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At least 163 records · Page 9Linked to original sources
PubMed2001

New tests of vestibular function.

The vestibulo-ocular reflex (VOR) is the only drive for short-latency eye movements stabilizing the retina during externally imposed, sudden, high-head accelerations. New strategies can exploit this unique VOR feature to study it under conditions relevant to the daily lives of patients, and to exclude the contributions from confounding nonvestibular mechanisms. Testing of the yaw vestibulo-ocular reflex (VOR) during random, whole-body rotational transients at < or = 2800 degrees/s2 delivered about centered and eccentric axes enables measurement of gains and millisecond latencies of the canal and otolith VORs in humans. Repeated measurements in acute unilateral deafferentation show sequential recovery of canal and otolith VORs to contralesional rotation, but severe and permanent deficits to ipsilesional rotation. Patients with bilateral loss of caloric responses show severe bilateral loss of VORs to transient rotation, suggesting that the apparent preservation of their VORs during sinusoidal rotations at moderate frequencies may be due instead to somatosensory inputs. Since visual acuity is degraded by retinal image motion, dynamic visual acuity (DVA) measured during imposed head-on-body or whole-body transient motion can correlate closely with VOR performance only if optotypes are presented during directionally and temporally unpredictable, high-acceleration head motion. Prediction and efference copy are relentlessly employed by vestibulopathic patients to enable good DVA during predictable or low-acceleration head motion. The linear VOR to transient lateral acceleration is strongly dependent upon viewing distance. The latency of this otolith VOR is slightly longer and more variable than the canal VOR. Unlike the canal VOR, the otolith VOR does not develop a strong directional asymmetry in unilateral deafferentation. The otolith VOR is bilaterally attenuated in bilateral vestibulopathy, and loses target distance dependence in cerebellar degeneration.

Adult↗
PubMed2000

Vestibular function in auditory neuropathy.

Auditory neuropathy is characterized by mild-to-moderate pure-tone hearing loss, poor speech discrimination out of proportion with this loss, absent or abnormal auditory brainstem responses and normal outer hair cell function as measured by otoacoustic emissions and cochlear microphonics. We followed three patients in our clinic whom we classified as auditory neuropathy patients. These patients also complained of balance disorders and we report our auditory and vestibular system analyses of these patients. The data presented herein include results of audiometric tests (serial pure-tone audiometry and speech discrimination tests), otoacoustic emissions, auditory-evoked brainstem responses and vestibular function tests (clinical tests of balance, electronystagmography, damped rotation tests and vestibular-evoked myogenic potentials). In all patients, pure-tone audiometry revealed mild-to-moderate sensorineural hearing loss, markedly poor speech discrimination scores and absent auditory-evoked brainstem responses, all in the presence of normal otoacoustic emissions. Balance tests (caloric tests and damped rotation test) were abnormal. Saccades, smooth pursuit eye movements and optokinetic nystagmus were normal in all patients. Neurological and motor system evaluations were normal in all patients. These three auditory neuropathy patients manifest a disorder of cochlear nerve function in the presence of normal outer hair cell activity. They additionally manifest a disorder of the vestibular nerve and its end organs. We conclude that, in patients with isolated auditory neuropathy, the vestibular branch of the VIIIth cranial nerve and its innervated structures may also be affected. We suggest the use of the term "cochlear neuropathy" to characterize those patients with involvement of only the auditory branch of the VIIIth cranial nerve and its innervation.

Aged↗
PubMed2006

Study of test of balance in tinnitus and vertigo patients.

The diagnosis of patient disorders in modern neurootological centers has to include not only history and examination but objective and quantitative tests. In this study, we stress the importance of a short but significant test used to study vestibular function--the vestibular test of balance. The most common and widespread technique used to evaluate a patient's equilibrium in static condition is the projection of the center of gravity with the patient in a standing position, which permits evaluation of visual, somatosensory, and vestibular contributions to stability or equilibrium. Modern physicians can improve their diagnoses by correlating patient history with clinical description and the results of exploration of vestibulospinal, retinoocular, and vestibuloocular systems of vertiginous patients.

Adult↗
PubMed1996

Vestibular Evoked Potentials (VestEP) and Brain Electrical Activity Mapping - A Test of Vestibular Function - A Review (1990 - 1996).

Brain Electrical Activity Mapping of Vestibular Evoked Potentials (BEAM-VestEP) is a new technology for investigation of the spatial and temporal properties of a rotationally-induced brain electrical events. The method consists of multichannel EEG registration and mapping of the brain isoelectrical contours during short-lasting repetitive angular accelerations. A special data bank containing more than 400 BEAM-VestEP investigations on more than 300 persons, either symptom free volunteers or neurotological patients suffering from vertigo, tinnitus, sudden hearing loss, acoustic tumors, balance disorders, has been created for this study. The VestEP wave set consists of 5 - 7 positive/negative wave components, appearing within the time interval of 70 - 850 ms after the onset of the acceleratory step stimulus. The principle components analysis reveals that the shortest latencies and the highest amplitudes of the VestEPs can be registered from the central transversal line of electrodes, T3-C3-Cz-C4-T4. The later components are generated from the more frontally located cortical areas. The VestEP is a compound electrical phenomenon. The initial complex ( waves I - III) is related to the activation of specific (vestibular) cortical areas. The later complex (waves IV - VI) reflects the supramodal cortical proceedings with sensory information (cognitive components).

Journal Article↗
PubMed2002

Migraine and isolated recurrent vertigo of unknown cause.

Chronic recurrent attacks of vertigo, not associated with any auditory or neurological symptoms, are a common reason for referral to our neurotology clinic. Even after an extensive neurotological evaluation, some cases remain undiagnosed. We prospectively evaluated 72 consecutive patients who presented to the clinic with isolated recurrent vertigo of unknown cause. All patients underwent diagnostic evaluation to exclude identifiable causes of isolated recurrent vertigo. We compared the prevalence of migraine, according to the International Headache Society (IHS) criteria, in the isolated recurrent vertigo group, with a sex- and age-matched control group of orthopedic patients. The prevalence of migraine according to IHS criteria was higher in the isolated recurrent vertigo group (61.1%) than in the control group (10%; p < 0.01). Only 16.7% of patients had an abnormal vestibular function test. The most common abnormal finding was a unilateral vestibular weakness to caloric stimulation. Our results suggest that migraine should be considered in the differential diagnosis of isolated recurrent vertigo of unknown cause.

Adolescent↗
PubMed1982

[Auditory and vestibular lesions in Behcet's disease].

Auditory and vestibular function tests were conducted in 16 patients with Behcet's disease. Vestibular lesions included spontaneous nystagmus in 5 cases, and a bilateral vestibular syndrome after provoked tests in 13 cases (7 of the deficiency type and 6 irritative in nature). Findings after auditory tests were bilateral symmetric deafness in 2 cases; one of the perception type and the other showing mixed features. Various etiopathogenic theories are discussed. The possibility of a bilateral central lesion of the VIIIth nerve was also considered, 8 patients in the series having cerebral manifestations, particularly as the results of visual fixation tests in these cases were in favor of this hypothesis.

Adult↗
PubMed2004

Temporal bone histopathology in dominantly inherited audiovestibular syndrome.

OBJECTIVE: To describe the clinical and pathologic features of a new dominantly inherited audiovestibular syndrome. METHODS: History, examination, and audiometric testing in the proband, brother, and son; quantitative rotational testing in the proband and son; histopathology of the cochlea and vestibular labyrinth in the proband; sequencing candidate genes COCH and MYO7A in the brother and son. RESULTS: Affected family members developed slowly progressive hearing loss beginning in their late 30s and progressive imbalance in their early 70s. Three of four affected had brief (minutes) episodes of vertigo typically occurring a few times per year. Auditory and vestibular function testing documented a slowly progressive loss of auditory and vestibular function. Postmortem examination showed a loss of hair cells in the cochlea and vestibular receptor organs. There were no cellular infiltrates or acidophilic deposits. No mutations were found in the COCH or MYO7A genes. CONCLUSIONS: This dominantly inherited audiovestibular syndrome results in a selective loss of hair cells in the auditory and vestibular end organs. Finding the causative gene could have important implications for understanding the pathophysiology of presbycusis and dysequilibrium of aging.

Adult↗
PubMed2003

Neurotological findings in a patient with narrow internal auditory canal: a case report.

We report neurotological findings in a patient with unilateral narrow internal auditory canal, as confirmed by computed tomography. The patient presented no auditory brainstem response on the affected side. Vestibular tests including vestibular-evoked myogenic potentials (VEMP) and caloric test revealed normal function of both inferior and superior vestibular neural pathways.

Acoustic Stimulation↗
PubMed1984

Is it possible to totally resect an acoustic tumor and conserve hearing?

Over the last 19 years there has been increasing interest in the conservation of hearing while acoustic tumors are being resected. As enthusiasm has increased for the conservation surgery, so has controversy. The key to the controversy is a dissociation between gross anatomic and histologic observations. The purpose of this paper is to summarize our laboratory experiments and clinical observations in three areas: (1) Our experiments and observations suggest that it is probably not possible to totally resect an acoustic tumor medial to Scarpa's ganglion and conserve hearing. (2) It has not been possible to predict from preoperative auditory and vestibular function tests the number of fibers present within the cochlear and vestibular nerves lateral to the tumor, nor the number of fibers in small aggregates that may pass the tumor periphery. (3) If microscopic amounts of tumor are left behind, is that significant? It is too early to answer this question.

Hearing Loss↗
PubMed2000

Relationship among balance impairments, functional performance, and disability in people with peripheral vestibular hypofunction.

BACKGROUND AND PURPOSE: Physical therapy interventions are often based on assumed relationships among impairments, functional performance, and disability. The purposes of this study were (1) to describe balance impairments, functional performance, and disability in subjects with unilateral peripheral vestibular hypofunction (UVH) and bilateral peripheral vestibular hypofunction (BVH), (2) to examine the relationship among these factors, and (3) to determine whether disability can be explained by commonly used tests of balance and functional performance. SUBJECTS: Participants were 85 subjects (mean age=62.5 years, SD=16.5) with UVH (n=41) or BVH (n=44) diagnosed by vestibular function tests and clinical examination. METHODS: Each subject completed the Dizziness Handicap Inventory (DHI) to obtain a measure of disability. Functional performance was measured with a modified Timed Up & Go Test (TUG). Balance impairments were measured with computerized posturography and balance tests. Descriptive statistics, correlational analyses, and stepwise regressions were performed. RESULTS: Subjects with BVH had poorer balance but similar TUG scores and perceived levels of disability, as compared with subjects with UVH. Weak to moderate correlations existed among balance measurements, TUG scores, and DHI scores. Balance impairments and TUG scores together explained 78% of the variance in DHI scores of the subjects with BVH, whereas balance impairments alone explained 13% of the variance in DHI scores of the subjects with UVH. CONCLUSION AND DISCUSSION: Balance impairments and functional performance appear to be more closely related to disability in individuals with BVH as compared with those with UVH. Clinical tests of balance impairments and functional performance appear to be useful in explaining disability.

Adult↗
PubMed2001

Fluctuant, progressive hearing loss associated with Menière like vertigo in three patients with the Pendred syndrome.

OBJECTIVE: To evaluate vestibular and long-term audiometric findings in patients with Pendred syndrome. STUDY DESIGN: Retrospective analysis of long-term clinical data. SETTING: University hospital department. PATIENTS: Three patients with Pendred syndrome caused by a mutation in the SLC26A4 gene. METHODS: Perchlorate discharge test, mutation analysis of the SLC26A4 gene, MR imaging of temporal bones, vestibular function test (in two cases) and serial audiometry. A saturation hyperbola with onset age was fitted to the audiometric threshold-on-age data using a nonlinear regression method. The residues remaining after regression were analyzed in a correlation analysis to detect significant ipsilateral or contralateral cofluctuation. RESULTS: All three patients had a mutation in the SLC26A4 gene and bilateral enlarged vestibular aqueduct; two of them had a positive perchlorate discharge test but in one of two siblings this test was negative. Hearing loss was significantly progressive with significant ipsilateral and contralateral cofluctuation in all evaluable cases, combined with episodes of Menière like vertigo in two cases. The episodes of vertigo are as seen in Menière disease. One case had unilateral caloric areflexia and one had bilateral vestibular hyporeflexia, proven to be progressive in a repeat examination. CONCLUSIONS: Patients with Pendred syndrome may exhibit progressive and fluctuant hearing loss with episodes of vertigo.

Adult↗