Vestibular Tests Research Articles

Vestibular Function in Patients With Vestibular Neuritis Experiencing Prodromal Dizziness.

It is unknown whether prodromal dizziness (PD) before an attack of vestibular neuritis (VN) has an association with peripheral vestibular lesions. The purpose of this study was to investigate whether the severity of vestibular dysfunction has an association with the presence of PD. We reviewed the medical records of 88 consecutive unilateral VN patients with unilateral canal paresis in caloric testing. Caloric test, cervical vestibular evoked myogenic potential test to air-conducted sound (ACS cVEMP), ocular vestibular evoked myogenic potential test to bone-conducted vibration (BCV oVEMP) and video head impulse test (vHIT) were used as vestibular function tests. Binomial logistic regression analyses were performed to see whether the subjects' age, sex, disease duration or the presence of PD is associated with the presence of vestibular dysfunction. Seventeen (19%) experienced an episode of PD. There was no significant association between the presence of PD and abnormality in ACS cVEMPs, BCV oVEMPs, vHIT for the posterior semicircular canal (SCC) or vHIT for the lateral SCC. The presence of PD had a significant positive association with abnormality in vHIT for the anterior SCC (ASCC) (p = 0.0248). The presence of PD in VN may be associated with the peripheral vestibular lesion.

Functional Outcome and Balance Compensation in Patients with Unilateral Vestibular Schwannoma After Surgical Treatment-Short- and Medium-Term Observation.

Objective: The aim was to evaluate vestibular function in patients with unilateral vestibular schwannoma before and in the short and medium term after surgical treatment to analyze vestibular compensation. The identification of the prognostic factors determining incomplete and slower balance recovery was assessed. Methods: Forty-five patients with unilateral vestibular schwannoma treated surgically through the middle cranial fossa and translabyrinthine approach were enrolled in this study. The data were collected in the period between April 2022 and August 2023. The clinical data, vestibular tests (video head impulse test, sensory organization test) and the dizziness handicap inventory (DHI) before and after surgery were evaluated. Results: One month after surgery, a temporary deterioration in the DHI results occurred (DHI total score before surgery 24.36 vs. one month after surgery 31.64); however, a significant increase was found only by analyzing the functional subscale (p = 0.0395) for the DHI functional, emotional and physical subscale results; in addition, the total score before and three months after the surgery did not differ significantly. No statistically significant differences between the preoperative sensory organization test and the test one month after the surgery were found, while a significant improvement in the vestibular parameters was observed three months after the surgery compared to the preoperative results (C5 0.0306, C6 0.0002, VEST 0.0294, COMP 0.0023). A negative correlation was found between the DHI total score and C5 (-0.3198, -0.3266), C6 (-0.3448, -0.46379), VEST (-0.3100, -0.3252) and COMP (-0.4018, -0.4854) one and three months after the surgery, respectively. A significant deterioration was found between the LSC gain results on the tumor side (p < 0.001) and on the healthy side before the surgery vs. one month afterwards (p = 0.0079) and before the surgery vs. three months afterwards (p = 0.0419). The middle cranial fossa or translabyrinthine approach had no influence on the postoperative results. Conclusions: In the postoperative period, vestibular compensation occurs spontaneously. The results show that the functional level deteriorates one month after surgery but then improves significantly three months after the surgery, which confirms that compensation occurs gradually. The DHI functional subscale results before surgery and three months afterwards did not differ significantly, which demonstrates that functional recovery after vestibular denervation should take place within that time. In the present study, no predictive factors for unsatisfactory functional postoperative outcomes were found.

Complete Hearing Recovery after Retrosigmoid Resection of Jugular Foramen Schwannoma with Concurrent Ipsilateral Vestibular Schwannoma

Introduction: Cerebellopontine angle (CPA) tumors frequently present with hearing loss, which influences whether a hearing preservation vs hearing ablative surgical approach is chosen. We discuss a case of complete hearing recovery after resection of a jugular foramen (JF) schwannoma in a patient who also had a small intracanalicular vestibular schwannoma (VS). Case: A 46-year-old woman presented with left ear fullness, tinnitus, and imbalance for nine months. She had no lower cranial nerve dysfunction. Audiometry demonstrated Class D hearing with 4% word recognition on the left. Vestibular testing showed absent caloric response on the left and subtle central findings. MRI demonstrated a left 3.3 cm JF schwannoma and separate left 1 cm intracanalicular VS. A retrosigmoid approach was performed for a radical subtotal resection of the JF schwannoma, relieving the mass effect on the vestibulocochlear nerve. The small intracanalicular VS was not manipulated. Pathology confirmed schwannoma with NF2 mutation in the tumor, but normal NF2 germline. Post-op audiometry at 6 weeks showed normal audiometric thresholds with 100% discrimination. Subtle left caloric response was noted on post-op vestibular testing and central oculomotor findings improved. Discussion: The presented case describes the management of concurrent ipsilateral VS and JFS in the absence of NF2 and demonstrates a unique complete and rapid recovery of hearing following JFS resection without manipulation of concurrent VS. This case supports the use of a hearing preservation approach in similar cases and corroborates previous reports of hearing recovery following resection of non-vestibular schwannoma CPA tumors with hearing preservation approaches.

Hearing loss rather than vestibular loss identifies patient subgroups with different outcomes in Meniere’s disease

Objective This study investigates the relationship between Meniere’s disease (MD) duration and both hearing thresholds and vestibular dysfunction. Design Retrospective cohort study. First, the relationships between MD duration and pure-tone audiometry thresholds for each frequency, the canal paresis (CP) ratio, and the vestibulo-ocular reflex (VOR) gain were analysed. Second, clinical characteristics, CP values, and VOR gains were compared between patient groups with low and high hearing thresholds to determine whether they exhibited different clinical presentations. Study sample The study included 69 patients diagnosed with unilateral MD within a duration of 10 years. A hearing dataset from 306 MD Spanish patients was used to cluster patients according to the hearing profile overtime. Results The thresholds at 250–2000 Hz frequencies increased with the duration of the disease. Conversely, vestibular function tests were not related to the duration of MD. Additionally, no statistically significant differences were observed in clinical characteristics, CP values, or VOR gain between patient groups with low and high hearing thresholds. Conclusions Hearing loss involves all frequencies in most patients and hearing outcome, rather than vestibular loss, may define patient subgroups in MD. Moreover, not all patients with MD experience hearing loss progression as the duration of the disease increases.

Evaluation of polygenic risk scores for hormones and receptors levels in patients with vestibulodynia: a case-control study.

Vulvodynia is a multifactorial disease affecting 7%-16% of reproductive-aged women in general population; however, little is still known about the genetics underlying this complex disease. To compare polygenic risk scores for hormones and receptors levels in a case-control study to investigate their role in vulvodynia and their correlation with clinical phenotypes. Our case-control study included patients with vestibulodynia (VBD) and healthy women. All participants underwent a vestibular cotton swab test and the assessment of their: pelvic floor, vestibular trophism, ultrasound vestibular mucosa thickness, and current perception threshold levels (Neurometer CPT device). Shallow whole genome sequencing and polygenic risk score calculations were performed. Linear regression models were applied to predict whether genomic predisposition varied significantly between cases and controls, and to investigate the relationship of polygenic risk scores with clinical endophenotypes. The genomic predisposition to hormones and receptors levels, together with clinical endophenotypes, can support VBD diagnosis and personalized treatment of related pain condition. Thirty women with VBD and 30 controls were recruited. Significant differences between cases and controls were observed for body mass index, vestibular mucosa thickness, vestibular trophic health, pelvic floor hypertone and pain sensitivity (P < .05). Cases showed a genomic predisposition to higher levels of membrane-associated progesterone receptor component 1 compared to controls (P < .05). When considering the clinical endophenotypes, cases showed significant correlations between their polygenic risk scores with several clinical measures: predicted genomic levels of testosterone and estrogen receptor and the vestibular mucosa thickness values (estimates: 9.74E-09 and 9.16E-08, respectively; P < .05); predicted genomic levels of prolactin and Neurometer data at 250Hz (-2.15E-07; P < .05); predicted genomic levels of prolactin, membrane-associated progesterone receptor component 2 and mineralocorticoid receptor and Neurometer data at 5Hz (-3.75E-07, -3.43E-07 and -3.06E-07, respectively; P < .05). Introduction of polygenic risk scores evaluation in clinical practice can assist early diagnosis and personalized therapeutic treatment of VBD. Polygenic risk scores and clinical data allowed the identification of disease endophenotypes and highlighted the possibility of a personalized therapeutic approach. As limitations, these data should be confirmed on a larger cohort and polygenic risk score calculation should be adapted to ancestries other than European. Cases showed significant differences compared to controls on both clinical and genetic data and specific endophenotypes necessary to classify disease development and treatment were identified.

Application of 3D-Flair MRI and vestibular function assessment in profound sudden sensorineural hearing loss patients

Objective: To analyse the 3D-Flair MRI manifestations of the inner ear, vestibular function status, and their correlation with hearing treatment outcomes in patients with severe sudden sensorineural hearing loss (SSNHL), and to explore potential prognostic indicators for sudden deafness. Methods: The clinical data of adult patients with unilateral profound sudden sensorineural hearing loss were retrospectively analyzed in Otorhinolaryngology Department of Shandong Provincial ENT Hospital from March 2018 to August 2020. Patients were categorized based on the results of their inner ear 3D-Flair MRI into two groups: the normal MRI group and the abnormal MRI group. The abnormal group was further divided into three subgroups: those with non-absorbed high signal in the inner ear, those with absorbed high signal, and those with destruction of the blood-labyrinth barrier. SPSS 26.0 statistical software was applied to analyze the differences in hearing efficacy, caloric tests, vestibular evoked myogenic potentials (VEMP), video head impulse tests (vHIT), and the incidence of dizziness/vertigo among various patient groups. Results: A total of 191 patients with complete data were collected (97 males and 94 females, aged from 13 to 69 years old). There were 50 cases in the normal inner ear 3D-Flair MRI group. A total of 141 cases were found in the group with abnormal 3D-Flair MRI, including 50 cases of high signal unabsorbed, 71 cases of absorption high signal and 20 cases of blood labyrinth barrier destruction. There were no significant differences in age, sex, lateral ratio of hearing loss and course of disease among four groups (all P>0.05).The significant efficiencies of hearing recovery, in the group with normal 3D-FLAIR MRI were better than those in the abnormal group (P<0.05) after treatment. Among the four groups, there were significant differences in the apparent efficiency and total effective rate between the normal group and the inner ear high signal absorption group (χ²=4.007, P=0.045; χ²=6.925, P=0.009). The abnormal rates of bithermal caloric test, vHIT results and dizziness/vertigo symptoms in the abnormal group were higher than those in the normal group (P<0.05). There were significant differences in oVEMP abnormality rate, vHIT abnormality rate and incidence of dizziness/vertigo among the three groups with 3D-FLAIR MRI abnormality (P<0.05). There were significant differences in caloric test, oVEMP, vHIT abnormality rate and incidence of dizziness/vertigo among the four groups (P<0.05). The positive rates of caloric test, cVEMP test and vHIT test in patients with dizziness/vertigo were higher than those in patients without dizziness/vertigo (P<0.05). The abnormal rates of posterior semicircular canal and horizontal semicircular canal in patients with dizziness/vertigo were significantly increased (P<0.05) than patients without dizziness/vertigo. The recovery rate, effective rate and total effective rate of patients without dizziness/vertigo were significantly better than those with dizziness/vertigo (P<0.05). Conclusions: The 3D-Flair MRI of the inner ear and vestibular function tests have reference value for the prognosis assessment of patients with severe sudden sensorineural hearing loss. Abnormal 3D-FLAIR MRI of the inner ear, especially absorption high signal, is associated with high incidence of vestibular dysfunction and dizziness/vertigo, with poor prognosis. Patients with severe sudden sensorineural hearing loss who have symptoms of dizziness/vertigo are more likely to exhibit abnormal results in vestibular function tests, with a higher susceptibility to involvement of the posterior and horizontal semicircular canals.

Surgical Management of Superior Semicircular Canal Dehiscence Syndrome

Superior semicircular canal dehiscence syndrome (SSCDS) is a condition in which the temporal bone covering the superior semicircular canal becomes progressively thinner until it eventually erodes, creating an inner ear “third window” with the intracranial cavity. The result of this dehiscence is a constellation of symptoms, including sound- and pressure-induced vertigo, autophony, hyperacusis for internal bodily sounds, and low-frequency conductive hearing loss (CHL). By using imaging, audiologic evaluation, and vestibular testing, audiologists and otolaryngologists can differentially diagnose SSCDS and determine course of treatment. Management options involve observation or surgery. In patients with minimal symptoms, observation is safe. In patients with severe symptoms, surgery via a transmastoid approach or middle fossa approach to plug or resurface the superior canal defect may be performed.

A retrospective analysis of the clinical characteristics of 63 patients with vestibular neuritis

Objective:To retrospectively analyze the results of auditory examination,vestibular function examination and laboratory examination of 63 patients diagnosed as vestibular neuritis.Methods:A total of 63 patients diagnosed with vestibular neuritis hospitalized in the Department of Otolaryngology, Head and Neck Surgery of the Third Affiliated Hospital of Sun Yat-sen University, from October 2012 to December 2022 were recruited. All patients met the diagnostic criteria for the 2022 Bárány association vestibular neuritis. Clinical data and the results of pure tone audiometry, electrocochleogram, video electronystagmogram, caloric test, cervical vestibuloevoked myogenic potential（cVEMP）, ocular vestibuloevoked myogenic potential（oVEMP）, video head impulse test（vHIT） was collected.A total of 63 age-and sex-matched healthy subjects in the physical examination center were randomly selected as the control group. The differences of blood indexs and lipid metabolism indexes between the two groups were compared. Results:In patients with vestibular neuritis, 50 out of 63 patients presented normal threshold in pure tone audiometry, 8 out of 63 patients had bilateral high-frequency sensorineural hearing loss and 5 out of 63 patients had unilateral mild high-frequency sensorineural hearing loss, 56 out of 63 cases completed the electrocochleogram, of which 3 cases had a binaural-SP/AP amplitude ratio≥0.4, 5 cases had monaural amplitude ratio ≥0.4. Fifty-five out of 63 patients completed the caloric test with CP values greater than 30% in all. The ratio of patients completed cVEMP, oVEMP and vHIT were 46 cases, 22 cases and 30 cases, respectively. 17 out of 63 cases completed all the four vestibular function tests. According to these tests, 49 patients could determine the extent of injury，including 27 cases with unilateral superior vestibular nerve injury, 21 cases with unilateral superior and inferior vestibular nerve injury and 1 case with unilateral inferior vestibular nerve injury. There were significant differences in neutrophil value（P<0.001）, lymphocyte value（P<0.005）, neutrophil/lymphocyte ratio（P<0.001） and apolipoprotein A1（P<0.001） between patient group and control group. Inflammatory markers were risk factors for patients with vestibular neuritis. The OR values of neutrophil value and blood neutrophil/lymphocyte ratio were 1.81（1.38-2.37, P<0.001） and 2.11（1.41-3.16, P<0.001）, respectively. Apolipoprotein A1 was a protective factor for patients with vestibular neuritis, and the OR value was 0.004（0.001-0.042, P<0.001）. Conclusion:Electrocochleogram could be used in vestibular neuritis patients with normal pure tone threshold to test whether there is hidden hearing loss in these patients. Neutrophil value, lymphocyte value, neutrophil/lymphocyte ratio and apolipoprotein A1 were correlated with vestibular neuritis. The Neutrophil value and neutrophil/lymphocyte ratio were risk factors for morbidity.

Isolated Corrective Saccades in the Bilateral Posterior Canal Stimulation During the Video Head Impulse Test: A Marker of Central Vestibulopathy?

This study aimed to determine if the presence of corrective saccades during video head impulse test (vHIT) stimulation of the bilateral posterior semicircular canals (PSCs) correlated with other vestibular test results, demographics, symptoms, or diagnoses. This study was a retrospective chart review where 1006 subjects' vHIT records were screened with 17 subjects meeting inclusion criteria for isolated bilateral PSC saccades. Of the 1006 patients undergoing vHIT testing, only 1.7% had isolated bilateral PSC saccades. The median age of subjects was 73 years, with a range of 61 to 85 years. Statistical significance was identified between groups with abnormal PSC vHIT gain and abnormal ocular vestibular evoked myogenic potential results as well as those with 1 to 2 diagnoses. Our study confirms the rarity of isolated bilateral PSC vHIT saccades and as well as association with central vestibulopathy. Correlations with other vestibular test results, demographics, symptoms, or diagnoses may be strengthened with future large-scale studies. Further understanding of the clinical utility of isolated bilateral PSC vHIT saccades is needed. Patients with bilateral PSC vHIT abnormalities may benefit from a comprehensive neurological evaluation and consultation.

Dorsolateral pontine lesions produce distinct ocular motor abnormalities with anatomical correlations.

The dorsolateral portion of the caudal pons contains the vestibular nucleus (VN) and inferior cerebellar peduncle (ICP) that play important roles in conveying and processing vestibular and ocular motor signals. This study aimed to characterize ocular motor abnormalities along with their anatomical correlations in dorsolateral pons (DLP) lesions. We analyzed clinical features, and results of neuro-otological evaluations and neuroimaging of 18 patients with unilateral DLP lesions (17 with DLP infarction and 1 with cavernous malformation) from among 506 patients with pontine infarction in a stroke registry. Most of the patients (n = 16) presented with isolated acute vestibular syndrome (AVS). The involved structures within the DLP were the ICP in four patients and the VN in the remaining 14. The unilateral ICP lesions were associated with consistent abnormalities in vestibular and ocular motor tests, including ipsilesional nystagmus without gaze-evoked nystagmus (GEN), and normal head impulse tests (HITs) and caloric response. In contrast, lesions of the VN were associated with a broader range of eye-movement abnormalities, including ipsi- or contralesional nystagmus with GEN, positive HITs, normal or abnormal caloric responses, and fixation nystagmus. Initial diffusion-weighted magnetic resonance imaging (within 48 h) was falsely negative in 41% (n = 7) of the DLP infarction cases. This study demonstrates that unilateral DLP lesions frequently present with isolated AVS and diverse ocular motor abnormalities. These characteristics may be due to the complex involvement of afferent or efferent fibers to and from the VN.

Prevalence and Pattern of Traumatic Dental Injuries in Children and Adolescents With Severe to Profound Hearing Impairment: A Hospital-Based Cross-Sectional Study.

Traumatic Dental Injuries (TDIs) are an emerging public health problem and a realm of research for oral health enthusiasts. Certain populations can be more vulnerable to injuries such as those with a sensory deficit. Nevertheless, literature is scarce, especially for those with hearing impairment. Therefore, the aim of the study was to compare the prevalence and patterns of TDI in children and adolescents with severe-to profound hearing impairments and children without hearing impairments. Three hundred and ninety participants (195 severe to profound hearing impaired and 195 age and sex-matched controls) between 4 and 18 years were recruited from a tertiary care setting. A single calibrated examiner evaluated TDI for both groups. Among those with TDI, a vestibular function test (VFT) was also performed to assess postural balance. A single examiner from the Department of Otorhinolaryngology evaluated the VFT results. The overall prevalence of TDI was found to be 12.82% among the severe to profound hearing-impaired individuals, and 11.79% in controls. The majority of participants were aged between 7 and 13 years, in the mixed dentition stage, and were males. Among the cases, the majority had profound hearing loss (≥ 91 dB HL) and bilateral ear involvement. The most common type of TDI was uncomplicated crown fractures. Falls were identified as the most common cause of TDI in both groups. Vestibular dysfunction and loss of postural control were identified in 12 out of 14 patients tested with VFT. A significant association was found between TDI and the dentition type, that is, primary dentition was more affected among the severe to profound hearing impaired as compared to controls (p < 0.05). There was no significant association between the severity of hearing impairment and the prevalence of dental trauma in children and adolescents with severe to profound hearing impairment. However, hearing-impaired individuals were susceptible to trauma at an early age compared to their healthy counterparts.

Is the Otolithic Function Affected in Patients with Obstructive Sleep Apnea Syndrome?

While cardiovascular and neurological diseases induced by obstructive sleep apnea syndrome (OSAS) hypoxia are well established, the association between neuro-otological diseases and OSAS is not entirely understood. Vestibular and audiological tests have been used to evaluate the degeneration of neurons in the brainstem caused by recurrent hypoxia. Evaluation of the vestibular-evoked myogenic potential (VEMP) test findings applied to detect the possible influence on the vestibular reflex arc due to hypoxia in patients diagnosed with OSAS using Activity-Specific Balance Confidence (ABC) and Berg Balance Scale (BBS) scales determination of scores. This was a cross-sectional study. Participants aged 18 to 60 who underwent polysomnography due to snoring/sleep apnea were divided into an OSAS, and a control group of subjects were also included. Each group consisted of 20 participants. All participants were evaluated with cervical VEMP (cVEMP) and ocular VEMP (oVEMP) tests. The groups were compared regarding variables such as the rate of oVEMP and cVEMP waves obtained, the interval between the waves, and the latency and amplitude. Also, BBS and ABC scales were applied to all participants. The cVEMP (50%) and oVEMP (45%) response rates and amplitudes were significantly lower in the OSAS group. No significant difference was found between the groups when comparing other VEMP parameters. However, a statistically significant decrease was observed in the ABC and BBS scores in the OSAS group. The identification of VEMP alterations in the OSAS group is a clear indication that the vestibular reflex pathways may be adversely affected by hypoxia. Personal rehabilitation programs can be created by evaluating activities of daily living with the ABC and static and dynamic balances with BBS in patients with OSAS.

Selective Bilateral Posterior Canal Dysfunction: A Case Series Investigation into the Clinical Trends and Associative Factors.

The video head impulse test measures high-frequency vestibulo-ocular function of all six semicircular canals. Isolated semicircular canal dysfunction has been correlated with several peripheral and central vestibular etiologies. Selective bilateral posterior canal dysfunction is a trend seen in the clinical setting but less commonly reported in the medical literature. The purpose of this work is to explore the clinical profile of bilateral posterior canal dysfunction along with other presenting factors such as hearing loss, increased age, and associated nystagmus patterns. A case series of three patients (age range: 67-74 years) is presented to illustrate the similarities and clinical associations between vestibular and balance history, medical history, and vestibular test results. All three patient cases presented with below reference range posterior semicircular canal function on video head impulse testing. Two patients also presented with down-beating nystagmus, and two endorsed subjective hearing loss while the third presented with presbycusis. Selective bilateral posterior canal dysfunction in association with advanced age, presbycusis, and signs of down-beating nystagmus may be associated with vestibulocochlear degenerative processes. Yet, central disorders, technical and patient factors may present clinical challenges to elucidate the cause.

Superior semicircular canal dehiscence isolation by transmastoid two-point canal plugging with preservation of the vestibulo-ocular reflex.

This article describes the surgical treatment of superior semicircular canal dehiscence syndrome (SCDS) by isolating the dehiscence using transmastoid two-point canal plugging while preserving the high-frequency vestibulo-ocular reflex (VOR) of the affected semicircular canal. The superior semicircular canal is opened via atransmastoid approach anterior (as far from the ampulla as possible) and posterior to the dehiscence and then plugged with connective tissue and bone dust. In two clinical exemplary cases, vestibular testing showed that the VOR measured by video head impulse (vHIT) test was preserved (patient1: gain preoperative 0.7, long-term postoperative 0.75; patient2: gain preoperative 0.64, long-term postoperative 0.79; reduction of corrective saccades in each case) with asimultaneous reduction in pathologically increased amplitudes of vestibular evoked myogenic potentials (VEMPs) and asignificant improvement in clinical symptoms with almost complete freedom from symptoms. One possible explanation for preservation of the high-frequency VOR of the superior semicircular canal would be the deformability of the endolymphatic space described at high stimulation frequencies, which can lead to endolymph movements in the area of the ampulla with deflection of the cupula despite blockage of the semicircular canal.

The Relationship between Chronic Unilateral Hearing Loss, Balance Function, and Falls Is Not Informed by Vestibular Status.

Recent studies suggest that hearing loss is associated with balance dysfunction and an increased risk of falls. The purpose of this study was to investigate whether adults with unilateral hearing loss (UHL) have an underlying vestibular dysfunction and whether vestibular testing explains balance function and fall risk. Cross-sectional. Urban otology practice and a human motion laboratory. We recruited 41 healthy controls (mean age, 52 years; range, 22-78 years) and 29 adults with stable UHL (mean age, 53 years; range, 18-80 years) who denied symptoms of dizziness (Dizziness Handicap Inventory average, 1.86; range, 0-14). UHL occurred an average of 4 years (range from sudden loss, 4 months to 27.5 years) prior to testing. We conducted the caloric portion of the videonystagmography test, video head impulse test (vHIT), and a battery of balance tests: standing on foam with eyes closed, timed up and go test, four square step test, 10-meter walk, and a virtual reality (VR) assessment of postural control. Hearing was quantified by four-frequency pure-tone average (PTA). Caloric weakness was defined as asymmetry greater than 25%. Participants self-reported falls over the past 12 months and history of vertigo. Performance on balance tests was quantified by time to completion or duration of hold. Performance on the VR assessment was quantified by root-mean-square velocity of head sway. Proportion of unilateral caloric weakness was significantly higher in the UHL group (25%) than the control group (12%). Five participants with UHL refused caloric testing. vHIT gains of lateral canals were normal in both groups. The majority of participants in the UHL group experienced vertigo at the onset of hearing loss (72%). There were five fallers in the UHL group (17%) and three in the control group (7%). Participants with caloric weakness or vertigo at onset did not differ from those without in age or in any of the balance tests. Participants with history of falls differed in head sway and duration of hold standing on foam with eyes closed. Individuals with UHL are more likely to have caloric weakness than healthy controls; however, these findings are not correlated with functional outcomes or history of falls. Postural control testing using virtual reality or standing on foam with eyes closed may help detect those at a risk for falls.

Evaluating the Auditory and Vestibular Functions of Patients with Multiple Sclerosis

Objective: Multiple sclerosis, a demyelinating disease of the central nervous system, is characterized by weakness of the arms and legs, sensory symptoms, ataxia, fatigue, diplopia, memory, concentration, attention disorder, and motor speech disorder. Common symptoms include epileptic seizures, cognitive impairment, hearing loss, and cortical symptoms. Materials and Methods: This study evaluated patients' mental functions with multiple sclerosis (MS) by considering their auditory and vestibular functions. A total of 30 patients, 15 healthy and 15 diseased, were recruited. In contrast, the experimental group consisted of individuals diagnosed with MS who had not had an attack for the last two months, over the age of 18, under the age of 60, and with similar characteristics in terms of gender. The audiological and vestibular tests on the experimental and patient groups were applied and the data obtained from these two groups were compared. Impedance audiometry test was performed on patients simultaneously. Result: The data obtained from our study, significant results were obtained for the right and left ears of MS patients to whom we applied the pure tone audiometry test. In the ABR test, unilateral hearing loss was observed in seven patients. In the VHIT test, while the VOR gains of 9 MS patients were outside the normal limits, the VOR gains of one patient in the left lateral canal were low. In the VEMP test, the wave latencies of 12 patients in the patient group were delayed, and the two patients' left-side P1 and N1 waveforms were not observed.

Is endolymphatic hydrops, as detected in MRI, a truly cochleocentric finding?

The most common histopathological finding in Ménière's disease (MD) is endolymphatic hydrops (EH), which involves the dilation of the membranous labyrinth. The direct relationship between EH and MD is debated, although EH plays a crucial role in auditory and vestibular functional tests. MRI sequences such as 3D-FLAIR and 3D-real-IR are used to study EH, with the latter being more effective. This study aimed to examine whether the severity of EH detected by MRI is always more pronounced in the cochlea than in the vestibule, indicating a cochleocentric progression of the condition. A retrospective longitudinal study was conducted at a tertiary care medical center from 2019 to 2023, involving patients diagnosed with unilateral Ménière's disease. All patients underwent MRI hydrops assessments (3D-REAL-IR sequences) using 3 Tesla magnets and gadobutrol contrast agent. EH was graded qualitatively and quantitatively for both ears using scales for cochlear endolymphatic hydrops (cEH) and vestibular endolymphatic hydrops (vEH). Volumetric measurements of the vestibule and endolymph were performed, and the vestibular endolymphatic ratio (vELR) was calculated. The degree of perilymphatic enhancement (PE) and endolymphatic herniation was also assessed. Patient data, including demographics, disease features, comorbidities, hearing loss, and vestibular function, were collected from medical records. Statistical analysis involved various tests to compare groups and evaluate correlations, using a significance level of p < 0.05. The study aimed to classify the patients into cochleocentric (CC) or non-cochleocentric (NCC) groups based on the difference in the severity of EH in both compartments. We included 137 patients, of whom 55 (40.15%) were classified as CC, and the remaining 82 (59.85%) were classified as NCC. The degree of vestibular EH (vEH) was more severe in the NCC group (p < 0.001), while cochlear EH (cEH) showed a moderate correlation with vEH. The mean vestibular endolymphatic ratio (vELR) was higher in the NCC group (80.5% ± 38%) compared to the CC group (55% ± 49.5%) (p < 0.0001). Vestibular herniation was more common in the NCC group, while vestibular perilymphatic enhancement was more prevalent in the CC group. Cardiovascular risk was associated with the CC group, while the NCC group reported more vestibular symptoms. Delayed Ménière's disease was linked to the CC group. The hearing loss and vestibular function tests did not show significant differences between the groups. In conclusion, our study found that endolymphatic hydrops (EH) was more severe in the vestibule than in the cochlea in nearly 60% of the cases, with a clinical correlation to the initial symptoms. However, no significant differences were observed in the auditory or vestibular function tests during the follow-up.V Previous studies have indicated that vestibular EH occurs early in Ménière's disease (MD) and subsequently progresses to the cochlea, a finding that challenges the traditional cochleocentric progression theory supported by experimental and clinical otopathology. MRI techniques have enhanced the detection of EH, revealing that the relative amount of endolymph is slightly higher in the vestibule than in the cochlea, thereby supporting the study's findings. We considered the important technical limitations in the MRI visualization of EH and suggested that advanced imaging techniques and volumetric quantification could enhance the classification of cochleocentric and non-cochleocentric groups. The clinical findings revealed that cardiovascular risk factors and delayed MD phenotypes were more common in the cochleocentric group, while the non-cochleocentric group exhibited poorer vestibular MRI results and a higher incidence of endolymph herniation into the semicircular canals.

Comparative analysis of audiovestibular testing results in vestibular schwannomas

Objective:This study aimed to analyze the results of auditory and vestibular function tests in patients with unilateral vestibular schwannoma and explore their association with tumor size. Methods:Clinical data from 81 patients diagnosed with unilateral vestibular schwannoma who underwent pure-tone audiometry（PTA）, cervical and ocular vestibular evoked myogenic potentials（c/oVEMP）, as well as video head impulse test（vHIT）, and subsequently underwent surgical treatment, were retrospectively analyzed. Patients were categorized into groups based on tumor size: small （≤ 15 mm）, medium（16-30 mm）, and large （>30 mm）, determined by the maximum tumor diameter on contrast-enhanced MRI scans. Results:PTA results indicated hearing loss in 73 cases（90.1%）; vestibular function tests revealed abnormal rates for the anterior semicircular canal, horizontal semicircular canal, posterior semicircular canal, utricle, and saccule at 29.6%, 77.8%, 54.3%, 90.1%, and 92.6%, respectively. Statistically, no significant differences were found in preoperative hearing test results among patients in different groups（F=0.393, P=0.676）. However, significant differences were observed in horizontal semicircular canal gain（r=-0.248, P=0.025）, abnormal rates of horizontal semicircular canal catch-up saccades（r=0.507, P<0.001）, as well as cVEMP（χ²=15.111, P=0.004） and oVEMP thresholds（χ²=18.948, P<0.001） across varying tumor size groups. Conclusion:The extent of hearing loss in patients with vestibular schwannoma is not correlated with tumor size, whereas the degree of vestibular dysfunction demonstrates a correlation with tumor size.

Effect and differentiation of spontaneous nystagmus of acute unilateral vestibulopathy on saccade in the video head impulse test

Objective:Exploring the performance characteristics of spontaneous nystagmus（SN） in video-head impulse test（vHIT） and its possible effects on saccade. Methods:Vestibular function tests such as vHIT and SN were conducted in 48 patients with acute unilateral vestibulopathy（AUVP）. The saccade characteristics of vHIT in patients without SN and those with SN were analyzed, as well as the expression characteristics of SN in vHIT. Results:Among the 48 AUVP patients, there were 34 cases with SN, including 31 cases with saccade on the healthy side, 11 cases with both the same and opposite directions of eye movement, 19 with the opposite only, 1 with same direction only, and 3 cases without saccade. There were 14 patients without SN, of whom 10 showed saccade on the healthy side, including 4 with both eye movements in the same and opposite direction, 2 in the opposite direction only, 4 in the same direction only, and 4 without saccade. There is a correlation between reverse saccade on the healthy side and the presence of SN in patients. SN in vHIT can appear opposite to the direction of eye movement on the healthy side, while on the affected side it can appear the same as the direction of eye movement and may cause more discrete overt saccade. 32 patients in the acute phase（≤2 w）, 29 patients with SN, SN intensity of（6.7 ± 3.2） °/s, and 3 patients without SN. 16 cases in non acute phase（>2 w）, 5 cases with SN, SN intensity of（3.7 ± 2.1） °/s, and 11 cases without SN. In the acute phase there were 30 cases of saccade on the healthy side, 10 cases with both the same and opposite direction of eye movement, 18 cases with only the opposite direction, 2 cases with only the same direction and 2 cases without saccade. There is a correlation between the duration of the disease and the occurrence of reverse saccade on the healthy side. The intensity cut off point of SN for reverse saccade is 2.1 °/s in the healthy lateral semicircular canal vHIT. Conclusion:Compensatory saccades and SN waves with similar waveforms are mostly present in vHIT in AUVP patients. SN wave is in the opposite direction of the normal side and eye movement wave, and the affected side and dominant saccade direction are in the same direction and mixed together, which can affect the dispersion and amplitude of overt saccade in vHIT. Accurate identification of SN in vHIT of AUVP patients is not only the key factor to identify compensatory saccade, but also can provide help for the diagnosis and compensatory assessment of AUVP.

Vestibulopathy in Patients Presenting With Ramsay Hunt Syndrome.

Ramsay Hunt syndrome (RHS) refers to a reactivation of the varicella-zoster virus in the distribution of the facial nerve, but it can involve other cranial nerves as well. In patients with polyneuropathy, the vestibulocochlear nerve is most involved after the facial nerve. The clinical manifestations and long-term vestibular outcomes in these patients remain unclear. This report aims to characterize the clinical course of this rare subset of RHS patients. This study is a retrospective case series. The study was conducted in a tertiary care institution. Patients with RHS polyneuropathy presenting with vestibular deficit were reviewed over a 30-year period. Case details including initial presentation, House-Brackmann grade, treatment regimen, vestibular examination and testing, MRI findings, and follow-up time were extracted. A total of 22 patients were identified. The mean age of diagnosis was 53 years and the average follow-up time was 23 months. Most patients demonstrated complete facial paralysis (88%) upon presentation. Nystagmus was rarely recorded during physical examination (18%, n = 4). For those patients who underwent MRI of the internal auditory canal (n = 17), 59% demonstrated enhancement of the facial nerve, with a notable absence of vestibulocochlear nerve abnormality. Of the patients who underwent vestibular testing, all demonstrated unilateral caloric weakness on videonystagmography (VNG; 66% ± 22%, n = 8). Patients with RHS polyneuropathy and vestibular complaints do not consistently demonstrate objective vestibular physical examination or imaging findings on presentation. However, VNG consistently demonstrates significant unilateral weakness on caloric stimulation. Most patients in our sample continued to have vestibular complaints at latest follow-up.