Introduction: The second most frequent cause of autosomal recessive nonsyndromic sensorineural hearing loss (AR-NSHL) worldwide is a biallelic pathogenic alteration of the STRC (stereocilin) gene, also named DFNB16. The type and severity of hearing impairment in DFNB16 patients were studied thoroughly, while information on a detailed examination of their vestibular function is still lacking. Our aim was to characterize the vestibular status of patients with biallelic pathogenic variants in STRC by performing a complete up-to-date test battery. Methods: Eight AR-NSHL patients, aged 6–37 (mean age ± standard error of the mean [SEM] 16.13 ± 8.67), underwent standard audiological testing and otoneurologic investigation, including videonystagmography (VNG) with caloric stimulation, video head-impulse test (vHIT), and cervical vestibular evoked myogenic potentials (c-VEMPs). Subjects were divided into three groups (group 1, 2, and 3) according to the type of diagnosed STRC gene variant. Results: The grade of the hearing loss was calculated as pure tone average (PTA) (mean PTA ± SEM 41.88 dB ± 5.49). The vHIT displayed nearly normal bilateral gain and mostly the absence of saccades in all examined groups. Cervical VEMPs in response to air-conducted and bone-conducted stimuli showed prolonged latencies of waves P1 and N1 bilaterally in group 1, although latencies in groups 2 and 3 were within normal range. The results of VNG indicated normal vestibular and central oculomotor function. Conclusions: Biallelic pathogenic variants in the STRC gene influence the inner ear’s cochlear and vestibular function. Certain vestibular abnormalities in DFNB16 patients were detected by detailed evaluation, despite none of the DFNB16 subjects in our study reported subjective symptoms.

Abstract Background Meniere’s disease (MD) is marked by fluctuating hearing loss, episodic vertigo, aural fullness, and tinnitus. Vestibulo-ocular reflex (VOR) assessment through video head impulse test (vHIT), caloric testing, and ocular vestibular evoked myogenic potentials (oVEMP) may provide complementary diagnostic insights. Objective To evaluate the sensitivity, compatibility, and diagnostic value of oVEMP, caloric testing, and vHIT in cases with MD. Methods This cross-sectional analytical study was conducted on 28 subjects with dizziness and/or vertigo in the Audiology unit outpatient clinic of the ENT department, during the period from March 2021 to August 2023. All participants underwent full history taking, dizziness analysis, audiological assessment, caloric testing, vHIT, and oVEMP recording. Results oVEMP abnormalities were detected in 68% of patients, most commonly delayed latency with abnormal inter-aural amplitude difference (IAAD). Caloric testing revealed abnormalities in 53.6%, predominantly unilateral weakness. vHIT showed the lowest sensitivity, with no patients demonstrating abnormal gain. Significant correlations were found between pure tone audiometry thresholds and oVEMP IAAD, caloric weakness percentage, and vHIT gain asymmetry. Sensitivity was highest for oVEMP (67.9%), followed by caloric testing (53.6%), while vHIT was least sensitive (7.1%). Specificity was highest for caloric testing (76.6%), moderate for vHIT (71.2%), and lowest for oVEMP (20.3%). Conclusion oVEMP demonstrated the greatest sensitivity for detecting vestibular dysfunction in MD, whereas caloric testing was more specific and superior to vHIT across disease stages. Dissociation between caloric and video head impulse test outcomes may represent a diagnostic indicator of Meniere’s disease.

This study aimed to characterize the imaging patterns of semicircular canal (SCC) aplasia on high-resolution computed tomography (CT) and magnetic resonance imaging (MRI) to identify associated cochleovestibular and internal auditory canal (IAC) abnormalities and to explore potential syndromic correlations. We retrospectively evaluated 12 patients (24 ears) diagnosed with SCC aplasia between January 2021 and January 2025. Imaging findings were reviewed for canal type, cochlear and vestibular abnormalities, vestibular aqueduct morphology, and IAC configuration. Syndromic associations and clinical outcomes were also assessed. Lateral SCC aplasia was most common (41.7%), followed by budding remnants (12.5%) and total aplasia (12.5%). Total aplasia consistently coexisted with vestibular hypoplasia (P = 0.020) and was frequently accompanied by narrowing of the IAC (P = 0.04). Cochlear hypoplasia was found in one patient with bilateral total aplasia. Sensorineural hearing loss was present in 75% of patients, and caloric testing revealed subclinical vestibular dysfunction in two clinically asymptomatic adults. Syndromic associations included two cases of DiGeorge syndrome and a newly identified coexistence with Gitelman syndrome. SCC aplasia encompasses a spectrum of rare anomalies, most commonly affecting the lateral canal and closely related to vestibular dysplasia. Recognition of IAC narrowing is important, as it can complicate cochlear implantation. The identification of Gitelman syndrome as a new association expands the spectrum of systemic diseases associated with SCC abnormalities. Comprehensive imaging with both CT and MRI is essential not only for diagnosis but also for surgical planning and syndromic screening. Systematic assessment of the IAC and vestibular structures on CT and MRI is essential in patients with congenital hearing loss. Recognizing IAC narrowing and vestibular dysplasia aids in preoperative cochlear implant planning and supports targeted syndromic or genetic evaluation.

ImportanceSudden sensorineural hearing loss (SSNHL) is often accompanied by vestibular dysfunction, yet the relationship between patterns of peripheral vestibular organ involvement and hearing prognosis requires systematic evaluation. Clarifying this association is essential for guiding clinical assessment and prognosis.ObjectiveTo explore the prognostic value of vestibular function tests in patients with SSNHL by assessing the functional status of peripheral vestibular receptors.DesignRetrospective cohort study.SettingInpatient departments of Jiaxing Second Hospital and the Hospital of the China Coast Guard (September 2020 to September 2021).ParticipantsA total of 76 inpatients with unilateral SSNHL were enrolled and divided into a vertigo group (n = 29) and a non-vertigo group (n = 47).Exposures or InterventionsAll patients underwent pure-tone audiometry (PTA), cervical vestibular-evoked myogenic potentials (cVEMP), ocular VEMP (oVEMP), video head impulse test, and caloric testing to assess peripheral vestibular involvement.Main Outcome MeasuresHearing recovery, defined by improvement in PTA thresholds.ResultsPatients with vertigo had significantly-worse baseline PTA thresholds compared with those without vertigo [67.91 ± 31.67 degrees of hearing loss (dBHL) vs 54.98 ± 29.03 dBHL, P = .001]. Vestibular dysfunction was common, most frequently involving semicircular canal lesions (49/76), followed by abnormal cVEMP (41/76) and abnormal caloric testing (39/76). Univariate analysis showed that cVEMP, oVEMP, and caloric testing results were significantly associated with treatment outcomes (all P < .001), with the combined assessment of oVEMP and caloric testing demonstrating particular prognostic value (P = .007). Multivariate logistic regression further identified vertigo (OR = 0.132), cVEMP abnormality (OR = 6.460), and oVEMP abnormality (OR = 0.147) as independent predictors of hearing prognosis (all P < .05).ConclusionVestibular dysfunction reflects the extent of inner ear involvement in SSNHL, with semicircular canal impairment being the most common, followed by saccular and utricular lesions. Combined oVEMP and caloric testing appears to be an optimal approach for evaluating vestibular function and predicting hearing prognosis.RelevanceThis study supports the integration of multiple vestibular assessments to more comprehensively characterize inner ear involvement in SSNHL and to provide clinicians with reliable prognostic reference tools.

Objective:This review compares acute low-tone sensorineural hearing loss（ALHL） and stage 1 and 2 Ménière's Disease（MD） in terms of their clinical presentation, audio-vestibular profiles, and pathophysiological mechanisms, aiming to elucidate key distinctions and commonalities to guide differential diagnosis and treatment. Methods:The study included 61 patients with unilateral ALHL and 41 patients with unilateral stage 1 and 2 MD. The demographic characteristics and findings from pure-tone audiometry, electrocochleography（ECochG）, spontaneous nystagmus（SN）, caloric test, vestibular evoked myogenic potentials（VEMP）, and the video head impulse（vHIT） were retrospectively analyzed. Results:①ALHL was associated with a significantly younger age of onset（t=-4.467, P<0.001） and a higher female preponderance（χ²=7.918, P=0.005） compared to the MD group. ②MD patients exhibited significantly higher mean hearing thresholds than ALHL patients（Z=-5.827, P<0.001）. While there was no significant difference in low-frequency hearing thresholds between the two groups, ALHL patients had significantly lower mean hearing thresholds at mid-frequency（F=13.901, P<0.001） and high-frequency（Z=-6.963, P<0.001）. Compared with MD patients, ALHL patients demonstrated a lower ECochG abnormality rate on the affected side（χ²=6.894, P=0.009） and a smaller summating potential/action potential ratio on the affected side（Z=-2.975, P=0.003）. ③No statistically significant difference in SN was found between ALHL and MD patients（χ²=1.051, P=0.305）. No significant differences were found between ALHL and MD patients regarding the abnormality rate of reduced caloric response on the affected side（χ²=1.943, P=0.163）. A lower canal paresis value was observed in ALHL patients compared to those with MD（F=5.345, P=0.024）. There was no significant difference in the abnormality rates of cervical VEMP（χ²=0.091, P=0.763） or ocular VEMP（χ²=1.024, P=0.312） between the groups. vHIT results were negative in all patients of both groups. Conclusion:Although both ALHL and stage 1 and 2 MD are hydropic disorders with comparable hearing loss patterns, their divergent clinical and audio-vestibular profiles point to differences in pathophysiology. Clarifying their interrelationship calls for additional long-term studies.

Ménière's disease is a chronic vestibular disorder characterised by vertigo, hearing loss and tinnitus, with noise exposure potentially exacerbating symptoms. This study aimed to evaluate the influence of noise reduction measures during noise-sensitive periods on vertigo symptoms and vestibular function in affected patients. This retrospective study included 223 patients diagnosed with Ménière's disease between May 2021 and June 2023. Participants were divided into two groups: the noise reduction measure group (NR group, n = 108) and the non-noise reduction measure group (NNR group, n = 115). Assessments included the Dizziness Handicap Inventory (DHI), Visual Analogue Scale (VAS) for vertigo severity, Pure Tone Audiometry (PTA), video Head Impulse Test, vestibular evoked myogenic potentials, caloric tests, Tinnitus Handicap Inventory (THI), Hospital Anxiety and Depression Scale (HADS) and the 36-Item Short Form Health Survey (SF-36). All measures were obtained at baseline and 3 months after the treatment initiation. Statistical comparisons between groups were performed using independent samples t-tests and chi-square tests, as appropriate. At the 3-month follow-up, the NR group demonstrated significantly greater improvements than the NNR group in THI (P = 0.011), DHI (P = 0.014), VAS (P < 0.001), PTA thresholds (P = 0.007), vestibular function parameters (all P < 0.05), HADS for anxiety (P = 0.020), HADS for depression (P = 0.014) and multiple SF-36 domains (P < 0.05). The basic vertigo control rate was also higher in the NR group than in the NNR group (P = 0.003). Implementing noise reduction measures during noise-sensitive periods significantly improved vertigo symptoms, reduced tinnitus handicap and enhanced hearing function in patients with Ménière's disease, suggesting that this approach may be a valuable adjunctive approach to standard medical treatment.

Ménière's disease (MD) is characterized by episodic vertigo, fluctuating hearing loss, tinnitus, and aural fullness. As vertigo is a cardinal symptom, evaluating vestibular function is essential for disease assessment. However, the relationship between vestibular function and the degree or location of endolymphatic hydrops (EH), as well as the stages of Ménière's disease (MD), remains unclear. Patients diagnosed with definite Unilateral Ménière's disease (UMD) underwent a comprehensive vestibular function evaluation, including cervical and ocular vestibular evoked myogenic potentials (cVEMP, oVEMP), video head impulse test (vHIT), caloric test, and sensory organization test (SOT). Inner ear gadolinium-enhanced MRI (Gd-MRI) was performed to the assessment of endolymphatic hydrops(EH).Vestibular function parameters were compared across MD stages and EH categories. Fisher's exact test was used for statistical analysis. cVEMP and oVEMP non-response rates increased significantly with advancing MD stage and were significantly higher in Stages III-IV compared to Stages I-II. vHIT abnormalities were predominantly observed in Stage IV. Caloric test abnormalities were significantly lower in Stage I but showed no significant differences among later stages(II, III, IV). No significant differences were found in SOT-derived balance function (BF) or vestibular function (VF) across MD stages. Furthermore, there was no linear correlation between vestibular test results and overall endolymphatic hydrops level(EHL). Similarly, vestibular dysfunction rates did not differ significantly among patients with isolated cochlear, isolated vestibular, or both cochlear and vestibular EH. Vestibular function changes in UMD are stage-dependent, with early involvement of otolithic and low-frequency semicircular canal function, while high-frequency canal dysfunction appears later. However, these changes do not consistently correlate with EH severity or anatomical distribution. Central compensation and functional-structural mismatch may underlie these discrepancies. Multimodal and longitudinal approaches are needed to better understand vestibular pathophysiology in MD.

Functional near-infrared spectroscopy (fNIRS) has emerged as a promising neuroimaging modality for investigating cortical activity in auditory and vestibular domains. Its portability, device compatibility, and motion tolerance make it particularly suited for use in populations that are challenging to study with conventional neuroimaging techniques, such as infants and cochlear implant (CI) users. The present study aims to explore the potential and limitations of this neuroimaging technique in the audiological and vestibular fields, offering an integrated perspective across pediatric, adult and elderly populations. A narrative review of studies using fNIRS in hearing loss, tinnitus, and vestibular disorders was conducted through searches in PubMed and Scopus up to March 2025. Studies were included if they employed fNIRS to investigate cortical responses in individuals with diagnosed hearing loss, chronic tinnitus or to investigate vestibular function. A total of 60 studies were reviewed: 36 on hearing loss, 11 on tinnitus, and 13 on vestibular disorders. In hearing research, fNIRS successfully identified cortical activation patterns related to auditory perception, speech processing, and cross-modal plasticity in CI users across development, adulthood and aging. The technique showed prognostic potential in predicting CI outcomes and monitoring listening effort and cognitive load. In tinnitus research, fNIRS consistently demonstrate hyper-activation in the auditory cortex and altered functional connectivity with frontal-limbic networks, reflecting sensory, cognitive, and emotional involvement. The technique was sensitive to treatment effects following interventions such as transcranial stimulation, acupuncture, and cochlear implantation. In vestibular research, fNIRS enabled the mapping of cortical networks involved in balance control and multisensory integration during various stimulation paradigms, including caloric testing, motion platforms, and optic flow in virtual environments. Although current applications are mostly exploratory, findings suggest fNIRS can capture vestibular-related cortical activity in real-world conditions. fNIRS offers a valuable, non-invasive, and ecologically valid method for investigating auditory and vestibular function across the lifespan. In hearing and tinnitus research, it shows strong potential for clinical translation, especially if methodological standardization is achieved. Applications in vestibular research remain preliminary but promising.

Vestibular neuritis (VN) etiology remains elusive, with hypotheses suggesting viral infection, non-infectious inflammation, or immune responses. Evaluating T and B Lymphocyte Subsets and cytokines gives a comprehensive snapshot of the body's immune function and inflammatory state. But comprehensive studies focusing on the T and B lymphocyte subsets and cytokine levels in VN are limited. This study aims to assess the T and B lymphocyte subsets and cytokine expressions in the blood of VN patients. This study shed light on its pathogenesis and provided valuable hematological markers for clinical prognosis. A retrospective analysis was conducted on subjects diagnosed with VN. Patients included exhibited acute, first-episode, persistent vertigo with accompanying symptoms of nausea, vomiting, postural instability, specific nystagmus, and positive head impulse test results. Exclusion criteria included hearing impairments, prior vestibular disorders, recent steroid therapy, and autoimmune conditions. Patients underwent blood tests (T and B lymphocyte subsets, cytokines) and DHI evaluations within days of onset, with a secondary assessment at discharge. Healthy individuals served as controls. The study included 25 individuals with VN (aged 34-73 years, 13males) and 25 healthy controls (aged 33-74 years, 7males). VN patients exhibited elevated levels of total B lymphocytes, helper/inducer (CD3+CD4+) T cells, and the helper/suppressor (CD4+/CD8+) T cell ratio all of which were statistically significant compared to the control group. In contrast, reduced levels of total T lymphocytes, suppressor/cytotoxic T cells, and natural killer cells were observed. Elevated Interleukin-6 levels and decreased Interleukin-17A levels were seen in the VN group. There are differences in the levels of CD3+CD4+ T cells and CD4+/CD8+ T cell ratio among patients in the three groups of mild, moderate, and severe, with the severe group significantly higher than the mild group. Admission levels of CD3+CD4+ T cells showed positive correlations with the DHI-Functional score within 1-3 days. Admission levels of CD3+CD4+ T cells and CD4+/CD8+ T cell ratio are positively correlated with all DHI scores at discharge. Immunological perturbations are implicated in pathogenesis of VN. Evaluation of these immune markers could offer insights into prognostic outcomes for VN patients, leading to development of therapeutic strategies.

To describe the clinical characteristics, vestibular function test results, and recovery patterns of patients with bilateral sequential vestibular neuritis (BSVN), and to highlight its diagnostic challenges and pathophysiological implications. Three male patients (aged 39, 47, and 57y) diagnosed with bilateral sequential vestibular neuritis were retrospectively analyzed, each presenting with a second episode involving the contralateral ear after a symptom-free interval. All patients underwent comprehensive vestibular assessments during both episodes, including caloric testing, video head impulse test (vHIT), and cervical and ocular vestibular evoked myogenic potentials (VEMP). Quantitative measures of vestibular dysfunction (canal paresis, vestibulo-ocular reflex gain, VEMP asymmetry ratio), symptom severity, and interval between sequential attacks were analyzed to assess the pattern of recovery and compensation. All patients initially presented with unilateral vestibular neuritis followed by contralateral involvement after 2 to 5 years. The first 2 patients achieved complete or near-complete recovery, while the third developed persistent bilateral vestibulopathy with prolonged oscillopsia and imbalance. Across all cases, spontaneous nystagmus and vertigo during the second attack were milder than those in the first, suggesting central compensation and the influence of residual vestibular function. BSVN is an exceptionally rare condition demonstrating both peripheral restoration and central adaptive mechanisms. Sequential vestibular testing provides valuable insights into its heterogeneous presentations and recovery patterns. Recognition of this condition is crucial for accurate diagnosis, patient counseling, and long-term management.

ObjectiveVestibular migraine (VM) and Meniere's disease (MD) are episodic vertigo disorders with overlapping symptoms, often leading to misdiagnosis. This study aimed to identify a cost-effective diagnostic method to distinguish VM and MD.MethodsIn this retrospective study, 108 VM patients and 65 MD patients were enrolled. Clinical symptoms, interictal videonystagmography (VNG) findings, and caloric test results were analyzed and compared between the two groups.ResultsThe VM group had a significantly higher proportion of females (p < 0.001). No significant differences were observed in any features of interictal nystagmus, including spontaneous or positional nystagmus (all p > 0.05). However, the caloric test revealed a significantly higher proportion of canal paresis (CP) in MD patients compared to VM patients (p < 0.001).ConclusionWhile clinical symptom profiles effectively distinguish VM from MD, interictal nystagmus analysis has limited diagnostic value. The caloric test is a reliable and practical tool, as the presence of significant canal paresis strongly indicates MD over VM. Combining symptom evaluation with caloric testing offers a cost-effective strategy for the differential diagnosis of these common vestibular disorders.

To investigate the associations between acoustically evoked short latency negative response (ASNR) and vestibular function in patients with large vestibular aqueduct syndrome (LVAS) before and after cochlear implantation (CI). Retrospective study. Tertiary medical center. The records of 64 patients (32 with bilateral LVAS and 32 with no inner ear malformations [IEMs]) who underwent unilateral CI were reviewed. Among them, the auditory brainstem response of 17 LVAS patients who presented with bilateral ASNRs was reassessed after CI, with a mean follow-up period of 4.18 ± 2.43 years. The ASNR could be detected more from LVAS ears than from ears without IEMs (67.18% vs 12.5%, P < .001). Compared with the LVAS ears without ASNR, the ears with an ASNR presented better vestibular function, with a lower abnormal rate in the caloric test and vestibular evoked myogenic potentials (VEMPs), before CI. After CI, the LVAS patients showed a significant increase in the abnormal rate of the caloric test (29.41% pre-CI to 70.59% post-CI, P = .038). Notably, patients with a preserved ASNR maintained normal cervical VEMP (cVEMP) responses (100%), whereas those with no robust ASNR had a higher rate of abnormal cVEMP (77.78%, P = .002). The presence of an ASNR in LVAS patients correlates with better vestibular function preservation both before and after CI. The function of otoliths in patients with LVAS is not significantly affected by CI. The ASNR may serve as a valuable noninvasive predictor of vestibular outcomes in LVAS patients.

Objective: To investigate whether the direction of air stimulation in caloric test affects the results, and to provide evidence for standardizing the procedure and quality control. Methods: The study subjects were 160 patients with vestibular peripheral vertigo who were treated in Tianjin First Central Hospital from June 2023 to May 2024, including 53 males and 107 females, aged from 12 to 84 years, with an average age of 51.9 years.Video nystagmography (VNG) and a thermal air stimulator were used to perform caloric tests on 160 patients with vertigo, who were randomly assigned to two groups by computer random number table method. In Group 1 (n=80), both ears were first stimulated in the posteroinferior direction, followed by anterosuperior stimulation of the left ear in 40 cases and the right ear in 40 cases. In Group 2 (n=80), the order was reversed: the left and right ears received anterosuperior stimulation first, followed by posteroinferior stimulation in both ears. The maximum slow phase velocity (SPV) of induced- nystagmus, unilateral weakness (UW), and directional preponderance (DP) were recorded and compared between different stimulation directions. Statistical analyses were performed using SPSS 26.0 software. Results: In Group 1, the slow-phase velocity (SPV) of nystagmus elicited by posterior-inferior air stimulation was consistently higher than that induced by anterior-superior stimulation. This difference was statistically significant, as determined by the Wilcoxon signed-rank test (P<0.05). Among the 31 participants who exhibited normal unilateral weakness (UW) following posterior-inferior stimulation, 24 (77.4%, 24/31) developed abnormal UW after subsequent anterior-superior stimulation. Conversely, among the 32 participants with initially abnormal UW after posterior-inferior stimulation, 14 (43.8%, 14/32) showed normalization of UW following anterior-superior stimulation. With respect to directional preponderance (DP), 65 participants had normal DP and 15 had abnormal DP after posterior-inferior stimulation. Following anterior-superior stimulation, 4 individuals with initially normal DP values became abnormal, whereas 3 individuals with initially abnormal DP values reverted to normal. In Group 2, the SPV of nystagmus induced by anterior-superior stimulation was significantly lower than that elicited by posterior-inferior stimulation, with a statistically significant difference (P<0.05) confirmed by the Wilcoxon signed-rank test. Among the 29 participants with normal UW after anterior-superior stimulation, 11 (37.9%, 11/29) exhibited abnormal UW upon subsequent posterior-inferior stimulation. Of the 39 participants with abnormal UW after anterior-superior stimulation, 21 (53.8%, 21/39) demonstrated normalized UW following posterior-inferior stimulation. Regarding DP, 70 participants had normal and 10 had abnormal baseline values after anterior-superior stimulation; after posterior-inferior stimulation, 2 participants with initially normal DP values developed abnormalities, while, 3 with initially abnormal values returned to normal. Conclusions: The direction of thermal stimulation in caloric testing significantly influences test outcomes. Posterior-inferior air stimulation appears to provide a more robust vestibular response. Standardization of airflow direction is therefore essential for ensuring reliability and accuracy in caloric testing, and should be considered a critical component of quality control in clinical vestibular assessment.

BackgroundTotal deafness-type sudden sensorineural hearing loss (SSNHL) represents one of the most challenging subtypes of SSNHL due to its poor response to initial therapy and uncertain prognosis. Secondary inpatient treatment has been proposed as a potential salvage strategy; however, its efficacy and predictors of favorable outcomes remain poorly defined.MethodsThis study included 120 patients with unilateral total deafness-type SSNHL, divided into secondary treatment and control groups. Hearing thresholds at low, middle, high, and full frequencies, pure-tone average (PTA) at speech frequencies, and speech recognition rate were evaluated across six time points (T1–T6). Tinnitus Handicap Inventory (THI) scores and improvement rates were also analyzed. Univariate and multivariate logistic regression analyses were performed to identify independent predictors of marked hearing recovery. A nomogram was constructed to predict the hearing prognosis of patients with SSNHL.ResultsCompared with the control group, the secondary treatment group exhibited significantly earlier onset and greater magnitude of improvements in hearing thresholds and speech recognition rate (all p < 0.05), with distinct frequency-specific patterns. Recovery initiated at 4–8 weeks and stabilized after 12 weeks, while the control group showed delayed improvement. Tinnitus relief occurred earlier in the secondary treatment group. Multivariate analysis identified age ≤50 years, disease duration ≤3 days, absence of vertigo, and normal vestibular function (vHIT and caloric test) as independent predictors of marked recovery (all p < 0.05). The area under the receiver operating characteristic (ROC) curve was 0.876 (95% confidence interval [CI]: 0.762–0.989). The calibration curve showed good agreement with the standard curve. The decision curve analysis demonstrated that the prediction model yielded positive net benefits across nearly all threshold probability ranges.ConclusionSecondary inpatient treatment offers a significant auditory benefit for patients with total deafness-type SSNHL by accelerating and amplifying recovery. Young age, early intervention, and well-preserved vestibular function are key determinants of a favorable prognosis. The predictive model constructed hereby can effectively predict the prognosis of patients.

Simulations of low-frequency vibration pattern at the inner ear for activation of the vestibular system.

Vestibular dose predicts toxicity in stereotactic radiosurgery for vestibular schwannomas

Background: Caloric reflex testing, first described by Robert Bárány, is a cornerstone in vestibular and neurological assessment. It evaluates the functional integrity of the lateral semicircular canals and brainstem pathways through thermal stimulation of the external auditory canal, eliciting vestibulo-ocular reflex (VOR) responses. Aim: This article aims to explore the clinical implications, techniques, interpretation, and limitations of caloric reflex testing in nursing and interprofessional practice. Methods: A comprehensive review of caloric testing procedures—including bithermal, monothermal, and ice-water techniques—was conducted. The physiological basis, assessment parameters (interaural variability, directional preponderance), and calculation methods such as the Jongkee formula were analyzed. Results: Caloric testing provides critical diagnostic insights into peripheral vestibular dysfunction, brainstem integrity, and cranial nerve lesions. It aids in differentiating central versus peripheral causes of vertigo, assessing comatose patients, and determining brain death. Nursing roles include patient preparation, monitoring for adverse effects, and accurate documentation. Limitations include procedural duration, interrater variability, patient discomfort, and restricted evaluation of high-frequency vestibular function. Conclusion: Despite its limitations, caloric reflex testing remains indispensable in neuro-otological diagnostics. Its ability to provide objective, quantifiable data supports clinical decision-making across diverse settings, from ambulatory care to intensive care units. Complementary vestibular assessments are recommended for comprehensive evaluation.

BackgroundUnilateral vestibulopathy (UVP) manifesting as episodic vestibular syndrome (EVS) is quite common in clinical practice. In recent years, post-contrast delayed three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) magnetic resonance imaging (MRI) has drawn increasing attention from clinicians owing to its effects in identifying the lesion site and speculating the possible mechanisms of UVP. This study aimed to investigate 3D-FLAIR MRI findings in patients with UVP manifesting as EVS, analyze their correlations with cochleovestibular function test results, determine the predictive factors for abnormal MRI findings in such patients, and explore the possible pathogenesis.MethodsA total of 134 patients with UVP presenting as EVS were included. Cochleovestibular function tests, including pure tone audiometry, caloric test, and video head impulse test (vHIT) were conducted. All patients underwent 3D-FLAIR MRI for evaluating endolymphatic hydrops (EH) and perilymphatic enhancement (PE). According to the MRI findings, patients were divided into MRI-negative (−), EH, PE, and EH + PE groups. The relationships between MRI findings and parameters of cochleovestibular function tests were analyzed. The predictive factors for abnormal MRI findings were determined.ResultsAmong the 134 patients with UVP included, 48.51% (65/134) had MRI-positive findings. The presence of EH, PE, and simultaneous presence of EH and PE were found in 21.64% (29/134), 17.16% (23/134), and 9.7% (13/13/4) of the patients, respectively. Compared with the MRI− group, the pure-tone average (PTA) was significantly higher in the EH (P=0.014) and EH + PE groups (P<0.05). The PE group had significantly higher canal paresis (CP) values than that in the MRI− (P<0.001), EH (P=0.003), and EH + PE groups (P<0.05), and significantly lower vHIT gain values than that in the MRI− (P=0.001), EH (P=0.001), and EH + PE groups (P<0.05). The proportion of patients with abnormal vHIT results was significantly higher in the PE group than that in the MRI− (P=0.001) and EH groups (P<0.001), which was also significantly higher in the EH + PE group than the EH group (P<0.05). The PE group had the highest prevalence of vascular risk factors (VRFs) (P<0.05). The CP value, PTA, and atherosclerotic VRFs were identified as significant and independent determinants for positive MRI findings.ConclusionsNearly half of the patients with UVP presenting with EVS had abnormal findings on 3D-FLAIR MRI, primarily showing vestibular EH and vestibular PE. Vestibular PE occurred more frequently in the acute phase of UVP, and was often accompanied by more severe vestibular function impairment. The presence of vestibular PE may be associated with ischemic and inflammatory mechanisms. The degree of vestibular EH was positively correlated with the severity of hearing impairment. CP value >49%, PTA >30 dB, and VRFs may help to predict abnormal MRI findings in UVP presenting with EVS.

IntroductionIn the early years following the development of the caloric test, one of the parameters used to quantify vestibular function was nystagmus duration. A common finding in patients with Meniere's disease (MD) is the presence of unilateral caloric weakness, despite normal results on the video head impulse test (vHIT). It has been proposed that the apparent caloric loss could be due to the creation of local flow facilitated by canal distention. If the nystagmus duration is linked to the hydrostatic effect, one could hypothesize that MD patients would demonstrate shorter slow-phase velocity (SPV) duration.ObjectiveThe aim of the study was to examine SPV and the duration of nystagmus following caloric testing in MD patients.Method24 participants (12 controls; 12 MD) were assessed using bithermal, bilateral caloric stimulation. To control for possible side differences, two subgroups were analyzed: MD-ipsilateral (affected ear); MD-contralateral (unaffected ears). Ears in the control group were side matched with ears in the MD groups and the terminology control-ipsilateral or control-contralateral was used to represent this matching.ResultsSignificant differences were observed for SPV between controls-contralateral and MD-ipsilateral ears (cold: p ≤ 0.001; warm: p = 0.02) and between controls-ipsilateral and MD-ipsilateral ears (cold: p ≤ 0.001; warm: p = 0.04). Significant SPV differences were observed between MD-contralateral and MD-ipsilateral ears (cold: p ≤ 0.001; warm: p = 0.03). However, no differences were found between groups in the duration of nystagmus following cold or warm irrigation (cold: p = 0.2; warm: p = 0.33).ConclusionResults support previous literature suggesting SPV can be affected in patients with MD even if vHIT gain is normal. However, mechanisms that influence the SPV seem to differ from those for the nystagmus duration. Indeed, nystagmus duration seems to remain unaffected in MD patients with vHIT-caloric dissociation, suggesting that it may be controlled by other factors.

Abstract Background The new coronavirus disease-2019 (COVID-19) mostly affects the respiratory system; other clinical observations and symptoms show that the digestive, hematological, cardiovascular, endocrine, and neurological systems are also affected. Neurological affection of COVID-19 involves both central and peripheral nervous systems, with symptoms such as dizziness, headaches, exhaustion, and loss of consciousness. Objectives To assess the long-term effects of COVID-19 on the vestibular system using videonystagmography (VNG). Methods The current study was a case–control study, which included 60 subjects; 30 subjects had a history of COVID-19 infection. They were examined at least 2 weeks and maximally 1 year following the onset of the infection. Thirty matched subjects with no history of COVID-19 infection for at least 1 year served as the control group. A full history, pure tone audiometry, and tympanometry were done for both groups. Both groups were tested using VNG, and the test battery included spontaneous nystagmus, gaze stabilization, static positional, Dix–Hallpike, oculomotor function (including saccade and smooth pursuit tests), and bithermal caloric tests. Results The VNG results revealed that the saccade velocity was significantly increased in the study group in comparison to the control group, while the saccade accuracy and latency showed no statistically significant difference. In the smooth pursuit test, the phase shift was significantly higher in the study group in the mid frequency region with no significant difference in both low and high frequencies. Findings from the Dix–Hallpike maneuver and positional test confirmed the diagnosis of benign paroxysmal positional vertigo (BPPV) in 6 out of the 30 cases (20%) included in the study. Conclusion The most prevalent vestibular symptom of COVID-19 in the current study was dizziness. BPPV was the most prevalent vestibular disorder in our cases, with the posterior semicircular canal being the most commonly affected. Our patients showed a significant increase in saccade velocity and smooth pursuit phase shift.