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BACKGROUND: Posturography power spectra (PS) implementation has been proven to discriminate between sensory inputs detriment of vestibular and proprioceptive origin. OBJECTIVE: To deepen the role of posturography testing in the diagnostic route of dizzy conditions, by comparing two groups of patients –93 affected by cervicogenic dizziness (CGD) and 72 by unilateral vestibular hypofunction (UVH) –with a group of 98 age- and gender-matched healthy subjects, serving as control group (CON). METHODS: All participants underwent otoneurological testing including video head impulse test (vHIT) and posturography testing with PS analysis. They also filled in Dizziness Handicap Inventory (DHI), Tampa Scale for Kinesiophobia and Hospital Anxiety and Depression Scale questionnaires. RESULTS: UVH and CGD patients were found to have significant increase in vestibular- and proprioceptive-related PS values when compared with CON. Receiver operating characteristic curves found PS values to reliably discriminate both groups from CON. Positive and negative correlations were respectively found between vestibular-/proprioceptive-related PS domain and DHI in both groups and between PS and vHIT scores in UVH patients. CONCLUSIONS: PS analysis demonstrated to be useful in differentiating CGD and UVH patients each other and when compared to CON, to objectively represent perceived symptoms filled along the DHI scale and to corroborate the rate of vestibular deficit in UVH patients.

Since cervical joint position error (JPE) and visual dependency (VD) may reflect altered ascending inputs from the neck receptors, the aim of the present study was to test how these parameters may be impacted by those clinical parameters in cervicogenic dizziness (CGD) patients when compared with healthy subjects participants.93 subjects participants fulfilling inclusion criteria for CGD and 98 age- and gender-matched healthy subjects volunteers - undergoing cervical relocation and rod and disc test to evaluate JPE and VD, respectively - were compared to each other. Cervical range of motion (CROM), Dizziness Handicap Inventory (DHI), Neck Disability Index (NDI), Neck pain intensity (NPI), Tampa Scale for Kinesiophobia (TSK-17) and Hospital Anxiety and Depression Scale (HADS) were also collected in both groups.When compared to healthy participants, CGD patients were found to have a higher degree of JPE in right (A possible common physiopathological background may impact on processes involved in both the JPE and VD behaviour, entangled in a vicious circle with the impaired subjective clinical and quality of life perception.

To analyze the cervical range of motion (CROM) and clinical parameters in patients affected by myogenous temporomandibular disorders (TMD), cervicogenic dizziness (CGD), both TMD and CGD (TMD/CGD), and a group of healthy subjects (HS).CROM degrees, Dizziness Handicap Inventory (DHI), Tampa Scale for Kinesiophobia (TSK-17), Hospital Anxiety and Depression Scale (HADS), and Jaw Functional Limitation Scale 20 (JFLS-20) scores were compared between 46 TMD patients, 49 CGD subjects, 43 TMD/CGD patients, and 98 HS.TMD/CGD and CGD patients demonstrated significantly lower CROM degrees and higher DHI, TSK-17, and HADS values when compared to TMD patients. TMD/CGD and TMD patients demonstrated higher JFLS-20 values when compared to CGD and HS. Significant negative correlations were found in TMD/CGD and TMD patients between JFLS-20 and CROM in flexion and extension.Present findings demonstrated a relation between spine movement impairment and TMD.

To evaluate posturography measurements, and their association with other clinical tests used for cervicogenic dizziness diagnosis, in a cohort of subjects suffering from cervicogenic dizziness, compared with healthy subjects.Ninety-three cervicogenic dizziness patients and 98 age- and gender-matched healthy subjects underwent video-Head impulse test, posturography testing, evaluation of cervical spine movements by means of cervical range of motion goniometer and self-report and performance measures, including Dizziness Handicap Inventory, Neck Disability Index, Neck Pain Intensity, Tampa Scale for Kinesiophobia and Hospital Anxiety and Depression Scale.Cervicogenic dizziness patients demonstrated significant increases in classical posturography parameters (i.e., surface and length) and in power spectra values within middle and high-frequency interval depicting balance control alterations especially due to proprioceptive integration changes. Furthermore, decreases in degrees of cervical range of motion and increases of self-report and performance measures - highlighting significant complaints of subjective feeling of dizziness - were found in these patients when compared with healthy subjects. Multiple correlations were found between posturography testing and cervical range of motion and Dizziness Handicap Inventory as well as between different self-report and performance measures in cervicogenic dizziness patients.The implementation of posturography - including power spectra analysis - coupled with appropriate exclusion of other disorders, may represent a useful tool in improving cervicogenic dizziness assessment in terms of cost, time consumption and correlation with other measurements.Implications for rehabilitationUncertainties in diagnostic assessment of cervicogenic dizziness reflect doubts regarding the causes underpinning the symptoms of imbalance, unsteadiness, and disorientation.Posturography measurement is a low-cost, time-sparing technique and its implementations have proven to be useful in detecting significant alterations in body sway during perturbating situations.Implementation of power spectra analysis on posturography testing may represent a useful tool in improving cervicogenic dizziness assessment also in terms of rehabilitative treatment follow-up.

Hypothesis Application of localized, mild therapeutic hypothermia during cochlear implantation (CI) surgery is feasible for residual hearing preservation. Background CI surgery often results in a loss of residual hearing. In preclinical studies, local application of controlled, mild therapeutic hypothermia has shown promising results as a hearing preservation strategy. This study investigated a suitable surgical approach to deliver local hypothermia in patients utilizing anatomical and radiologic measurements and experimental measurements from cadaveric human temporal bones. Methods Ten human cadaveric temporal bones were scanned with micro-computed tomography and anatomical features and measurements predicting round window (RW) visibility were characterized. For each bone, the standard facial recess and myringotomy approaches for delivery of hypothermia were developed. The St. Thomas Hospital (STH) classification was used to record degree of RW visibility with and without placement of custom hypothermia probe. Therapeutic hypothermia was delivered through both approaches and temperatures recorded at the RW, RW niche, over the lateral semicircular canal and the supero-lateral mastoid edge. Results The average facial recess area was 13.87 ± 5.52 mm. The introduction of the cooling probe through either approach did not impede visualization of the RW or cochleostomy as determined by STH grading. The average temperatures at RW using the FR approach reduced by 4.57 ± 1.68 °C for RW, while using the myringotomy approach reduced by 4.11 ± 0.98 °C for RW. Conclusion Local application of therapeutic hypothermia is clinically feasible both through the facial recess and myringotomy approaches without limiting optimal surgical visualization.

Objective: To evaluate how self-report and posturographic measures could be affected in patients with cervicogenic dizziness undergoing sustained natural apophyseal glides. Design: Randomised controlled single-blind study. Setting: Tertiary rehabilitation centre. Subjects: Patients affected by cervicogenic dizziness, diagnosed by applying accepted criteria. Forty-one patients (19 male, 22 female: mean age 44.3 ± 14.8 years) receiving treatment, and 39 patients (18 male, 21 female: mean age 43.8 ± 13.9 years) receiving placebo were included in the study. Interventions: The treatment group underwent sustained natural apophyseal glides, while the placebo was constituted by a detuned laser. Both groups received their interventions six times over 4 weeks. Main measures: Outcomes were tested by means of self-report measures such as perceived dizziness, neck disability, anxiety and depression. Also, cervical range of motion and posturography testing with power spectra frequency were analysed. Results: When compared to placebo, treated patients demonstrated a significant decrease in perceived dizziness (post-treatment total Dizziness Handicap Inventory score 20.5 ± 5.3 as compared to 26.2 ± 6 baseline), neck disability and pain (Neck Disability Index and Neck Pain Index post-treatment scores 12.5 ± 4.3 and 45.6 ± 15.1, respectively, as compared to baseline scores of 15.1 ± 4.8 and 62.5 ± 14.3), as well as significant improvement in cervical range of motion and some posturographic parameters. Conclusion: Sustained natural apophyseal glides may represent a useful intervention in reaching short-term beneficial effects in patients with cervicogenic dizziness, with respect to self-perceived symptoms, proprioceptive integration and cervical range of motion improvement.

OBJECTIVE Evaluating postural function in patients with otosclerosis by assessing otoneurological function and balance-related quality of life before and 6 weeks after surgical treatment. Correlations between and clinical features were investigated. METHODS Thirty-three patients affected by otosclerosis underwent otoneurological examination, video Head Impulse Test (vHIT), and static posturography before and after stapedotomy. Quality of life and dizziness-related handicap were screened by means of validated questionnaires. Correlation analysis was performed in order to discover possible relations with audiological pre- and postoperative parameters. RESULTS A significant improvement in posturographic parameters was found. Correlation analysis yielded a negative correlation between preoperative bone conduction auditory threshold and both vHIT scores and postural performance improvement, evaluated by spectral analysis. Moreover, a positive correlation was also found between improvements in posturographic scores and quality-of-life questionnaires. CONCLUSION The study results demonstrated an improvement in postural function and self-reported measures in a cohort of patients with otosclerosis 6 weeks after stapedotomy. The inverse correlation with preoperative auditory levels may reflect lesser chance for balance restoration in cases with worse sensorineural function. Possible implications for daily activities and overall quality of life were suggested by improved self-report questionnaire results. LEVEL OF EVIDENCE 4 Laryngoscope, 130:2448-2454, 2020.

To assess whether vestibulo-ocular reflex (VOR) gain, posturography parameters and related clinical outcomes can improve in OSA patients after 12 months of CPAP treatment, taking into consideration that a certain degree of vestibular dysfunction has been identified in these subjects. Vestibular, postural, clinical, and polygraphic parameters were assessed in 32 OSA patients before and after beneficial CPAP treatment by means of video head impulse test (vHIT), static posturography (SP), Dizziness Handicap Inventory (DHI), Epworth Sleepiness Scale (ESS), and Apnea–Hypopnea Index (AHI), respectively, and were compared by means of a “within-subject” ANOVA model and Spearman’s rank correlation. After the 12-month period of treatment, OSA patients demonstrated a significant reduction in AHI values, in both opened and closed eyes conditions of surface and length as well as in power spectra recorded in low, middle, and high frequency interval. Although a significant improvement was also recorded among DHI and ESS scores, VOR gain increase did not survive to post-hoc corrections. Finally, positive correlations between the differences between pre- and post-treatment AHI, ESS, and PS values were found. The present work highlighted that postural instability and dizziness-related conditions due to OSA may improve after 12 months of CPAP treatment. Although VOR gain did not demonstrate significant improvement, this study might open future perspectives directed to assessing VOR gain changes after longer periods of CPAP treatment.

Considering recent advances in central cognitive- and age-related processing interfering with balance and sensory reweighting in uncompensated vestibular disorders, purpose of this study is to highlight the vestibular rehabilitation (VR) outcomes in a population of older adults and age-matched mild cognitive impairment (MCI) patients, both affected by unilateral vestibular hypofunction (UVH) and undergoing VR. Vestibulo-ocular reflex (VOR), postural sway examination (respectively, performed by video head impulse test and static posturography) and dizziness-related and quality-of-life scores were collected in 12 UVH MCI individuals ≥ 55 years and 12 matched UVH older adults with age-appropriate cognitive function—cognitively evaluated by means of Mini-Mental State Examination (MMSE) and Alzheimer’s Disease Assessment Scale—before and after a VR protocol. A significant post-treatment reduction in surface, length and power spectra (PS) values within low-frequency domain and an improvement in performance measures were recorded in both groups. Moreover, the VR protocol highlighted—when comparing pre-/post-treatment differences (Δ)—a significant (i) increase in Δ VOR gain; (ii) decrease in Δ surface and length and (iii) increase in Δ PS within low-frequency domain in older adults when compared to MCI patients. Positive correlations were found between MMSE and Δ Dynamic Gait Index, Δ surface and Δ PS within low-frequency domain when treating patients as ‘a continuum’ along the cognitive decline. Present pilot findings suggest that the cognitive domain insight in older adults scheduled for VR protocols may positively impact on disability consequences.

Multiple chemical sensitivity (MCS) also known as idiopathic environmental intolerance/illness (IEI) encompasses a cohort of subjective symptoms characterized by susceptibility to a wide spectrum of environmental compounds, causing symptoms involving various organs and a decrease in quality of life. The aim of this systematic review is to summarize evidence about MCS, with focus on indexed studies analyzing sensory pathway-related disorders. Medical databases were searched for English language articles related to the topic, published between 1965 and 2017 in academic, peer-reviewed journals. Particular focus was concentrated on articles depicting disturbances involving sensory organs. References of the relevant articles were examined to identify additional significant documents. Fifty-eight studies were eligible for full text review. Of these, 34 studies met the selection criteria and were included in this analysis. Many variables, such as different diagnostic criteria, lack of homogeneous symptom questionnaires and the general incidence of personality traits in control subjects, biased studies as confounding factors. However, moderate evidences show that sensory pathways are somewhat altered, especially with respect to information processing in the limbic system and related cortical areas. Recent studies suggested the presence, in MCS cohorts, of attention bias, sensitization and limbic kindling, as well as recently revealed subclinical organic alterations along sensory pathways. Evidences are consistent with MCS/IEI to be the result of a neural altered processing of sensorial ascending pathways, which combined with peculiar personality traits constitutes the underpinning of a multisensory condition needing multidisciplinary clinical approach.

Objective: To investigate the long-term effects of adding virtual reality–based home exercises to vestibular rehabilitation in people with unilateral vestibular hypofunction. Design: Follow-up otoneurological examination in two randomized groups following a previous one-month trial. Setting: Tertiary rehabilitation center. Subjects: A total of 47 patients with unilateral vestibular hypofunction, one group ( n = 24) undergoing conventional vestibular rehabilitation and the other one ( n = 23) implementing, in addition, head-mounted gaming home exercises, 20 minutes per day for one month. Interventions: One year after completing rehabilitation, patients underwent testing with static posturography, video head impulse test, self-report questionnaires, and a performance measure. Main measures: Vestibulo-ocular reflex gain, posturographic parameters such as length, surface, and fast Fourier transform power spectra, self-report, and gait performance measure scores. Results: Vestibulo-ocular reflex gain was significantly better with respect to pretreatment in both groups. The mixed-method group showed significantly higher gain scores: mean (standard deviation (SD)) at 12 months was 0.71 (0.04), versus 0.64 (0.03) for the vestibular rehabilitation–only group ( P Conclusion: Results suggest that head-mounted gaming home exercises are a viable, effective, additional measure to improve long-term vestibular rehabilitation outcomes.

Human maintain their body balance by sensorimotor controls mainly based on information gathered from vision, proprioception and vestibular systems. When there is a lack of information, caused by pathologies, diseases or aging, the subject may fall. In this context, we developed a system to augment information gathering, providing the subject with warning audio-feedback signals related to his/her equilibrium. The system comprises an inertial measurement unit (IMU), a data processing unit, a headphone audio device and a software application. The IMU is a low-weight, small-size wireless instrument that, body-back located between the L2 and L5 lumbar vertebrae, measures the subject's trunk kinematics. The application drives the data processing unit to feeding the headphone with electric signals related to the kinematic measures. Consequently, the user is audio-alerted, via headphone, of his/her own equilibrium, hearing a pleasant sound when in a stable equilibrium, or an increasing bothering sound when in an increasing unstable condition. Tests were conducted on a group of six older subjects (59y-61y, SD = 2.09y) and a group of four young subjects (21y-26y, SD = 2.88y) to underline difference in effectiveness of the system, if any, related to the age of the users. For each subject, standing balance tests were performed in normal or altered conditions, such as, open or closed eyes, and on a solid or foam surface The system was evaluated in terms of usability, reliability, and effectiveness in improving the subject's balance in all conditions. As a result, the system successfully helped the subjects in reducing the body swaying within 10.65%-65.90%, differences depending on subjects' age and test conditions., Comment: 8 pages, 7 figures, 2 tables

Considering the emerging advantages related to virtual reality implementation in clinical rehabilitation, the aim of the present study was to discover possible (i) improvements achievable in unilateral vestibular hypofunction patients using a self-assessed head-mounted device (HMD)-based gaming procedure when combined with a classical vestibular rehabilitation protocol (HMD group) as compared with a group undergoing only vestibular rehabilitation and (ii) HMD procedure-related side effects. Therefore, 24 vestibular rehabilitation and 23-matched HMD unilateral vestibular hypofunction individuals simultaneously underwent a 4-week rehabilitation protocol. Both otoneurological measures (vestibulo-ocular reflex gain and postural arrangement by studying both posturography parameters and spectral values of body oscillation) and performance and self-report measures (Italian Dizziness Handicap Inventory; Activities-specific Balance Confidence scale; Zung Instrument for Anxiety Disorders, Dynamic Gait Index; and Simulator Sickness Questionnaire) were analyzed by means of a between-group/within-subject analysis of variance model. A significant post-treatment between-effect was found, and the HMD group demonstrated an overall improvement in vestibulo-ocular reflex gain on the lesional side, in posturography parameters, in low-frequency spectral domain, as well as in Italian Dizziness Handicap Inventory and Activities-specific Balance Confidence scale scores. Meanwhile, Simulator Sickness Questionnaire scores demonstrated a significant reduction in symptoms related to experimental home-based gaming tasks during the HMD procedure. Our findings revealed the possible advantages of HMD implementation in vestibular rehabilitation, suggesting it as an innovative, self-assessed, low-cost, and compliant tool useful in maximizing vestibular rehabilitation outcomes.

Results in studies concerning cortical changes in idiopathic sudden sensorineural hearing loss (ISSNHL) are not homogeneous, in particular due to the different neuroimaging techniques implemented and the diverse stages of ISSNHL studied. Considering the recent advances in state-of-the-art positron emission tomography (PET) cameras, the aim of this study was to gain more insight into the neuroanatomical differences associated with the earliest stages of unilateral ISSNHL and clinical-perceptual performance changes. After an audiological examination including the mean auditory threshold (mean AT), mean speech discrimination score (mean SDS) and Tinnitus Handicap Inventory (THI), 14 right-handed ISSNHL patients underwent brain [ 18 F]fluorodeoxyglucose (FDG)-PET within 72 h of the onset of symptoms. When compared to an homogeneous group of 35 healthy subjects by means of statistical parametric mapping, a relative increase in FDG uptake was found in the right superior and medial frontal gyrus as well as in the right anterior cingulate cortex in ISSNHL patients. Conversely, the same group showed a significant relative decrease in FDG uptake in the right middle temporal, precentral and postcentral gyrus as well as in the left posterior cingulate cortex, left lingual, superior, middle temporal and middle frontal gyrus and in the left insula. Regression analysis showed a positive correlation between mean THI and glucose consumption in the right anterior cingulate cortex and a positive correlation between mean SDS and glucose consumption in the left precentral gyrus. The relative changes in FDG uptake found in these brain regions and the positive correlation with mean SDS and THI scores in ISSNHL could possibly highlight new aspects of cerebral rearrangement, contributing to further explain changes in those functions that support speech recognition during the sudden impairment of unilateral auditory input.

Vestibular dysfunction was linked to moderate-to-severe obstructive sleep apnea syndrome (OSAS) patients in literature. However, due to a lack of knowledge among valid and recent implementations conceived to study postural control on static posturography (SP) and vestibulo-ocular reflex (VOR) gain under physiological conditions (video Head Impulse Test; vHIT), the aim of this work was to integrate (i) VOR changes via vHIT implementation, (ii) postural arrangement by studying both classical parameters and frequency spectra (PS) and (iii) correlation between these findings, polygraphic (PG) and subjective scores along Dizziness Handicap Inventory (DHI) and Epworth Sleepiness Scale (ESS). Thus, 32 moderate-to-severe OSAS patients and 32 healthy subjects - studied by using PG, DHI and ESS - underwent vHIT and SP posturographic assessment. Analysis of variance was performed to disclose between-group effects and correlation analysis was implemented between otoneurological, PG, DHI and ESS values. OSAS group demonstrated a significant decay of VOR gain and an increase in both frequency spectra PS values, especially within the low-frequency interval, and in classical posturographic SP parameters. Further, positive and negative correlations between mean SaO2 and gain and low frequency interval spectra PS were found, respectively. Strengthening previous hypothesis related to brainstem chronic hypoxemia phenomena affecting vestibular network, implementation of these data could generate future attentions (i) for screening under physiological conditions postural and vestibular detriments in OSAS subjects, especially exposed at risk settings, and (ii) among PG parameters, such as mean SaO2 , to propose further reliable tools in monitoring postural and vestibular decay in these patients demonstrating PG parameters detriments.

Multiple chemical sensitivity (MCS) is a common clinical diagnosis in western populations and its symptoms are thought to be mainly related to chemical compounds exposure. Although MCS subjects refer to complain from many central nervous system symptoms, including dizziness, no study to now deepened vestibular detriment nor to what extent such an impairment could worsen MCS. Thus, the purpose of present study was to objectively highlight those clinical/subclinical aspects of vestibular impairment that could be related to MCS symptoms cohorts. A principal component analysis within a wide battery of otoneurological test scores was employed in 18 right-handed MCS patients and 20 sex- and age-matched healthy individuals. A deranged dimensionality in near-optimal re-weighting within otoneurological variables was found in MCS as compared with healthy subjects. These data seem to support the idea that MCS physiopathological underpinnings could lead to a peripheral and higher vestibular decay that could be addressed as a further aspect to better follow MCS patients up along natural history of disease in clinical practice.

Due to the fact that no study to date has shown the experimental validity of ACC-based measures of body sway with respect to posturography for subjects with vestibular deficits, the aim of the present study was: i) to develop and validate a practical tool that can allow clinicians to measure postural sway derangements in an otoneurological setting by ACC, and ii) to provide reliable, sensitive and accurate automatic analysis of sway that could help in discriminating unilateral vestibular failure (UVF) patients. Thus, a group of 13 patients (seven females, 6 males; mean age 48.6 +/- 6.4 years) affected for at least 6 months by UVF and 13 matched healthy subjects were instructed to maintain an upright position during a static forceplate-based posturography (FBP) acquisition while wearing a Movit sensor (by Captiks) with 3-D accelerometers mounted on the posterior trunk near the body centre of mass. Pearson product moment correlation demonstrated a high level of correspondence of four time-domain and three frequency-domain measures extracted by ACC and FBP testing; in addition, t-test demonstrated that two ACC-based time- and frequency-domain parameters were reliable measures in discriminating UVF subjects. These aspects, overall, should further highlight the attention of clinicians and researchers to this kind of sway recording technique in the field of otoneurological disorders by considering the possibility to enrich the amount of quantitative and qualitative information useful for discrimination, diagnosis and treatment of UVF. In conclusion, we believe the present ACC-based measurement of sway offers a patient-friendly, reliable, inexpensive and efficient alternative recording technique that is useful - together with clinical balance and mobility tests - in various circumstances, as well as in outcome studies involving diagnosis, follow-up and rehabilitation of UVF patients., 6 pages, 2 figures, 2 tables

BACKGROUND Marfan syndrome (MFS) is a rare autosomal dominant connective tissue disorder affecting virtually every organ. Sleep disturbances, associated to high collapsibility in upper airways, are common in MFS; daytime sleepiness could lead to reduction in attention and motor coordination, with detrimental effects on balance. OBJECTIVE To evaluate otoneurological function in MFS patients, compared to healthy subjects, and to investigate possible correlations with sleep deprivation extent. METHODS Forty-one MFS patients underwent a thorough otoneurological examination, video Head Impulse Test (vHIT), and static posturography. Sleep parameters were recorded by home monitoring. Daytime sleepiness and dizziness-related handicap were screened by means of Dizziness Handicap Inventory (DHI) and Epworth Sleepiness Scale (ESS). Results were compared with 49 healthy controls (HC). RESULTS DHI and ESS scores were increased in MFS patients (p

The aim of this study was to outline an age-dependent range of posturography measures obtained from healthy children. One hundred and fifty healthy 4-18-year-old children underwent video Head Impulse Test and static posturography testing. Surface, length and power spectra values were compared between each group of pupils and 32 healthy adults. As well as a significant (

Multiple chemical sensitivity (MCS) is a chronic disorder characterized by a variety of symptoms associated with the exposure to chemicals at a concentration below the toxic level. Previous studies have demonstrated peculiar responses in brain activity in these patients with respect to sensory stimuli while the association between chemical sensitivity and other environmental intolerances such as noise sensitivity has been questioned by researchers. In this study, a cohort of 18 MCS patients underwent transient-evoked otoacoustic emission (TEOAE) testing with and without contralateral suppression to evaluate the functionality of the medial olivocochlear (MOC) reflex involved in speech-in-noise sensitivity. Results were compared with an age- and gender-matched control group (n = 20) and correlation analysis with disease onset and quick environmental exposure sensitivity inventory (qEESI) symptom severity scale was performed. Subjects affected by MCS showed statistically significant impairment of MOC reflex, and the onset of the disease and several symptom subscales showed to be correlated to such reduction in some of the frequencies tested. These data suggest that alterations of MOC reflex could be part of the complex features of this disease although more studies are needed to further explore auditory perception disorders in environmental intolerances.

Several studies have investigated the possible influence of temporomandibular disorders (TMD) on body posture and whether cervical spine disorders, such as cervicogenic dizziness (CGD) could play an additional role in affecting static balance. The purpose of this study was to analyze static postural behavior by means of static posturography, in patients affected by either TMD or CGD alone or by both conditions, and to compare findings with a group of healthy subjects. Significant changes in posturographic parameters were found among the three groups of patients and when compared with controls. When the three study groups were compared to each other, subjects affected by a combination of TMD and CGD showed worse postural performances with respect to subjects affected by CGD or TMD alone. Correlations with self-perceived dizziness, anxiety, depression and jaw functionality, investigated by means of validated questionnaires, were found among all patient groups. These results provide new evidences for the presence of static balance alterations in patients suffering from TMD with and without associated cervical spine impairment, by using a reliable diagnostic technique. Further studies are needed in order to identify any causal relation between these two disorders.

OBJECTIVE Considering the altered multisensory signal compensation during senescence, the aim of the present study was to evaluate the integration rearrangements in unilateral vestibular hypofunction (UVH) during age-related cognitive decline. STUDY DESIGN Cross-sectional study. SETTING Longitudinal cohort study unit and of University tertiary referral center. PATIENTS Older UVH individuals ≥ 55 years with Mild Cognitive Impairment (MCI) or Alzheimer Disease (AD) and matched UVH control group with age-appropriate cognitive function. INTERVENTION Vestibulo-ocular reflex, postural sway examination (respectively performed by means of video head impulse test and static posturography), and dizziness-related and quality of life scores were collected in all three groups of UVH patients cognitively evaluated by means of Mini Mental State Examination and Alzheimer's Disease Assessment Scale (ADAS-cog). MAIN OUTCOME MEASURES Vestibulo-ocular reflex gain, length, surface, and spectral values of body oscillation were measured. Dizziness Handicap Inventory, Activities-specific Balance Confidence scale, and Dynamic Gait Index scores were collected. RESULTS A significant (p

Background: Multiple chemical sensitivity (MCS) is a chronic multisystem condition characterized by low levels of multiple chemical susceptibility inducing a spectrum of central nervous system symptoms, including dizziness. Thus, considering (i) the overlapping psychogenic and organic burdens shared in MCS development and in vestibular disorders; (ii) the number of previous studies describing central processing impairment related to inner ear inflow in this syndrome; and (iii) the lack of literature with respect to clinical evidence of the presentation of MCS dizziness, the purpose of the present study was to highlight the possible hidden aspects of vestibular impairment by applying the recent contribution of implemented otoneurological testing, inferential statistic and principal component (PC) analysis in 18 MCS and 20 healthy subjects (HC); Methods: Both groups filled in a dizziness and environment exposure inventory and underwent the Rod and Disc and Rod and Frame Test, video Head Impulse Test (vHIT) and Static Posturography Test (SPT) with fast Fourier Transform (FFT). Between-group analysis of variance and PC analysis implemented on otoneurological variables were performed; Results: Defective vestibular processing was identified in 18 MCS patients (11 female and 7 male; mean age 49.5 ± 9.3 years) by finding a significant increase in SPT and FFT parameters and in Visual Dependency (VD) behaviour and a decrease in vHIT scores. Component correlation analysis in MCS showed a positive correlation of FFT parameters in PC1 and SPT parameters in PC2 with a negative correlation of vHIT and VD values in PC2. HC subjects demonstrated a positive correlation of VD and SPT parameters in PC1 and FFT parameters in PC2. Conclusion: Inferential and PC analysis provided the opportunity to disclose such possible hidden phenomena to (i) support that MCS physiopathological cascades could lead to a vestibular decay; and (ii) suggest rearrangement of the dimension of the variables as an aspect of near-optimal re-weighting, possibly underpinning the dizzy symptoms complained of by MCS patients.

The aim of this study was to investigate the presence of noise sensitivity and hyperacusis in patients suffering from multiple chemical sensitivity (MCS), a chronic condition characterized by several symptoms following low-level chemical exposure. Moreover, distortion product otoacoustic emissions (DPOAE) were performed to further study cochlear function. A questionnaire-based survey was performed. Eighteen MCS patients, selected with strict diagnostic criteria, and 20 healthy age- and gender-matched subjects filled Weinstein’s Noise Sensitivity Questionnaire (WNS) and Khalfa’s Hyperacusis Questionnaire (HQ). Results were compared with scores from the quick Environmental Exposure Sensitivity Index (qEESI), a routinarily used questionnaire to screen MCS symptoms, and with DPOAE values. An analysis of variance (ANOVA) was performed between MCS and control subjects scores; moreover, Spearman’s rank correlation test was performed between questionnaire results. ANOVA testing on DPOAE values showed any significant difference between groups, while WNS, HQ and qEESI scores were significantly higher in MCS group compared to controls. Correlation analysis showed strong positive correlation between WNS, HQ and qEESI in MCS subjects. For the first time, auditory-related perceptual disorders were studied in MCS. A strong association between WNS, HQ results and MCS symptoms severity has been highlighted. These findings suggest that decreased sound tolerance and noise sensitivity could be considered as possible new aspects of this syndrome, contributing to its peculiar phenotype. Furthermore, as DPOAE values did not differ from healthy subjects, present findings might suggest a ‘central’ source for such disorders in this group of patients.