Presence Of Vestibular Symptoms Research Articles

The Natural History of Primary Inner Ear Schwannomas: Outcomes of Long-Term Follow-Up.

To describe the natural history of primary inner ear schwannomas over a long follow-up period. Retrospective case series. Tertiary referral center. Patients with primary inner ear schwannomas with serial audiometric and radiologic follow-up. Patterns of hearing loss, rate of hearing decline, presence of vestibular symptoms, and rate of tumor growth. A total of 12 patients with 13 tumors were identified. The mean duration of follow-up was 7 years. Forty-six percent of tumors were intracochlear, 15% were intravestibular, 23% were transmodiolar, and 15% were intravestibular-cochlear. Hearing loss was the most common presenting symptom, occurring in all patients. Among patients with serviceable hearing (American Academy of Otolaryngology-Head and Neck Surgery Class A or B) at the time of presentation, the average time to decline to a nonserviceable hearing level was 57.3 months (range, 21-117 mo). Hearing loss was sudden in 31% of patients, progressive in 61% and fluctuating in 8%. No patients had intractable vertigo; however, two required vestibular physiotherapy. On initial magnetic resonance imaging, the mean largest tumor dimension was 3.1 mm (standard deviation, 1.2 mm), and the mean largest dimension on most recent magnetic resonance imaging was 4.4 mm (standard deviation, 1.1 mm). Two tumors exhibited no growth over a follow-up of 11.3 and 2.8 years, respectively. Overall, the mean growth was 0.25 mm per year followed. Two patients underwent cochlear implantation with simultaneous tumor resection and had favorable outcomes. Long-term follow-up suggests a conservative approach, with possible hearing rehabilitation at the time of deterioration, is a safe management strategy for primary inner ear schwannomas.

Vestibular dysfunction after cochlear and auditory brainstem implantation: Madras ENT Research Foundation experience

<p><strong>Background:</strong> Cochlear implantation is an established procedure for patients with bilateral severe to profound sensorineural hearing loss. CI may, in some implantees, have a detrimental impact on vestibular function. Auditory brainstem implantation is a safe and effective procedure in children with bilateral cochlear and cochlear nerve aplasia. The aim of the study was to assess the impact of cochlear implantation and auditory brainstem implantation on the vestibular function.</p><p><strong>Methods:</strong> Three hundred and twenty patients who underwent CI surgery over a four years period from November 2016 to November 2020 were studied for symptoms of vestibular disturbance. Twenty three patients complained of giddiness and underwent vestibular function testing including videooculography, caloric test and vestibular evoked myogenic potentials. 48 patients with cochlear and cochlear nerve aplasia underwent ABI surgery from September 2009 to March 2019. The correlation between the size of the flocculus and the presence of vestibular symptoms was studied.</p><p><strong>Results: </strong>After CI, vestibular disturbances were seen in 23 patients (7.2%) and were transient. In auditory brainstem implantees, vestibular disturbances were seen in eight patients (16.7%) and were found to correlate with the size of the cerebellar flocculus.<strong></strong></p><p><strong>Conclusions: </strong>Vestibular disturbances are rare after cochlear and auditory brainstem implant surgery. During CI, the preservation of vestibular function should be attempted using minimally invasive techniques. ABI surgery requires meticulous dissection, especially of a large cerebellar flocculus to minimize the possibility of vestibular disturbances.<strong></strong></p>

Subdiagnosis, but not presence of vestibular symptoms, predicts balance impairment in migraine patients \u2013 a cross sectional study

BackgroundVestibular symptoms and balance changes are common in patients with migraine, especially in the ones with aura and chronic migraine. However, it is not known if the balance changes are determined by the presence of vestibular symptoms or migraine subdiagnosis. Therefore, the aim of this study was to verify if the migraine subdiagnosis and/or the presence of vestibular symptoms can predict balance dysfunction in migraineurs.MethodsThe study included 49 women diagnosed with migraine with aura, 53 without aura, 51 with chronic migraine, and 54 headache-free women. All participants answered a structured questionnaire regarding migraine features and presence of vestibular symptoms, such as dizziness/vertigo. The participants performed the Modified Sensory Organization Test on an AMTI© force plate. The data were analysed using a linear mixed-effect regression model.ResultsThe presence of vestibular symptoms did not predict postural sway, but the subdiagnosis was a significant predictor of postural sway. Migraine with aura patients exhibited more sway than migraine patients without aura when the surface was unstable. Additionally, we found high effect sizes (ES > 0.79) for postural sway differences between patients with chronic migraine or with aura compared to controls or migraine without aura, suggesting that these results are clinically relevant.ConclusionsThe subdiagnosis of migraine, instead of the presence of vestibular symptoms, can predict postural control impairments observed in migraineurs. This lends support to the notion that balance instability is related to the presence of aura and migraine chronicity, and that it should be considered even in patients without vestibular symptoms.

Evaluation of vestibular symptoms and postural balance control in patients with chronic otitis media.

Evidence to support potential links between chronic otitis media (COM) and vestibular impairment/postural balance control issues is lacking. To investigate whether COM associates with vestibular symptoms, balance problems, and abnormalities in vestibular function tests. We selected 126 patients with COM and excluded patients with any identifiable underlying causes for vestibular dysfunction. Fifty-two healthy volunteers were included as controls. All subjects underwent anamnesis, physical examination, posturography, and video-head impulse tests. We found a high prevalence of vestibular symptoms (58.4%) among patients with COM, while only 2% of the controls had vestibular symptoms. There was a positive correlation between COM activity with the presence of tinnitus and vestibular symptoms (P < 0.05). Clinical vestibular tests were abnormal in 63% of patients with COM, and those positively associated with presence of vestibular symptoms. Posturography results shown worse postural balance control in patients with COM as compared with controls, especially in the limit of stability (LOS) (Mean LOS, COM = 157.56 cm2; controls = 228.98 cm2; p < 0.001) and worse results in the test with eyes closed while standing on a foam mattress (sway area, COM = 10.91 cm2; controls = 5.90 cm2; p < 0.001) in patients with COM as compared with controls. We did not observe differences in the average vestibuloocular reflex gains in the video-head impulse test between our COM and control groups. Our results show that COM associates with higher prevalence of vestibular symptoms and abnormalities in clinical vestibular function tests, and worse postural control as compared with controls. Among patients with COM, the activity of the middle-ear inflammation seemed to positively associate with the severity of hearing and balance problems.

Presence of vestibular symptoms and related disability in migraine with and without aura and chronic migraine.

To assess the presence and handicap due to vestibular symptoms in three subgroups of patients with migraine and controls. Women between 18-55 years old were diagnosed by headache specialists and stratified as migraine with aura (n = 60), migraine without aura (n = 60), chronic migraine (n = 60) and controls (n = 60). Information regarding demographics, headache and vestibular symptoms were collected in this cross-sectional study. The self-perceived handicap related to vestibular symptoms was assessed through the Dizziness Handicap Inventory questionnaire. A total of 85% of women with migraine with aura and chronic migraine had vestibular symptoms contrasted to 70% of the migraine without aura group ( p < 0.05), and 12% of the control group reported symptoms ( p < 0.0001). Patients with migraine exhibited greater Dizziness Handicap Inventory scores than controls ( p < 0.001); and migraine with aura and chronic migraine groups reached greater scores than migraine without aura ( p < 0.01). Presence of migraine is associated with a greater risk of vestibular symptoms (migraine without aura: 5.20, migraine with aura: 6.60, chronic migraine:6.20, p < 0.0003) and with a greater risk of moderate-to-severe handicap (migraine without aura: 20.0, migraine with aura: 40.0, chronic migraine: 40.0, p < 0.0003). The presence of aura and greater migraine frequency adds to the risk of any handicap (migraine with aura: 1.9, chronic migraine: 1.7, p < 0.04) and to the risk of moderate-to-severe handicap (migraine with aura: 2.0, chronic migraine: 2.0, p < 0.0003). Migraine aura, intensity and frequency predict 36% of the dizziness handicap. The prevalence of vestibular symptoms is increased in migraine during and between headache attacks, particularly in migraine with aura and chronic migraine along with an increased handicap due to those symptoms. Vestibular symptoms among subgroups of migraine should be considered when evaluating the functional impact of migraine.

Assessment of otolith mediated neural reflexes through cervical and ocular vestibular evoked myogenic potentials in individuals with auditory neuropathy spectrum disorders

Auditory neuropathy spectrum disorder (ANSD) is characterized by abnormal auditory neural function in the presence of normal cochlear function. Although the presence of vestibular dysfunction has been reported in ANSD through sporadic studies, cervical and ocular vestibular evoked myogenic potentials (cVEMP and oVEMP) were sparingly explored in the same individuals with ANSD. Thus, the present study aimed at investigating otolith modulated neural function in individuals with ANSD. A static group comparison research design was used. cVEMP and oVEMP were elicited by 500-Hz tone bursts from 31 individuals with ANSD and 31 age- and gender-matched healthy controls. Results showed that the response prevalence was less than 20% for both potentials. The present responses were characterized by significant prolongation of later peaks and inter-peak latency intervals and significantly reduced amplitudes compared to the controls (p < 0.001). Both potentials exhibited larger asymmetry ratios compared to the controls, but only cVEMP asymmetry ratio reached a statistically significant level. There was no association of cVEMP and oVEMP response prevalence with the presence of vestibular symptoms. Abnormal or absent responses in the majority of individuals suggest superior and inferior vestibular nerve dysfunction in ANSD. A detailed vestibular evaluation, in addition to the auditory system assessment, is strongly recommended in ANSD.

Characterization of presbyequilibrium among institutionalized elderly persons

The aim was to characterize dizziness, vertigo, poor maintenance of posture, and sudden instabilities (called presbyequilibrium) among institutionalized elderly to model and identify possible treatable causes. A questionnaire based study focusing on symptoms among 72 elderly persons from a single residential facility and followed them for 3 years. Dizziness, vertigo, poor maintenance of posture, and black-outs were reported by 68% of the 72 elderly and make them at risk for falls, and reduced quality of life. The most common complaint was postural instability, with a tendency to fall. "Spinning" vertigo and "floating" sensation had a strong inter-correlation and correlated with habitual falls. The various dizziness symptoms often occurred in combinations. Attacks of self-experienced syncope never occurred alone but always in combination with "spinning vertigo" or "tendency to fall". In factorial analysis, presbyequilibrium could be divided into six categories. Two of these categories correlated with falls. Among elderly, presbyequilibrium is commonly characterized by a combination of phenomena involving perceptual, orientation, postural, and autonomic manifestations. It is often difficult to obtain an accurate history from the elderly and the presence of vestibular symptoms is frequently overlooked. Taking a careful history and utilizing the classification of symptoms that emerged from the factorial analysis may give a deeper understanding of the etiology of presbyequilibrium, thereby facilitating appropriate rehabilitation.

Intratemporal Complications From Acute Otitis Media in Children: 17 Cases in two Years

BackgroundTo describe the clinical features of intratemporal complications of acute otitis media (AOM) in children, a retrospective study was carried out for 2 years. MethodsWe considered acute mastoiditis, presence of postauricular swelling, erythema and tenderness, and anteroinferior displacement of the auricle; labyrinthitis, presence of vestibular symptoms (spontaneous nystagmus and ataxia with or without vomiting; and facial nerve palsy, absence or decreased motility in hemiface.All children underwent otomicroscopy for evidence of coexistent or recent AOM. Cultures were obtained by tympanocentesis and myringotomy, drainage of subperiosteal abscess, or from granulation tissue during tympanomastoidectomy. ResultsFrom January 2008 to December 2009, 17 patients fulfilled the entry criteria. Median age: 54.2 months. Of the 17 cases, 30% were infants younger than 12 months and most were boys (70.6%).8/17 were receiving antimicrobial treatment. Diagnoses included 9/17 (52.9%) acute mastoiditis, 7/17 (41.2%) labyrinthitis, and 1/17 (5.9%) facial nerve palsy. Intracranial complications were present in 17.6%. All required intravenous antimicrobial treatment. Myringotomy was performed in 16/17, drainage of subperiosteal abscess in 3/17, and tympanomastoidectomy in 2/17. Bacteriology was positive in 9/17 cases, isolating Streptococcus pyogenes (S. pyogenes) in 44% of patients. Secuelaes: One unilateral sensorineural hearing loss. ConclusionsAcute mastoiditis is the most common complication. Labyrinthitis was diagnosed in 41.2% of cases. S. pyogenes was prevalent in these serious invasive infections in our area. Associated intracranial complications were present in 17.6% cases. Resolution of AOM complications required surgical procedures in all cases (myringotomy, drainage of subperiosteal abscess, or tympanomastoidectomy).

Diecisiete casos de complicaciones intratemporales de otitis media aguda en niños en dos años

BackgroundTo describe the clinical features of intratemporal complications of acute otitis media (AOM) in children, a retrospective study was carried out for two years. MethodsWe considered acute mastoiditis, presence of postauricular swelling, erythema and tenderness and anteroinferior displacement of the auricle; labyrinthitis, presence of vestibular symptoms (spontaneous nystagmus and ataxia with or without vomiting; and facial nerve palsy, absence or decreased motility in hemiface.All children underwent otomicroscopy for evidence of coexistent or recent AOM. Cultures were obtained by tympanocentesis and myringotomy, drainage of subperiosteal abscess or from granulation tissue during tympanomastoidectomy. ResultsFrom January 2008 to December 2009, 17 patients fulfilled the entry criteria. Median age: 54.2 months. Of the 17 cases, 30% were infants younger than twelve months and most were boys (70.6%).8/17 were receiving antimicrobial treatment. Diagnoses included 9/17 (52.9%) acute mastoiditis, 7/17 (41.2%) labyrinthitis and 1/17 (5.9%) facial nerve palsy. Intracranial complications were present in 17.6%. All required intravenous antimicrobial treatment. Myringotomy was performed in 16/17, drainage of subperiosteal abscess in 3/17 and tympanomastoidectomy in 2/17. Bacteriology was positive in 9/17 cases, isolating Streptococcus pyogenes (S. pyogenes) in 44% of patients. Secuelaes: One unilateral sensorineural hearing loss. ConclusionsAcute mastoiditis is the most common complication. Labyrinthitis was diagnosed in 41.2% of cases. S. pyogenes was prevalent in these serious invasive infections in our area. Associated intracranial complications were present in 17.6% cases. Resolution of AOM complications required surgical procedures in all cases (myringotomy, drainage of subperiosteal abscess or tympanomastoidectomy).

Current strategies in management of intracanalicular vestibular schwannoma

The current practitioner is more often managing intracanalicular vestibular schwannomas than in the past, as improved imaging and heightened awareness leads to earlier diagnosis of these tumors. The role of observation, microsurgery, and radiation treatment in the management of intracanalicular tumors continues to evolve. The goal of this article is to evaluate and summarize recent literature pertaining to the management of intracanalicular vestibular schwannomas. Watchful waiting is an important management option for patients with minimal symptoms. The literature on the natural history of small vestibular schwannomas continues to expand, with particular emphasis on the expected hearing outcomes. Microsurgical techniques also focus on hearing preservation. Presence of fundal fluid and good or normal hearing preoperatively are positive predictors of hearing preservation after surgery. Long-term follow-up after radiation therapy for vestibular schwannomas continues to demonstrate excellent tumor control rates, although hearing preservation rates are modest. Multiple factors, including status of hearing, presence of vestibular symptoms, patient age, medical comorbidities, institutional outcomes, and patient preferences, help determine the management strategy for patients with an intracanalicular vestibular schwannoma.

How endolymph pressure modulates semicircular canal primary afferent discharge.

Histological observation of endolymphatic hydrops in subjects suffering from Meniere's disease/syndrome and the presence of vestibular symptoms in experimentally induced endolymphatic hydrops have led to considerable debate regarding the potential role of inner-ear pressure. Could a condition influencing endolymphatic volume regulation lead to transient changes in translabyrinthine pressure sufficiently large to alter primary afferent discharge rates? To investigate this question we built a highly sensitive laser-based pressure sensor and recorded endolymphatic pressure modulations within the horizontal semicircular canal ampulla in response to mechanical stimuli for simple head rotation and controlled volume injection. The most sensitive primary afferents responded to changes in endolymph pressures as low as 0.005 Pa (re: perilymph)--a pressure considerably lower than that observed in most experimentally induced hydropic conditions. This threshold pressure was generated by a approximately 25 picoliter volume injection stimulus. Semicircular canal afferent responses to endolymphatic pressure can be explained on the basis of pressure-induced hydrops, which causes dilation of the ampulla, deformation of the cupula, hair bundle movement, and afferent discharge. Primary afferent responses to maintained stimuli were transient in nature and recovered to pre-stimulus background discharge rates following a period of adaptation. Results demonstrate that the semicircular canals are indeed sensitive to small changes in translabyrinthine pressure in addition to head-movement-related changes in transcupular pressure.

Psychiatric morbidity in patients with peripheral vestibular disorder: a clinical and neuro-otological study.

This study reports the psychiatric morbidity in 54 patients with objective evidence of peripheral vestibular disorder seen three to five years after their original referral. A third of the patients were free from vestibular symptoms at follow up and a further third had experienced some improvement. Two thirds of the patients had experienced psychiatric symptoms during this period, although only 50% were rated above the cut off point for significant psychiatric disturbance when interviewed. Panic disorder with or without agoraphobia and major depression were the commonest psychiatric diagnoses. Patients with classical "labyrinthine" symptoms had a more severe canal paresis than the rest, but the degree of the abnormalities in the neuro-otological tests was unrelated to outcome or to psychiatric morbidity. On the other hand, there was a significant correlation between the presence of vestibular symptoms and psychiatric morbidity, which in turn correlated with measures of anxiety, perceived stress and previous psychiatric illness.