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Objective: To explore the application value of video head impulse test（vHIT）, caloric test（CT） and the dizziness handicap inventory（DHI） in the diagnosis of acoustic neuroma（AN）, to analyze the correlation between vHIT and CT, and to determine the correlationsof tumor size, vHIT, CT and DHI score. Methods: The clinical data of 24 patients with AN who underwent surgery in our department from January 2019 to January 2022 were analyzed retrospectively, including craniocerebral MRI, vHIT, caloric test and DHI score. All the data were statistically analyzed by GraphPadPrism9.0. Results: There was a significant negative correlation between the UW value of CT and the vestibular eye reflex gain of vHIT（ P <0.01, r =-0.62）. The tumor size was significantly correlated with the increase of UW value of CT（ P <0.01, r =0.69）, and with the decrease of vestibulo-ocular reflex gain of vHIT（ P <0.01, r =-0.53）. The average Dizziness Handicap Inventory score was 8.9±16.2, which was not correlated with tumor size（ P >0.05）. Conclusion: Both vHIT and CT can effectively evaluate the vestibular function of patients with AN（and they are complementary）, and they are related to the size of the tumor and have certain value in the diagnosis of acoustic neuroma., Competing Interests: The authors of this article and the planning committee members and staff have no relevant financial relationships with commercial interests to disclose., (Copyright© by the Editorial Department of Journal of Clinical Otorhinolaryngology Head and Neck Surgery.)

Objective: To analyze the preoperative patterns of caloric test, eye tracking test (ETT), and optokinetic pattern (OKP) in patients with acoustic neuroma (AN) and compare them with the postoperative patterns of ETT and OKP results METHODS: A total of 166 patients with AN (102 women; mean age: 41 years, range: 11-79 years) who were being treated at our hospital between 2013 and 2016 were enrolled. Preoperatively, a detailed history was taken regarding the presence of subjective symptoms of equilibrium dysfunction, and the patients underwent caloric test, ETT, and OKP. They were classified into three groups based on the preoperative ETT and OKP results as follows: Group A, normal ETT and OKP; Group B, either ETT or OKP was abnormal; and Group C, both ETT and OKP were abnormal. All patients were evaluated for subjective symptoms of vestibular dysfunction and were also grouped based on the tumor size on imaging. All surgeries were performed by a neurosurgeon using the lateral suboccipital retrosigmoid approach. About one month later after surgery, postoperatively ETT was performed on 150 patients and OKP was performed on 148 patients. The preoperative and postoperative ETT and OKP results were compared. The same two specialists analyzed the postoperative ETT and OKP findings as improved, unchanged, or worse. Student t-test was used for statistical analysis and a P-value of <0.05 was considered to indicate a statistically significant difference., Results: The average canal paresis(CP) % was 65.8%. No correlation was found between tumor size and CP%. The other side, the average tumor size in each group was 26.6 mm, 28.7 mm, and 37.8 mm in the Group A, B, and C, respectively. The average tumor size in Group C was significantly greater than those of Group A and B (P<0.01). The presence of gait disturbance in Group C was significantly higher than the other groups (P<0.01). The other side, abnormal ETT and OKP were seen in 32.5% and 31.9% of all patients, respectively. ETT and OKP results improved postoperatively in 67.4% and 68.9% of these patients., Conclusions: Abnormal ETT and OKP results showed positive correlations with the tumor size and presence of subjective symptoms. Further, dysfunction of cerebellum and brain stem owing to tumor compression was observed to recover in many cases after surgery., Competing Interests: Declaration of Competing Interest The authors declare no conflicts of interest., (Copyright © 2021. Published by Elsevier B.V.)

Background: It is generally accepted that headshake nystagmus (HSN) is generated from an asymmetrical peripheral vestibular input and a correlation exists between HSN and canal paresis. There have been limited reports, however, how HSN correlates with the more recently introduced tests of vestibular function., Aims/objectives: To evaluate the correlation between HSN and unilateral weakness on caloric testing, high-frequency vestibulo-ocular reflex (VOR) function on video head impulse testing (VHIT) and otolith function determined by vestibular evoked myogenic potentials (VEMPs)., Methods: A retrospective study of all patients who underwent complete vestibular function testing at our tertiary referral center from 2016 to 2019 was performed. Demographic data, clinical diagnosis (where available), the results of video-nystagmography, vHIT, and VEMPs were evaluated., Results: Of the 1499 patients in the study period, 101 (6.7%) had HSN. Vestibular test abnormalities were more common in patients with HSN. The sensitivity of HSN for underlying pathology was low in comparison with vestibular testing. However, HSN demonstrated a high specificity., Conclusions and Significance: HSN generation is likely more complex than caloric-induced nystagmus, probably due to additional variables within the vestibular system. HSN may provide clinicians with additional information concerning high-frequency VOR function involving lateral semicircular and otolith dysfunction., (© 2021. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)

Objective: To explore the clinical characteristics of patients with dizziness/vertigo who showed a dissociation between the results of the caloric test and video head impulse test (vHIT)., Methods: A total of 327 patients who complained of dizziness/vertigo were continuously included. All patients underwent both the horizontal vHIT (h-vHIT) and caloric tests. Of the 327 patients, 69 patients showed a dissociation between the results of the two tests, 4 patients were excluded because the interval between the two tests exceeded 7 days. Finally, 65 patients were included in the analysis., Results: Among the 65 patients, 55 (84.6%) patients showed a positive caloric test (+) with a negative h-vHIT (-), and 10 (15.4%) patients showed a negative caloric test (-) with a positive h-vHIT (+). Peripheral and central lesions were identified in 50 (90.9%) and 5 (9.1%) patients, respectively, in the caloric test (+)/h-vHIT (-) group; and central lesions were found in 6 (60%) patients in caloric test (-)/h-vHIT (+) group. The etiologies were unilateral peripheral vestibular dysfunction (n = 25), Meniere's disease (MD, n = 10), sudden hearing loss with vertigo (SHLV, n = 7), benign paroxysmal positional vertigo (n = 5), vestibular neuritis (n = 2), autoimmune inner ear disease (n = 1), vestibular migraine (VM, n = 3), multiple sclerosis (n = 1), and multiple system atrophy (n = 1) in the caloric test (+)/h-vHIT (-) group, which were SHLV (n = 3), MD (n = 1), VM (n = 1), episodic ataxia type 2 (n = 1), cerebellopontine angle tumor (N = 1), Parkinson's disease (n = 1), Persistent postural perceptual dizziness (n = 1), and posterior circulation ischemia (n = 1) in the caloric test (-)/h-vHIT (+) group., Conclusion: Dissociation between the results of caloric test and h-vHIT is not uncommon. A positive caloric test with a negative h-vHIT occurred more frequently, and these patients mostly had peripheral vestibular lesions; while a negative caloric test with a positive h-vHIT was unusual, these patients had both peripheral and central lesions., Competing Interests: Declaration of conflicting interestsThe author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Abstract: Objective: Recent development of 3-dimensional analysis of eye movement enabled to detect the eye rotation axis, which is used to determine the responsible semicircular canal(s) in dizzy patients. Therefore, the knowledge of anatomical orientation of bilateral semicircular canals is essential, as all 6 canals influence the eye movements. Subjects and methods: Employing the new head coordinate system suitable for MR imaging, we calculated the angles of semicircular canal planes of both ears in 11 dizzy patients who had normal caloric response in both ears. Results: The angles between adjacent canal pairs were nearly perpendicular in both ears. The angle between the posterior canal planes and head sagittal plane was 51° and significantly larger the angle between the anterior canal planes and head sagittal plane, which was 35°. The angle between the horizontal canal plane and head sagittal plane was almost orthogonal. Pairs of contralateral synergistic canal planes were not parallel, forming 10° between right and left horizontal canal planes, 17° between right anterior and left posterior canal planes and 19° between the right posterior and left anterior canal planes. Conclusion: Our measurement of the angles of adjacent canal pairs and the angle between each semicircular canal and head sagittal plane coincided with those of previous reports obtained from CT images and skull specimens. However, the angles between contralateral synergistic canal planes were more parallel than those of previous reports. [Copyright &y& Elsevier]

Objectives: The aim of this study was to reveal the clinical characteristics of dissociated bilateral vestibulopathy (BV) affecting the superior vestibular nerve system on one side and the inferior vestibular nerve system on the other side. It is probable that B V does not always show bilateral deficits of the same vestibular nerve system. Methods: In a retrospective study of 2,752 consecutive new patients, 1,560 patients had undergone both caloric testing and cervical vestibular evoked myogenic potential testing. All 1,560 patients had also undergone a battery of tests including standardized neurologic, neuro-otologic, neuro-ophthalmologic, and audiological examinations. Results: Forty-three patients (2.8% of 1,560 patients) were given a diagnosis of dissociated BV. Among them, 10 patients (23%) had Meniere's disease and 6 patients (14%) had vestibular neuritis. Eighteen patients (42%) did not have any identifiable disease involving the peripheral vestibule, and 9 patients (21%) could be regarded as having a novel subtype of idiopathic BV. Conclusions: Although dissociated BV might be induced by some of the same causes that provoke bilateral vestibular dysfunction, a definite proportion of the patients did not have any identifiable causes of dissociated vestibular dysfunction. Idiopathic cases could be categorized into a novel subtype of idiopathic BV. [ABSTRACT FROM AUTHOR]

Although biphasic head-shaking nystagmus (HSN) is a basic response to head shaking in patients with unilateral vestibular loss, monophasic HSN is commonly seen in patients with dizziness of undetermined etiology. Since the clinical significance of HSN remains unclear, we sought to characterize different types of HSN in patients with vestibular neuritis (VN) during the acute stage (within 7 days after the onset of vertigo) and at follow-up (about 2 months after the onset of vertigo), and to compare HSN and caloric responses. We analyzed HSN, spontaneous nystagmus and caloric tests in 66 patients with VN. Overall, HSN showed high abnormal rates (94 and 89%) during the acute and follow-up stages and could detect vestibular hypofunction even when canal paresis (CP) had normalized at follow-up. All patients in the acute stage and most patients at follow-up showed HSN with the slow phase to the lesioned side (paretic). Biphasic HSN was common at follow-up, and many patients with a monophasic paretic pattern during the acute stage had evolved to a biphasic paretic pattern at follow-up. Initial slow-phase eye velocities (SPVs) in biphasic HSN were larger than those in monophasic HSN at follow-up. Absence of HSN or reversal of its direction was closely related to normalized caloric responses, but SPVs of HSN did not correlate with the severity of CP. These findings indicate that the HSN test is a sensitive detector of vestibular hypofunction upon 2-Hz head rotation. HSN may reveal previous vestibular hypofunction in the 2-Hz frequency range even at follow-up, when caloric responses detecting vestibular hypofunction in the low-frequency range had normalized. The two tests utilize different mechanisms to assess vestibular hypofunction and are complementary. Biphasic paretic HSN is the most common pattern at follow-up and occurs when the initial SPVs induced by head rotation are large enough to induce the adaptation of primary vestibular afferent activity. Monophasic HSN, which is commonly found in dizzy patients, indicates less severe vestibular hypofunction than biphasic HSN in the 2-Hz frequency range, and the caloric tests can provide further information about the side and presence of vestibular hypofunction at lower frequencies. Copyright © 2012 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: The vestibular system plays an important role in control of arterial pressure (AP) upon head-up tilt (HUT). To examine this role in human subjects, we previously compared changes in AP with and without high-amplitude galvanic vestibular stimulation (GVS), which is considered to obscure vestibular input. In contrast, regarding sensory function in skin and muscle, it has been documented that low-amplitude electrical stimulation improves both sensitivity and response. In the present study, we examined whether GVS of smaller amplitude improves AP control upon HUT. GVS was applied at the amplitude of the somatosensory threshold (0.3–0.8mA), 0.1mA over the threshold, and 0.1 and 0.2mA below the threshold during HUT. AP decreased at the onset of HUT compared with that in the supine position in 15 of 25 subjects without GVS (−12±2mmHg), but applying GVS at 0.1mA below the somatosensory threshold diminished the decrease (0.3±0.7mmHg). The APs of another 10 subjects were maintained or decreased by less than 5mmHg without GVS at the onset of HUT (4±2mmHg), but applying GVS at the amplitude of 0.1mA below the somatosensory threshold further increased the AP (12±2mmHg). GVS at the other amplitudes did not result in AP changes in either group. Thus, subsensory weak GVS enhances AP control at the onset of HUT. [Copyright &y& Elsevier]

Abstract: Objective: To investigate the diagnostic value of vestibular test and high stimulus rate auditory brainstem response (ABR) test and the possible mechanism responsible for benign paroxysmal vertigo of childhood (BPVC). Methods: Data of 56 patients with BPVC in vertigo clinic of our hospital from May 2007 to September 2008 were retrospectively analyzed in this study. Patients with BPVC were tested with pure tone audiometry, high stimulus rate auditory brainstem response test (ABR), transcranial Doppler sonography (TCD), bithermal caloric test, and VEMP. The results of the hearing and vestibular function test were compared and analyzed. Results: There were 56 patients with BPVC, including 32 men, 24 women, aged 3–12years old, with an average of 6.5years. Among 56 cases of BPVC patients, the results of pure tone audiometry were all normal. High stimulus rate ABR was abnormal in 66.1% (37/56) of cases. TCD showed 57.1% abnormality in 56 cases, including faster flow rate in 28 cases and slower flow rate in 4 cases. High stimulus rate ABR and TCD were both abnormal in 48.2% (27/56) of cases. Bithermal caloric test was abnormal in 14.3% (8/56) of cases. VEMP showed 32.1% abnormality, including amplitude abnormality in 16 cases and latency abnormality in 2 cases. The abnormal rate of VEMP was much higher than that of caloric test. Conclusion: Vascular mechanisms might be involved in the pathogenesis of BPVC and there is strong evidence for close relationship between BPVC and migraine. High stimulus rate ABR is helpful in the diagnosis of BPVC. The inferior vestibular pathway is much more impaired than the superior vestibular pathway in BPVC. [Copyright &y& Elsevier]

This study wants to show the diagnostic value of vestibular evoked myogenic potential (VEMP) in the diagnosis of vestibular neuritis (VN), independently of the caloric test results. Twenty patients were enrolled with acute vertigo caused by VN. VEMP was tested with the binaural simultaneous stimulation method. Surface electromyographic activity was recorded in the supine patients from symmetrical sites over the upper half of each sternocleidomastoid muscle, with a reference electrode on the lateral end of the upper sternum. During the acute attack, 8 days, 1 month and 3 months after the beginning of the acute attack, all the patients underwent the following examinations: Dix-Hallpike manoeuvre, Pagnini-McClure manoeuvre, head shaking test, pure-tone audiometry, tympanometry, caloric labyrinth stimulation according to the Fitzgerald-Hallpike method and VEMP. At the last visit, the 11 patients diagnosed with superior branch vestibular neuritis did not show any improvement at the caloric labyrinth stimulation and presented VEMP on both sides with normal amplitude and latency; in the 9 cases diagnosed with inferior branch vestibular neuritis, there was an improvement of the VEMP reflex and normal caloric test. Our experience highlights that VEMP recording is applicable for patients with VN as a screening test. [ABSTRACT FROM AUTHOR]

Conclusion. The inner ear monitoring system is useful for identifying the affected branches of the vestibular nerve in cases of vestibular neuritis, providing insight about the interval for the relief of vertigo. Objective: This study conducted an inner ear monitoring system including audiometry, and caloric, ocular vestibular evoked myogenic potential (oVEMP), and cervical VEMP (cVEMP) tests in cases of vestibular neuritis for assessing the affected branches of the vestibular nerve. Methods: Twenty patients with vestibular neuritis underwent caloric, oVEMP, and cVEMP tests. Type I indicates that one of the three tests is abnormal; type II indicates that two test results are abnormal; and type III indicates that no test result is normal. Results: All patients had normal hearing, bilaterally. Nineteen (95%) of 20 patients had abnormal caloric responses, 11 patients (55%) had abnormal oVEMPs, and 5 patients (25%) had abnormal cVEMPs. Restated, of all 20 patients, 8 patients were classified as type I, 9 were type II, and 3 were type III. The mean intervals between presentation and relief of vertigo were significantly different among the three types. One year after treatment, caloric, oVEMP, and cVEMP tests returned to normal responses in three (60%) of five patients. [ABSTRACT FROM AUTHOR]

Conclusion: Chances of hearing preservation are better in patients with vestibular schwannoma (VS) from the superior vestibular nerve (SVN) than from the inferior vestibular nerve (IVN). Pathologic posturography and electronystagmography (ENG) findings are more common in schwannomas from the SVN compared with tumors from the IVN. In this way, computerized dynamic platform posturography (CDPP) and ENG contribute to predict the nerve of origin of VS and can be used indirectly as a prognostic factor for hearing preservation. Objectives: To test whether preoperative CDPP or ENG results contribute to predict the nerve of origin in VS and also to evaluate the influence of the nerve of origin on hearing preservation. Methods: Eighty-nine patients with VS originating from the IVN and 22 patients with VS from the SVN were included. Hearing loss due to surgery was calculated on postoperative and preoperative audiograms. Caloric response was measured by ENG and condition 5 and 6 score were recorded by CDPP before surgery. Results: Hearing loss due to surgery was significantly lower in patients with tumors from the SVN than from the IVN ( p == 0.011). Pathologic results in preoperative ENG ( p < 0.0001) and CDPP ( p == 0.025) were significantly more frequent in subjects with SVN than with IVN schwannomas. [ABSTRACT FROM AUTHOR]

The influence of aging on hearing and vestibular function in patients with auditory neuropathy has not been investigated. The purpose of this study was to investigate how hearing and vestibular function in this disease change with aging. The subjects were three female patients with auditory neuropathy. We checked their hearing and vestibular function by speech discrimination tests, ABR, ECochG, DPOAE, caloric test, damped-rotational chair test, and VEMPs. In all three patients, speech discrimination ability and vestibular function markedly declined with aging. However, speech language understanding and higher brain function were less affected by aging. [ABSTRACT FROM AUTHOR]

Conclusion: GJB2 mutations are responsible not only for deafness but also for the occurrence of vestibular dysfunction. However, vestibular dysfunction tends to be unilateral and less severe in comparison with that of bilateral deafness. Objectives: The correlation between the cochlear and vestibular end-organs suggests that some children with congenital deafness may have vestibular impairments. On the other hand, GJB2 gene mutations are the most common cause of nonsyndromic deafness. The vestibular function of patients with congenital deafness (CD), which is related to GJB2 gene mutation, remains to be elucidated. The purpose of this study was to analyze the relationship between GJB2 gene mutation and vestibular dysfunction in adults with CD. Methods: A total of 31 subjects, including 10 healthy volunteers and 21 patients with CD, were enrolled in the study. A hearing test and genetic analysis were performed. The vestibular evoked myogenic potentials (VEMPs) were measured and a caloric test was performed to assess the vestibular function. The percentage of vestibular dysfunction was then statistically analyzed. Results: The hearing level of all CD patients demonstrated a severe to profound impairment. In seven CD patients, their hearing impairment was related to GJB2 mutation. Five of the seven patients with CD related to GJB2 mutation demonstrated abnormalities in one or both of the two tests. The percentage of vestibular dysfunction of the patients with CD related to GJB2 mutation was statistically higher than in patients with CD unrelated to GJB2 mutation and in healthy controls. [ABSTRACT FROM AUTHOR]

Conclusions: Our study revealed that VEMPs in responses to clicks and 500 Hz STB were abnormal in 25% of athletes with congenital profound sensorineural hearing loss for the Deaf Olympic Games. These results confirm that a part of deaf athletes with congenital vestibular failure is well compensated for higher level sport activities. Objectives: The aim of this study was to investigate the appearance rate of VEMP, vestibular failure and its compensation in Japanese deaf athletes by the VEMP test, caloric test and balance test. Methods: Sixteen subjects among the Deaf Olympic Games athletes of Japan volunteered to participate in this study. All the subjects have congenital profound sensorineural hearing loss. Results: In the VEMP test, 24 ears (75%) showed normal click-evoked responses, 5 ears (16%) showed decreased click-evoked responses, 3 ears (9%) showed no click-evoked responses, 28 ears (87.5%) showed normal 500 Hz short tone burst (STB)-evoked responses and 4 ears (12.5%) showed decreased responses. In the ice-water caloric test, 11 subjects (69%) showed normal responses bilaterally, 3 subjects showed bilateral responses with asymmetrical responses and 2 subjects (12%) showed no response bilaterally. All the subjects showed normal balance test results. [ABSTRACT FROM AUTHOR]

Abstract: Objective: To evaluate the value of different variables of the clinical history, auditory and vestibular tests and handicap measurements to define intractable or disabling Ménière''s disease. Methods: This is a prospective study with 212 patients of which 155 were treated with intratympanic gentamicin and considered to be suffering a medically intractable Ménière''s disease. Age and sex adjustments were performed with the 11 variables selected. Discriminant analysis was performed either using the aforementioned variables or following the stepwise method. Results: Different variables needed to be sex and/or age adjusted and both data were included in the discriminant function. Two different mathematical formulas were obtained and four models were analyzed. With the model selected, diagnostic accuracy is 77.7%, sensitivity is 94.9% and specificity is 52.8%. Conclusion: After discriminant analysis we found that the most informative variables were the number of vertigo spells, the speech discrimination score, the time constant of the VOR and a measure of handicap, the “dizziness index”. [Copyright &y& Elsevier]

Abstract: OPA1 mutations are known to cause autosomal dominant optic atrophy (ADOA), and some types of OPA1 mutations also cause auditory neuropathy. In the present study, we evaluated the vestibular dysfunction that accompanied auditory neuropathy in a patient with an OPA1 mutation. A caloric test failed to elicit nystagmus or dizziness in either ear. Vestibular evoked myogenic potentials (VEMPs) in the right ear were characterized by a normal biphasic waveform. In contrast, no VEMPs were evoked in the left ear. Model building suggested that the OPA1 mutation, p.R445H, indirectly distorts the catalytic structure of the GTPase reaction center and decreases GTPase activity. The patient complained of instability while walking or moving but thought these symptoms were caused by visual dysfunction. This is the first report of a detailed evaluation of vestibular dysfunction in a patient with an OPA1 mutation. This case suggests that vestibular dysfunction may be involved in motor instability in patients with an OPA1 mutation, even when patients do not complain of vestibular symptoms. Based on this case, we suggest that vestibular evaluation should be performed in auditory neuropathy patients carrying an OPA1 mutation, even if the patients are free of symptoms of vestibular dysfunction. [Copyright &y& Elsevier]

Objectives: To determine whether the caloric vestibular test causes significant changes in heart rate and mean arterial blood pressure. Materials and methods: Changes in heart rate and mean arterial blood pressure before and after caloric irrigation were compared with the degree of nystagmus (as measured by maximum slow phase velocity) and the patient's subjective dizziness (scored from 0 to 10). A cardiologist reviewed each patient's heart rate and mean arterial blood pressure changes. Patients' anxiety levels were also assessed. Results: Eighteen patients were recruited. There were no adverse events in any patient. There were no overall significant differences between the heart rate and mean arterial pressure before and after each irrigation. There was a significant correlation between the maximum slow phase velocity and patients' subjective dizziness scores. Conclusion: Heart rate and mean arterial blood pressure are not significantly influenced by the caloric vestibular test. This preliminary study will enable patients with stable cardiovascular disease to be recruited for further risk determination. [ABSTRACT FROM AUTHOR]

Conclusion: We developed a new coordinates system for magnetic resonance imaging (MRI) that utilizes the labyrinth and eyeballs as references to measure the spatial arrangement of cranial organs, and we verified its usefulness by observing small structures in the labyrinth in 39 ears from 33 patients. Our new coordinates system could be used for stereotactic analysis of cranial organs in MRI. Objectives: To research semicircular canal anatomy in healthy organisms, we propose a method that employs references visible on MRI for stereotactic measurement of cranial structures, and we evaluated the usefulness of our method. Methods: Using the new coordinates system and vector analysis, we calculated angles among the semicircular canals and sagittal head plane from MRI volume data containing temporal bone and orbit. Results: The angle between the anterior semicircular canal plane and sagittal plane was 35.3 ± 4.1°; posterior semicircular canal plane and sagittal plane, 50.9 ± 4.7°; and horizontal semicircular canal plane and sagittal plane, 90.4 ± 7.0°. The angle between the anterior and posterior semicircular canal planes was 95.1 ± 4.2°; anterior and horizontal semicircular canal planes, 92.3 ± 7.5°; and posterior and horizontal semicircular canal planes, 93.5 ± 4.9°. [ABSTRACT FROM AUTHOR]

The most common cause of whiplash injury today is the road traffic accidents. These patients report to a neurotologist with complaints of long-standing duration including vertigo, nausea, hearing loss and tinnitus. In addition to neck trauma there is also intracranial trauma due to movement of the brain within the skull thus affecting the brainstem and the supratentorial structures. In this retrospective study 426 patients of whiplash injury were selected from databank NODEC IV of the University head centre, Wurzburg, Germany. The results of monaural caloric test by means of butterfly chart in all these patients were analysed. The authors present the most prevalent caloric butterfly patterns of this study and pathophysiology explaining them. The study reveals that the more frequent pathological patterns in this study are the central brainstem lesions. [ABSTRACT FROM AUTHOR]

The ocular counterrolling can be static or dynamic. The purpose of this work is to connect the clinical absence of dynamic ocular counterrolling with bilateral caloric paresis. A prospective study on 216 patients in whom the absence of dynamic ocular counterrolling was tested and standard caloric test was performed. The cut-off value for bilateral caloric paresis is an absolute reflectivity of 10 in nystagmic frequency and 8 in slow phase velocity. The adequate contingency tables were constructed and tests of Chi-squared calculated. Sensitivity, specificity, positive and negative predictive values, positive and negative likelihood ratios, and area under receiver operating characteristic (ROC) curve were also calculated. Using the reflectivity according to the nystagmic frequency, we obtained P = 0.000 for Chi-squared, area under ROC curve was 0.832 and positive likelihood ratio 11.47. For slow-phase velocity, the results were P = 0.000, area ROC of 0.735 and positive likelihood ratio 9.43. There is a statistically significant connection between the clinical absence of dynamic ocular counterrolling and bilateral caloric paresis, with a strong diagnostic power. The mechanisms by which this phenomenon can be attributed to canalicular damage instead of otolithic damage are discussed. [ABSTRACT FROM AUTHOR]

Abstract: Background and objective: Studies have already investigated vestibulo-ocular reflex (VOR) responses in elderly subjects, mostly at low frequencies (<1Hz) during passive head turns, or continuous active head turns in a rotational chair. However, natural head movements usually occur at frequencies above 1Hz and at varying rates, rather than at continuously increasing rates as tested in most studies to date. The aim of this study was to compare VOR responses within or between normal and bilateral peripheral vestibular hypofunction (BPVH) elderly subjects with a computer base program incorporating random active high-frequency head movements. Subjects: Seventeen senior patients with bilateral peripheral vestibular hypofunction and 13 age-matched paid healthy subjects participated in this study. Design: All the subjects performed 8s of active, side-to-side head motions at 1Hz, 2Hz and 3Hz in response to four experimental conditions: (A) a stationary visual target; (B) a stationary visual target and a moving target with a horizontal trajectory; (C) a stationary visual target and a moving target with a spiral trajectory; and (D) a stationary visual target with combined horizontal- and vertical-spiral moving targets. Results: Repeated-measures ANOVA showed that across the different frequencies of headshaking, a significant increase took place in the phase lag of the BPVH subjects (p <0.001) compared with the normal controls. Post hoc analysis showed significant within-group differences in BPVH subjects (1Hz vs 2Hz, 2Hz vs 3Hz) and normal controls (1Hz vs 2Hz, 1Hz vs 3Hz). A significant VOR gain took place among the BPVH subjects at 3Hz VAT (p <0.001) as compared with 1Hz VAT and no significant differences in VOR gain could be detected among the controls at either of these frequencies. Repeated-measures ANOVA revealed that under our test conditions, significant main effect was noted for VOR asymmetry (F =4.45, p <0.05). Post hoc analysis showed significant within-group differences in the BPVH subjects (test A vs test B, test A vs test C, and test A vs test D). Conclusions: Our results showed that the VAT paradigm can be improved by using concurrent horizontal and vertical moving targets. The VOR phase may be useful for differentiating VAT responses between BPVH and healthy elderly subjects. Moreover, the results of this study demonstrate that gains in VOR at different frequencies of headshaking and asymmetry during different test conditions can be useful parameters for within-group assessment. [Copyright &y& Elsevier]

Conclusions: Three possible results are commonly seen after ice-water caloric irrigation and to correctly interpret them the function of the corresponding vestibular receptor and of normal endolymphatic flow must be taken into account. Bedside vestibular examination helps to interpret discrepant findings. Objective: To review the findings obtained with the ice-water caloric test in patients with dizziness and to compare the results with those of the bedside test. Patients and methods: The study was undertaken in a university hospital, tertiary medical center. The indications to perform the ice-water caloric test were: 1) unilateral canal weakness >90%; 2) a maximum slow phase velocity of nystagmus after hot (44°C) and cold (30°C) caloric stimulation in either ear of <9° s–1; or 3) in both ears <15° s–1. After irrigating the ear with ice water, nystagmus was recorded in the face-up and face-down positions. The result of the test was classified as a response (nystagmus beats away from the irrigated ear in the supine position and changes when in prone), a gravity-independent response (nystagmus does not change in direction in the prone position) or no response. The spontaneous and post head-shaking nystagmus, as well as the results of the head-impulse test, were also analyzed. When indicated, a rotatory chair test was performed. Results: In the 71 patients that displayed unilateral hypofunction, the ice-water test produced a normal response in 24, a gravity-independent response in 31, and no response in 14. In two of these patients a vertical gravity-independent nystagmus response was observed. Bilateral hypofunction was found in 12 patients and the results in the head-impulse test were in agreement with the results in the ice-water test. [ABSTRACT FROM AUTHOR]

Background: Head trauma may result in many kinds of otoneurologic disorders. However, there are very few studies associated with the evaluation of the disorder. Research question: The aim of the study is to clarify the effects of long-term impact to the head in advanced boxers regarding vestibular evoked myogenic potentials (VEMP). Type of study: Prospective study. Material and methods: VEMPs were collected from 14 advanced boxers (13 M, 1 F, aged 16-28 years). The otoscopic findings, audiograms and caloric test were recorded. The VEMP responses of strong side (right for right-handed) and weak side were compared to each other and to the healthy volunteers. Results: The 14 enrolled subjects had been engaged in the sport of boxing for 4 to 15 years (median: 8.9 years). In comparison with the control group, the results of the caloric test of the subjects were not significantly different (p>0.05). The VEMP responses in boxers showed significant delay of p13 and n23 latencies in both strong side and weak sides in comparison with healthy volunteers (p<0.05). Moreover, the p13 and n23 latencies of VEMP responses showed significant delay over strong side as compared with the weak side (p<0.05). Conclusion: VEMP responses were significantly affected by chronic head trauma in the boxers. Furthermore, p13 and n23 latencies of VEMP responses of strong side showed significant delay compared with those of the weak side. [ABSTRACT FROM AUTHOR]

Rotational tests are aimed at producing a more natural, precise, repeatable, and broadband evaluation of the vestibular function. Currently, two types of rotation tests are in clinical use: passive whole-body rotation where the stimulus is produced by a motorized chair, and active rotation where the stimulus is produced by voluntary head movements. In both methods, the frequency response of the vestibulo-ocular reflex (VOR) is determined by measuring the eye movements and comparing the head velocity with the slow-phase eye velocity. Rotation tests offer several advantages over other vestibular function tests in patients with bilateral caloric weakness, in young children, or in patients for whom VOR changes have to be assessed over time. In most other patients, rotation tests do not offer a significant advantage because of their low sensitivity to common vestibular abnormalities. [ABSTRACT FROM AUTHOR]

Conclusions. The results of the caloric test, vestibular evoked myogenic potential (VEMP), and auditory brainstem response (ABR) in patients with vestibular schwannoma (VS) did not show clear correlation with the nerve origin of the tumor but with tumor size. When we focused on patients with VS within the internal acoustic canal (IAC), neither the nerve origin of the tumor nor the tumor size showed clear correlation with the results of these tests. Objectives. This study examined the correlation of the nerve origin of VS, superior or inferior vestibular nerve, with the results of function tests. Subjects and methods. Subjects comprised 109 consecutive patients diagnosed as having unilateral VS. Each test was performed before surgery. Tumor size was measured with preoperative MRI. Results. The nerve origin of the tumor was identified in 63 of the 109 patients. The percentage of patients showing abnormal responses in each test was not different between 37 patients with superior VS and 26 patients with inferior VS. Also, no difference was observed for patients with VS within the IAC. Mean tumor size in patients showing abnormal responses was larger than that in patients showing normal responses on each test. However, this tendency was not observed for patients with VS within the IAC. [ABSTRACT FROM AUTHOR]

Abstract: Objective: This study examined the diagnostic value of the vestibular-evoked myogenic potential (VEMP) in comparison with the caloric test in patients with vestibular schwannoma (VS). Methods: Data were retrospectively collected from 803 consecutive patients who visited our vertigo clinic and underwent vestibular tests. Amongst them, 78 patients were diagnosed as having untreated unilateral VS. VEMP was performed using click and short-tone burst stimulation. The caloric test was performed using ice water. The sensitivity and specificity of each test were evaluated. Results: Of the 78 patients with VS, 63 had abnormal VEMPs as well as abnormal caloric responses. Of the 725 patients without VS, 382 had normal VEMPs and 416 had normal caloric responses. The sensitivity and specificity of VEMP were 80.8% (95% CI: 72.0–89.5%) and 52.7% (95% CI: 49.1–56.3%), respectively; those of the caloric test were 80.8% (95% CI: 72.0–89.5%) and 57.4% (95% CI: 53.8–61.0%), respectively. Conclusions: The sensitivity and specificity of VEMP and the caloric test showed no significant differences. Significance: In patients with VS, although the specificity of VEMP was not very high, its sensitivity was high and comparable to that of the caloric test. [Copyright &y& Elsevier]

Conclusion. Abnormal caloric and vestibular evoked myogenic potential (VEMP) responses are frequently encountered with a large cerebellopontine angle (CPA) schwannoma, while normal caloric responses and abnormal VEMPs are noted with a large CPA meningioma. This difference may possibly exist because schwannoma causes vestibular deficits via parenchymal involvement, while vestibular deficits in the meningioma are mostly due to compression neuropathy. Objectives. This study aimed to compare the tumor characteristics in relation to vestibular function, i.e. caloric and VEMP responses, between large-sized (>2.5 cm) meningioma and schwannoma in the CPA. Patients and methods. Five patients with large CPA meningioma and nine patients with large CPA schwannoma were enrolled in this study. Each patient underwent a battery of tests including audiometry, caloric test, VEMP test, and MRI study. Results. The meningioma group showed 20% caloric abnormality and 75% VEMP abnormality, while the schwannoma group revealed 100% caloric and 100% VEMP abnormalities. A significant difference existed in relation to caloric abnormality between the two groups, but not in relation to VEMP abnormality. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate vestibular evoked myogenic potentials (VEMPs) and their clinical significance in Behcet’s disease. Twenty-six patients with Behcet’s disease and 25 healthy volunteers were evaluated for pure tone audiometry, caloric response, and VEMPs. Sensorineural hearing loss was found in 53.8% of patients with Behcet’s disease, which was significantly higher than controls. Four patients had canal paresis, but no controls; this difference was not significant. Although VEMP recordings were elicited in all study subjects, mean p13 and n23 latencies were prolonged in Behcet’s patients compared with controls. Seven patients had delayed VEMP responses. There were no correlations regarding p13 values and age, duration or activity of disease, vertigo, or sensorineural hearing loss. The results of this preliminary study suggest an association between delayed VEMP responses and Behcet’s disease. Further research with large samples is needed to confirm that VEMP testing is useful to diagnose and follow vestibular dysfunction in Behcet’s disease. [ABSTRACT FROM AUTHOR]

The article reports on the study which was aimed to analyze the correlation between the effects of subjective visual horizontal (SVH) and other vestibular purpose trials in patients with untreated unilateral vestibular schwannoma (VS). It discusses that Vestibular schwannoma (VS) is a benign tumor that originates from the superior or inferior vestibular nerve.

Congenitally deaf infants and children commonly suffer vestibular failure in both ears, and impairment of postural control, locomotion, and gait. The development of gross motor functions, such as head control, sitting, and walking is likely to be delayed, but fine motor function is usually preserved unless disorders of the central nervous system are present. These children can eventually catch up with their normal peers in terms of development and growth as a result of central vestibular compensation. The visual and somatosensory systems, pyramidal and extrapyramidal motor system (cerebellum, basal ganglia, cerebrum) and intellectual development, compensate for vestibular failure in infants and children with congenitally hypoactive or absent function of the semicircular canals and otolith organs. [ABSTRACT FROM AUTHOR]

Conclusion. Subjectivity seems to play a definite role in the interpretation of the pendular test, but somewhat less for caloric testing, where pure visual analysis seems to be more reliable. Automated values provided by proof-tested software may be useful. Objectives. In some centers, the interpretation of videonystagmography is still based on direct visual analysis of recorded tracings. Our study addresses the importance of subjectivity in the interpretation of videonystagmographic readings. Patients and methods. Two experts (one junior and the other senior) were asked to interpret the same caloric and pendular tests on two different occasions, 3 months apart. Initial reading was performed without knowledge of the patient's history or the results of other neuro-otological tests. Three months later, interpretations were done with complete access to the patient's charts. The experts' answers were compared to the values provided by the computer software. Results. For the pendular test, inter-expert agreement was poor. With knowledge of the patient's history, the expert's interpretations tended to coincide with the software's calculations. For the caloric test, interpretation was less variable. [ABSTRACT FROM AUTHOR]

Conclusion. The tumor size of acoustic neuroma correlates with cochleovestibular deficits. Those tumors with global frequency hearing loss, bilateral gaze nystagmus, or absent caloric and VEMP responses may indicate a tumor size >2.5 cm. Objective. This study aimed to investigate the correlation between cochleovestibular deficits and the size of acoustic neuroma. Patients and methods. A total of 44 patients with acoustic neuroma were enrolled in this study. Pure tone audiometry, electronystagmography, caloric test, vestibular evoked myogenic potential (VEMP) test, and MRI were conducted. Results. There is a trend of correlation between tumor size and audiographic configuration, with small-sized tumor in normal and rising types, medium-sized tumor in mid- and high-frequency hearing loss, and large-sized tumor in flat and deafness types. Five patients with bilateral gaze nystagmus had significantly larger tumor size than those without nystagmus. When 1 and 0 are used to represent abnormal and normal responses, respectively, the relationship between tumor size and vestibular function can be expressed as: tumor size (cm)=1.43 (caloric response)+1.35 (VEMP response), indicating that the estimated tumor size for those with abnormal caloric or VEMP responses increased by 1.43 or 1.35 cm, respectively. [ABSTRACT FROM AUTHOR]

We report a case of mumps deafness with acute vestibular symptoms secondary to both retrolabyrinthine and inner ear dysfunction. To our knowledge, no such case has been reported elsewhere. The patient was a 6-year-old girl in whom mumps deafness was initially diagnosed. Two days after onset of the hearing impairment, severe vertigo developed. Neurotologic examinations revealed spontaneous right-beating nystagmus, left canal paresis, absence of vestibular-evoked myogenic potentials in the left ear, and absence of responses to a left galvanic body sway test (GBST). The vertigo resolved 7 days after onset. However, the left hearing impairment progressed to complete deafness. Six months later, left canal paresis was still present, but bilateral GBST responses were normal, suggesting that retrolabyrinthine vestibular function had been restored. Mumps virus may affect retrolabyrinthine function as well as the inner ear. [ABSTRACT FROM AUTHOR]

Conclusion. The skull vibration-induced nystagmus test (SVINT) is a useful complementary test to the caloric test, which evaluates very low frequencies, and the head shaking test (HST), which explores medium range frequencies. These three tests are fully correlated in total unilateral vestibular lesions (tUVL) with a sensitivity of 98% and a specificity of 94% for the SVINT. The results of the interference of the SVINT with the cold caloric test on the intact ear suggest that different vestibular sensory cells are involved in these two tests. The stimulus location optimization suggests that vibrations directly stimulate the inner ear on the intact side. Objectives. The aim of this study was to establish the effectiveness of a rapid, non-invasive test used to detect vestibular asymmetry at 30, 60 and 100 Hz stimulation in tUVL. Patients and methods. The high frequency vibration test applied to the skull using the SVINT was compared to the results of HST and caloric test in 134 patients and 95 normal subjects: 131 patients had a total unilateral vestibular dysfunction and 3 had a bilateral total lesion (tBVL). The effects of stimulus frequency, topography and head position were studied using a video-nystagmograph. Results. In tUVL, the SVINT always revealed a lesional nystagmus beating toward the healthy side at all frequencies. The mastoid site was more efficient than the cervical and vertex sites (p<0.005). The mean skull vibratory nystagmus (SVN) slow phase velocity (SPV) is 10.7°/s (SD =7.5; n=20). Mastoid stimulation efficiency was not correlated with the side of stimulation. SVN SPV was correlated with the total caloric efficiency on the healthy ear (p=0.03). The interference of the SVINT during the cold caloric test on the intact ear demonstrated a reversal of the caloric nystagmus at each application of the vibrator. In tBVL, SVINT revealed no nystagmus. [ABSTRACT FROM AUTHOR]

This study presents the neuro-otological findings of 523 patients attending a tertiary vestibular clinic with migraine- and nonmigraine-related dizziness. Subjects were categorized into one of 4 groups, definite migrainous vertigo, probable migrainous vertigo, vestibular disorder coexisting with migraine and nonmigraine-related dizziness. No notable relationship was found between the numbers of abnormal findings between the groups for the majority of the neuro-otological tests. However, there was a significant trend in emetic response to caloric testing. The definite migrainous vertigo group were at least 4 times more likely to be nauseous to caloric testing than any other migraine category. This difference was independent of the magnitude of caloric responses between the emetic migraine groups. While further investigation is required, this study has potentially identified that nauseous/emetic response to caloric stimulation may be a distinguishing factor between migrainous vertigo and other vestibular disorders including those with a coexisting history of migraine. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

We aimed to investigate if there is a concordance between summation potential (SP)/action potential (AP) ratio and unilateral weakness in patients with definite-Meniere’s disease. There were two groups, a group of unilateral definite-Meniere patients who received no treatment and another group of control subjects. Twenty-six patients were identified as complying with the defined criteria. Fifteen healthy subjects with no hearing and balance disorders were assigned to the control group. Arithmetic mean of the four-tone average of thresholds at 0.5, 1, 2, and 3 or 4 kHz, SP/AP ratio and degree of unilateral weakness were calculated. The number of patients was tabulated based on the presence of abnormal SP/AP ratio and unilateral weakness. Co-occurrence of unilateral weakness and elevated-SP/AP ratio was investigated with reference to the stage of the disease. A correlation was sought among pure-tone average, SP/AP ratio and degree of unilateral weakness in a pair-wise manner. Unilateral weakness and abnormal SP/AP ratio were identified in 53.8% and 38.4% of the patients, respectively. Co-occurrence of unilateral weakness and abnormal SP/AP ratio was observed in 34.6% of the patients. However, it was noticed that this co-occurrence gradually increased when the disease progressed. Mean SP/AP ratio also gradually increased as the stage progressed. Of pair-wise correlations among pure-tone average, SP/AP ratio and degree of unilateral weakness, a weak correlation ( r = 0.383) was found only between SP/AP ratio and degree of unilateral weakness with marginal significance ( P = 0.053). We concluded that co-occurrence of unilateral weakness and elevated SP/AP ratio increases when the disease progresses. This co-occurrence is less encountered in earlier stages. This difference might be resulted from a difference in distension capability of the endolymphatic space of the cochlea and the vestibule. Albeit weak, there was a correlation between mean SP/AP ratio and degree of unilateral weakness, which suggests that the disease parallelly disturbs the lateral semicircular or cochlear functions especially in advanced stages. [ABSTRACT FROM AUTHOR]

Conclusion. Testing of the horizontal vestibulo-ocular reflex (VOR) with head rotations (including head impulses) using the magnetic scleral search coil technique (SCT HHI) provides valuable additional diagnostic information in patients with persistent dizziness, oscillopsia or imbalance. It identifies high and low frequency/acceleration vestibular abnormalities that are frequently missed using other methods. Objectives. To evaluate the diagnostic utility of SCT measurement of the horizontal VOR in the multidisciplinary neurotology clinic of a tertiary referral centre. Patients and methods. The records of 127 consecutive patients referred for persistent dizziness, oscillopsia, imbalance, or with clinical findings suggestive of high frequency/acceleration vestibular dysfunction were reviewed. All had been tested with clinical head impulses, bithermal calorics and vestibular-evoked myogenic potentials. VOR gain (peak eye velocity/peak head velocity) had been measured both in response to sinusoidal oscillations in a rotating chair (0.1-11Hz) and to manually delivered horizontal head rotations (peak head velocities 50-500°/s) using SCT. Results. Agreement between the different test modalities of horizontal semicircular canal function was moderate. Relative to SCT HHI, clinical HHI showed the highest sensitivity and the lowest specificity (both 70%). SCT HHI appeared to have the greatest diagnostic yield, when compared with calorics and SCT ROT (23% of all abnormalities shown were detected only by SCT HHI) and also allowed detection of significant asymmetries in patients with bilateral vestibular dysfunction. [ABSTRACT FROM AUTHOR]

Conclusion. Condition-5-score (C5S) and condition-6-score (C6S) of computerized dynamic platform posturography (CDPP) can detect the presence of a functional deficit of the lateral semicircular canal (and the superior vestibular nerve), irrespective of the central vestibular compensatory status, in vestibular schwannoma (VS) patients. Objectives. To test whether CDPP findings differ between VS patients with and without asymmetry on caloric and/or rotational ENG studies. Patients and methods. This was a retrospective review of 216 consecutive patients with VS. C5S and C6S of CDPP (Equitest®) were compared among patients with normal caloric and rotational studies, patients with asymmetry on caloric studies and normal rotational studies, and patients with asymmetric caloric and rotational studies using the Wilcoxon-Mann-Whitney test. Results. C5S and C6S of VS patients with normal caloric and rotational studies were significantly higher than in VS patients with either asymmetry on both rotational and caloric test results (p<0.001 for both C5S and C6S) or normal rotational studies and asymmetry on caloric testing (p<0.001 for both C5S and C6S). Neither C5S nor C6S were significantly different between patients with asymmetry on caloric testing and normal rotational studies and patients with asymmetry on both rotational and caloric testing. [ABSTRACT FROM AUTHOR]

The aim of this study was to investigate the effect of alcohol on sacculocollic and vestibulo-ocular reflex systems, when the breath alcohol concentration (BrAC) is close to the legal limit of 0.25 mg/l. Twenty healthy male volunteers underwent vestibular evoked myogenic potential and caloric coupled with visual suppression tests. These tests were conducted prior to imbibing alcohol at a dosage of 0.5 g/kg to achieve a peak BrAC of around 0.25 mg/l. Once the peak BrAC was reached, these tests were performed again. Predosing and postdosing analytical results were compared, as were those with BrAC levels ≥ 0.25 mg/l and <0.25 mg/l. After ingesting alcohol, 36 ears (90%) showed vestibular evoked myogenic potential responses, with a significantly increased latency of peak p13. The mean slow-phase velocity of caloric nystagmus in 40 ears after dosing was significantly reduced, and that with BrAC ≥0.25 mg/l was significantly less than that with BrAC <0.25 mg/l. Likewise, the visual suppression index decreased considerably after alcohol ingestion. In conclusion, from the perspective of vestibular function, the 0.25-mg/l BrAC limit gains clinical significance, because the vestibulo-ocular reflex performance deteriorates further, when the BrAC exceeds 0.25 mg/l. However, impaired performance of sacculocollic reflex and vestibulocerebellar interaction has occurred, when the BrAC was <0.25 mg/l, suggesting that a lower legal threshold is appropriate. Copyright © 2007 S. Karger AG, Basel [ABSTRACT FROM AUTHOR]

Abstract: Intracochlear infusion of (±)-α-amino-3-hydroxy-5-methyl-isoxazole-4-propionic acid (AMPA) was performed with a syringe pump in guinea pigs, and peripheral vestibular dysfunction was induced. Animals were administered edaravone systemically or topically. In the systemic application group, animals were administered edaravone once a day for 7 days after AMPA infusion. In the topical application group, edaravone-soaked gelfoam was placed on the round window membrane just after, 12 h after or 24 h after AMPA infusion. Spontaneous nystagmus was observed after AMPA infusion. Immunohistochemistry for 4-hydroxy-2-nonenal (4-HNE), a marker of free radical-induced lipid peroxidation, was performed 24 h after AMPA infusion. In addition, caloric tests were performed to evaluate vestibular function 1 week after AMPA infusion. Animals in both groups showed decreased spontaneous nystagmus, but results were not significant. Animals treated topically with edaravone within 12 h of AMPA infusion showed normal morphology of the ampullar sensory epithelia of the lateral semicircular canals and showed a good response to the caloric tests. 4-HNE immunoreactivity in the sensory epithelia was very low in these animals. In contrast, untreated animals and animals treated with edaravone systemically or topically 24 h after AMPA infusion showed morphologic hair cell damage, reduced caloric response and remarkable 4-HNE immunoreactivity in the sensory epithelia. These results indicate that topical application of edaravone within 12 h after damage protects the vestibular periphery from free radical-induced toxicity in response to intracochlear infusion of AMPA. [Copyright &y& Elsevier]

Abstract: Cisplatin has been used as a chemotherapeutic agent to treat many kinds of malignancies. Its damage to the vestibulo-ocular reflex (VOR) system has been reported. However, the underlying biochemical change in the inner ear or central vestibular nervous system is not fully understood. In this study, we attempted to examine whether cisplatin-induced vestibulotoxicity and d-methionine protection were correlated with the changes of ATPase activities and oxidative stress of ampullary tissue of vestibules as well as cerebellar cortex (the inhibitory center of VOR system) of guinea pigs. By means of a caloric test coupled with electronystagmographic recordings, we found that cisplatin exposure caused a dose-dependent (1, 3, or 5 mg/kg) vestibular dysfunction as revealed by a decrease of slow phase velocity (SPV). In addition, cisplatin significantly inhibited the Na+, K+-ATPase and Ca2+-ATPase activities in the ampullary tissue with a good dose–response relationship but not those of cerebellar cortex. Regression analysis indicated that a decrease of SPV was well correlated with the reduction of Na+, K+-ATPase and Ca2+-ATPase activities of the ampullary tissue. d-Methionine (300 mg/kg) reduced both abnormalities of SPV and ATPase activities in a correlated manner. Moreover, cisplatin exposure led to a significant dose-dependent increase of lipid peroxidation and nitric oxide concentrations of the vestibules, which could be significantly suppressed by d-methionine. However, cisplatin did not alter the levels of lipid peroxidation and nitric oxide of the cerebellum. In conclusion, cisplatin inhibited ATPase activities and increased oxidative stress in guinea pig vestibular labyrinths. d-Methionine attenuated cisplatin-induced vestibulotoxicity associated with ionic disturbance through its antioxidative property. [Copyright &y& Elsevier]

Conclusions. Inferior vestibular nerve functions could recover in patients with vestibular neuritis (VN). Objectives. Although the recovery of superior vestibular nerve functions has been reported, there is little information about the recovery of inferior vestibular nerve functions in patients with VN. This study was done to clarify if inferior vestibular nerve functions recover after an attack of VN. Methods. Neuro-otological tests including vestibular evoked myogenic potential (VEMP) testing and caloric testing were sequentially performed in 13 patients with VN, who showed absence of VEMP on the affected side at the initial examination (7 men and 6 women, 28–82 years of age). VEMPs to click stimulation (95 dBnHL) were recorded with surface electrodes over each sternocleidomastoid muscle. Results. Among the 13 patients, 5 patients (4 men and 1 woman) showed recovery of VEMP responses. Four of the five patients (three men and one woman) showed recovery of VEMP to the normal range. It takes 6 months to 2 years to recover within the normal range. On the other hand, caloric responses recovered to the normal range only in one patient. [ABSTRACT FROM AUTHOR]