Glycerol Test Research Articles

Diagnosis dan Penatalaksanaan Penyakit Meniere

ABSTRACT
 Background: Meniere's disease is the third leading cause of vertigo after Benign Paroxysmal Positional Vertigo and vestibular neuritis. Meniere's disease is also known as endolymphatic hydrops. Acute symptoms of Meniere's disease are characterized by triad of vertigo, tinnitus and hearing loss. This disease is a challenge for ENT specialist in making a diagnosis and determining the right and optimal management. Objective: Provides knowledge about the diagnosis and management of Meniere's disease, so that it can be handled appropriately. Literature Review: Meniere's disease is an inner ear disorder characterized by spontaneous vertigo attacks, fluctuating low-tone sensorineural hearing loss, aural fullness and tinnitus. The most consistent finding and still being used as the basic mechanism of Meniere's disease to date is the discovery of endolymphatic hydrops. Diagnostic tests to diagnose Meniere's disease include audiometry, glycerol test, caloric test and electrocochleography. Meniere's disease can significantly affect quality of life and generally managed with dietary modifications such as a low-salt diet, medical therapy such as diuretics and surgery such as intratimpani injection and endolymphatic sac surgery. Conclusion: Meniere's disease is characterized by a triad of vertigo symptoms, low-tone sensorineural hearing loss and tinnitus. Making the diagnosis requires a detailed history with a complete audiology and vestibular examination. The management of Meniere's disease consists of dietary modifications, medical therapy and surgery.
 Keywords: meniere’s disease, endolymphatic hydrops, diuretics, intratimpani injection, endolymphatic sac surgery

Colloidal synthesis of phospholipid-copper nanoclusters as active catalysts for the oxidative degradation of water tracer fluorescent molecule

At present the performance of biocompatible metal nanoparticles-driven degradation in solution phase reaction processes are keep on challenging and limited by the lack of common tools to understand. Soy lecithin (SL)–copper oxide nanosuspension (nSLC) was synthesized as an effective homogeneous catalyst for the sonochemical oxidative degradation of rhodamine B (RB) as a model pollutant. SL is known as phosphatidylcholine which is the zwitterionic form of phospholipids that comprise hydrophilic head groups and two tailored hydrophobic groups, assisted in the synthesis of stabilized nanoparticles (NPs); they possibly control the particle growth and stability of the NPs. The nSLC was synthesized by a simple reaction between SL and copper salt, reduction, and purification through simple dialysis. The physicochemical characterizations such as XRD, SEM-EDX, TEM, ATR-FTIR, ZP, DLS and UV–vis spectrophotometry confirmed the formation of nano-lecithin–copper oxides (Cu2O and CuO;<100 nm) with spherical and tailored shapes. The nSLC remained stable for one month and exhibited an excellent catalytic ability for the sonochemical degradation of RB. The stability of nSLC arises from the functional groups of SL that have electron buffering capacity. Various analytical parameters for the degradation of RB were optimized, and complete RB degradation was achieved (>99%) in 5.5 h using H2O2 (100 µL) at pH between 4 and 7. The surface charge of the nSLC and the structure of RB are influenced by pH, which is controlling the degradation pathway. The kinetics of the sonochemical RB degradation fit the first-order kinetic model well with a high r2. The glycerol test confirmed that RB degradation was purely assisted by •OH. The nSLC synthesis and its catalytic application make it a promising environmental catalyst to treat similar organic pollutants and open a new platform for the further development of SL metal-based functional NPs.

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.

Оценка зависимости скорости лизиса эритроцитов от количества микросфероцитов при наследственном сфероцитозе

INTRODUCTION: Hereditary spherocytosis (HS) is a disease, which belongs to congenital membranopathies and runs with hemolytic anemia of different severity. In patients with HS, morphologically transformed erythrocytes — microspherocytes — appear in blood in different quantities. Erythrocyte lysis rates in patients with HS are significantly higher than in individuals with no hematologic diseases in history, however, there are no studies demonstrating the relationship between the amount of microspherocytes and erythrocyte lysis rates. AIM: Was to establish correlation between erythrocyte lysis rates and the amount of microspherocytes in patients with HS. MATERIALS AND MATERIALS: Study material was venous blood of 15 patients with HS (the main group) and of 14 “healthy” individuals (control group). Venous blood was taken into test tubes with K3EDTA as an anticoagulant for calculation of morphometric parameters of erythrocytes, and into test tubes with Li-heparin for determination of erythrocyte lysis rates. Morphometric parameters of erythrocytes were calculated using VideoTesT-Morphologia hardware and software complex. For each erythrocyte, average surface area, average diameter, thickness and sphericity index were determined Erythrocyte lysis rate was determined with use of glycerol reagent (glycerol test) on Vitalon-400 semi-automatic biochemical analyzer, and was assessed by reduction of optical density of the incubation medium and expressed as the difference between the initial and final optical densities multiplied by 1 000 (standard units). Statistic data processing was carried out using parametric and non-parametric statistical methods, and Spearman correlation analysis was performed by Spearman method using Sigma-Plot 11.0 software. RESULTS: Erythrocyte lysis in glycerol test occurred faster in patients with HS than in “healthy” persons due to instability of membrane of microspherocytes which make a significant proportion of erythrocytes in peripheral blood of patients with HS. CONCLUSIONS: A proportional dependence was established between the amount of microspherocytes and increase in the rate of erythrocyte lysis, which indicates their instability typical of HS. This dependence permits to use the automated glycerol test with graphic record of erythrocyte lysis rate for detection of microspherocytes in blood of patients with HS, when morphometric hardware and software complex is not available in clinical diagnostic laboratories.

Delayed diagnosis of complex glycerol kinase deficiency in a Chinese male infant: a case report

BackgroundXp21 contiguous gene deletion syndrome is a rare genetic metabolic disorder with poor prognosis in infants, involving deletions of one or more genes in Xp21. When deletions of adrenal hypoplasia (AHC), Duchenne muscular dystrophy (DMD), and chronic granulomatosis (CGD) loci are included, complex glycerol kinase deficiency (CGKD) can be diagnosed. We present a case of CGKD that was initially misdiagnosed and died during treatment in our hospital in terms of improving our understanding of the clinical features and diagnosis of this disease, as well as highlighting the need for more precise dosing of corticosteroid replacement therapy.Case presentationA 48-day-old full-term male infant was transferred to our medical center with global growth delay and persistent vomiting. Routine laboratory tests revealed hyperkalemia, hyponatremia, and a high level of creatine kinase. The initial diagnosis was adrenal cortical hyperplasia (ACH), then revised to adrenocortical insufficiency with a normal level of ACTH detected. After supplementing the routine lipid test and urinary glycerol test, CGKD was diagnosed clinically due to positive triglyceridemia and urinary glycerol, and the follow-up gene screening further confirmed the diagnosis. The boy kept thriving after corticosteroid replacement and salt supplementation. While levels of serum ACTH and cortisol decreased and remained low after corticosteroid replacement was administered. The patient died of acute type 2 respiratory failure and hypoglycemia after an acute upper respiratory tract infection, which may be the result of adrenal crisis after infection. Infants with CGKD have a poor prognosis, so physicians should administer regular follow-ups, and parents counseling during treatment to improve the survival of patients.ConclusionsOverall, CGKD, although rare, cannot be easily excluded in children with persistent vomiting. Extensive blood tests can help to detect abnormal indicators. Adrenal crisis needs to be avoided as much as possible during corticosteroid replacement therapy.

Comparison between 3D-FLAIR and 3D-real IR MRI sequences with visual classification method in the imaging of endolymphatic hydrops in Meniere's disease

BackgroundClinically, the evidence of endolymphatic hydrops (EH) in Meniere's disease (MD) primarily relies on audiological examinations, such as glycerol tests and electrocochleography, to suggest the presence of EH indirectly. However, these techniques lack sensitivity and specificity, and they do not sufficiently assess the degree of EH. This study aims to explore the application of three-dimensional fluid-attenuated inversion recovery (3D-FLAIR) and three-dimensional real inversion recovery (3D-real IR) sequence imaging of EH in MD and to assess the image quality and grading of EH. MethodsThe study included 50 patients with definite MD. The 3D-FLAIR and 3D-real IR sequence images were performed 24 h after bilateral intratympanic injection of gadolinium. The image quality of both sequences was reviewed by two experienced radiologists. The vestibular and cochlear EH grades of both sequences were reviewed by two experienced otologists using a visual grading method. The Cohen's kappa and Pearson tests were used to analyze the data. ResultsThe reliability of image quality between the two radiologists was excellent (0.7 < kappa < 0.9). There were significant statistical differences in the image quality between the 3D-real IR and 3D-FLAIR sequences (p = 0.023 and p = 0.035, respectively). The reliability for the grading of vestibular and cochlear EH between the two otologists was excellent (0.7 < kappa < 0.9). The 3D-real IR sequence detected more severe hydrops than did the 3D-FLAIR sequence (p < 05). ConclusionThe image quality of the 3D-real IR sequence is better than that of the 3D-FLAIR sequence, and there are differences in the vestibular and cochlear EH grades of both sequences. The sensitivity of the 3D-real IR sequence in the cochlea is higher. The method of visual grading can be applied to both technologies when combined with 3D-real IR.

A Method for Solving Percolation Overflow Boundary Based on Maximum of Horizontal Energy Loss Rate

The determination of overflow boundary is a prerequisite for the accurate solution of the seepage field by the finite element method. In this paper, a method for solving overflow boundary according to the maximum value of horizontal energy loss rate is proposed, which based on the analysis of the physical meaning of functional and the water head distribution of seepage field under different overflow boundaries. This method considers that the overflow boundary that makes the horizontal energy loss rate reach the maximum value is the real boundary overflow. Compared with the previous iterative computation method of overflow point and free surface, the method of solving overflow boundary based on the maximum horizontal energy loss rate does not need iteration, so the problem of non-convergence does not exist. The relative error of the overflow points is only 1.54% and 0.98% by calculating the two-dimensional model of the glycerol test and the three-dimensional model of the electric stimulation test, respectively. Compared with the overflow boundary calculated by the node virtual flow method, improved cut-off negative pressure method, initial flow method, and improved discarding element method, this method has a higher accuracy.

UNILATERAL PROFOUND DEAFNESS – A POSSIBLE MECHANISM

Purpose: To explain the clinical findings of patients with profound unilateral deafness who have recovered the hearing function after a combined treatment of hyperbaric oxygenation and dehydrant therapy. Material and method: 11 patients with profound sudden unilateral hearing loss above 90 dB SPL, intolerance to sounds similar to recruitment, at levels 10-20 dB above the hearing threshold (105-120 dB SPL), positive glycerol test and unexpected good recovery of hearing within 1-2 months are described. Results: All patients have perfect outcome results without the use of glucocorticoids. Conclusions: Based on articles about experiments with genetically modified animals and acquired deafness, we propose a possible mechanism of damage explaining the clinical findings and the favorable outcome of the disease – a disconnection between the tectorial membrane and stereocilia. Thus mechano-electrical transducer (MET) of hair cells cannot be activated. The combined use of hyperbaric oxygenation and dehydrant medications can lead to recovery of the hearing function.

Bioethanol production from pretreated palm empty fruit bunch (PEFB) using sequential enzymatic hydrolysis and yeast fermentation

This study investigated the effectiveness of steam pretreatment using distilled water or waste glycerol as solvents to produce soluble sugars via enzymatic hydrolysis of palm empty fruit bunch (PEFB). Subsequently, two yeast species (S. cerevisiae and P. stipitis) were introduced to stimulate the fermentation of the soluble sugars to ethanol. The fermentable sugar (glucose plus xylose) concentration generated during hydrolysis of pretreated PEFB was found to be mainly a function of the pretreatment conditions (i.e. type of solvent, liquid-phase pH, and reaction time) as well as the hydrolysis time. Glucose was the major component of fermentable sugar in all tests; while the xylose content fluctuated from 3 to over 40% of that of glucose, with the higher percentages obtained at the shortest pretreatment time. The use of alkaline waste glycerol (pH 11) as a solvent during pretreatment resulted in optimum hydrolysis with a mean fermentable sugar concentration of 51.5 ± 4.1 g/L, while the corresponding mean value of the waste glycerol tests (pH 8.3) was 35.3 ± 4.9 g/L. Regarding fermentation, alkaline waste glycerol pretreatment enhanced ethanol production by over 50% compared to distilled water. It was also observed that fermentation using a S. cerevisiae monoculture was more effective than that of an equivalent co-culture.

Comparison of Glycerol Test, ECochG and VEMP Findings in Patients with Meniere's Disease.

Present study aimed to find if multiple audio-vestibular tests can be used to improve in diagnosing Meniere's disease. The study compares the results of four test procedures of glycerol test, Electrocochleography (ECochG), cervical Vestibular Evoked Myogenic Potential (c-VEMP) and ocular Vestibular Evoked Myogenic Potential (o-VEMP) individually and also together to see whether the diagnosis of Meniere's disease can be improved. Experimental group consist of 16 participants (32 ears) diagnosed with Meniere's disease as per American Academy of Otolaryngology (AAO) -Head and Neck Foundation (2020) guidelines. Control group consist of 16 participants with compliant of only vertigo participated in the study. Participants in both group underwent glycerol test, Electrocochleography (ECochG), cervical Vestibular Evoked Myogenic Potential (c-VEMP) and ocular Vestibular Evoked Myogenic Potential (o-VEMP). Glycerol test showed a 38% positive rate for the presence of Meniere's disease. ECochG indicated the presence of endolymphatic hydrops in 62% of the participants. Abnormal finding in c-VEMP and o-VEMP was seen in 31% and 56% of the participants respectively. The combination of two tests such as ECochG and o-VEMP has increased the positive rate upto 87%. Adding one more test of c-VEMP or combining all four audiovestibular tests had a positive rate of 94% only. The present study indicated ECochG is a more sensitive tool in the diagnosis of Meniere disease followed by o-VEMP. Thus, the present study indicated that combination ECochG and o-VEMP could be used to find the presence of Meniere's disease successfully.

Vestibulo-ocular reflex tests may reflect unilateral Ménière disease progression: A cross-sectional study.

Vestibular disorders can manifest several patterns of horizontal vestibulo-ocular reflex (VOR) impairment, which can be detected by caloric test and video head impulse test (vHIT). Several studies have examined the patterns of caloric-vHIT response in Ménière disease (MD). The purpose of this study was to investigate the diversity of caloric-vHIT response and its related factors in unilateral MD patients. We also explore the possibility of assessing the progression of unilateral MD by using the horizontal VOR tests.Ninety-eight patients with unilateral MD were enrolled and underwent a battery of audio-vestibular evaluations, including the pure tone audiogram, caloric test, and horizontal vHIT. Some patients received the electrocochleography and glycerol test. The combined results of caloric test and horizontal vHIT were categorized qualitatively into 4 patterns: Pattern I: normal caloric and vHIT responses; Pattern II: abnormal caloric and normal vHIT responses; Pattern III: normal caloric and abnormal vHIT response; and Pattern IV: abnormal caloric and vHIT responses. The abnormal caloric results were semi-quantitatively subdivided into sub-patterns as mild, moderate, and severe abnormality. The associations between these patterns/sub-patterns and related factors were analyzed.Pattern I was found in 35 cases (35.7%), Pattern II in 57 (58.2%), and Pattern IV in 6 (6.1%). No patient had Pattern III. No significant differences were found between the patterns/sub-pattern distribution and age, electrocochleography, and glycerol test results. Disease duration was not associated with the pattern distribution, while remained a relation with sub-pattern distribution. The pattern/sub-pattern distribution varied significantly across MD stages. The proportion of pattern II or pattern IV increased with the stage of unilateral MD.MD can manifest several patterns of horizontal VOR impairment, of which the impaired caloric response with normal vHIT is the most common pattern. With the progression of unilateral MD, the caloric-vHIT pattern tends to shift, which may reflect the deterioration of endolymphatic hydrops and vestibular hair cells impairments.

Features of Manifestation of Optokinetic Nystagmus in Meniere’S Disease

The characteristics of optokinetic nystagmus (O?N) were studied in 20 healthy individuals and 30 individualssuffering from Meniere’s disease in remission. The results recorded by the method of electronystagmographyat frequency optokinetic stimulation 66,90 156 and field/min. found that in healthy people, the frequencyof IPOs, the total amplitude and the speed of the slow phase(sp) nystagmus increases proportional to theincrease in the frequency optokinetic stimulation; accordingly, consistently reduced the average amplitudewindow. In Meniere’s disease, O?N indicators are generally characterized by lower values than normal,and an increase in the frequency of optokinetic stimulation is accompanied not only by a more pronounceddecrease in the total amplitude indicators, but also by a decrease in the speed of the slow phase of O?N.After the glycerol load and with positive results of the glycerol test, the quantitative indicators of O?Nincrease in patients, approaching the physiological norm. It is concluded that it is appropriate to study theO?N in Meniere’s disease to clarify the stage of the disease and predict the effectiveness of treatment.

Comparison of the video head impulse test results with caloric test in patients with Meniere’s disease and other vestibular disorders

Background: The caloric test has been used to evaluate the semi-circular canal function for decades. In 2009, the video head impulse test (vHIT) was introduced, which can be used to evaluate the semi-circular canal function within a short time. Although both tests examine the semi-circular canal, the stimulation methods differ and it is unclear whether the vHIT is equivocal to the caloric test.Aims/objectives: This study aimed to discern the differences between the vHIT and caloric test.Material and methods: This study comprised 112 patients with vertigo who visited the vertigo/dizziness centre at our university hospital. Each of these patients underwent a caloric test and vHIT within the same day, and their results were compared. Additionally, an electrocochleography (EcoG) examination, glycerol test (G test), and MRI (performed 4 h after an intravenous gadolinium injection) were conducted to evaluate the influence of endolymphatic hydrops (EH) on the caloric test and vHIT results.Results: Differences in the caloric test and vHIT results, among those with and without EH, were observed in 66.7 and 35.3% of patients, respectively.Conclusions and significance: EH resulted in a difference in results between the caloric test and vHIT. Activated hair cell type may also be implicated.

Contrast-Enhanced MRI Combined With the Glycerol Test Reveals the Heterogeneous Dynamics of Endolymphatic Hydrops in Patients With Menière's Disease.

The sensitivity of endolymphatic hydrops (EH) to the glycerol test varies in patients with Menière's disease (MD). To explore the features of EH and its glycerol-induced dynamics in MD. Case-control study. Twenty patients with MD (24 affected ears) were included. 3.0T 3D-FLAIR (fluid-attenuated inversion recovery) MRI and late gadolinium enhancement. Intratympanic gadolinium-enhanced MRI was performed in the MD-affected ears before and after the glycerol test. The borders of the endolymphatic and total lymphatic space were contoured on the axial MRI slices to evaluate the volume of hydrops in both the cochlear and vestibular regions. Paired and unpaired t-tests, the Mann-Whitney U-test, linear discriminant analysis, Pearson's correlation, and linear regression. After glycerol ingestion, vestibular EH decreased in all patients, whereas cochlear EH significantly decreased only in patients with positive glycerol test results (all P < 0.01). At baseline, cochlear EH in the positive result group was greater than in the negative result group (P = 0.007). Unexpectedly, in the positive result group a drastic glycerol-induced dehydrating effect was observed in patients whose pretest cochlear EH ratio was >16% (P = 0.011). Moreover, the dehydrating role of glycerol was positively correlated with the baseline cochlear hydrops level (r = 0.7691, P < 0.001). MRI provides evidence that glycerol administration improves the hearing threshold via dehydrating the EH. In the cochlear region, the baseline level of cochlear EH is a closely related factor for the validity of the glycerol test, whereas EH is consistently dehydrated in the vestibular component. 2 TECHNICAL EFFICACY STAGE: 3 J. Magn. Reson. Imaging 2020;52:1066-1073.

Effects of Glycerol Test on Resonance Frequency in Patients with Ménière’s Disease

Objective: To evaluate resonance frequency (RF) values via dehydration effects in the inner ear caused by the glycerol test, which is used as a diagnostic method for Ménière’s disease (MD). Methods: Twenty adult patients with unilateral MD were included in the study. Before, and then at 1, 2, and 3 h after administration of glycerol (1 g/kg), pure-tone hearing levels (125–8,000 kHz) and multifrequency tympanometry tests were performed. As a control, the RF values of the ears of 25 healthy subjects (i.e., 50 ears) were compared to the affected and unaffected ears in the 20 MD patients. Results: There was a significant difference between the RF values of affected and healthy ears before glycerol administration (p = 0.047). The RF values before and after glycerol administration into affected ears were compared. The average RF values decreased significantly from 748.0 ± 402.1 to 808.0 ± 410.1 Hz at 1 h after glycerol intake, and this value increased during the subsequent hours. There were no statistically significant differences between the pure-tone levels before and 1 h after glycerol administration, but a significant decrease was observed at 3 h. Conclusion: We suggest that MD has different inner-ear dynamics and normal RF values when compared to healthy ears. Furthermore, decreased inner ear pressure causes reduction of the mass effect and a stiffening of the annular ligament. We conclude that pre- and post-RF tests should be added to the test battery for diagnosis of MD.

Influence of the Processing Method on the Properties of Ti-23 at.% Mo Alloy

In this paper, binary β type Ti-23 at.% Mo alloys were obtained by arc melting as well as by mechanical alloying and powder metallurgical process with cold powder compaction and sintering or, interchangeably, hot pressing. The influence of the synthesis method on the microstructure and properties of bulk alloys were studied. The produced materials were characterized by an X-ray diffraction technique, scanning electron microscopy and chemical composition determination. Young’s modulus was evaluated with nanoindentation testing method based on the Oliver and Pharr approach. The mechanically alloyed Ti-23 at.% Mo powders, after inductively hot-pressed at 800 °C for 5 min, allowed the formation of single Ti(β) phase alloy. In this case, Young’s modulus and Vickers hardness were 127 GPa and 454 HV0.3, respectively. Among the examined materials, the porous (55%) single-phase scaffold showed the lowest indentation modulus (69.5 GPa). Analytical approach performed in this work focuses also on the surface properties. The estimation includes the corrosion resistance analyzed in the potentiodynamic test, and also some wettability properties as a contact angle, and surface free energy values measured in glycerol and diiodomethane testing fluids. Additionally, surface modification of processed material by micro-arc oxidation and electrophoretic deposition on the chosen samples was investigated. Proposed procedures led to the formation of apatite and fluorapatite layers, which influence both the corrosion resistance and surface wetting properties in comparison to unmodified samples. The realized research shows that a single-phase ultrafine-grained Ti-23 at.% Mo alloy for medical implant applications can be synthesized at a temperature lower than the transition point by the application of hot pressing of mechanically alloyed powders. The material processing, that includes starting powder preparation, bulk alloy transformation, and additional surface treatment functionalization, affect final properties by the obtained phase composition and internal structure.

The prognostic value of glycerol test of electrocochleography on the effects of endolymphatic sac decompression surgery in patients with unilateral Meniere's disease

Objective:To determine whether the preoperative results of glycerol test of electrocochleography and hearing stage have a prognostic value on the effects of endolymphatic sac decompression surgery in patients with unilateral Meniere's disease. Method:A retrospective study was conducted of 58 unilateral Meniere's disease patients who underwent endolymphatic sac decompression surgery. The correlation between the preoperative results of glycerol test of electrocochleography， hearing stage and vertigo control was analyzed by Kendall test. Result:Patients in the positive glycerol test of electrocochleography group had better vertigo control after the decompression of the lymphatic sac than the negative group(P=0.029). Preoperative hearing staging was significantly associated with vertigo control after endolymphatic sac decompression(P=0.028). The better the preoperative hearing, the higher the control rate of vertigo after endolymphatic sac decompression. The stage Ⅰ patients were 91.7%, the stage Ⅱ patients were 78.1%, and the third stage Ⅲ patients were 57.1%, respectively. Conclusion:Our findings suggested that the positive preoperative results of glycerol test of electrocochleography and better hearing stage may indicate a better effects of endolymphatic sac decompression surgery in patients with unilateral Meniere's disease.

Ménière’s disease with unremitting floating sensation is associated with canal paresis, gravity-sensitive dysfunction, mental illness, and bilaterality

ObjectiveThe aim of the present study was to evaluate the association of neuro-otological examination, blood tests, and scoring questionnaire data with treatment-resistant intractability of persistent dizziness in Ménière’s disease. MethodsWe managed 1520 successive vertigo/dizziness patients at the Vertigo/Dizziness Center in Nara Medical University from May 2014 to April 2018. Five hundred and twenty-two patients were diagnosed with Ménière’s disease (522/1520; 34.3%) according to the 2015 diagnostic guideline of the International Classification of Vestibular Disorders. Among the patients with Ménière’s disease there were 102 with intractable rotatory vertigo attacks for more than 3–6 months (102/522; 19.5%), including 20 bilateral cases (20/102; 19.6%), and 88 with intractable unremitting floating sensation rather than rotatory vertigo attacks for more than 3–6 months (88/522; 16.9%), including 28 bilateral cases (28/88; 31.8%). Sixty out of 88 cases with intractable unremitting floating sensation were unilateral and were enrolled for hospitalization to undergo neuro-otological examinations including pure-tone audiometry (PTA), the caloric test (C-test), vestibular evoked cervical myogenic potentials (cVEMP), subjective visual vertical (SVV) test, glycerol test (G-test), electrocochleogram (ECoG), inner ear magnetic resonance imaging (ieMRI), blood tests including anti-diuretic hormone (ADH) and bone alkaline phosphatase (BAP), and self-rating questionnaires of depression score (SDS). Data are presented as positive (+) ratios of the number of patients with examination and questionnaire data outside of the normal range. ResultsThe ratios (+) were as follows: C-test=33.3% (20/60), cVEMP=25.0% (15/60), SVV=50.0% (30/60), G-test=55.0% (33/60), ECoG=63.3% (38/60), ieMRI=86.7% (52/60), ADH=35.0% (21/60), BAP=11.7% (7/60), and SDS=40.0% (24/60). Multivariate regression analysis revealed that the periods of persistent dizziness were significantly longer in unilateral Ménière’s patients with C-test(+), SVV(+), and SDS(+) compared with those with negative findings. Additionally, the periods in bilateral cases were significantly longer than those in unilateral ones. ConclusionsAlthough approximately 70% of patients with Ménière’s disease are usually treatable through the appropriate conservative medical therapy, the presence of canal paresis, gravity-sensitive dysfunction, neurosis/depression, and bilaterality may make the persistent dizziness intractable and may thus require additional treatments.

Idiopathic benign paroxysmal positional vertigo with persistent vertigo/dizziness sensation is associated with latent canal paresis, endolymphatic hydrops, and osteoporosis

ObjectiveThe aim of the present study was to examine the association of neuro-otological examination, blood test, and scoring questionnaire data with treatment-resistant intractability in idiopathic benign paroxysmal positional vertigo (BPPV) patients. MethodsWe experienced 1520 successive vertigo/dizziness patients at the Vertigo/Dizziness Center in Nara Medical University during May 2014 to April 2018. Six hundred and eleven patients were diagnosed as BPPV (611/1520; 40.2%) according to the diagnostic guideline of the International Classification of Vestibular Disorder in 2015. Among BPPV patients, there were 201 intractable patients (201/611; 32.9%), 66 of whom were idiopathic and enrolled to be hospitalized and receive neuro-otological examinations, including the caloric test (C-test), vestibular evoked cervical myogenic potentials (cVEMP), subjective visual vertical (SVV), glycerol test (G-test), electrocochleogram (ECoG), inner ear magnetic resonance imaging (ieMRI), blood tests including anti-diuretic hormone (ADH) and bone alkaline phosphatase (BAP), and self-rating questionnaires of depression score (SDS). Sixty-six patients were diagnosed as horizontal type cupula (hBPPVcu; n=30), horizontal type canal (hBPPVca; n=10), posterior type (n=20), and probable and/or atypical BPPV (n=6). Data are presented as ratios (+) of the number of idiopathic BPPV patients with examination and questionnaire data outside of the normal range. ResultsThe ratio (+) data were as follows: C-test=21.2% (14/66), cVEMP=24.2% (16/66), SVV=48.5% (32/66), G-test=18.2% (12/66), ECoG=18.2% (12/66), ieMRI=12.1% (8/66), ADH=9.1% (6/66), BAP=13.6% (9/66), and SDS=37.9% (25/66). Multivariate regression analysis revealed that the periods of persistent vertigo/dizziness were significantly longer in BPPV patients with hBPPVcu, C-test (+), endolymphatic hydrops (+), and BAP (+) compared with those with negative findings. ConclusionAlthough patients with idiopathic BPPV are usually treatable and curable within 1 month, the presence of hBPPVcu, canal paresis, endolymphatic hydrops, and elevated BAP may make the disease intractable, and thus require additional treatments.

Role of Cervical Vestibular Evoked Myogenic Potentials (cVEMP) as Outcome-Measure of Glycerol Test.

Diagnosis of Meniere's disease is mainly clinical although many tests have been studied for efficacy in diagnosis of Meniere's disease. Glycerol test is a functional test to identify hydrops in Meniere's disease and can be done with PTA, Speech audiometry, otoacoustic emission, EcochG and cVEMP as its outcome measures. The study aimed to compare two outcome measures of glycerol test to identify Meniere's disease; to determine whether the stage of Meniere's disease affected glycerol outcomes; and to attempt to identify independent variables that could predict outcomes of glycerol test. 26 ears of 20 Meniere's disease participants were evaluated using PTA-based and cVEMP-based glycerol tests. Each test identified ten of 26 ears with Meniere's disease; and high agreement was noted in the two outcome measures. The stage of Meniere's disease based on fourfrequency hearing threshold average was not associated with outcome of glycerol test, but staging of Meniere's disease based on symptom duration was associated with glycerol test results. As the duration of symptoms increased there was lesser chance of positive outcomes on glycerol test; but intermediate stages of Meniere's disease showed positive outcomes. Variables such as age, gender, severity of hearing loss, duration of symptoms and pre-glycerol cVEMP measurements could not predict glycerol test outcomes. PTA-based and cVEMP- based glycerol tests hold promise in the test battery for identification of Meniere's disease. Positive findings on the test lead to confirmatory diagnosis but a negative glycerol test does not rule out Meniere's disease.