Audiovestibular Findings Research Articles

Association of audiovestibular findings with fluid-attenuated inversion recovery magnetic resonance imaging in patients with vestibular schwannoma

BackgroundVestibular schwannoma (VS) is a benign tumor of the vestibular nerve. Flair-attenuated inversion recovery (FLAIR) of magnetic resonance imaging (MRI) images are sensitive in detecting high protein contents of fluids. ObjectivesTo investigate the association between signal intensity (SI) on FLAIR images and audiovestibular findings in patients with VS. MethodsMedical records of twenty-five patients with VS were retrospectively analyzed. ResultsLarger tumors were associated with increased FLAIR SI of the cochlea, vestibule, and semicircular canal (SCC) on the affected side compared to those of the unaffected side. Pure-tone audiometry (PTA), and speech audiometry were associated with the SI of the affected cochlea. There was no significant correlation between the SI of the vestibule and vestibular evoked myogenic potential, SI of the SCC, and caloric test or video head impulse test results. ConclusionOur study suggests that tumor size was significantly associated with high SI on FLAIR imaging, and audiological findings were associated with the SI of the affected cochlea. Further studies with larger cohorts are required to confirm the association between vestibular function and FLAIR imaging in VS.

Audiovestibular Findings in Patients with Concurrent Superior Canal Dehiscence and Vestibular Schwannoma.

To describe the clinical-instrumental findings in case of concurrent superior canal dehiscence (SCD) and ipsilateral vestibular schwannoma (VS), aiming to highlight the importance of an extensive instrumental assessment to achieve a correct diagnosis. Retrospective case review. Tertiary referral center. Five patients with concurrent SCD and VS. Clinical-instrumental assessment and imaging. Clinical presentation, audiovestibular findings, and imaging. The chief complaints were hearing loss (HL) and unsteadiness (80%). Other main symptoms included tinnitus (60%) and pressure-induced vertigo (40%). Mixed-HL was identified in three patients and pure sensorineural-HL in 1, including a roll-over curve in speech-audiometry in two cases. Vibration-induced nystagmus was elicited in all cases, whereas vestibular-evoked myogenic potentials showed reduced thresholds and enhanced amplitudes on the affected side in three patients. Ipsilesional weakness on caloric testing was detected in three patients and a bilateral hyporeflexia in one. A global canal impairment was detected by the video-head impulse test in one case, whereas the rest of the cohort exhibited a reduced function for the affected superior canal, together with ipsilateral posterior canal impairment in two cases. All patients performed both temporal bones HRCT scan and brain-MRI showing unilateral SCD and ipsilateral VS, respectively. All patients were submitted to a wait-and-scan approach, requiring VS removal only in one case. Simultaneous SCD and VS might result in subtle clinical presentation with puzzling lesion patterns. When unclear symptoms and signs occur, a complete audiovestibular assessment plays a key role to address imaging and diagnosis.

The "Near"-Narrowed Internal Auditory Canal Syndrome in Adults: Clinical Aspects, Audio-Vestibular Findings, and Radiological Criteria for Diagnosis.

Vestibular Paroxysmia (VP) refers to short attacks of vertigo, spontaneous or triggered by head movements, and implies the presence of a compressive vascular loop in contact with the cochleovestibular nerve (CVN). Classically, a narrowed internal auditory canal (IAC) corresponds to a diameter of less than 2 mm on CT, usually associated with a hypoplastic CVN on MRI. The aim of this study was to discuss a distinct clinical entity mimicking VP in relation to a "near"-narrowed IAC (NNIAC) and to propose radiological criteria for its diagnosis. Radiological measurements of the IAC were compared between three groups: the study group (SG, subjects with a clinical presentation suggestive of VP, but whose MRI of the inner ear and pontocerebellar angle excluded a compressive vascular loop) and two control groups (adult and children) with normal vestibular evaluations and no history of vertigo. 59 subjects (18 M and 41 F) were included in the SG. The main symptoms of NNIAC were positional vertigo, exercise- or rapid head movements-induced vertigo, and dizziness. The statistical analysis in the study group showed that the threshold values for diagnosis were 3.3 mm (in tomodensitometry) and 2.9 mm (in MRI) in coronal sections of IAC. Although a significantly lower mean value for axial IAC diameter was found in SG compared with controls, the statistics did not reveal a threshold due to the large inter-individual variations in IAC measurements in normal subjects. There was no significant difference in IAC diameter between the adult and pediatric controls. In the present study, we report a new anatomopathological condition that appears to be responsible for a clinical picture very similar-but not identical-to VP in association with the presence of an NNIAC. The diagnosis requires a careful analysis of the IAC's shape and diameters in both axial and coronal planes.

Audiovestibular Findings in a Cohort of Patients with Chiari Malformation Type I and Dizziness.

Chiari Malformation Type I (CM1) is a neurological condition in which the cerebellar tonsils extend past the foramen magnum. While many studies have reported dizziness symptoms in patients with CM1, the prevalence of peripheral labyrinthine lesions is largely unknown. This study aimed to comprehensively describe the audiovestibular phenotype in a cohort of patients with CM1 expressly referred for dizziness. Twenty-four patients with CM1 and a complaint of dizziness/vertigo were evaluated. Hearing and auditory brainstem tract function were essentially normal. While vestibular abnormalities were most prevalent during rotational testing (33%), abnormal functional balance was the most common finding (40%). Patients with CM1 had a greater likelihood of exhibiting an abnormal sensory organization test (SOT) postural stability score for fixed platform conditions, and for the somatosensory analysis score. While no significant associations were identified between tonsillar ectopia extent and any vestibular/balance outcome measure, a significant negative association was identified between neck pain and the somatosensory sensory analysis score. Abnormal functional balance in the somatosensory domain was remarkable, with poorer scores associated with neck pain. An isolated peripheral vestibulopathy was present in only 8% of patients. Despite the low prevalence of vestibulopathy, vestibular/balance assessment is warranted to identify patients who may benefit from referral to specialized medical disciplines.

Comparison between audio-vestibular findings and contrast-enhanced MRI of inner ear in patients with unilateral Ménière's disease.

The diagnosis of Ménière's disease (MD), characterized by idiopathic endolymphatic hydrops (ELH), remains a clinical priority. Many ancillary methods, including the auditory and vestibular assessments, have been developed to identify ELH. The newly emerging delayed magnetic resonance imaging (MRI) of the inner ear after intratympanic gadolinium (Gd) has been used for identifying ELH in vivo. We aimed to investigate the concordance of audio-vestibular and radiological findings in patients with unilateral MD. In this retrospective study, 70 patients with unilateral definite MD underwent three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) sequences following intratympanic application of Gd. Audio-vestibular evaluations were performed, including pure tone audiometry, electrocochleogram (ECochG), glycerol test, caloric test, cervical and ocular vestibular evoked myogenic potentials (VEMPs), and video head impulse test (vHIT). The relationship between imaging signs of ELH and audio-vestibular results was investigated. The incidence of radiological ELH was higher than that of neurotological results, including the glycerol test, caloric test, VEMPs, and vHIT. Poor or slight agreement was observed between audio-vestibular findings and radiological ELH in cochlear and/or vestibular (kappa values <0.4). However, the pure tone average (PTA) in the affected side significantly correlated with the extent of both cochlear (r = 0.26795, p = 0.0249) and vestibular (r = 0.2728, p = 0.0223) hydrops. Furthermore, the degree of vestibular hydrops was also positively correlated with course duration (r = 0.2592, p = 0.0303) and glycerol test results (r = 0.3944, p = 0.0061) in the affected side. In the diagnosis of MD, contrast-enhanced MRI of the inner ear is advantageous in detecting ELH over the conventional audio-vestibular evaluations, which estimates more than hydropic dilation of endolymphatic space.

Confrontation of endolymphatic hydrops diagnosis on 3-Tesla MRI to clinical and audiovestibular findings in Meniere's disease.

The aim of this study was to compare different MRI diagnostic criteria for endolymphatic hydrops (EH) and to investigate the relation between audiovestibular and MRI findings in Meniere's disease (MD). Prospective cross-sectional cohort study in 2 referral centers included 76 patients with unilateral (n = 62) or bilateral (n = 14) MD. All patients underwent inner ear 3T-MRI 4 h (n = 52) or >24H (n = 24) following audiovestibular tests. T2-CISS and 3D-FLAIR images 4H after gadolinium were obtained. EH diagnosis was based on saccular morphology on coronal views (T2 and 3D-FLAIR), semi quantitative estimation of endolymphatic space enlargement, and saccule utricle ratio inversion (SURI) on 3D-FLAIR axial views. SURI was the best criterion related to the disease side (43 SURI+ on symptomatic ears, n = 77, vs. 6 SURI+ on asymptomatic ears, n = 53, p < 0.0001, Chi-2). Same-day MRI revealed relation between EH, hearing loss and caloric weakness which could not be detected on delayed MRI: SURI was associated with a higher pure-tone average (43 ± 4.1 dB in SURI+ ears, n = 42 vs. 23 ± 2.6 SURI-, n = 62, p < 0.0001, unpaired t-test,), and a higher proportion of vestibular caloric weakness (23/46 SURI+ ears vs. 4/62 SURI-, p < 0.001, Chi-2). Among all criteria, SURI combined to caloric weakness was the best predictor of the affected side in a logistic regression model. SURI had the strongest relation to the side the disease and audio vestibular findings for unilateral, probable and definite meniere disease. A short delay between MRI and audio vestibular tests improved the coherence between the findings.

Correlations of Clinical and Audio-Vestibulometric Findings with Coexisting Anxiety and Depression in Ménière’s Disease Patients

Introduction: Ménière’s disease (MD) is an inner ear disorder, characterized by vertiginous attacks, fluctuating sensorineural hearing loss, tinnitus, and a feeling of ear fullness. Endolymphatic hydrops has been proven as the underlying pathology. Frequently, psychopathologies accompany the disease. The aim of this study was to investigate the correlation of anxiety and depression with demographic, clinical, and audio-vestibular findings in MD patients. Methods: The study included 40 consecutive unilateral MD patients. Demographic data (age, sex, education, employment, and marital status), clinical variables of drop attacks, the duration, frequency and severity of vertigo attacks, and tinnitus disturbance levels were recorded. Hearing threshold levels were graded between 1 and 4. Vestibulometric variables were taken as the presence of saccades and vestibulo-ocular reflex (VOR) gain deficits in the video head impulse tests (vHIT) and canal paresis in bithermal caloric tests. Becks’s depression and anxiety scales were used for psychometric evaluations and graded by 4 and 5 from normal to severe and normal to very severe, respectively. Results: The median age of the patients was 48.94 years, and the numbers of both sexes were almost equal (male/female = 19/21). All patients reported at least one vertigo attacks within the last year. The duration of attacks was most commonly (62.5%) 1–3 h, ranging from <1 h to 17 h. Most attacks were graded as mild (67.5%), and the frequency was 2–3 episodes per year in 22 (55%) patients. The number of attacks within the last year was 1–12. Three patients reported having drop attacks. Hearing loss in the affected ear was moderate/moderately severe in 20 (50%) patients. Thirty-seven (92.5%) patients had complaints of tinnitus. In vHIT, saccades and VOR gain deficits were found in 33 (82.5%) and 11 (27.5%) patients, respectively. Canal paresis was present in 18 (45%) patients. The depression and anxiety rates were 35% and 90%, respectively. Depression scores were correlated with education, marital status, and the presence of saccades. Anxiety was correlated only with tinnitus severity and VOR gain deficits. Depression and anxiety were also correlated. Conclusion: Vertigo appears to be more intrusive than the other MD symptoms, and a higher correlation with anxiety than depression was demonstrated in this cohort. However, depression was seen less among married and educated patients, suggesting the role of coping capability, and had more pronounced clinical/vestibulometric correlates. Overall, these results indicated that it is mainly the severity of organic/physiological pathology which determines the degree of depression and anxiety in MD rather than vice versa.

Audiovestibular Findings in Celiac Patients

Objective: Celiac is a small intestine disease that occurs in susceptible individuals with a cellular and humoral immunological response that develops against gluten, a cereal protein. There are few studies evaluating the audiovestibular system in celiac patients. This study aims to evaluate audiovestibular findings in celiac patients. Materials and Methods: 40 patients with celiac disease and 40 healthy volunteers were enrolled in this sudy. Each subject underwent a neurotologic examination including pure tone audiometry (PTA), Transient Evoked Otoacoustic Emission (TEOAE) with 1000 Hz, 1500 Hz, 2000 Hz, 3000 Hz and 4000 Hz, Videonystagmography (VNG), and binaural bithermal caloric test. It was evaluated whether the test results indicated significant differences between the celiac patient and control group. Results: Sensorineural hearing loss was detected in the right and left ear of the 7 patients. In the pure tone audiometry (PTA) test, there was no statistically significant difference between celiac patients and controls in both air conducted and bone conducted hearing thresholds (p=0,389 for the right ear, p=0,083 for the left ear). Speech reception thresholds of celiac patients were significantly higher than the controls (p= 0,000 for right ear, p=0,001 for the left ear) While OAE response was obtained in the right ear of 24 patients and in the left ear of 23 patients; OAE response was obtained in all of the control group. In the OAE test, in response to 2000 Hz stimuli, there was no significant difference in the right ear responses, although there was a lower signal-to-noise ratio in patients compared to the control group. At all other frequencies, a statistically significant lower signal-to-noise ratio was found in the patient group. Statistically significant pathological differences were found in spontaneaus nystagmus, gaze, saccade, smooth pursuit, optokinetic nystagmus and caloric tests in celiac patients compared to the control group (p &lt; 0.05). Conclusion: Pure tone audiometry, otoacoustic emision, oculomotor and caloric tests findings indicated that auditory system, periphral and central vestibular system may be affected in individuals with celiac disease.

Common and uncommon audio-vestibular findings in COVID-19 patients

BackgroundCOVID-19 is the new version of the old coronavirus known since 1960, which caused the Middle East respiratory syndrome (MERS-CoV) in 2012 and the severe acute respiratory syndrome (SARS) in 2003.Symptoms included fever and cough, diarrhea and vomiting, and neurological symptoms like anosmia.MethodsOne hundred twenty-eight patients diagnosed as COVID-19 with audio-vestibular complaints were subjected to audio-vestibular assessment and were included in the study.ResultsIn our study on COVID-19 patients who reported audio-vestibular complaints, hearing loss was found in 43.8% of patients in comparison to vertigo that represented 40.6% of cases. The most common type was sensorineural hearing loss representing 29.7% of patients and which was unilateral and sudden in 35.7% of them. Less commonly conductive hearing loss (CHL) was found in 14.1% of cases the most common form was bilateral mild to moderate CHL (83.3%) due to bilateral middle ear effusion.Among cases with vertigo, the most common etiology was benign paroxysmal positional vertigo (BPPV) (42.5%) then uncompensated vestibular neuritis (VN) (31.5%), and lastly, combined BPPV with VN (25%) of cases. Less frequently we found tinnitus in (13.3%) which was bilateral in (64.7%), labyrinthitis (5.5%), and acute VN 5.5%).The significant increase in the number of audiovestibular complaining cases that were observed in the course of the recurrent waves’ peaks pushed us to study the relationship between the pandemic and the audiovestibular system. The effect of COVID on AV systems is well noticed and management would be mandatory.

Association Between Early-Onset Osteoporosis With Hearing Loss and Benign Paroxysmal Positional Vertigo (BPPV): A Systematic Review and Meta-Analysis.

Osteoporosis is a chronic systemic disease characterized by low bone mass, progressive microarchitectural deterioration and increased bone fragility. Hearing loss and benign paroxysmal positional vertigo (BPPV) have been found in patients diagnosed with osteoporosis over 65 years, however, there is lack of information about these conditions in young patients. Herein, we conducted a systematic review and meta-analysis to provide evidence of the association between osteoporosis and audio-vestibular findings in young subjects. Systematic review and meta-analysis were performed according to PRISMA guidelines. Searches were conducted in PubMed, Embase, and Web of Science Core Collection. Mean age, proportion of patients with low mineral density, hearing loss, and BPPV were calculated for the systematic review and meta-analysis. Odds Ratio (OR) with their corresponding 95% confidence intervals (CI) were calculated. A total of 26 articles were reviewed. Only 10 studies met inclusion criteria for the meta-analysis. Six were assessed pursuing the association between osteoporosis and hearing loss. Pooled evidence suggested in patients with osteoporosis, an increased risk for developing hearing loss (OR = 1.52, 95% CI 1.06-2.19; P = .02) compared to controls. Another 6 studies reported the association between osteoporosis and BPPV. A significant increased risk for BPPV was found in individuals with osteoporosis (OR = 1.58, 95% CI 1.02-2.4; P = .04). There was no publication bias. Subjects younger than 65 years with osteoporosis have an increase odds for hearing loss and BPPV compared to controls. These conditions could be associated with early inner or middle ear bone morphologic changes.

Evaluation of the effects of Covid-19 on cochleovestibular system with audiovestibular tests.

The purpose of the present study was to investigate the effects of COVID-19 on audiovestibular system with Transiently Evoked Distortion Otoacoustic Emissions (TOAE), Distortion Product Otoacoustic Emissions (DPOAE), video head impulse test (vHIT) and caloric test. Audiovestibular findings of 24 patients with moderate/severe COVID-19 and 24 healthy controls were compared using pure tone audiometry, tympanometry, TOAE, DPOAE, caloric test, and vHIT. On audiometry, the pure tone averages of the COVID-19 patients were higher than the controls (P = .038). The TEOAE amplitudes at 4000 and 5000Hz (P = .006 and P < .01), and DPOAE amplitudes at 3000, 6000, and 8000Hz (P < .001, P = .003 and P < .001) were significantly lower in COVID-19 patients compared to the controls. On vestibular tests, there was no significant difference between the caloric test results of the patients and the controls (P > .05). On vHIT testing, amplitudes of right semicircular canal was found to be significantly lower in COVID-19 group compared to the control group (P = .008). COVID-19 may affect inner ear functions causing a subtle damage in the outer hair cells and lateral semicircular canals. It must be kept in mind that COVID-19 may cause cochleovestibular problems.

Anatomical variation of inner ear may be a predisposing factor for unilateral M\xe9ni\xe8re\u2019s disease rather than for ipsilateral delayed endolymphatic hydrops

ObjectiveRadiological anatomical variations, measured by magnetic resonance imaging (MRI), were evaluated in patients with ipsilateral delayed endolymphatic hydrops (DEH) and unilateral Ménière’s disease (MD). The role of anatomical variations in different subtypes of hydropic ear disease was investigated.MethodsTwenty-eight patients with ipsilateral DEH, 76 patients with unilateral MD, and 59 control subjects were enrolled. The radiological indices included the distance between the vertical part of the posterior semicircular canal and the posterior fossa (MRI-PP distance) and the visibility of vestibular aqueduct (MRI-VA). These variations among patients with DEH, MD, and control subjects were compared. The correlation between radiological anatomical variations and clinical features or audio-vestibular findings was also examined.Results(1) MRI-PP distance in the affected side of unilateral MD was shorter than that in ipsilateral DEH (Z = − 2.481, p = 0.013) and control subjects (Z = − 2.983, p = 0.003), while the difference of MRI-PP distance between the affected side of ipsilateral DEH and control subjects was not statistically significant (Z = − 0.859, p = 0.391). (2) There was no significant interaural difference of MRI-PP distance in patients with unilateral MD (Z = − 0.041, p = 0.968) and ipsilateral DEH (t = − 0.107, p = 0.915) respectively. (3) No significant interaural difference of MRI-VA visibility was observed in patients with unilateral MD (χ2 = 0.742, p = 0.389) and ipsilateral DEH (χ2 = 0.327, p = 0.567) respectively. (4) No correlation was found between these anatomical variables and clinical features or audio-vestibular findings in patients with unilateral MD and ipsilateral DEH respectively (p > 0.05).ConclusionsAnatomical variations of inner ear may be a predisposing factor in the pathogenesis of unilateral MD rather than ipsilateral DEH.Key Points• Patients with ipsilateral delayed endolymphatic hydrops showed normal distance between the vertical part of the posterior semicircular canal and the posterior fossa.• Compared to patients with ipsilateral delayed endolymphatic hydrops and control subjects, patients with unilateral Ménière’s disease exhibited shorter distance between the vertical part of the posterior semicircular canal and the posterior fossa.• Anatomical variations of inner ear may be a predisposing factor in the pathogenesis of unilateral Ménière’s disease rather than ipsilateral delayed endolymphatic hydrops.

Audiovestibular Dysfunction in Siblings with Charcot-Marie-Tooth Disease 4F: A Case Series.

Charcot-Marie-Tooth disease type 4F (CMT4F) is an autosomal recessive disorder with symptoms presenting in early adulthood. This clinical case series demonstrates atypical findings in cervical and ocular vestibular evoked myogenic potentials (VEMP) in siblings with CMT4F. The aim of this study was to highlight the audiovestibular test findings in CMT4F. Case series study sample: 4 siblings, 3 of whom diagnosed with CMT4F. Audiological test battery and electrophysiological tests comprising auditory brainstem response (ABR) and VEMP (both cervical and ocular) were performed in our patient population. Older siblings, in whom the hearing loss was present, manifested prolonged peak V latencies in ABR. Three out of four siblings with CMT4F showed prolongation of latencies on cervical and ocular VEMP. In many neurodegenerative conditions, prolongation of ABR peak latencies has often been reported in the literature. There have also been a few reports of prolonged VEMP peak latencies. This article reports prolongation of only VEMP peak latencies (in both cervical and ocular recordings). The youngest sibling had prolongation of VEMP latencies, with ABR peak latencies being normal. The assumption we put forth that CMT4F may affect the vestibular pathway first requires to be tested on a larger sample and by longitudinally studying the individuals with disease condition.

Audio-Vestibular Findings in Individuals with Takayasu's Arteritis.

Takayasu's Arteritis is defined as inflammatory disease of the large blood vessels with unknown cause mostly affecting the aorta and its main branches. The patients diagnosed with Takayasu's arteritis are reported to have complaint of chronic dizziness. However, literature lacks detailed clinical evaluation of the auditory vestibular function in such patients. The current study documents the findings of auditory and vestibular evaluations in a rare syndrome. It was observed that patients with Takayasu's arteritis had abnormal auditory and vestibular evoked potentials.

Vestibular Function in Children With Von Hippel-Lindau Disease.

Von Hippel–Lindau disease (VHL) is a rare autosomal dominant disorder. It is caused by a mutation in the tumor suppressor gene localized at 3p25-26. Endolymphatic sac tumors (ELSTs) are rare low-grade adenocarcinomas which can occur sporadically but are more commonly found in association with VHL disease. In this paper, we present 3 siblings who underwent comprehensive vestibular assessment following a genetic diagnosis of VHL, and review the literature on audiovestibular findings in VHL/ELST in children. This is the first time that newer objective vestibular function tests like the video head impulse test (vHIT), the suppression head impulse test (SHIMP), and the cervical vestibular evoked myogenic potential test (cVEMP) have been performed in children with VHL to yield meaningful information about vestibular function. Monitoring audiological function has been suggested for early detection of ELSTs. It remains to be seen whether monitoring of vestibular function in patients with VHL from an earlier age may yield valuable information about progression of the disease.

Superior Semicircular Canal Dehiscence by Superior Petrosal Sinus: Proposal for Classification.

This study aimed to present 3 different clinical stages in patients presenting with superior semicircular canal dehiscence (SSCD) by the superior petrosal sinus (SPS). A specific 3-class classification based on clinical, radiological, and audio-vestibular arguments is proposed. We retrospectively compared clinical and radiological findings in 3 patients with different degrees of audio-vestibular dysfunction in whom the imagery evocated the diagnosis of SSCD by SPS. Imaging sensitivity was improved by combining inner ear high-resolution computed tomography (HRCT) scan and magnetic resonance imaging in fusion, allowing us to compare and corroborate clinical and audio-vestibular findings in each case with the imagery. HRCT and 3T inner ear fusion imaging highlighted a direct contact and/or compression between SPS and the membranous superior semicircular canal (SSC). We propose a new classification of SSCD by SPS. Class "A" corresponds to an HRCT image with a "cookie bite" and thin bone still covering the SSC. Class "B" corresponds to a "cookie bite" image with confirmed contact between the SPS wall and the membranous SSC in MRI labyrinthine sequences. Class "C" type corresponds to a "cookie bite" image, contact, and obvious compression of the membranous SSC by SPS on MRI sequences. Anatomical systematization is needed for daily practice. This classification of SSCD by SPS would contribute to a better understanding of the wide variety and variability in the occurrence and onset of symptoms.

Audio-Vestibular Findings in Patients with Hyperuricemia

Background: Hyperuricemiais a common biochemical disturbance in which serum concentration of uric acid exceeds the normal values which is 7.0 mg/dl in men and more than 6.0 mg/dl in women leading to deposition of monosodium urate [MSU] crystals in joints and soft tissues resulting in inner ear functions affection. Aim of the work: To elaborate the effect of hyperuricemia on the peripheral hearing as well as peripheral vestibular functions. Subjects and Methods: This study included 40 subjects with hyperuricemia and 40 healthy controls. Participants underwent serum uric acid assay, full history taking, basic audiological evaluation and vestibular evaluation. Results: 37[92.5%] hyperuricemic subjects had normal peripheral hearing sensitivity, only 3[7.5%] had mild high frequencies sensori-neural hearing loss [SNHL] at 8 kHz. 31[77.5%] Hyperuricemic patients had normal peripheral vestibular functions, only 9[22.5%] subjects had BPPV; They also had higher serum uric acid [SUA] level. No correlation between duration of hyperuricemia and occurrence of BPPV. Conclusions: The hyperuricemic subjects had a significant higher incidence of BPPV. Other investigations to detect early and subtle changes in cochlear function of hyperuricemic subjects were recommended.

Audiovestibular findings in a 6 year old child with pilocytic astrocytoma – a case report

Objective: Pilocytic astrocytoma commonly occurs in children and depending on the extension of the lesion may cause varied audiovestibular dysfunctions. However, audiovestibular findings are scarcely reported in the literature.Design: Audiovestibular testing was performed on a single subject on two occasions pre-surgically.Study sample: A 6 year old girl with pilocytic astrocytoma.Results: All audiological tests revealed normal findings except for the cervical vestibular evoked myogenic potential testing (cVEMP). The amplitude of cVEMP was higher in the lesion side indicating a hypersensitive vestibulocollic reflex pathway functioning.Conclusions: This case study reported a unique finding of hypersensitive cVEMP findings in the lesion side in a patient with pilocytic astrocytoma. The pathophysiological basis for this hypersensitivity is attributed to anatomical connections between the cerebellum and the vestibular nuclei through the inferior cerebellar peduncle.

Audiovestibular Loss of Function Correlates in Vestibular Schwannomas.

The aim of the present study was to investigate the relationships between tumor size, hearing, and vestibular outcomes in patients with vestibular schwannomas (VSs). Adult patients (n=124) with unilateral extrameatal VS prior to surgery were included in the study. This was a retrospective cohort study of preoperative audiovestibular investigations including audiometry, discrimination test, caloric test, cervical vestibular evoked myogenic potential (c-VEMP), and ocular vestibular evoked myogenic potential (o-VEMP). The difference between lesioned and non-lesioned ear was significant for all audiovestibular outcomes. The mean caloric deficit was 74%. No tumor sided o-VEMPs were elicited. Caloric deficit correlated with hearing loss measured with pure tone average and discrimination score. c-VEMP deficit was significantly associated with severe hearing loss and larger tumors. The presence of VS leads to a significant deterioration of audiovestibular function in all objective measures. Caloric test and o-VEMPS are sensitive though unspecific measures of VSs. Increasing tumor size is not directly associated with hearing loss and only somewhat to vestibular deficit. However, audiovestibular findings are correlated.

Acute Unilateral Audiovestibulopathy due to Embolic Labyrinthine Infarction.

Labyrinthine infarction is a cause of acute audiovestibulopathy, but can be diagnosed only in association with other infarctions involving the brainstem or cerebellar areas supplied by the anterior inferior cerebellar artery (AICA) since current imaging techniques cannot visualize an infarction confined to the labyrinth. This case series aimed to establish embolic labyrinthine infarction as a mechanism of isolated acute audiovestibulopathy. We analyzed clinical features, imaging findings, and mechanisms of embolism in 10 patients (8 men, age range: 38-76) who had developed acute audiovestibulopathy in association with an obvious source of embolism and concurrent acute embolic infarctions in the non-anterior inferior cerebellar artery territories. The presence of audiovestibulopathy was defined when bedside or laboratory evaluation documented unilateral vestibular (head-impulse tests or caloric tests) or auditory loss (audiometry). Six patients showed combined audiovestibulopathy while three had isolated vestibulopathy. One patient presented isolated hearing loss. Audiovestibular findings were the only abnormalities observed in nine patients. In all patients, MRIs documented single or multiple infarctions in the cerebellum (n = 5) or cerebral hemispheres (n = 5). Especially three patients showed single or scattered foci of tiny acute infarctions only in the cerebral hemispheres. Cardiac sources of embolism were found in eight, and artery-to-artery embolism was presumed in two patients. Selective embolism to the labyrinth may be considered in patients with acute unilateral audiovestibulopathy and concurrent acute infarctions in the non-AICA territories.