Vestibular Dysfunction In Patients Research Articles

Vestibular dysfunction in Parkinson’s disease: a neglected topic

Dizziness and postural instability are frequently observed symptoms in patient with Parkinson’s disease (PD), potentially linked to vestibular dysfunction. Despite their significant impact on quality of life, these symptoms are often overlooked and undertreated in clinical practice. This review aims to summarize symptoms associated with vestibular dysfunction in patients with PD and discusses vestibular-targeted therapies for managing non-specific dizziness and related symptoms. We conducted searches in PubMed and Web of Science using keywords related to vestibular dysfunction, Parkinson’s disease, dizziness, and postural instability, alongside the reference lists of relevant articles. The available evidence suggests the prevalence of vestibular dysfunction-related symptoms in patients with PD and supports the idea that vestibular-targeted therapies may be effective in improving PD symptoms.

Features of vestibular function in patients with sensorineural deafness of vascular origin

Objective: to study the features of vestibular dysfunction in patients with sensorineural hearing loss of vascular origin, depending on the degree of discirculation in the main vessels of the head. Metods. We examined 60 patients with various degrees of sensorineural hearing loss with circulatory disorders in the vertebrobasilar system (VBS), including 36 (60%) women and 24 (40%) men. The average age of the surveyed was 49.9±1.89 years. All patients underwent audiometry in an extended frequency range up to 20 kHz, the study of acoustic stem evoked potentials, acoustic reflexometry. A caloric test was used to study experimental vestibular reactions, and the results were recorded using computerized electronystagmography. Results. According to the otoneurological examination, the patients were divided into 3 subgroups. Peripheral cochleovestibular syndrome (PCVS) was diagnosed in 14 (23%) patients, central cochleovestibular syndrome (CCVS) in 19 (32%), and combined cochleovestibular syndrome (CVS) was diagnosed in 27 (45%) patients. In the analysis of complaints presented by patients with SHD of vascular origin, the combined complaints of hearing deafness, tinnitus and neurological symptoms (headaches, amnesia, paresthesia, fatigue, etc.), as well as dizziness and neurological symptoms, significantly prevailed compared with individual complaints of hearing loss or dizziness (p < 0.05). An analysis of the asymmetry of the pathological process on the right or left side did not reveal significant differences, however, the proportion of patients with bilateral lesions in the subgroup with CCVS was significantly higher. If vestibular nystagmus is an unconditioned stem reflex, then optokinetic nystagmus is a product of the activity of the cerebral cortex and occurs with the active participation of the patient himself in the process of research. Conclusion. The obtained data were compared with the structural changes and hemodynamic parameters in the blood of vertebral arteries (VA) and internal carotid arteries (ICA), as well as magnetic resonance imaging of the brain (MRI).

Gravity perception disturbance in patients with unilateral Meniere disease.

To investigate gravity perception disturbance (GPD) in patients with Meniere disease (MD), we classified GPD type based on the results of the head-tilt perception gain (HTPG) and the head-upright subjective visual vertical (HU-SVV) evaluated by the head-tilt SVV (HT-SVV) test in patients with unilateral MD. We conducted the HT-SVV test on 115 patients with unilateral MD and 115 healthy controls. Among the 115 patients, the period from the first vertigo episode to the examination (PFVE) was known for 91 patients. The HT-SVV test classified 60.9% and 39.1% of patients with unilateral MD as GPD and non-GPD, respectively. GPD was classified according to HTPG/HU-SVV combinations as follows: Type A GPD (21.7%, normal HTPG/abnormal HU-SVV), Type B GPD (23.5%, abnormal HTPG/normal HU-SVV), and Type C GPD (15.7%, abnormal HTPG/abnormal HU-SVV). As the PFVE became longer, patients with non-GPD and Type A GPD decreased; however, those with Types B and C GPD increased. This study provides novel information on unilateral MD from the perspective of gravity perception by classifying GPD based on the results of the HT-SVV test. This study's findings suggest that overcompensation for vestibular dysfunction in patients with unilateral MD exhibited by large HTPG abnormalities may be strongly associated with persistent postural-perceptual dizziness. 3b.

Postisometrical Relaxation Hemodynamic Effects in Patients with Cervicocranialgia and Vestibular Dysfunction

Aim: To investigate the hemodynamic indexes during the postisometric relaxation in patients with cervicocranial pain and vestibular dysfunction in patients with the cervical spine pathology. Materials and Methods: The clinical examination included 85 patients of the young age with cervical spine instability. We use randomization into 41 patient with cervicogenic cranialgia and 44 patients with vestibular dysfunctions. Postizometric relaxation (PIR) sessions were included into patients treatment. Results: Our results revealed increased time-averaged indexes of maximal blood flow velocity through vertebral and basilar arteries in patients with cervicogenic cranialgia. The same indexes were registered to be decreased in patients on the 2nd group. We found that hperreactivity to flexion-extension was determined in patients of both groups, and in patients of the 1st group to left-right rotation. After post-izometric relaxation sessions we registered a decrease in the headache intensity, frequency and duration in patients with cervicogenic cranialgia, and a decrease in dizziness intensity and ringing and tinnitus regression in patients with vestibular dysfunctions. Conclusions: We found that hemodynamic changes in patients with cervicogenic cranialgia were manifested in the form of hyperperfusion through vertebral artery and basilar artery and a half-increase in reactivity indexes on rotatory tests. The hemodynamic effect of PIR was determined in the form of vertebral blood flow indexes through vertebral artery and basilar artery stabilization, as well as indexes of reactivity to rotatory tests normalization.

Evaluation of Vestibular Function in Sleep Disorders

Objectives: The aim of this study was to evaluate dizziness in patients with sleep disorders, objectively identify vestibular function through the vestibulo-ocular reflex (VOR) using the video Head Impulse Test (vHIT), and evaluate the association between these findings.Methods: Among the patients who visited the sleep clinic from June to October 2021, 69 who underwent both polysomnography (PSG) and vHIT were included. Participants completed questionnaires including the Dizziness Handicap Inventory (DHI), Beck Anxiety Inventory, Korean-Beck Depression Inventory-II, Epworth Sleepiness Scale, Insomnia Severity Index (ISI), and Pittsburgh Sleep Quality Index (PSQI). The subjects were classified into four groups: insomnia (n=4), rapid eye movement sleep behavior disorder (RBD) (n=13), obstructive sleep apnea syndrome (OSAS) (n=34), and RBD and OSAS (n=18). Moderate to severe OSAS (n=49) was compared with no OSAS and mild OSAS (n=20).Results: In comparison of the four groups according to sleep disorders, the OSAS patients showed the highest DHI scores and the lowest VOR gain, but statistical significance was not found. Although all VOR gains were within the normal range, the VOR gain of the left posterior semicircular canal was significantly lower in the moderate to severe OSA group than in the no OSA and mild OSA groups (1.02±0.18 vs. 0.94±0.10, <i>p</i>=0.019). DHI total scores showed no correlation with VOR gain but showed a positive correlation with ISI (r=0.422, <i>p</i>=0.001) and PSQI (r=0.287, <i>p</i>=0.022). Among PSG parameters, lowest oxygen saturation (SaO<sub>2</sub>) and percentage of time with SaO<sub>2</sub> less than 90% were correlated with the emotional score of DHI (r=-0.245, <i>p</i>=0.043 and r=0.311, <i>p</i>=0.010, respectively).Conclusions: Although our study could not objectively confirm vestibular dysfunction in patients with sleep disorders, we found that subjective sleep complaints were associated with dizziness and hypoxic conditions during sleep were associated with emotional aspects of dizziness. This suggests that the treatment of concomitant sleep disorders may improve dizziness.

Perceptual visual dependence for spatial orientation in patients with schizophrenia.

Patients with schizophrenia are reported to have vestibular dysfunction and to weigh vestibular input to a lesser extent compared to healthy controls. Such deficits may increase visual dependence (VD) for spatial orientation at a perceptual level in these patients. The aim of this study is to compare VD levels between healthy control and patients with schizophrenia and to explore associations between VD and clinical measures in these patients. Relation of VD to antipsychotic drug treatment is also discussed. 18 patients with schizophrenia and 19 healthy controls participated in this study. The Rod and Disc Test (RDT) was used to create an optokinetic surround around a centrally located rod. Participants aligned the rod to their subjective visual vertical (SVV) in both static and dynamic disc conditions. VD was calculated as the difference in SVV between these two conditions. There was no group difference or gender difference in static or dynamic SVV as well as VD. There was no correlation between VD and any of the Positive and Negative Syndrome Scale (PANSS) scores, however VD was significantly correlated to illness duration in the patient group. Schizophrenia is not associated with greater VD levels at a perceptual level, compared to controls, indicating adequate visuo-vestibular integration for judging line verticality in these patients. Patients with greater chronicity of the disease are more visually dependent than those less chronically ill, consistent with previous reports of possible vestibular dysfunction in patients with schizophrenia. This may affect their daily functioning in dynamic visual environments.

Dissociation of the results of caloric and video head impulse tests as a marker of Meniere's disease

The study of vestibular function in patients with Meniere's disease (MD) is an urgent task, since it influences the choice of treatment tactic. We evaluated the results of caloric and video head impulse (vHIT) tests in 76 patients who met the clinical criteria for significant Meniere's disease (AAO-HNS modified by the Barany Society, 2015). Dissociation of the results of caloric and vHIT tests is observed in the majority (74%) of patients with MD: at normal gain, according to vHIT data, hypofunction of peripheral vestibular structures is recorded according to the caloric test (KASL 47 ± 7.8%). In patients with MD, vestibular dysfunction is observed mainly at low frequencies (0.003 Hz), therefore vHIT, which allows assessing horizontal semicircular canal function at high frequencies (3-5 Hz), is not an optimal study for assessing the degree of vestibular dysfunction in patients with MD.

Possibilities of non-drug prevention of vestibular dysfunction in patients with migraine

<h3></h3> Современное состояние немедикаментозной профилактики вестибулярных нарушений при мигрени свидетельствует о необходимости дальнейших исследований. <h3>ЦЕЛЬ ИССЛЕДОВАНИЯ</h3> Изучить возможности коррекции вестибулярной дисфункции у пациентов с мигренью с помощью профилактического воздействия кетогенной диеты. <h3>МАТЕРИАЛ И МЕТОДЫ</h3> В исследование включено 46 пациентов (10 мужчин и 36 женщин) в возрасте от 18 до 50 лет с вестибулярной мигренью, получавших кетогенную диету на протяжении 3 месяцев. В контрольную группу вошли 46 пациентов с вестибулярной мигренью без модификаций их рутинных диетических предпочтений. Исследование проведено на базе ФГБОУ ВО СГМУ Минздрава России. Использованы «Шкала оценки головокружения», 5-балльная «Шкала субъективной оценки выраженности головокружения», а также «Вестибулярный опросник», позволяющий определить качество жизни пациентов. <h3>РЕЗУЛЬТАТЫ</h3> Выявлена положительная динамика у всех пациентов, получавших кетогенную диету, при анализе данных физикальной, функциональной и эмоциональной подшкал «Шкалы оценки головокружения», «Шкалы субъективной оценки выраженности головокружения», «Вестибулярного опросника». Отмечено снижение интенсивности вестибулярной дисфункции, уменьшение количества дней с головокружением и улучшение качества жизни у пациентов с вестибулярной мигренью после получения кетогенной диеты. Медиана показателя дефицита качества жизни у больных до использования кетогенной диеты составила 59 (95% ДИ 53,3—67,8) и после — 37 (95% ДИ 31,7—45,6). Изменение показателей качества жизни коснулось физического и эмоционального дискомфорта в равных пропорциях. <h3>ЗАКЛЮЧЕНИЕ</h3> Кетогенная диета может быть рассмотрена как актуальный профилактический нефармакологический способ коррекции вестибулярной дисфункции у пациентов с вестибулярной мигренью.

Vestibular migraine

To study the clinical features and the possibility of objectification of vestibular dysfunction in patients with vestibular migraine. The study included 46 patients (10 men and 36 women) aged 18 to 50 years, with vestibular migraine and control groups. A targeted collection of complaints was carried out with an assessment of vestibular symptoms; a detailed history; a study of neurological status, with an emphasis on the study of oculomotor reactions, vestibular tests. Functional computer stabilometric tests were used to objectify vestibular dysfunction. Clinical features, as well as features of stabilometric parameters in patients with vestibular migraine have been identified, which can be used to obtain a quantitative assessment of vestibular dysfunction and objectification of vertigo in this category of patients. A purposeful and complete collection of complaints and anamnesis detailing the features of the symptoms in patients with vestibular migraine helps to identify the clinical polymorphism of the pathology in question and contributes to the correct diagnosis. And the use of functional stabilometric tests contributes to the objectification of vestibular dysfunction in this category of patients, quantifying the distinctive features of the balance system in vestibular migraine.

789 Obstructive Sleep Apnea (OSA) and Vestibular Dysfunction in Patients with Traumatic Brain Injury (TBI)

Abstract Introduction Recent work has highlighted prevalent OSA after TBI. Vestibular dysfunction is also common and associated with adverse outcomes particularly in military personnel. Vestibular dysfunction has been identified in patients with moderate to severe OSA, yet the relationship remains unexplored in those with TBI. This study examined the relationship of vestibular dysfunction with OSA in a large cohort of Veterans and Military Service Members (V/SM) with documented TBI. Methods Data are secondary analyses from a five-center prospective observational cohort study of V/SM admitted for inpatient rehabilitation for TBI and enrolled in the VA TBI Model Systems. Participants completing study measures from 2015 to March of 2020 were included in analyses. Study measures includes the Centers for Disease and Control’s National Health and Nutrition Education Survey (NHANES, OSA item embedded) epidemiologic survey and Neurobehavioral Symptom Inventory (NSI). T-tests and chi-square tests compared patients with OSA to those without OSA on the vestibular subscale on the NSI. Results The sample was mostly male (93%), a mean of 38 years of age, and predominantly with mild (52%) or severe (41%) TBI. OSA was reported in 30.6% on the NHANES. Vestibular symptoms were more common among those with OSA (24%) compared to those without (12%) with a significant difference on the NSI Vestibular Total Score (3.84 vs 2.88 respectively; p&amp;lt;0.001). Similar results were seen across all three NSI vestibular items (dizziness, balance difficulties, poor coordination). Conclusion Participants with TBI and comorbid OSA are more likely to endorse the presence and greater severity of vestibular symptoms compared to those without OSA. Future research is needed to improve understanding of the inter-relationship of OSA and vestibular dysfunction to inform clinical management. Support (if any) VA TBIMS &amp; TBICoE (HT0014-19-C-0004), NIDILRR, North Texas TBI Model System (Grant #90DPTB0013), TIRR TBIMS (Grant #90DPTB0016)

CORTICAL INTEGRATIVE THERAPY EFFECTIVENESS IN THE TREATMENT OF VERTIGO/BALANCE ISSUES

Primary care physicians see a very high incidence of vertigo, dizziness, and balance issues resultant from a broad spectrum of etiologies from vestibular dysfunction, brain injury, neck trauma, metabolic diseases to autonomic dysfunction and psychological conditions. Because dizziness is by definition a subjective condition, self-report questionnaires such as the Dizziness Handicap Index (DHI) are commonly utilized in assessing the impact of vestibular dysfunction in patients. However, objective metrics like Computerized Dynamic Posturography (CDP) can be useful tools for the assessment of dizziness and the validation of diagnoses and treatment effectiveness. In this retrospective study of 50 patients charts, the effectiveness of Cortical Integrative Therapy (PedroCIT®) was evaluated using the DHI and CDP. In particular, the therapy outcome was investigated to determine if it was affected by a vertigo diagnosis, a vertigo comorbidity or by the simple presence of vertigo symptoms. The result of this investigation showed that PedroCIT® is indeed an effective treatment method for vertigo and dizziness: subjects demonstrated and reported improvement in their clinical outcomes, and both CDP and DHI metric in general reflected the significant improvement the subject experienced. For those subjects that still were in the worse categories according to the CDP and DHI metrics, the effect of treatment were potentially influenced by uncontrolled variables such as a change in medications, mental status, or concomitant worsening in the subject's comorbidities, amongst other unknown variables contributing to individual unsatisfying outcomes. Further studies involving larger number of subjects are needed to address these issues.

Оценка равновесия и объективизация головокружения у пациентов с вестибулярной мигренью

Study Objective: To study the balance in patients with vestibular bilious headache (BH) and possible use of a special comprehensive stabilometrical program for dizziness objectification in them. Study Design: open comparative study. Materials and Methods. The study included 188 patients. Group 1 were 94 patients with confirmed BH (according to the International Headache Classification). Group 2 were 94 patients with common migraine. The stabilometrical control group included 94 healthy subjects. The balance and dizziness objectification were assessed using a special comprehensive method comprising a set of stabilometrical tests. Study Results. The most marked changes in stabilometrical parameters were recorded in patients with BH. Primary frequency spectra of these patients were in a range of 0.3 Hz and above 2 Hz, showing the dysfunction of the postural system and vestibular component in particular. The rate of pressure centre deviation and statokinesigram area were increased in the patients from group 2 vs controls; however, statistically significant differences were noted only in opticokinetic test, sensory and vestibular, and closed-eye tandem results. Comparison of the two clinical groups demonstrates significant differences in basic stabilometrical parameters of all challenge tests. Visual control exclusion as well as substandard visual stimulation had significant impact on changes in the analysed parameters. Conclusion. The use of special stabilometrical tests (opticokinetic stimulation, sensory and vestibular and tandem tests) described in this article allows assessing the balance, quantifying vestibular dysfunction in patients with BH, and objectifying dizziness. Keywords: dizziness, balance, vestibular migraine, computer-aided stabilometry.

Effect of Vestibular Rehabilitation on Spontaneous Brain Activity in Patients With Vestibular Migraine: A Resting-State Functional Magnetic Resonance Imaging Study.

Previous studies have shown that vestibular migraine (VM) is a cerebral disease with recurrent vertigo. Vestibular rehabilitation (VR) is an effective type of physical therapy for minimizing vestibular symptoms, as it improves vestibular compensation in patients with VM. Currently, the cerebral regions that are associated with the pathogenesis of VM are largely unknown. To further understand the underlying mechanisms of VM, we performed resting-state functional magnetic resonance imaging (fMRI) before and after 1 month of VR in 14 patients with VM. The Dizziness Handicap Inventory (DHI), the 36-Item Short-Form Health Survey (SF-36), the Hamilton Depression Scale (HAMD) and the Hamilton Anxiety Scale (HAMA) scores were included as clinical outcomes. The amplitude of low-frequency fluctuation (ALFF) was assessed to characterize spontaneous brain activity. The correlations between the clinical characteristics and ALFF values were assessed. After 1 month of VR training, the DHI scores in patients with VM were significantly lower than those at baseline (p = 0.03), as were the HAMA scores (p = 0.02). We also found that the ALFF values in the left posterior cerebellum of VM patients increased significantly after 1 month of VR training. Moreover, the ALFF values in the left cerebellum were inversely correlated with the patients’ DHI scores. Overall, this study showed that VR exercise for 1 month has a positive effect on vestibular symptoms in patients with VM. Asymmetric cerebellar hyperactivity might be a functional compensation for vestibular dysfunction in patients with VM.

Calcitonin gene-related peptide facilitates sensitization of the vestibular nucleus in a rat model of chronic migraine

BackgroundVestibular migraine has recently been recognized as a novel subtype of migraine. However, the mechanism that relate vestibular symptoms to migraine had not been well elucidated. Thus, the present study investigated vestibular dysfunction in a rat model of chronic migraine (CM), and to dissect potential mechanisms between migraine and vertigo.MethodsRats subjected to recurrent intermittent administration of nitroglycerin (NTG) were used as the CM model. Migraine- and vestibular-related behaviors were analyzed. Immunofluorescent analyses and quantitative real-time polymerase chain reaction were employed to detect expressions of c-fos and calcitonin gene-related peptide (CGRP) in the trigeminal nucleus caudalis (TNC) and vestibular nucleus (VN). Morphological changes of vestibular afferent terminals was determined under transmission electron microscopy. FluoroGold (FG) and CTB-555 were selected as retrograde tracers and injected into the VN and TNC, respectively. Lentiviral vectors comprising CGRP short hairpin RNA (LV-CGRP) was injected into the trigeminal ganglion.ResultsCM led to persistent thermal hyperalgesia, spontaneous facial pain, and prominent vestibular dysfunction, accompanied by the upregulation of c-fos labeling neurons and CGRP immunoreactivity in the TNC (c-fos: vehicle vs. CM = 2.9 ± 0.6 vs. 45.5 ± 3.4; CGRP OD: vehicle vs. CM = 0.1 ± 0.0 vs. 0.2 ± 0.0) and VN (c-fos: vehicle vs. CM = 2.3 ± 0.8 vs. 54.0 ± 2.1; CGRP mRNA: vehicle vs. CM = 1.0 ± 0.1 vs. 2.4 ± 0.1). Furthermore, FG-positive neurons was accumulated in the superficial layer of the TNC, and the number of c-fos+/FG+ neurons were significantly increased in rats with CM compared to the vehicle group (vehicle vs. CM = 25.3 ± 2.2 vs. 83.9 ± 3.0). Meanwhile, CTB-555+ neurons dispersed throughout the VN. The structure of vestibular afferent terminals was less pronounced after CM compared with the peripheral vestibular dysfunction model. In vivo knockdown of CGRP in the trigeminal ganglion significantly reduced the number of c-fos labeling neurons (LV-CGRP vs. LV-NC = 9.9 ± 3.0 vs. 60.0 ± 4.5) and CGRP mRNA (LV-CGRP vs. LV-NC = 1.0 ± 0.1 vs. 2.1 ± 0.2) in the VN, further attenuating vestibular dysfunction after CM.ConclusionsThese data demonstrates the possibility of sensitization of vestibular nucleus neurons to impair vestibular function after CM, and anti-CGRP treatment to restore vestibular dysfunction in patients with CM.

Balance function after cochlear implant and inner ear anomaly: Comparison of dynamic posturography.

IntroductionPatients with sensorineural hearing loss suffer concomitant vestibular dysfunction that is more prevalent in patients with inner ear anomaly and could be aggravated with cochlear implantation. To assess the vestibular dysfunction in patients with cochlear implantation, we compared their results with those of patients with and without inner ear anomaly.Materials and methodsThis is a historical cohort study lasting for 20 years on 50 patients with cochlear implantation. All patients underwent dynamic posturography and Bruininks‐Oseretsky Test.ResultsTwenty‐two (44%) of the participants showed some types of inner ear anomaly. The frequency of abnormal Bruininks‐Oseretsky Test was 45.5% and 10.7% (P = .005, odds ratio [OR] = 6.9). Abnormal composite was seen in 77.3% and 21.4%, respectively (P < .001; OR = 12.5). The mean strategy score in the fifth condition of the sensory organization test was 25.0 ± 20.4 in patients with inner ear anomaly, whereas it was 44.1 ± 18.9 in those without it (P = .001).ConclusionBalance capability in cochlear implantation patients with inner ear anomaly compared to those without inner ear anomaly was worse. More vestibular rehabilitation treatment plans are suggested for these patients.

Vestibular dysfunction in patients with auditory neuropathy detected by vestibular evoked myogenic potentials

ObjectivesThis study aimed to determine vestibular involvement in patients with auditory neuropathy (AN) using ocular vestibular evoked myogenic potential (oVEMP), cervical vestibular evoked myogenic potential (cVEMP), caloric tests, video Head Impulse Tests (vHIT), and Suppression Head Impulse Paradigm (SHIMP) tests. MethodsTwenty-two patients with AN (study group) and 50 age-and-gender-matched healthy subjects (control group) were enrolled. All patients underwent air-conducted sound oVEMP and cVEMP tests. In the study group, 20 patients underwent a caloric test, 10 patients underwent a video Head Impulse Test (vHIT), and nine patients underwent the Suppression Head Impulse Paradigm (SHIMP) test. ResultsSignificant differences in VEMP abnormalities were found between the two groups. Most AN patients showed no VEMP response, while only a few patients showed VEMP responses with normal parameters. Some AN patients presented abnormal VEMP parameters, including thresholds, latencies, and amplitudes. The abnormal rate (including no response and abnormal parameters) was 91% in the cVEMP test and 86% in the oVEMP test. No significant difference was found between oVEMP and cVEMP abnormalities. AN patients exhibited a 70% abnormal rate in the caloric test. Most AN patients showed normal VOR gains. Most patients showed no overt corrective saccades in vHIT, and exhibited normal anticompensatory saccades in the SHIMP test. ConclusionMany AN patients experience vestibular dysfunction, which may be detected by using a vestibular functional test battery. SignificanceVEMP abnormalities might reflect the status and degree of vestibular involvement in AN.

Auditory and vestibular dysfunction in patients with Parkinson\u2019s disease

BackgroundMotor dysfunction in patients with Parkinson disease (PD) is just the tip of the iceberg. Auditory and vestibular dysfunction in patients with PD gained much attention owing to them being one of the nonmotor symptoms.AimTo explore abnormalities of pure tone audiometry (PTA), brainstem auditory evoked potentials (BAEPs), vestibular evoked myogenic potential (VEMP), and videonystagmography (VNG) in patients with PD and their correlation with motor and cognitive dysfunction.Patients and methodsThe study was conducted on 20 patients with PD and 15 controls. Selected patients were subjected to evaluation of motor symptoms using Unified Parkinson’s Disease Rating Scale (UPDRS) and cognitive function using Parkinson disease-Cognitive Rating Scale (PD-CRS). PTA, BAEPs, cervical VEMPs, and VNG were carried out for all patients and controls.ResultsPatients with PD show higher mean hearing thresholds at all PTA frequencies in both ears than controls. Analysis of BAEP demonstrated that patients with PD have significantly prolonged absolute latencies of wave III and wave V and interpeak latencies of I–III and I–V in both ears than controls. VEMP findings revealed that patients have significantly delayed P13 and N23 latencies and smaller P13–N23 amplitude in both ears than controls. VNG findings showed canal paresis in 60% of patients with PD and nystagmus in 60% of patients with PD. Correlative results revealed statistically significant correlations between VEMP parameters and UPDRS as well as PD-CRS, but there were no statistically significant correlations between PTA frequencies or BAEP latencies and UPDRS or PD-CRS.ConclusionAuditory and vestibular dysfunction is common in PD but cannot be totally correlated with the motor and cognitive symptoms.

Prognosis of Vestibular Dysfunction in Patients With Idiopathic Sudden Sensorineural Hearing Loss

Prognosis of Vestibular Dysfunction in Patients With Idiopathic Sudden Sensorineural Hearing Loss

Clinical Study to Determine Occult Vestibular Dysfunction in Patients of Chronic Otitis Media using Computerized Static Posturography

Introduction&#x0D; Various studies have shown high incidence of subjective vestibular dysfunction in cases of chronic otitis media (COM). Evaluation of vestibular dysfunction in chronic otitis media patients is becoming an integral part of comprehensive management of COM. In our study, we have evaluated vestibular dysfunction in patients with COM, using computerized static posturography, an objective technique in contrast to other subjective tests of vestibular dysfunction.&#x0D; Materials and Methods&#x0D; In this prospective case control study done over a period of 1.5 years, 50 cases of COM and 50 healthy controls were included and they underwent Computerized Static Posturography. Parameters taken were Somaesthetic, visual and vestibular scores in both antero-posterior (AP) and medio-lateral (ML) axis; and in combined axis (Antero-posterior +Medio-lateral) and these scores were compared with those of healthy controls.&#x0D; Results&#x0D; Total 50 cases of COM (average disease period - 5.7 years), of both sexes, with age range of 15-60 years and mean age of 31.58 years were taken. On analyzing above mentioned parameters using SPSS software, we found no significant difference in vestibular function in cases of COM as compared with healthy individuals. &#x0D; Discussion&#x0D; The outcome of computerized static posturography can be quantified with respect to changes in center-of-force sway amplitude, distance, or velocity, which, by virtue of not being burdened by subjective interpretation, its results can be, documented both graphically and numerically.&#x0D; Conclusion&#x0D; This study, further solidified with objective evidence, raises a question on COM without complications being directly responsible for vestibular dysfunction.

Progression of Peripheral Vestibular Dysfunctions in Patients With a Mitochondrial A3243G Mutation.

To evaluate the progression of peripheral vestibular dysfunction in patients with an A-to-G point mutation at nucleotide pair 3243 in mitochondrial DNA (A3243G mutation). Retrospective patient series. Tertiary referral center. Six unrelated patients with an A3243G mutation (four mitochondrial encephalomyopathy, lactic acidosis, and stroke-like episodes; and two maternally inherited diabetes and deafness; five females and one male; average age 41 ± 11.3 yr old), who underwent repeated vestibular examinations, were included (average interval between the first and second examinations: 5.7 ± 2.1 yr). Diagnostic. Results of caloric testing and cervical vestibular evoked myogenic potential testing in response to air-conducted sound were analyzed. All the patients except one, who was already completely deaf in both ears at the first examination, showed progression of hearing loss (average 4.0 ± 6.3 dB per year). Five of the six patients had vestibular symptoms at the first examination. The other patient developed dizziness later. Caloric responses were abnormal in four patients at the first examination and in five patients at the second examination. Cervical vestibular evoked myogenic potential responses were bilaterally absent in three patients at the first examination and in five patients at the second examination. The A3243G mutation causes progression of peripheral vestibular dysfunction as well as that of hearing loss.