scholarly journals Long-Term Vestibular Outcomes in Cochlear Implant Recipients

2021 ◽  
Vol 12 ◽  
Author(s):  
Kasper Møller Boje Rasmussen ◽  
Niels West ◽  
Luchen Tian ◽  
Per Cayé-Thomasen
Keyword(s):  
Cochlear Implantation ◽  
Vestibular Function ◽  
Vestibular Dysfunction ◽  
Vestibular Evoked Myogenic Potentials ◽  
Significant Deterioration ◽  
Caloric Irrigation ◽  
Vestibular Tests ◽  
Wide Range

Background: Vestibular dysfunction is likely the most common complication to cochlear implantation (CI) and may, in rare cases, result in persistent severe vertigo. Literature on long-term vestibular outcomes is scarce.Objective: This paper aims to evaluate vestibular dysfunction before and after cochlear implantation, the long-term vestibular outcomes, and follows up on previous findings of 35 consecutive adult cochlear implantations evaluated by a battery of vestibular tests.Methods: A prospective observational longitudinal cohort study was conducted on 35 CI recipients implanted between 2018 and 2019; last follow-up was conducted in 2021. At the CI work-up (T0) and two postoperative follow-ups (T1 and T2), 4 and 14 months following implantation, respectively, all patients had their vestibular function evaluated. Evaluation with a vestibular test battery, involving video head impulse test (vHIT), cervical vestibular evoked myogenic potentials (cVEMP), caloric irrigation test, and dizziness handicap inventory (DHI), were performed at all evaluations.Results: vHIT testing showed that 3 of 35 ears had abnormal vHIT gain preoperatively, which increased insignificantly to 4 of 35 at the last follow-up (p = 0.651). The mean gain in implanted ears decreased insignificantly from 0.93 to 0.89 (p = 0.164) from T0 to T2. Preoperatively, 3 CI ears had correction saccades, which increased to 11 at T2 (p = 0.017). Mean unilateral weakness increased from 19 to 40% from T0 to T2 (p < 0.005), and the total number of patients with either hypofunctioning or areflexic semicircular canals increased significantly from 7 to 17 (p < 0.005). Twenty-nine percent of CI ears showed cVEMP responses at T0, which decreased to 14% (p = 0.148) at T2. DHI total mean scores increased slightly from 10.9 to 12.8 from T0 to T1 and remained at 13.0 at T2 (p = 0.368). DHI scores worsened in 6 of 27 patients and improved in 4 of 27 subjects from T0 to T2.Conclusion: This study reports significant deterioration in vestibular function 14 months after cochlear implantation, in a wide range of vestibular tests. vHIT, caloric irrigation, and cVEMP all measured an overall worsening of vestibular function at short-term postoperative follow-up. No significant deterioration or improvement was measured at the last postoperative follow-up; thus, vestibular outcomes reached a plateau. Despite vestibular dysfunction, most of the patients report less or unchanged vestibular symptoms.

Video head impulse test saccades and loss of cervical vestibular evoked myogenic potentials are late vestibular footprints of cochlear implantation

2020 ◽  
pp. 1-7
Author(s):  
Niels West ◽  
Mads Klokker ◽  
Per Cayé-Thomasen
Keyword(s):  
Cochlear Implantation ◽  
Vestibular Function ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Video Head Impulse Test ◽  
Before And After ◽  
The Mean ◽  
Vestibular Assessment

BACKGROUND: Cochlear implantation may be complicated by concurrent injury to the vestibular apparatus, potentially resulting in disabling vertigo and balance problems. Information on vestibular function before implantation as measured by the video head impulse test (VHIT) and cervical vestibular evoked myogenic potentials (cVEMPs) is scarce and literature on long-term effects is non-existing. OBJECTIVE: We aimed to evaluate how vestibular function was affected by cochlear implantation (CI), as measured by VHIT and cVEMPs in the late phase after implantation. METHODS: Retrospective repeated measurement study. Patients: Among the 436 patients elected for CI surgery during 2013 to 2018, 45 patients met the inclusion criteria (CI recipients with a vestibular assessment prior to the first CI and a repeated vestibular assessment after the CI operation). Intervention: VHIT and cVEMPs before and after cochlear implantation. Main outcome measures were vestibular function as evaluated by VHIT gain, saccades and cVEMPs. RESULTS: The mean time between first and second vestibular screening was 19 months. The mean VHIT gain on implanted ears was 0.79 before the operation and showed no change at follow-up (p = 0.65). Likewise, the number of abnormal VHIT gain values was equal before and after the operation (p = 0.31). Preoperatively, saccades were present on 12 ears (14% ) compared with 25 ears (29% ) postoperatively (p = 0.013) and were associated with significantly lower VHIT gain values. Preoperatively, positive cVEMPs were found in 20 CI ears (49% ) and 24 contralateral ears (62% ). 10 CI ears lost cVEMP postoperatively compared with 2 ears on the contralateral side (p = 0.0047). CONCLUSIONS: Even though VHIT gain has been reported to be affected in the immediate post-implantation period, the findings in this study show that VHIT gain is normalized in the long-term. However, cochlear implantation is associated with the occurrence of VHIT saccades in the long-term and these are associated with lower VHIT gain values. In addition, cVEMP responses are significantly reduced long-term on implanted ears, which agrees with other studies with shorter follow-up.

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.

A follow-up study of long-term results after cochlear implantation in children and adolescents

1996 ◽  
Vol 253 (3) ◽  
pp. 158-166 ◽  
Author(s):  
J. Kiefer ◽  
V. Gall ◽  
C. Desloovere ◽  
R. Knecht ◽  
A. Mikowski ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Cochlear Implantation ◽  
Long Term Results ◽  
Follow Up Study

Serving Students With Acquired Brain Injury: Understanding Long-Term Need and Outcomes After the BrainSTEPS Program

2021 ◽  
pp. 1-14
Author(s):  
Jessica Salley Riccardi ◽  
Libby Crook ◽  
Brenda Eagan-Johnson ◽  
Monica Vaccaro ◽  
Angela H. Ciccia
Keyword(s):  
Brain Injury ◽  
Regular Education ◽  
Acquired Brain Injury ◽  
Transition Services ◽  
Student Outcome ◽  
Severe Injuries ◽  
School Based ◽  
Wide Range

Purpose: The purpose of this study was to inform school-based services for children with acquired brain injury (ABI) by describing and analyzing functional student-outcome data from a state-wide, school-based, school re-entry consultation program, BrainSTEPS (Strategies Teaching Educators, Parents, and Students), in Pennsylvania. Method: A nonexperimental, retrospective analysis was conducted with data collected during a pilot follow-up survey for BrainSTEPS. Caregivers reported on 337 students with ABI participating in BrainSTEPS. Results: Most students post-ABI who were participating in BrainSTEPS were enrolled in regular education and reported no ongoing symptoms, as well as no parent perception of need for additional BrainSTEPS consultation during the time period of the follow-up survey. Current receipt of therapy was significantly associated with injury type, χ 2 (1, n = 329) = 16.72, p < .001. A multiple logistic regression was significant ( p < .001) in predicting the need for additional BrainSTEPS consultation. More severe injuries, educational placement postinjury of regular education with a 504 plan (compared to regular education), and current receipt of therapy significantly increased the odds of need for consultation. Conclusions: Due to the wide range of experiences of students in this sample, hospital-to-school transition services, educational supports and services, and long-term follow-up must be individualized for children with ABI. Speech-language pathologists are critical members of the school-based academic team for students with ABI to decrease long-term unmet needs.

scholarly journals 084 Separating stroke from vestibular neuritis by vestibular function test parameters

2019 ◽  
Vol 90 (e7) ◽  
pp. A27.1-A27
Author(s):  
Zeljka Calic ◽  
Benjamin Nham ◽  
Rachel Taylor ◽  
Allison Young ◽  
Craig Anderson ◽  
...  
Keyword(s):  
Three Dimensional ◽  
Vestibular Function ◽  
Vestibular Neuritis ◽  
Vestibular Evoked Myogenic Potentials ◽  
Head Impulse Test ◽  
Saccade Amplitude ◽  
Vestibular Tests ◽  
Acute Vestibular Syndrome ◽  
Significant Difference ◽  
Catch Up

IntroductionVestibular neuritis (VN) and posterior circulation stroke (PCS) are the commonest causes of acute vestibular syndrome (AVS). We aim to identify discriminators of VN from PCS by testing all five vestibular end-organs in patients presenting with AVS.MethodsThree-dimensional video-head impulse test (v-HIT), cervical and ocular-vestibular evoked myogenic potentials (c-and oVEMP) and subjective visual horizontal (SVH) tests were performed in 22 patients with VN and 22 with PCS. Ipsilesional horizontal, anterior and posterior canal (HC, AC, PC) v-HIT gain and first catch-up saccade characteristics, VEMP amplitude asymmetry-ratios were compared.ResultsAll VN and 6 PCS patients had positive clinical HIT. Mean time to testing was 4.7 days for VN, 7.0 days for PCS. VN mean ipsilesional HC and AC first saccade amplitude was larger, peak-velocities faster and onset latencies earlier compared to PCS (p<0.05). No significant difference between VN and PCS in first saccade characteristics was found in PC. Ipsilesional first saccade amplitude, peak-velocity and duration were significantly different between PCS and controls for all canals (p<0.05). A gain <0.68 and first saccade amplitudes >2.2°separated VN from PCS with sensitivities of 95.5% and 86.4% and specificities of 72.7% and 63.6%. First saccade amplitude of >0.91°identified PCS from controls with sensitivity of 68.2% and specificity of 70%. Abnormality rates for AC cVEMP, BC oVEMP and SVH were 42.9%, 50% and 91% for VN and 38.1%, 9% 72% for PCS.Conclusion v-HIT gain and catch-up saccade metrics are useful separators of VN from PCS. Detailed saccade analysis complements existing vestibular tests.

Successful cochlear implantation in a patient with Epstein syndrome during long-term follow-up

2020 ◽  
Author(s):  
Anjin Mori ◽  
Hidehiko Takeda ◽  
Marina Kobayashi ◽  
Takeru Misawa ◽  
Ryoko Watanabe ◽  
...  
Keyword(s):  
Cochlear Implantation ◽  
Long Term Follow Up ◽  
Epstein Syndrome

scholarly journals Long-term outcome of indigenous 177Lu-DOTATATE PRRT in patients with Metastatic Advanced Neuroendocrine Tumours: a single institutional observation in a large tertiary care setting

2021 ◽  
Vol 94 (1117) ◽  
pp. 20201041
Author(s):  
Keerti Sitani ◽  
Rahul V Parghane ◽  
Sanjay Talole ◽  
Sandip Basu
Keyword(s):  
Primary Tumour ◽  
Univariate Analysis ◽  
Tertiary Care ◽  
Previous History ◽  
Term Outcome ◽  
Long Term Outcome ◽  
Wide Range ◽  
Grade 3

Objectives: Assessment of long-term outcome and toxicity of indigenous 177Lu-DOTATATE PRRT in patients of metastatic/advanced NETs in a large tertiary-care PRRT setting. Methods: A total of 468 metastatic/advanced NET patients (wide range of primary sites including CUP-NETs), who underwent at least two cycles of 177Lu-DOTATATE PRRT with available follow-up information, were included and analysed retrospectively in this study. In-house labelling of DOTATATE with 177Lu (direct route produced) was carried out in the hospital radiopharmacy and treatment administered in cycles (dose: 5.55 to 7.4 GBq per patient), at 10–12 weeks interval. The assessment of long-term outcome was undertaken under three broad headings: (a) Therapeutic response, (b) Survival outcome and (c) Toxicity assessment. The median point estimate with 95% CI for progression free survival (PFS) and overall survival (OS) were calculated by Kaplan–Meier method. Prognostic covariates for association with PFS and OS was investigated by Cox proportional hazards model (univariate and multivariate Hazard Ratios) and with disease control rate (DCR) by Chi-square test, with significant P value defined as <0.05. Results: Long-term outcome (follow-up ranging from 4 to 97.6 months; median period:46 months following first 177Lu-DOTATATE PRRT) results showed, (i) on symptomatic response evaluation scale, complete response (CR) in 214 patients (45.7%), partial response (PR) in 108 (23.1%), stable disease (SD) in 118 (25.2%), progressive disease (PD) in 28 (6%). (ii) Biochemical response evaluation showed CR in 52 (12%), PR in 172 (40%), SD in 161 (38%), and PD in 42 patients (10%). (iii) Molecular imaging response (by PERCIST criteria) showed CR in 29 (6%), PR in 116 (25%), SD in 267 (57%) and PD in 56 (12%) patients. (iv) On RECIST 1.1 criteria, CR was observed in 14 patients (3%), PR in 126 patients (27%), SD in 282 patients (60%) and PD in 46 patients (10%). The median PFS and OS were not reached at a median follow-up of 46 months. Observed PFS and OS at 7 years were 71.1% 95% CI (62.4–79.7%) and 79.4% 95% CI (71.4–86.9%) respectively. PFS was dependent on previous history of chemotherapy, baseline 68Ga-DOTATATE and 18F-FDG uptake, site of primary tumour, total cumulative dose and number of PRRT cycles on univariate analysis, whereas multivariate analysis showed significant association for previous history of chemotherapy, baseline 68Ga-DOTATATE and 18F-FDG uptake and number of PRRT cycles. The OS was dependent on baseline 68Ga-DOTATATE uptake, site of primary tumour, presence of bony metastatic disease, total cumulative dose and number of PRRT cycles on univariate analysis, whereas multivariate analysis showed significant association for bony metastatic disease and number of PRRT cycles. Transient haematological toxicity of Grade 1, Grade 2, and Grade 3 was found in 8 (1.7%), 1 (0.2%) and one patient (0.2%), respectively. Nephrotoxicity of Grade 1, Grade 2, Grade 3, and Grade 4 were seen in 16 (3.5%), 3 (0.6%), 2 (0.4%) and one patient (0.2%), respectively. On a separate sub-analysis of 322 NET patients with progressive disease at the initiation point of PRRT, overall response rates (CR + PR + SD) were 93.5%, 88.5%, 89.1 and 87.9% on symptomatic, biochemical, RECIST 1.1 and PERCIST criteria and PFS and OS at 7 years 68.3% and 79.2%, respectively. Conclusions: The present results demonstrate that 177Lu-DOTATATE PRRT improved symptoms and biochemical markers substantially in most of the NET patients, with disease stabilisation on both anatomical and molecular imaging in majority and response in a sizeable fraction. Additionally, the therapeutic protocol with lesser dose per cycle (mean 5.92 GBq/cycle) and prolonged duration (over 5 cycles and 1.5 years) in a metastatic NET setting proved equally efficacious (with superior PFS and OS rates) and relatively better tolerated with minimal toxicity. Advances in knowledge: The present work critically examines the long-term results, survival outcome and toxicity profile of the indigenous 177Lu-DOTATATE (produced through direct neutron activation of enriched 176Lu) in metastatic progressive NETs across a wide range of primary sites and malignancies. Such long-term outcome data establishes the favourable impact of PRRT in a wide patient base and also the therapeutic efficacy of the product.

scholarly journals Depressive symptoms, emotional support and activities of daily living disability onset: 15-year follow-up of the Bambuí (Brazil) Cohort Study of Aging

2018 ◽  
Vol 34 (7) ◽  
Author(s):  
Juliana Lustosa Torres ◽  
Erico Castro-Costa ◽  
Juliana Vaz de Melo Mambrini ◽  
Sérgio William Viana Peixoto ◽  
Breno Satler de Oliveira Diniz ◽  
...  
Keyword(s):  
Cohort Study ◽  
Social Network ◽  
Depressive Symptoms ◽  
Activities Of Daily Living ◽  
Psychosocial Factors ◽  
Emotional Support ◽  
Daily Living ◽  
Wide Range

Psychosocial factors appear to be associated with increased risk of disability in later life. However, there is a lack of evidence based on long-term longitudinal data from Western low-middle income countries. We investigated whether psychosocial factors at baseline predict new-onset disability in long term in a population-based cohort of older Brazilians adults. We used 15-year follow-up data from 1,014 participants aged 60 years and older of the Bambuí (Brazil) Cohort Study of Aging. Limitations on activities of daily living (ADL) were measured annually, comprising 9,252 measures. Psychosocial factors included depressive symptoms, social support and social network. Potential covariates included sociodemographic characteristics, lifestyle, cognitive function and a physical health score based on 10 self-reported and objectively measured medical conditions. Statistical analysis was based on competitive-risk framework, having death as the competing risk event. Baseline depressive symptoms and emotional support from the closest person were both associated with future ADL disability, independently of potential covariates wide range. The findings showed a clear graded association, in that the risk gradually increased from low emotional support alone (sub-hazard ratio - SHR = 1.11; 95%CI: 1.01; 1.45) to depressive symptoms alone (SHR = 1.52; 95%CI: 1.13; 2.01) and then to both factors combined (SHR = 1.61; 95%CI: 1.18; 2.18). Marital status and social network size were not associated with incident disability. In a population of older Brazilian adults, lower emotional support and depressive symptoms have independent predictive value for subsequent disability in very long term.

scholarly journals Prospective long-term follow-up analysis of the cardiovascular system in marathon runners: study design of the Pro-MagIC study

2020 ◽  
Vol 6 (1) ◽  
pp. e000786
Author(s):  
Julia Schoenfeld ◽  
Michael Johannes Schindler ◽  
Bernhard Haller ◽  
Stefan Holdenrieder ◽  
David Christopher Nieman ◽  
...  
Keyword(s):  
Cardiovascular System ◽  
Cardiopulmonary Exercise Testing ◽  
Strenuous Exercise ◽  
Ventricular Ejection Fraction ◽  
Cardiovascular Changes ◽  
Link Type ◽  
Wide Range ◽  
Exercise Induced

IntroductionProlonged strenuous exercise training may result in structural, functional and electrical cardiac remodelling, as well as vascular and myocardial injuries. However, the extent to which high-volume, intense exercise is associated with arrhythmias, myocardial fibrosis, coronary heart disease and pathological alterations of the vasculature remains unknown. In addition, there is no clear consensus on the clinical significance of these exercise-induced changes. Previous studies typically used cross-sectional designs and examined exercise-induced cardiovascular changes in small cohorts of athletes for up to 3–7 days of recovery. Long-term longitudinal studies investigating cardiovascular changes induced by prolonged strenuous exercise in large cohorts of athletes are needed to improve scientific understanding in this area.Methods and analysisIn this prospective observational monocenter study, 277 participants of the Beer, Marathon, Genetics, Inflammation and the Cardiovascular System (Be-MaGIC) study (ClinicalTrials.gov: NCT00933218) will be invited to participate in this 10-year follow-up study. A minimum target sample size of 130 participants will be included in the study. Participating athletes will be examined via the following: anthropometry, resting electrocardiography and echocardiography, blood sampling, retinal vessel diameters, carotid sonography and cardiopulmonary exercise testing, including exercise electrocardiography.DiscussionThis longitudinal study will provide comprehensive data on physiological changes in the cardiovascular system and the development of pathologies after a 10-year period of prolonged and strenuous endurance exercise. Since the participants will have engaged in a wide range of training loads and competitive race events, this study will provide useful risk factor determinants and training load cut-off values. The primary endpoint is the association between the exercise-induced increase in cardiac troponin during the Munich marathon 2009 and the decline in right ventricular ejection fraction over the next 10 years.Trial registration numberNCT04166903.

Pets and Health

1998 ◽  
Vol 83 (3) ◽  
pp. 1011-1024 ◽  
Author(s):  
James Robert Brasić
Keyword(s):  
Adverse Effects ◽  
Objective Assessment ◽  
Wide Range ◽  
Follow Up Studies ◽  
Long Term Follow Up

Beneficial and adverse effects of pets for individuals in a wide range of circumstances have been reported. Nevertheless, well-designed unbiased experiments and long-term follow-up studies are needed. Pets appear to be therapeutic for some individuals and deleterious for others. The controversies concerning the effects of pets on health merit objective assessment by unbiased researchers.

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