dr Dorin Hociota, Carol Davila University of Medicine and Pharmacy, Bucharest, 5ENT Department, University of Medicine and Pharmacy Grigore T Popa, Audiology and Vestibulogy Department, Rehabilitation Clinical Hospital, Iasi, 6Transilvania University, Faculty of Medicine, Department: Doctoral Program (PhD, Brasov, 7"RoNeuro" Institute for Neurological Research and Diagnostic Cluj-Napoca, University of Medicine and Pharmacy "Iuliu Haţieganu", Department of Clinical Neurosciences, Cluj-Napoca, Romania Background and methods: An efficacy population of 245 patients with vertigo of peripheral vestibular origin was recruited in Romania as part of a 3-month multinational, post-marketing surveillance study of open-label betahistine 48 mg/day (OSVaLD. Endpoints were changes in the Dizziness Handicap Index (primary endpoint, Medical Outcome Study Short-Form 36 (SF-36v2®, and the Hospital Anxiety and Depression Scale. Results: During treatment, the total Dizziness Handicap Index score improved by 41 points (on a 100-point scale. Statistically significant improvements of 12–14 points were recorded in all three domains of the Dizziness Handicap Index scale (P<0.0001. Betahistine therapy was also accompanied by progressive improvements in mean Hospital Anxiety and Depression anxiety and depression scores (P<0.0001 and significant improvements in both the physical and mental component summary of the SF-36v2 (P<0.0001. Betahistine was well tolerated, with only one suspected adverse drug

  15. The Vestibular-Evoked Postural Response of Adolescents with Idiopathic Scoliosis Is Altered.

    Directory of Open Access Journals (Sweden)

    Jean-Philippe Pialasse

    Full Text Available Adolescent idiopathic scoliosis is a multifactorial disorder including neurological factors. A dysfunction of the sensorimotor networks processing vestibular information could be related to spine deformation. This study investigates whether feed-forward vestibulomotor control or sensory reweighting mechanisms are impaired in adolescent scoliosis patients. Vestibular evoked postural responses were obtained using galvanic vestibular stimulation while participants stood with their eyes closed and head facing forward. Lateral forces under each foot and lateral displacement of the upper body of adolescents with mild (n = 20 or severe (n = 16 spine deformation were compared to those of healthy control adolescents (n = 16. Adolescent idiopathic scoliosis patients demonstrated greater lateral displacement and net lateral forces than controls both during and immediately after vestibular stimulation. Altered sensory reweighting of vestibular and proprioceptive information changed balance control of AIS patients during and after vestibular stimulation. Therefore, scoliosis onset could be related to abnormal sensory reweighting, leading to altered sensorimotor processes.

  16. Correlation of interdental and interradicular bone loss in patients ...

    African Journals Online (AJOL)

    Objective: The aim of this study was to investigate the correlation between interdental and interradicular bone loss and clinical parameters in patients with chronic periodontitis. Materials and Methods: One hundred-twenty intraoral periapical radiographs of first molars were obtained from patients with chronic periodontitis ...

  17. Correlation of interdental and interradicular bone loss in patients ...

    African Journals Online (AJOL)

    2012-01-19

    Jan 19, 2012 ... Objective: The aim of this study was to investigate the correlation between interdental and interradicular bone loss and clinical parameters in patients with chronic periodontitis. Materials and Methods: One hundred-twenty intraoral periapical radiographs of first molars were obtained from patients with ...

  18. Biochemical parameters response to weight loss in patients with non ...

    African Journals Online (AJOL)

    The aim of this study was to detect changes in biochemical parameters including insulin resistance, cytokines, blood lipid profile and liver enzymes following weight loss in patients with non-alcoholic steatohepatitis. Materials and methods: One hundred obese patients with NASH, their age between 35-50 years, body mass ...

  19. Oncologists' protocol and coping strategies in dealing with patient loss.

    Science.gov (United States)

    Granek, Leeat; Mazzotta, Paolo; Tozer, Richard; Krzyzanowska, Monika K

    2013-01-01

    To identify what protocol and coping strategies oncologists turn to cope with patient loss, the authors interviewed 20 oncologists at 3 hospitals. Using the grounded theory method, findings revealed that their protocol may include meeting with families, participating in bereavement rituals, making a phone call, or sending a condolence card. Coping strategies included social support, activity-oriented coping, turning to faith, compartmentalization, and withdrawing from patients and families. The authors conclude by offering implications from this research on how to address oncologists' grief over patient loss in institutional settings in order to improve bereavement care for families and enhance oncologists' quality of life.

  20. Audio-Vestibular Findings in Increased Intracranial Hypertension Syndrome.

    Science.gov (United States)

    Çoban, Kübra; Aydın, Erdinç; Özlüoğlu, Levent Naci

    2017-04-01

    Idiopathic intracranial hypertension (IIH) can be manifested by audiological and vestibular complaints. The aim of the present study is to determine the audio-vestibular pathologies and their pathophysiologies in this syndrome by performing current audio-vestibular tests. The study was performed prospectively on 40 individuals (20 IIH patients, 20 healthy volunteers). Pure tone audiometry, tympanometry, vestibular evoked myogenic potentials, and electronystagmography tests were performed in both groups and the results were compared. The mean age of both groups was found to be 30.2±18.7. There were 11 females and 9 males in each group. The study group patients had significantly worse hearing levels. Pure tone averages were significantly higher in both ears of the study group (pintracranial pressure may affect the inner ear with similar mechanisms as in hydrops.

  1. Distinct spontaneous shrinkage of a sporadic vestibular schwannoma

    DEFF Research Database (Denmark)

    Huang, Xiaowen; Cayé-Thomasen, Per; Stangerup, Sven-Eric

    2013-01-01

    We present a case with outspoken spontaneous vestibular schwannoma shrinkage and review the related literature. The patient was initially diagnosed with a left-sided, intrameatal vestibular schwannoma, which subsequently grew into the cerebello-pontine angle (CPA), followed by total shrinkage...... of the CPA component without any intervention over a 12-year observation period. The literature on spontaneous tumor shrinkage was retrieved by searching the subject terms "vestibular schwannoma, conservative management" in PubMed/MEDLINE database, without a time limit. Of the published data, the articles...... on "shrinkage" or "negative growth" or "regression" or "involution" of the tumor were selected, and the contents on the rate, extent and mechanism of spontaneous tumor shrinkage were extracted and reviewed. The reported rate of spontaneous shrinkage of vestibular schwannoma is 5-10% of patients managed...

  2. Accuracy of patient-reported height loss and risk factors for height loss among postmenopausal women.

    Science.gov (United States)

    Briot, Karine; Legrand, Erik; Pouchain, Denis; Monnier, Stéphanie; Roux, Christian

    2010-04-06

    Since loss of height may indicate vertebral fracture, the accuracy of the information on height is relevant for clinical practice. We undertook this study to compare reported and measured loss of height among post-menopausal women in a primary care setting. We also analyzed the determinants of this height loss. In an observational study conducted between December 2007 and May 2008, we asked 1779 randomly selected general practitioners to recruit the first five female patients who were more than 60 years of age, regardless of the reason for the consultation. Using a questionnaire, physicians collected data on demographic and clinical variables, history of osteoporosis and current anti-osteoporotic treatment. We used three assessments of height: tallest height in early adulthood recalled by the patient, estimated current height reported by the patient at the visit and current measured height. We defined loss of height as the difference between the patient's tallest recalled height and her current measured height. A total of 8610 patients were included in the analysis; the mean age was 70.9 (standard deviation [SD] 7.2) years. The mean loss of height was 4.5 cm. The mean current reported height was 2.1 (SD 2.5) cm lower than the tallest recalled height and 2.4 (SD 2.6) cm lower than the measured current height. The best predictors of a loss of height of 3 cm or more were age (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.08-1.10), previous vertebral fracture (OR 1.49, 95% CI 1.16-1.91), previous nonvertebral fracture (OR 1.26, 95% CI 1.06-1.51), thoracic kyphosis (OR 2.07, 95% CI 1.69-2.55), scoliosis (OR 1.35, 95% CI 1.12-1.63), back pain (OR 1.22, 95% CI 1.07-1.39) and osteoporosis (OR 1.39, 95% CI 1.20-1.60). Our study showed that the patients' estimated current height was not correct, with a mean difference of -2.5 cm from the current measured height. The mean height loss was 4.5 cm. Previous vertebral fracture and thoracic kyphosis were strong determinants

  3. Older adults demonstrate superior vestibular perception for virtual rotations.

    Science.gov (United States)

    Peters, Ryan M; Blouin, Jean-Sébastien; Dalton, Brian H; Inglis, J Timothy

    2016-09-01

    Adult ageing results in a progressive loss of vestibular hair cell receptors and afferent fibres. Given the robustness of vestibulo-ocular and vestibular-evoked whole-body responses to age-related deterioration, it was proposed that the vestibular system compensates centrally. Here we examine the potential for central compensation in vestibular sensitivity with adult ageing by using a combination of real and virtual rotation-based psychophysical testing at two stimulus frequencies (0.1 & 1Hz). Real rotations activate semi-circular canal hair cell receptors naturally via mechanotransduction, while electrical current used to evoke virtual rotations does not rely on mechanical deformation of hair cell receptors to activate vestibular afferents. This two-pronged approach allows us to determine the independent effects of age-related peripheral afferent receptor loss and potential compensatory mechanisms. Older adults had thresholds for discriminating real rotations that were significantly greater than young adults at 0.1Hz (7.2 vs. 3°/s), but the effect of age was weaker (non-significant) at 1Hz (2.4 vs. 1.3°/s). For virtual rotations, older adults had greater thresholds than young adults at 0.1Hz (1.2 vs. 0.5mA), however, older adults outperformed young adults at 1Hz (0.6 vs. 1.1mA). Based on these thresholds, we argue that central vestibular processing gain is enhanced in older adults for 1Hz real and virtual rotations, partially offsetting the negative impact of normal age-related hair cell receptor and primary afferent loss. We propose that the frequency dependence of this compensation reflects the physiological importance of the 1-5Hz range in natural vestibular input. Crown Copyright © 2016. Published by Elsevier Inc. All rights reserved.

  4. Compensatory saccades benefit from prediction during head impulse testing in early recovery from vestibular deafferentation.

    Science.gov (United States)

    Mantokoudis, Georgios; Agrawal, Yuri; Newman-Toker, David E; Xie, Li; Saber Tehrani, Ali S; Wong, Aaron; Schubert, Michael C

    2016-06-01

    The head impulse test (HIT) can identify a deficient vestibulo-ocular reflex (VOR) by the compensatory saccade (CS) generated once the head stops moving. The inward HIT is considered safer than the outward HIT, yet might have an oculomotor advantage given that the subject would presumably know the direction of head rotation. Here, we compare CS latencies following inward (presumed predictable) and outward (more unpredictable) HITs after acute unilateral vestibular nerve deafferentation. Seven patients received inward and outward HITs delivered at six consecutive postoperative days (POD) and again at POD 30. All head impulses were recorded by portable video-oculography. CS included those occurring during (covert) or after (overt) head rotation. Inward HITs included mean CS latencies (183.48 ms ± 4.47 SE) that were consistently shorter than those generated during outward HITs in the first 6 POD (p = 0.0033). Inward HITs induced more covert saccades compared to outward HITs, acutely. However, by POD 30 there were no longer any differences in latencies or proportions of CS and direction of head rotation. Patients with acute unilateral vestibular loss likely use predictive cues of head direction to elicit early CS to keep the image centered on the fovea. In acute vestibular hypofunction, inwardly applied HITs may risk a preponderance of covert saccades, yet this difference largely disappears within 30 days. Advantages of inwardly applied HITs are discussed and must be balanced against the risk of a false-negative HIT interpretation.

  5. Neuropharmacology of Vestibular System Disorders

    OpenAIRE

    Soto, Enrique; Vega, Rosario

    2010-01-01

    This work reviews the neuropharmacology of the vestibular system, with an emphasis on the mechanism of action of drugs used in the treatment of vestibular disorders. Otolaryngologists are confronted with a rapidly changing field in which advances in the knowledge of ionic channe