Association between vestibular dysfunction and findings of horizontal head-shaking and vibration-induced nystagmus

2020 ◽  
Vol 30 (5) ◽  
pp. 319-327
Author(s):  
Chisato Fujimoto ◽  
Takuya Kawahara ◽  
Masato Yagi ◽  
Toshihisa Murofushi
Keyword(s):  
Medical Records ◽  
Vestibular Function ◽  
Mixed Effects ◽  
Vestibular Dysfunction ◽  
Regression Analyses ◽  
Lateral Semicircular Canal ◽  
Vestibular Evoked Myogenic Potential ◽  
Vestibular Diseases ◽  
Ocular Vemp ◽  
Horizontal Head

BACKGROUND: The association between vestibular function and findings of horizontal head-shaking nystagmus (HHSN) and vibration-induced nystagmus (VIN) tests is not well understood. OBJECTIVE: To investigate the association between function in the five distinct vestibular end organs and findings of these nystagmus tests. METHODS: We retrospectively reviewed the medical records of 50 patients with vestibular diseases who underwent HHSN testing, VIN testing, video head impulse testing (vHIT), cervical vestibular evoked myogenic potential testing to air-conducted sound (ACS cVEMP) and ocular VEMP testing to ACS (ACS oVEMP). We performed mixed-effects logistic regression analyses to see whether age, sex or the presence of nystagmus in HHSN or VIN have an association with the presence of peripheral vestibular dysfunction on the opposite side to the direction of nystagmus. RESULTS: The presence of HHSN had a significant association with abnormal vHIT in the lateral semicircular canal (LSCC) on the opposite side to the direction of nystagmus. The presence of VIN had a significant association with abnormal vHIT in all the SCCs and abnormal ACS oVEMP on the opposite side to the direction of nystagmus. CONCLUSIONS: HHSN had an association with LSCC dysfunction alone. VIN had an association with dysfunction in all the SCCs and the utricle.

Comparison of Horizontal and Vertical Dynamic Visual Acuity in Patients with Vestibular Dysfunction and Nonvestibular Dizziness

2007 ◽  
Vol 18 (03) ◽  
pp. 236-244 ◽  
Author(s):  
Richard A. Roberts ◽  
Richard E. Gans
Keyword(s):  
Visual Acuity ◽  
Head Movement ◽  
Vestibular Function ◽  
Vestibular Dysfunction ◽  
Common Symptom ◽  
Dynamic Visual Acuity ◽  
Blurred Vision ◽  
Ocular Reflex ◽  
Vestibulo Ocular Reflex ◽  
Horizontal Head

Blurred vision with head movement is a common symptom reported by patients with vestibular dysfunction affecting the vestibulo-ocular reflex (VOR). Impaired VOR can be measured by comparing visual acuity in which there is no head movement to visual acuity obtained with head movement. A previous study demonstrated that dynamic visual acuity (DVA) testing using vertical head movement revealed deficits in impaired VOR. There is evidence that horizontal head movement is more sensitive to impaired VOR. The objective of this investigation was to compare horizontal and vertical DVA in participants with normal vestibular function (NVF), impaired vestibular function (IVF), and participants with nonvestibular dizziness (NVD). Participants performed the visual acuity task in a baseline condition with no movement and also in two dynamic conditions, horizontal head movement and vertical head movement. Horizontal DVA was twice as sensitive to impaired VOR than vertical DVA. Results suggest that horizontal volitional head movement should be incorporated into tasks measuring functional deficits of impaired VOR. Una visión borrosa con los movimientos de la cabeza es un síntoma común reportado por los pacientes con una disfunción vestibular que afecta el reflejo vestíbulo-ocular (VOR). La alteración en el VOR puede ser medida comparando la aguda visual no acompañada de movimientos de la cabeza, con la aguda visual obtenida con movimientos cefálicos. Un estudio previo demostró que la prueba de aguda visual dinámica (DVA) usando movimiento vertical de la cabeza revelaba deficiencias relacionados con un VOR alterado. Existe evidencia que el movimiento cefálico horizontal es más sensible a un VOR alterado. El objetivo de esta investigación fue comparar el DVA horizontal y vertical en participantes con funcional vestibular normal (NVF), con función vestibular alterada (IVF) y en sujetos con mareo no vestibular (NVD). Los participantes realizaron sus tareas de agudeza visual en una condición basal, sin movimiento, y también en dos condiciones dinámicas, con movimientos de cabeza horizontales y verticales. El DVA horizontal fue dos veces más sensible a un VOR alterado que el DVA vertical. Los resultados sugieren que los movimientos volitivos horizontales de la cabeza deben incorporarse en las tareas que midan deficiencias funcionales con un VOR alterado.

scholarly journals Vestibular prognosis in idiopathic sudden sensorineural hearing loss with vestibular dysfunction treated with oral or intratympanic glucocorticoids: a protocol for randomized controlled trial

Trials ◽  
2020 ◽  
Vol 21 (1) ◽  
Author(s):  
Weiming Hao ◽  
Liping Zhao ◽  
Huiqian Yu ◽  
Huawei Li
Keyword(s):  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Vestibular Function ◽  
Vestibular Dysfunction ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Vestibular Evoked Myogenic Potential ◽  
Hearing Outcome ◽  
Myogenic Potential ◽  
Secondary Outcomes

Abstract Background Idiopathic sudden sensorineural hearing loss (ISSNHL) is a rapid-onset sensorineural hearing impairment with unclear etiology and unsatisfying treatment effects. Vestibular dysfunction has been considered as a poor indicator in the clinical manifestations and prognosis of ISSNHL, which occurred in approximately 28–57% cases. Glucocorticoids, administered through oral or intratympanic way, are currently regularly and standardly applied for ISSNHL to improve the hearing outcome. However, the vestibular prognosis of ISSNHL after routine treatments remains seldom explored. This study aims to compare the effectiveness of oral and intratympanic glucocorticoids in ISSNHL with vestibular dysfunction in terms of the pattern and trajectory of possible process of vestibular function recovery. Methods/design A randomized, outcome-assessor- and analyst-blinded, controlled, clinical trial (RCT) will be carried out. Seventy-two patients with ISSNHL complaining of vestibular dysfunction appearing as vertigo or imbalance will be recruited and randomized into either oral or intratympanic glucocorticoid therapy group with a 1:1 allocation ratio. The primary outcomes will be vestibular function outcomes assessed by sensory organization test, caloric test, video head impulse test, cervical vestibular evoked myogenic potential, and ocular vestibular evoked myogenic potential; the secondary outcomes include self-reported vestibular dysfunction symptoms; dizziness-related handicap, visual analogue scale for vertigo and tinnitus; and pure tone audiometry. Assessments of primary outcomes will be performed at baseline and at 4 and 8 weeks post-randomization, while assessments of secondary outcomes will be performed at baseline and 1, 2, 4, and 8 weeks post-randomization. Discussion Previous intervention studies of ISSNHL included only hearing outcomes, with little attention paid on the prognosis of vestibular dysfunction. This trial will be the first RCT study focusing on the progress and prognosis of vestibular dysfunction in ISSNHL. The efficacy of two commonly used therapies of glucocorticoids will be compared in both auditory and vestibular function fields, rather than in the hearing outcome alone. Trial registration ClinicalTrials.gov NCT03974867. Registered on 23 July 2019

scholarly journals Diagnostic capabilities of the vestibular evoked myogenic potential test in children with vestibular dysfunction

2020 ◽  
Vol 6 (4) ◽  
pp. 606 ◽  
Author(s):  
Kalina I. Madzharova ◽  
Ana P. Beshkova
Keyword(s):  
Vestibular Dysfunction ◽  
Otolith Organs ◽  
Vestibular Evoked Myogenic Potential ◽  
Additional Method ◽  
Analysis And Evaluation ◽  
Myogenic Potential ◽  
Ocular Vemp ◽  
Cervical Vemp ◽  
Diagnostic Capabilities

<p class="abstract"><strong>Background:</strong> Vestibular evoked myogenic potential (VEMP) testing is used in the diagnosis of vestibular disorders. It is an objective method for testing the the otolith organs of the vestibular system. VEMP test is an additional method for diagnosing vestibular neuritis (VN). The combination of cervical VEMP (cVEMP) and ocular VEMP (oVEMP) testing has an advantage in long-term monitoring of patients with VN. The VEMP test is well-studied for adults but studies involving children are insufficient. The aim of this study was to analysis and evaluation of the results from VEMP testing of children diagnosed with vestibular dysfunction. Analysis and evaluation of the results from VEMP testing of children diagnosed with vestibular dysfunction.</p><p class="abstract"><strong>Methods:</strong> History, examination of ENT organs, tone threshold audiometry, tympanometry, otoneurological examination, VEMP test.  </p><p class="abstract"><strong>Results:</strong> Children with vestibular dysfunction who were examined showed changes predominantly in the oVEMP test. The upper branch of the vestibular nerve is affected.   </p><p class="abstract"><strong>Conclusions:</strong> The VEMP test is an additional method for diagnosing patients with vestibular dysfunction. It is safe when used for children.</p>

scholarly journals Impact of digitally acquired peer diagnostic input on diagnostic confidence in outpatient cases: A pragmatic randomized trial

2020 ◽  
Author(s):  
Elaine C Khoong ◽  
Valy Fontil ◽  
Natalie A Rivadeneira ◽  
Mekhala Hoskote ◽  
Shantanu Nundy ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Randomized Trial ◽  
Odds Ratio ◽  
Primary Outcome ◽  
Mixed Effects ◽  
Regression Analyses ◽  
Diagnostic Confidence ◽  
Diagnostic Uncertainty ◽  
Intervention Impact ◽  
High Uncertainty

Abstract Objective The study sought to evaluate if peer input on outpatient cases impacted diagnostic confidence. Materials and Methods This randomized trial of a peer input intervention occurred among 28 clinicians with case-level randomization. Encounters with diagnostic uncertainty were entered onto a digital platform to collect input from ≥5 clinicians. The primary outcome was diagnostic confidence. We used mixed-effects logistic regression analyses to assess for intervention impact on diagnostic confidence. Results Among the 509 cases (255 control; 254 intervention), the intervention did not impact confidence (odds ratio [OR], 1.46; 95% confidence interval [CI], 0.999-2.12), but after adjusting for clinician and case traits, the intervention was associated with higher confidence (OR, 1.53; 95% CI, 1.01-2.32). The intervention impact was greater in cases with high uncertainty (OR, 3.23; 95% CI, 1.09- 9.52). Conclusions Peer input increased diagnostic confidence primarily in high-uncertainty cases, consistent with findings that clinicians desire input primarily in cases with continued uncertainty.

scholarly journals ALLY in fighting COVID-19: magnitude of albumin decline and lymphopenia (ALLY) predict progression to critical disease

2021 ◽  
pp. jim-2020-001525
Author(s):  
Johanna S van Zyl ◽  
Amit Alam ◽  
Joost Felius ◽  
Ronnie M Youssef ◽  
Dipesh Bhakta ◽  
...  
Keyword(s):  
Medical Records ◽  
Resource Planning ◽  
Mixed Effects ◽  
Mixed Effects Models ◽  
Disease Course ◽  
Risk Models ◽  
Simple Tool ◽  
Laboratory Results ◽  
Risk Of Disease ◽  
Critical Patients

The global severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic leading to coronavirus disease 2019 (COVID-19) is straining hospitals. Judicious resource allocation is paramount but difficult due to the unpredictable disease course. Once hospitalized, discerning which patients may progress to critical disease would be valuable for resource planning. Medical records were reviewed for consecutive hospitalized patients with COVID-19 in a large healthcare system in Texas. The main outcome was progression to critical disease within 10 days from admission. Albumin trends from admission to 7 days were analyzed using mixed-effects models, and progression to critical disease was modeled by multivariable logistic regression of laboratory results. Risk models were evaluated in an independent group. Of 153 non-critical patients, 28 (18%) progressed to critical disease. The rate of decrease in mean baseline-corrected (Δ) albumin was −0.08 g/dL/day (95% CI −0.11 to −0.04; p<0.001) or four times faster, in those who progressed compared with those who did not progress. A model of Δ albumin combined with lymphocyte percentage predicting progression to critical disease was validated in 60 separate patients (sensitivity, 0.70; specificity, 0.74). ALLY (delta albumin and lymphocyte percentage) is a simple tool to identify patients with COVID-19 at higher risk of disease progression when: (1) a 0.9 g/dL or greater albumin drop from baseline within 5 days of admission or (2) baseline lymphocyte of ≤10% is observed. The ALLY tool identified >70% of hospitalized cases that progressed to critical COVID-19 disease. We recommend prospectively tracking albumin. This is a globally applicable tool for all healthcare systems.

scholarly journals Assessment of cervical and ocular vestibular evoked myogenic potentials in migraine patients

2020 ◽  
Vol 36 (1) ◽  
Author(s):  
Doaa Elmoazen ◽  
Hesham Kozou ◽  
Jaidaa Mekky ◽  
Dalia Ghanem
Keyword(s):  
Vestibular Function ◽  
Vestibular Dysfunction ◽  
Peak Amplitude ◽  
Vestibular Evoked Myogenic Potentials ◽  
Healthy Controls ◽  
Latency Difference ◽  
Significant Difference ◽  
Cervical Vemp ◽  
Vestibular Symptoms ◽  
Function Assessment

Abstract Background Patients suffering from vestibular migraine (VM) are known to have various vestibular test abnormalities interictally and ictally. Recently, vestibular evoked myogenic potentials (VEMPs) have become accepted as a valid method for otolith function assessment. Many studies have identified various vestibular symptoms and laboratory abnormalities in migraineurs. Since migraineurs with no accompanying vestibular symptoms might exhibit subclinical vestibular dysfunction, we investigated vestibular function using ocular and cervical VEMPs in migraine patients. The aim was to study cervical VEMP and occular VEMP in migraineurs with and without vestibular symptoms interictally. Results Migraine and VM patients showed significantly longer P13 latency of cVEMP compared to controls. A statistically significant cVEMP interaural P13 latency difference was found in VM compared to healthy controls. Cervical VEMP N23 latency, peak-to-peak amplitude, interaural N23 latency, and amplitude asymmetric ratio did not show any significant difference in migraine and VM patients compared to healthy controls as well as no significant difference across the three groups regarding oVEMP parameters. Conclusions Abnormal interictal cVEMP results in migraineurs might indicate subclinical vestibulo-collic pathway dysfunction.

The alternative negative constructions in spoken and written Korean: Logistic regression analysis

2019 ◽  
Vol 15 (2) ◽  
pp. 419-442
Author(s):  
Beom-mo Kang
Keyword(s):  
Logistic Regression ◽  
Regression Analysis ◽  
Logistic Regression Analysis ◽  
Mixed Effects ◽  
Written Language ◽  
Regression Analyses ◽  
Relevant Factor ◽  
Factors Influencing ◽  
Frequency Of Use ◽  
Relevant Factors

AbstractAdopting quantitative corpus-based methods, this paper focuses on the alternative negative constructions in Korean, [anV] and [Vanhda]. Logistic regression analyses for a mixed-effects model were carried out on data drawn from the Sejong Korean Corpus. Certain features of the verb or adjective in negative constructions significantly affect the use of the two negative constructions. A relevant factor is register/medium (spoken or written), among other significant interactions of factors. Furthermore, the fact that frequency is consistent with other relevant factors, together with certain diachronic facts of Korean, supports the claim that frequency of use plays an important role in linguistic changes. Another finding is that, notwithstanding noticeable differences between spoken and written language, the factors influencing the use of the two negative constructions in Korean are largely similar in the spoken and written registers.

scholarly journals Vestibular prognosis in idiopathic sudden sensorineural hearing loss with vestibular dysfunction treated with oral or intratympanic glucocorticoids: a protocol for randomized controlled trial

2020 ◽  
Author(s):  
Huawei Li ◽  
Weiming Hao ◽  
Liping Zhao ◽  
Huiqian Yu
Keyword(s):  
Randomized Controlled Trial ◽  
Hearing Loss ◽  
Sensorineural Hearing Loss ◽  
Controlled Trial ◽  
Vestibular Function ◽  
Vestibular Dysfunction ◽  
Sudden Sensorineural Hearing Loss ◽  
Sensorineural Hearing ◽  
Hearing Outcome ◽  
Randomized Controlled

Abstract Background Idiopathic sudden sensorineural hearing loss (ISSNHL) is a rapid-onset sensorineural hearing impairment with unclear etiology and unsatisfying treatment effects. Vestibular dysfunction has been considered as a poor indicator in the clinical manifestations and prognosis of ISSNHL, which occurred in approximately 28%-57% cases. Glucocorticoids, administered through oral or intratympanic way, is currently a regular and standard treatment for ISSNHL based on hearing outcome. However, little investigations have been conducted on the recovery process and treatment effects of glucocorticoids on vestibular dysfunctions of ISSNHL. This study aims to compare the efficacy of oral or intratympanic glucocorticoids in ISSNHL with vestibular dysfunction in terms of the pattern and trajectory of possible process of vestibular function recovery.Methods/Design A randomized, outcome-assessor- and analyst-blinded, controlled, clinical trial (RCT) will be carried out. A group of seventy-two patients with ISSNHL complaining of vestibular dysfunction appearing as vertigo, dizziness or imbalance will be recruited and randomized into two arms of either oral or intratympanic glucocorticoids therapy with a 1:1 allocation ratio. The primary outcomes will be vestibular function outcomes assessed by sensory organization test, caloric test, video head impulse test, and vestibular evoked myogenic potentials; the secondary outcomes include self-reported vestibular dysfunction symptoms; dizziness-related handicap, visual analogue scale for vertigo and tinnitus; and pure tone audiometry. Assessment will be performed at baseline and at 1, 2, 4, and 8 weeks post-randomization. To our knowledge, this will be the first randomized controlled trial focusing on the prognosis of vestibular dysfunction in ISSNHL and the efficacy of glucocorticoids therapy for the vestibular dysfunction in this disease.Discussion This trial will be the first RCT study focusing on the progress and prognosis of vestibular dysfunction in ISSNHL. Efficacy of two commonly used therapies of glucocorticoids will be compared in both auditory and vestibular function fields, rather than in the hearing outcome alone. Trial registration ClinicalTrials.gov, NCT03974867. Registered on July 23, 2019.

scholarly journals Vestibular Preservation After Cochlear Implantation Using the Round Window Approach

2021 ◽  
Vol 12 ◽  
Author(s):  
Keita Tsukada ◽  
Shin-ichi Usami
Keyword(s):  
Cochlear Implantation ◽  
Round Window ◽  
Surgical Techniques ◽  
Vestibular Function ◽  
Vestibular Evoked Myogenic Potential ◽  
Flexible Electrodes ◽  
Caloric Testing ◽  
Before And After ◽  
Window Approach ◽  
Caloric Response

Background: The development of less traumatic surgical techniques, such as the round window approach (RWA), as well as the use of flexible electrodes and post-operative steroid administration have enabled the preservation of residual hearing after cochlear implantation (CI) surgery. However, consideration must still be given to the complications that can accompany CI. One such potential complication is the impairment of vestibular function with resulting vertigo symptoms. The aim of our current study was to examine the changes in vestibular function after implantation in patients who received CI using less traumatic surgery, particularly the RWA technique.Methods: Sixty-six patients who received CI in our center were examined by caloric testing, cervical vestibular evoked myogenic potential (cVEMP) and ocular VEMP (oVEMP) before or after implantation, or both, to obtain data on semicircular canal, saccular and utricular function, respectively. Less traumatic CI surgery was performed by the use of the RWA and insertion of flexible electrodes such as MED-EL FLEX soft, FLEX 28, and FLEX 24 (Innsbruck, Austria).Results: Caloric response and the asymmetry ratio of cVEMP and oVEMP were examined before and after implantation using less traumatic surgical techniques. Compared with before implantation, 93.9, 82.4, and 92.5% of the patients showed preserved vestibular function after implantation based on caloric testing, cVEMP and oVEMP results, respectively. We also examined the results for vestibular function by a comparison of the 66 patients using the RWA and flexible electrodes, and 17 patients who underwent cochleostomy and insertion of conventional or hard electrodes. We measured responses using caloric testing, cVEMP and oVEMP in patients after CI. There were no differences in the frequencies of abnormal caloric and oVEMP results in the implanted ears between the RWA and cochleostomy. On the other hand, the frequency of abnormal cVEMP responses in the implanted ears in the patients who received implantation by cochleostomy was significantly higher than that in the patients undergoing surgery using the RWA.Conclusion: Patients receiving CI using less traumatic surgical techniques such as RWA and flexible electrodes have reduced risk of damage to vestibular function.

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