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PubMed1978

[Unilateral deafness (author's transl)].

Unilateral conductive deafness has a readily determined aetiology in most cases. In contrast, unilateral sensorineural hearing loss requires more refined and extensive investigation. The most frequent causes of unilateral sensorineural hearing loss in our patients were sudden deafness, Menière's disease, cranio-vertebral dysplasia and cerebellopontine angle tumors. Early diagnosis of acoustic neuroma or other lesions of the internal auditory meatus or cerebellopontine angle requires special attention. The definitive diagnosis of these tumors often demands intensive clinical investigation but a high degree of suspicion may be entertained following modern routine audiometry, vestibular function testing and radiological examination. The importance of early diagnosis of these lesions is stressed with regard to the mortality rate for larger tumors and to the preservation of facial nerve function. The reliability of different diagnostic investigations is documented.

Brain Diseases↗
PubMed1996

Neurotology.

As in most areas of clinical medicine, the history often is the key to determining the diagnosis in patients presenting with neurotologic symptoms. The most common cause of vertigo--benign positional vertigo--can be diagnosed at the bedside based on the characteristic history and the finding of fatigable positional nystagmus on the Dix-Hallpike positional test. Furthermore, it can be cured with a simple positioning maneuver. Quantitative auditory and vestibular function tests are important for documenting the site and severity of deficit in patients with chronic neurotologic symptoms. Only a few presentations (listed in section on acute vertigo) require immediate neuroimaging.

Audiometry↗
PubMed1991

Investigation of vestibular damage by antituberculous drugs.

Vestibular function testing was performed regularly on patients who were administered streptomycin, kanamycin, or enviomycin, and vestibular damage was detected at an early stage, and quantitatively. We investigated the point in time at which the therapy should be discontinued. Subjects consisted of 204 cases of tuberculosis treated with streptomycin, kanamycin, enviomycin. They were admitted to the hospital between December 1984 and August 1989. Twenty-eight cases of vestibular dysfunction due to streptomycin, kanamycin, and enviomycin could easily be detected at an early stage by performing Meyer zum Gottesberge's head-shaking test for the evaluation of jumbling, together with Romberg's test and the stepping test. All cases who had vestibular dysfunction completely recovered because of early detection. In addition, 7 cases recovered afterwards from temporary vestibular damage shown only in Meyer zum Gottesberge's head-shaking test (abnormality of vestibulo-ocular reflex was only detected and vestibulo-spinal reflex remained intact), despite continuation of streptomycin injection. When the results of the head-shaking test are less than 50% and when a sway and/or rotation in the stepping test occurs, the injections should be discontinued.

Adult↗
PubMed1988

Infrared/video ENG recording of eye movements to evaluate the inferior vestibular nerve using the minimal caloric test.

The technique was originally developed to test the inferior vestibular nerve in tumor suspects whose high-frequency hearing loss exceeded the capabilities of the auditory brainstem response tests and whose electronystagmographic results showed no significantly reduced vestibular response. The test has subsequently been found effective to demonstrate persistent singular nerve fiber function in patients with persistent vertigo after retrolabyrinthine vestibular nerve section.

Caloric Tests↗
PubMed1995

Perceptual studies in patients with vestibular neurectomy.

Twelve patients undergoing unilateral vestibular neurectomy for the treatment of refractory vertigo were investigated. Vestibular motion perception was assessed using a self-rotational task and "vestibular remembered saccades". Cervical perception was also measured with remembered saccades. The tests were performed pre- and post-operatively to examine changes in vestibular and cervical perception following an acute vestibular lesion, and to monitor the progress of vestibular compensation. These perception tests were carried out in conjunction with a conventional evaluation of the vestibular ocular reflex (VOR), using electro-oculography. The patients' subjective symptoms at each stage of testing were also quantified with questionnaires. Generally, in the vestibular tests, for stimulation to the operated side, responses became strongly hypometric directly after the neurectomy, with a partial recovery during convalescence. In the cervical test, responses were bilaterally reduced immediately after operation. Results from both of the vestibular perception tests were significantly correlated with the VOR assessment of vestibular function. Scores for the patients' subjective symptoms of "vertigo" were only significantly correlated with the vestibular perception tests, and not with the conventional measures of vestibular function. Perceptual measurements afford useful complementary information in the assessment of vestibular patients.

Adult↗
PubMed2000

Vestibular anomalies in CHARGE syndrome: investigations on and consequences for postural development.

UNLABELLED: Recently, vestibular anomalies have been described as a frequent feature in children with coloboma-heart-atresia-retarded-genital-ear (CHARGE) syndrome. They are likely to play an important role in the psychomotor retardation affecting these children. In order to test this hypothesis, we prospectively performed complete vestibular investigations in a series of 17 CHARGE syndrome patients including inner ear CT scan and functional vestibular evaluation of both canal and otolith functions. These results were correlated with the postural anomalies observed during the children's development and showed that vestibular dysfunction is a constant feature in CHARGE syndrome and has very good sensitivity for confirming the diagnosis. Anomalies of semicircular canals were frequently found (94%), easily detectable on CT scan and associated with no response on canal function evaluation. They were considered as partly responsible for the retardation of postural stages. Vestibular functional tests were consistently abnormal but allowed detection of residual otolith function in most patients (94%). All children of this series had an atypical pattern of postural behaviour that we consider to be related to their vestibular anomalies. Residual otolith function seems to have a positive influence for postural development. CONCLUSION: Vestibular investigations are valuable for diagnosis, developmental assessment, and adaptation of specific rehabilitation programmes in CHARGE syndrome patients.

Abnormalities, Multiple↗
PubMed1985

The large vestibular aqueduct syndrome.

The hypocycloidal polytomographic temporal bone studies performed on 2683 patients were reviewed, and the radiographic appearance of the vestibular aqueduct was evaluated. Within this group of 5366 ears, forty-seven ears (1%) in twenty-six patients demonstrated a large vestibular aqueduct (diameter greater than 1.5 mm). A review of the relevant embryology, anatomy, and physiology is reported. A discussion of hypocycloidal polytomography and computed tomography of the temporal bone as well as a discussion of the Mondini dysplasia is also presented. The twenty-six patients underwent a battery of audiometric and vestibular function tests. These data were compiled and correlations made, allowing for a more complete characterization of the large vestibular aqueduct syndrome.

Adolescent↗
PubMed1997

Rehabilitation of balance in two patients with cerebellar dysfunction.

The treatment of two patients with cerebellar dysfunction is described. One patient was a 36-year-old woman with a 7-month history of dizziness and unsteadiness following surgical resection of a recurrent pilocystic astrocytoma located in the cerebellar vermis. The other patient was a 48-year-old man with cerebrotendinous xanthomatosis (CTX) and diffuse cerebellar atrophy, and a 10-year history of progressive gait and balance difficulties. Each patient was treated with a 6-week course of physical therapy that emphasized the practice of activities that challenged stability. The patient with the cerebellar tumor resection also performed eye-head coordination exercises. Each patient had weekly therapy and performed selected balance retraining exercises on a daily basis at home. Measurements taken before and after treatment for each patient included self-perception of symptoms, clinical balance tests, and stability during selected standing and gait activities; for the patient with the cerebellar tumor resection, vestibular function tests and posturography were also performed. Both patients reported improvements in symptoms and demonstrated similar improvements on several kinematic indicators of stability during gait. The patient with the cerebellar tumor resection improved on posturography following treatment, whereas the patient with CTX improved on clinical balance tests. This case report describes two individualized treatment programs and documents functional improvements in two patients with different etiologies, durations, and clinical presentations of cerebellar dysfunction. The outcomes suggest that patients with cerebellar lesions, acute or chronic, may be able to learn to improve their postural stability.

Adult↗
PubMed2000

Cervicogenic dizziness: a review of diagnosis and treatment.

The diagnosis of cervicogenic dizziness is characterized by dizziness and dysequilibrium that is associated with neck pain in patients with cervical pathology. The diagnosis and treatment of an individual presenting with cervical spine dysfunction and associated dizziness complaints can be a challenging experience to orthopaedic and vestibular rehabilitation specialists. The purpose of this article is to review the incidence and prevalence, historical background, and proposed pathophysiology underlying cervicogenic dizziness. In addition, we have outlined the diagnostic criteria, evaluation, and treatment of dizziness attributed to disorders of the cervical spine. The diagnosis of cervicogenic dizziness is dependent upon correlating symptoms of imbalance and dizziness with neck pain and excluding other vestibular disorders based on history, examination, and vestibular function tests. When diagnosed correctly, cervicogenic dizziness can be successfully treated using a combination of manual therapy and vestibular rehabilitation. We present 2 cases, of patients diagnosed with cervicogenic dizziness, as an illustration of the clinical decision-making process in regard to this diagnosis.

Cervical Vertebrae↗
PubMed2005

Sensitivity and specificity of mastoid vibration test in detection of effects of vestibular neuritis.

Aim of this study was to determine sensitivity and specificity of the mastoid vibration test in patients who had suffered an attack of vestibular neuritis. Results were compared with the caloric test and two bedside tests of vestibular function (head shaking test and head thrust test). Results are reported in 28 patients who had a residual vestibular deficit 6 months after acute neuritis and in 25 healthy subjects. Mastoid vibration nystagmus was evoked in 21 patients but not in controls. In these patients, mastoid vibration test had a sensitivity of 75% and specificity of 100%. Since one patient had inverted mastoid vibration nystagmus, specificity of identification on the pathological side was 95%. Sensitivity of the test increased with increasing severity of the vestibular lesion. Indeed, mastoid vibration nystagmus was induced in 93% of patients with caloric paralysis and in 58% of those with caloric paresis. Nystagmus could usually be modulated or elicited by stimulation of either mastoid. In the few patients in whom mastoid vibration nystagmus was elicited only from one side, or when there was a clear difference in intensity of the nystagmus induced on the two sides, the stimulated side was more often the affected side. Four patients still showed spontaneous nystagmus. The caloric test was abnormal in 26/28 patients (93%) with paralysis in 16 and paresis in 12; 71% of patients had a head shaking induced nystagmus: 64% had an asymmetrical response in head thrust test. In conclusion, mastoid vibration test was overall more sensitive than head thrust test. Mastoid vibration test was slightly less sensitive than head shaking test in patients with severe residual deficit and more sensitive in patients with partial deficit. Mastoid vibration test, a valid, low cost clinical screening test for rapid detection of asymmetrical vestibular function, does not cause patient discomfort. It is suggested that this test be included in the diagnostic workup of all patients with suspected vestibular dysfunction.

Acute Disease↗
PubMed1986

Clinical investigation of vestibular damage by antituberculous drugs.

Vestibular function testing was done regularly on the cases given streptomycin, kanamycin, or enviomycin and a method to detect the cases of vestibular dysfunction at an early stage was discussed, as well as the time these drugs should be discontinued. Subjects were 85 cases of tuberculosis treated with streptomycin, kanamycin, or enviomycin who were admitted to our hospital from December 1984 to May 1986. The method of equilibrium examination performed at regular intervals is as follows: standing test (Romberg test), stepping test, and Meyer zum Gottesberge's head-shaking test were done once a week for a month after starting antituberculous injections and they were re-examined once every 2 weeks for at least 3 months after beginning the injections. After the 3 months these tests were done once a month. Eight cases of vestibular damage due to streptomycin or enviomycin could be easily detected at an early stage by performing Meyer zum Gottesberge's head-shaking test, together with the standing test and the stepping test. Vestibular dysfunction is apt to occur after about 1 month or within a month from the start of daily injections especially with streptomycin. Therefore, the method of equilibrium examination, we suggest, is that the Meyer zum Gottesberge's head-shaking test, the standing test (Romberg test), and the stepping test should be performed once a week during the first month after the start of this drug. When the result of the Meyer zum Gottesberge's head-shaking test is less than 50% and swaying and/or rotation occur in the stepping test, the drugs being given should be discontinued.

Aged↗
PubMed2001

[Diagnostic significance of audiological and vestibular function examination in the pontocerebellar angle tumor].

OBJECTIVE: To study the diagnostic value of audiological and vestibular function examination in the pontocerebellar angle tumor. METHOD: The data of audiological and vestibular function test were analized retrospectively in 20 subjects with tumors of the pontocerebellar angle. RESULT: Pure tone and ABR waveforms were abnormal in 20 subjects (21 ears), moreover acoustic stapedius reflex and the vestibular function were abnormal in 19 subjects. CONCLUSION: It's valuable that audiological and vestibular function examinations are able to diagnosis the pontocerebellar angle tumor.

Adult↗
PubMed2005

Effects of vestibulo-ocular reflex exercises on vestibular compensation after vestibular schwannoma surgery.

OBJECTIVE: To assess vestibular function in a large group of vestibular schwannoma patients so that we could determine whether simple vestibular exercises speed vestibular dysfunction recovery after tumor removal surgery. STUDY DESIGN: A prospective investigation of the vestibular dysfunction experienced by patients in the first 12 weeks after surgery. SETTING: Vestibular investigation unit at a tertiary referral institution. PATIENTS: Sixty-five patients with identified vestibular schwannoma referred for preoperative vestibular investigations. Thirty-two men and 33 women, with a mean age 51 years (range, 24-77 yr). INTERVENTIONS: There were 27 control patients, 30 exercise patients, and 8 patients that had balance physiotherapy. Exercise patients began simple vestibulo-ocular reflex gaze stabilization exercises 3 days after surgery. MAIN OUTCOME MEASURES: Postoperative vestibular function testing was performed at 2 to 3, 6 to 7, and 10 to 12 weeks after surgery. Objective measurements of vestibular compensation status were as follows: spontaneous nystagmus and sinusoidal harmonic acceleration asymmetry and gain values. Dizziness Handicap Inventory questionnaires were used to assess subjective perceptions. RESULTS: The main findings were reduced dispersion in vestibulo-ocular reflex asymmetry at 2 to 3 weeks, reduced mean in asymmetry at 6 to 7 weeks, less dizziness/imbalance according to the Dizziness Handicap Inventory questionnaire, and that preoperative caloric tests did not predict postoperative severity of vestibular systems. CONCLUSION: This large study provided unique evidence that a program of simple vestibular exercises and education can speed the rate of compensation after vestibular schwannoma surgery.

Adolescent↗
PubMed2006

Audio-vestibular disturbance in patients with Behçet's disease.

OBJECTIVE: The present study prospectively investigated the frequencies and characteristics of audio-vestibular disturbance and the results of audiologic and vestibular function tests in patients with Behçet's disease. STUDY DESIGN: A prospective study. METHODS: Seventeen patients with Behçet's disease (mean age 41.2 [30-56] years, 5 males and 12 females), as well as age- and sex-matched healthy controls, were included in this study. All subjects satisfied the diagnostic criteria of the International Study Group for Behçet's Disease. Information on the subjects was obtained through questionnaires. Tests, including those for hearing impairment, tinnitus, ear fullness, and dizziness, pure-tone audiometry, and vestibular function, were performed. RESULTS: Auditory symptoms were reported by 7 (41.2%) and dizziness by 14 (82.4%) of the subjects. Sensorineural hearing loss was present in four (23.5%) subjects. One was treated with a cochlear implantation because of bilateral sudden deafness. Spontaneous nystagmus was detected in two (11.8%) subjects. Abnormal findings were noted in 1 (5.9%) in saccadic movement, 5 (29.4%) in the bithermal caloric tests, and 10 (58.9%) in the rotation chair tests. In total, audiologic or vestibular disturbance were noted in 16 (94.1%) of the subjects. However, audio-vestibular abnormalities were not noted in the healthy controls. CONCLUSION: Audio-vestibular disturbance is not rare in Behçet's disease patients compared with healthy controls. We believe that audio-vestibular assessment and management may be helpful for the diagnosis and treatment of patients with Behçet's disease.

Adult↗
PubMed1992

Spatial disorientation and dysfunction of orientation/equilibrium reflexes: aeromedical evaluation and considerations.

Loss of spatial awareness has been implicated as a direct causal factor in 4-10% of serious aircraft mishaps and 10-20% of fatal aircraft mishaps (7). Spatial disorientation in flight usually results from misperception of visual, vestibular, or proprioceptive cues. Pathologic causes have rarely been implicated. A student naval aviator with recurrent loss of spatial awareness due to a defective vestibulo-ocular reflex (VOR), presumably from vestibular neuronitis in adolescence, is reported. His chief complaint, an inability to focus on the instrument panel during turbulent instrument meteorological conditions (IMC), resulted in spatial disorientation and adverse flight attitude. A simple test of visual-vestibular interaction, the dynamic visual acuity test, could identify a defective vestibulo-ocular reflex in aviation personnel. An absent or defective vestibulo-ocular reflex has potential for disorientation in instrument flight. A comprehensive vestibular function test battery is indicated in individuals with recurrent or overwhelming spatial disorientation who fail a screening dynamic visual acuity test. The aeromedical disposition of vertigo and dysequilibrium is discussed.

Adult↗