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At least 199 records · Page 11Linked to original sources
PubMed1998

Disability from vestibular symptoms after acoustic neuroma resection.

OBJECTIVE: This study aimed to evaluate the recovery of balance function after acoustic neuroma resection. STUDY DESIGN: This study was a retrospective case review with patient survey. SETTING: The surgery was conducted at a tertiary referral center. PATIENTS: Patients who underwent surgical resection of acoustic neuroma and had preoperative vestibular function testing were eligible for entering the study. INTERVENTIONS: All patients received surgical resection of acoustic neuroma. Patients treated since 1990 received postoperative vestibular habituation exercises. MAIN OUTCOME MEASURES: These included postoperative symptom and disability scores, dizziness handicap inventory (DHI) total and subset scores, time after surgery at which patients were able to walk independently, whether patients returned to their usual professional responsibility, and time to return to full activities at work. RESULTS: Significant correlation was found between several preoperative symptoms and vestibular testing results and the resulting postoperative disability from dizziness. CONCLUSIONS: This information may be helpful in counseling patients before surgery with respect to the degree of postoperative dysequilibrium and may suggest that the clinician should initiate more aggressive vestibular rehabilitation exercises in patients who may be at greater risk of having persistent dysequilibrium develop after surgery.

Adolescent↗
PubMed2004

Vestibular effects of cochlear implantation.

OBJECTIVES/HYPOTHESIS: Cochlear implantation (CI) carries with it the potential risk for vestibular system insult or stimulation with resultant dysfunction. As candidate profiles continue to evolve and with the recent development of bilateral CI, understanding the significance of this risk takes on an increasing importance. STUDY DESIGN: Between 1997 to 2001, a prospective observational study was carried out in a tertiary care medical center to assess the effects of unilateral CI on the vestibular system. METHODS: Assessment was performed using the dizziness handicap inventory (DHI), vestibulo-ocular reflex (VOR) testing using both alternate bithermal caloric irrigations (ENG) and rotational chair-generated sinusoidal harmonic accelerations (SHA), and computerized dynamic platform posturography (CDP) at preoperative, 1-month, 4-month, 1-year and 2-year postimplantation visits. CI was carried out without respect to the preoperative vestibular function test results. RESULTS: Specifically, 86 patients were entered into the study after informed consent. For the group as a whole, pair wise comparisons revealed few significant differences between preoperative and postoperative values for VOR testing (ENG and SHA) at any of the follow-up intervals. Likewise, DHI testing was also unchanged except for significant reductions (improvements) in the emotional subcategory scores at both the 4-month and 1-year intervals. CDP results demonstrated substantial improvements in postural sway in the vestibular conditions (5 and 6) as well as composite scores with the device "off" and "on" at the 1-month, 4-month, 1-year, and 2-year intervals. Device activation appeared to improve postural stability in some conditions. Excluding those patients with preoperative areflexic or hyporeflexic responses in the implanted ear (total [warm + cool] caloric response or=21 deg/s maximum slow phase velocity) in total caloric response were observed for 8 (29%) patients at the 4-month interval. These persisted throughout the study period. These changes were accompanied by significant low frequency phase changes on SHA testing confirming a VOR insult. Of interest, no significant changes were detected in the DHI or CDP, and there were no effects of age, sex, device manufacturer, or etiology of hearing loss (HL) for these patients. CONCLUSIONS: Unilateral CI rarely results in significant adverse effects on the vestibular system as measured by the DHI, ENG, SHA, and CDP. On the contrary, patients that underwent CI experienced significant improvements in the objective measures of postural stability as measured by CDP. Device activation in music appeared to have an additional positive effect on postural stability during CDP testing. Although VOR testing demonstrated some decreases in response, patients did not suffer from disabling vestibular effects following CI. The mechanism underlying these findings remains speculative. These findings should be considered in counseling patients about CI.

Adolescent↗
PubMed1989

Exercise strategies for vestibular disorders.

Two exercise approaches can be used in the treatment of decreased or absent vestibular function--adaptation of the vestibular system and the substitution of alternative strategies to replace vestibular function. If the patient has remaining vestibular function, exercises that enhance vestibular adaptation are emphasized. Patients with complete loss of vestibular function are given exercises that promote substitution of alternative strategies for the lost vestibular function. The exercises can be modified according to certain characteristics of the vestibular system. Vestibular function tests such as caloric, rotational, and posturography tests provide necessary information for deciding which exercise approach is most appropriate for the patient.

Adaptation, Physiological↗
PubMed2007

The influence of otolith dysfunction on the clinical presentation of people with a peripheral vestibular disorder.

BACKGROUND AND PURPOSE: Traditional vestibular function testing has measured horizontal semicircular canal function only. Otolith function tests have recently been developed, but their clinical significance has not been determined. The purpose of this study was to investigate the influence of otolith dysfunction on the clinical presentation of individuals with a peripheral vestibular disorder. SUBJECTS AND METHODS: Twenty-one subjects with loss of horizontal semicircular canal function only and 37 subjects with combined loss of horizontal semicircular canal and otolith organ function were recruited. All subjects received a comprehensive clinical assessment, including self-report questionnaires and measures of balance performance. RESULTS: No significant differences were identified between subjects with or without otolith dysfunction with respect to symptom severity, self-perceived handicap, functional limitations, or balance performance. DISCUSSION AND CONCLUSION: Otolith dysfunction does not significantly influence the clinical presentation of individuals with a peripheral vestibular disorder. Other factors, including symptom severity, may be more influential.

Activities of Daily Living↗
PubMedDate not supplied

The effect of the rotational magnification of corrective spectacles on the quantitative evaluation of the VOR.

The gain of the vestibulo-ocular reflex (slow-phase eye velocity/chair velocity, measured in the dark) was compared in 11 normal healthy subjects who habitually wore corrective spectacles of varying strength. The rotational magnification (or prismatic effect) induced by habitually wearing corrective spectacles caused the VOR gain measured in darkness to vary systematically with diopter of correction. Even when allowances were made for the inherent variability of measurement of the VOR gain, myopes tended to have lower gains and hyperopes higher gains. This study demonstrates that the clinician should account for spectacle adaptation to properly interpret the results of vestibular function tests.

Adaptation, Ocular↗
PubMed1995

Neurotological evaluation of Harada's disease.

We have had 30 patients with Harada's disease at our clinic from 1980 to 1993 and their neurotological findings were retrospectively reviewed. There were 12 males and 18 females, whose ages ranged from 15-years to 67-years. Preceding symptoms such as headache or common cold were observed in 50% of the patients. Pleocytosis of the cerebrospinal fluid was found in 89% of the patients. Subjective cochlear and/or vestibular symptoms were noted in 60% of the patients. In 43 of the 50 ears, sensorineural hearing loss (< 40 dB) was observed. In 77% of the patients, vestibular function tests gave abnormal results. On the basis of our findings, it was suggested that Harada's disease with vertiginous and cochlear symptoms could be classified as follows: cochlear type, peripheral vestibular type, cochleovestibular type, central type, and 'unclassified', based on the neurotological results.

Adolescent↗
PubMed1990

Audiovestibular functions in rheumatoid arthritis.

Audiologic, middle ear impedance and vestibular function tests were administered to 25 patients with classical or definite rheumatoid arthritis and 25 normal control subjects of 30 to 50 years age group. Any possible influence of other common causes of hearing loss was avoided by carefully selecting the patients. Six patients had mild sensorineural hearing loss and another had bilateral mixed hearing loss. Results of tone decay test, speech reception threshold, speech discrimination score and short increment sensitivity index tests suggested cochlear pathology being responsible for the sensorineural hearing loss. There was no statistical correlation between hearing loss or otoadmittance abnormality and duration or activity of rheumatoid arthritis or positivity of rheumatoid factor. Electronystagmographic recording of saccades and bithermal caloric induced nystagmus revealed no significant abnormality.

Acoustic Impedance Tests↗
PubMed2001

Dizziness and headache: a common association in children and adolescents.

Vertigo has long been recognized by the clinician as a frequent accompanying symptom of the adult migraine syndrome. This association has not been so readily identified in the pediatric population, and, as a consequence, children undergo unnecessary evaluations. We reviewed the charts of all children and adolescents referred for vestibular function testing to the Balance Center at the Barrow Neurological Institute between July 1994 and July 2000 (N = 31). Items analyzed included age, gender, symptoms that prompted the referral, test outcomes, family medical history, and final diagnosis. The most common justification for vestibular testing referral was the combination of dizziness and headache. Other less common reasons were "passing out" episodes, poor balance, and blurred vision. Normal test results were obtained from 70% of patients (n = 22). The most common abnormal test outcome was unilateral vestibular dysfunction (n = 5). Bilateral peripheral vestibular dysfunction was present in three patients. One patient had central vestibular dysfunction. The final diagnoses were vestibular migraine (n = 11), benign paroxysmal vertigo of childhood (n = 6), anxiety attacks (n = 3), Meniere's disease (n = 2), idiopathic sudden-onset sensorineural hearing loss (n = 1), vertigo not otherwise specified (n = 1), familial vertigo/ataxia syndrome (n = 1), and malingering (n = 1); in five patients, no definitive diagnosis was established. The stereotypical patient with vestibular migraine was a teenage female with repeated episodes of headache and dizziness, a past history of carsickness, a family history of migraine, and a normal neurologic examination. Patients who fit this profile are likely to have migrainous vertigo. Consequently, a trial of prophylactic migraine medication should be considered for both diagnostic and therapeutic purposes. Brain imaging and other tests are appropriate for patients whose symptoms deviate from this profile.

Adolescent↗
PubMed1991

Clip electrode method for recording eye movements in experimental animals.

Both the guinea pig and squirrel monkey were used in this study. An animal model for inner ear disease was established, and each animal was subjected to vestibular function tests consisting of spontaneous nystagmus recording, positional testing, caloric testing, and optokinetic stimulation testing. Recordings of nystagmus in the guinea pig and squirrel monkey were successfully obtained by using newly devised clip electrodes. A variety of nystagmic patterns in animal models following experimentally created perilymphatic fistula and labyrinthectomy are presented in this study.

Animals↗
PubMed1989

Vestibular functions in conservatively treated chronic renal failure.

Chronic renal failure can produce malfunction of multiple organs, including auditory and vestibular apparatus. Twelve patients of chronic renal failure of varying etiologies treated conservatively were subjected to vestibular function tests. Only 33% of the patients had normal ENG data. Fifty-eight per cent of the patients had canal paresis and 8% showed hyperactive response. Ototoxic drugs like furosemide may be most important factor in aetiology of vestibular dysfunction in chronic renal failure.

Adult↗
PubMed2000

Falls in patients with vestibular deficits.

OBJECTIVE: To determine to what extent patients with vestibular hypofunction experience falls. STUDY DESIGN: Prospective clinical study. SETTING: Outpatient tertiary care facility in a university. PATIENTS: Patients with unilateral (n = 70) and bilateral (n = 45) vestibular hypofunction, confirmed on vestibular function testing, aged 24 to 89 years. INTERVENTION: None. MAIN OUTCOME MEASURE: Incidence of falls. RESULTS: There was a significant difference in the incidence of falls reported since the onset of the vestibular deficit by patients with unilateral (UVL) and bilateral (BVL) vestibular hypofunction. The incidence of falls for BVL was significantly greater than that for UVL. The incidence of falls for UVL was not different from that expected in a community-based population when age was considered. The incidence of falls for BVL was significantly greater than that reported for the general population aged 65 through 74 years (51.1% for BVL, 25% for community-dwelling individuals) but was significantly less than expected for persons aged > or =75 years (18.2% for BVL, 49% for community-dwelling individuals). The lower incidence of falls in patients with BVL aged > or =75 years may be related to the use of assistive devices and to a decrease in risky behavior. All patients with serious injury were from the UVL group, and all were >65 years old. The incidence of fall-related injuries requiring medical attention among patients with UVL was similar to that in community-dwelling individuals. CONCLUSIONS: Falls are an important consequence of bilateral vestibular hypofunction, and patients should be counseled about the increased risk of falling. Assistive devices should be considered, especially for persons aged >65 years with BVL.

Accidental Falls↗
PubMed1984

Clinical monitoring of the effects of gentamicin by electrocochleography.

Eight patients receiving prolonged treatment with gentamicin for bacterial endocarditis were monitored for possible ototoxicity using transtympanic electrocochleography as an adjunct to pure tone audiometry, vestibular function tests and serum gentamicin levels. An immediate effect of intravenous gentamicin on the cochlea, shown by changes in the whole nerve action potential and/or cochlear microphonic was recorded in seven patients, none of whom had experienced vestibular or auditory symptoms with gentamicin prior to testing. Two patients subsequently developed evidence of vestibular dysfunction, and a high frequency sensorineural hearing loss occurred in a third individual. There have been no previous report of the immediate effects of gentamicin on the human cochlea to date. The significance of these findings in routine clinical monitoring of ototoxicity is discussed in the light of clinical and animal evidence for the possible mode of action of aminoglycosides on the auditory and vestibular apparatus.

Action Potentials↗
PubMed1997

Head-shaking nystagmus: a sensitive indicator of vestibular dysfunction.

This study investigated 258 consecutive patients with the complaint of vertigo undergoing vestibular function tests between August 1992 and July 1994. The head-shaking nystagmus test was performed in a passive fashion with the patient placed in a sitting position with the head anteflexed at 30 degrees and oscillated +/- 45 degrees horizontally for 30 cycles in 15 s; the post head-shaking nystagmus was recorded by electronystagmography. Conventional bithermal caloric tests were conducted with the normal limit of canal paresis set at 20%. The results show significant correlation between head-shaking nystagmus and canal paresis. Head-shaking nystagmus is more sensitive than canal paresis in predicting vestibular dysfunction. The sensitivity of head-shaking nystagmus in detecting a canal paresis was 90%. Although the direction of head-shaking nystagmus does not always accord with the side of peripheral vestibular dysfunction, it is an indicator of vestibular dysfunction and this test could be performed easily as a screening test in every otoneurological investigation.

Adolescent↗
PubMed1995

Modulation of inner ear pressure in experimental endolymphatic hydrops.

Physiologic study of the guinea pig model of endolymphatic hydrops has been used to better understand the manifestations of Meniere's disease. Quantitative vestibular function testing demonstrates some changes in the hydrops subjects, especially if an additional stress such as postural inversion is imposed. Understanding the hydrodynamic changes on the endolymphatic and perilymphatic fluids by the hydrops condition as well as postural inversion may be useful in explaining the vestibular findings. These pressure effects may alter the micromechanics of the inner ear or possibly induce a relative vascular ischemia. Auditory dysfunction is speculated to occur through similar mechanisms.

Animals↗
PubMed1988

[Vestibular apparatus and hereditary hearing impairment].

Vestibular function tests in 33 cases of hereditary monosymptomatic symmetric sensorineural hearing loss do not show any significantly reduced excitability, but a mild difference between the groups with and without progression. A positive correlation is seen with the age of the children.

Child↗
PubMedDate not supplied

Comparison of subjective symptomatology and responses to harmonic acceleration in patients with Menière's disease.

Vestibular function testing employing caloric stimulation has been of limited value in the evaluation of patients with Menière's disease, with its cardinal shortcoming being poor repeatability. This modality has not been useful in determining appropriate treatment for these individuals. We have used low frequency harmonic acceleration to study patients with vestibular pathology and have noted a high level of repeatability of responses to this type of stimulation. This study was designed to determine if the clinical status of patients with Menière's disease could be correlated with their responses to harmonic acceleration. Thirty-six patients with typical symptoms of Menière's disease were evaluated and divided into four groups based on severity of symptoms. Analysis of variance of the phase shifts in asymmetry (or preponderance) showed a significant difference between the groups. Responses to this type of stimulation correlated with the clinical status of the patients to a significant degree. These data indicate that harmonic acceleration can be of value to the otologist in the evaluation of patients with Menière's disease.

Adult↗
PubMedDate not supplied

Vestibular evoked myogenic potentials in patients with idiopathic bilateral vestibulopathy. Report of three cases.

Idiopathic bilateral vestibulopathy (IBV) is an acquired bilateral peripheral vestibular disorder of unknown cause. Three patients diagnosed as IBV by neuro-otological examination were reported. They underwent vestibular evoked myogenic potential (VEMP) testing which reflects the functionality of the sacculo-collic pathway. As a result, 2 of the 3 patients showed bilateral absence of VEMPs and one showed unilateral absence. The VEMPs of the 3 patients revealed that IBV affects not only the superior but also the inferior vestibular nerve systems. As previously reported in the cases of vestibular neuritis, VEMP could be useful for classifying IBV according to the function of the inferior vestibular nerve.

Aged↗