Arthur I Mallinson | PubMed Health

PubMed2002

Visual vestibular mismatch in patients treated with intratympanic gentamicin for Meniere's disease.

OBJECTIVE: To support the hypothesis that the symptom complex known as visual vestibular mismatch (VVM) can be induced by peripheral vestibular disease. DESIGN: Retrospective chart review; prospective questionnaire. SETTING: A tertiary/quaternary care hospital clinic. METHODS: The charts of 28 patients who were treated for Meniere's disease were studied. Their responses to a pretreatment VVM questionnaire were scored and compared with their answers in a telephone follow-up to the same questions posttreatment. These questionnaires were compared with those filled in by 100 control patients without ear disease. MAIN OUTCOME MEASURES: Patients' responses to a VVM-specific questionnaire. RESULTS: Seventeen of 28 patients had VVM. Gentamicin therapy increased the number of positive answers. There was no correlation between the development of VVM complaints, caloric scores, and posturography performance. No control patients had symptoms of VVM. CONCLUSION: We conclude that the development of VVM indicates the onset or worsening of vestibular disease as it can be induced or exacerbated by gentamicin therapy. As there is no correlation between VVM and caloric scores, we suggest that otolithic damage may be responsible for this symptom set developing.

Anti-Bacterial Agents↗

PubMed2002

Motion sickness and vestibular hypersensitivity.

OBJECTIVE: Motion sickness is poorly understood, although it has been recognized for years as debilitating. Vestibular function is required for motion sickness to occur, but motion sickness can also be brought on without body motion. The aim of this study was to see if there was a correlation between caloric response and motion sickness susceptibility. DESIGN: One experiment was a prospective study carried out on 200 patients. A second prospective study was carried out on 121 patients. SETTING: Patients referred to our tertiary/quaternary care dizziness clinic. METHODS: In experiment 1, caloric scores in patients were correlated with symptoms of motion sickness as established by responses to a simple question. In experiment 2, caloric scores were correlated with symptomatic responses to caloric testing itself. MAIN OUTCOME MEASURES: Caloric responses of the best ear were measured according to standardized caloric evaluation methods. RESULTS: There was no correlation between motion sickness and caloric scores. There was a significant difference in caloric scores between patients made symptomatic by calorics and those who were not. CONCLUSIONS: The autonomic response seen in some patients is not triggered by a specific level of semicircular canal response (as measured by caloric testing). We hypothesize that (similar to space motion sickness) the trigger is a signal differential that arises between semicircular canals and otoliths and that some patients are unable to suppress this response. These patients often suffer motion sickness on a long-term basis.

Adult↗