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Study aimed to assess short- and long-term impact of unilateral cochlear implantation in children on the angular vestibulo-ocular reflex using rotatory chair test. Two groups; A (early postoperative evaluation) and B (later on evaluation) were included, each consisted of 23 cochlear implant candidates’ children with unilateral implant surgeries were performed in El-Galaa Hospital, Cairo, Egypt. They were assessed by rotatory chair test; sinusoidal harmonic acceleration paradigm. Three parameters: average gain, asymmetry, and phase results of each group were compared with the manufacturer’s norms and with each other. Further analysis by comparing each group implanted side specific gain results with the same group non-implanted side specific gain and with the other group implanted side specific gain results. Group A versus norms showed only significant differences in average gain and phase at 0.02 Hz and 0.01 Hz test frequencies respectively. However, three parameters in group B showed no significant differences when compared with norms. When comparing the results of both groups relieved significant differences only in average gain at 0.02 Hz and in phase at both 0.01 Hz and 0.04 Hz. Comparing specific gain results for both sides of group A showed significance at 0.32 Hz test frequency, while those of group B showed no significant differences. The analysis of implanted sides gain results of both groups showed differences at 0.16 Hz and 0.32 Hz. Bilateral restoration and improvement of angular vestibulo-ocular reflexes after unilateral cochlear implantation was reported with long-term assessment by rotatory chair test.

Objectives: Correlation between Narrow Band Chirp Auditory Brainstem Response (NB-CE chirp ABR) as a frequency specific method for hearing threshold detection in children and Tone burst Auditory Brainstem Response (Tb-ABR) in reference to behavioral hearing threshold audiometry. Material and Methods: This study was conducted on 100 patients at audiology unit, Menoufia University hospital, in the period from Oct. 2015 to Feb. 2017. Patients enrolled within this study were classified into four groups: Group I: included 40 patients diagnosed with normal hearing, Group II: included 48 patients with mild to moderate sensorineural hearing loss (SNHL), Group III: included 56 patients with moderate to moderately severe SNHL and Group IV: included 56 patients with severe to profound SNHL. All patients’ enrolled NB-CE chirp ABR, Tb-ABR as well as pure tone audiogram (PTA). Results: there was a significant correlation between NB-CE chirp ABR and PTA hearing threshold. The use of a chirp-ABR testing ensures higher sensitivity and accuracy than that of Tb-ABR for measuring frequency-specific thresholds in young children. Conclusion: NB-CE Chirp ABR is more efficient than Tb-ABR as a frequency specific tool for hearing threshold estimation in children.

Objectives: To standardize the Arabic language version of the visual vertigo analogue scale (VVAS) and to determine its reliability and validity. It is a simple and supplemental kind of assessments of visual vertigo syndrome.Methods: The Arabic VVAS (AVVAS) was developed using the cross-cultural adaptation guidelines. The scale was tested by 70 patients with visual vertigo (VV) (patient group) and 100 normal subjects (control group). Participants’ responses were statistically analyzed for internal consistency between both groups. Repeatability was calculated using Spearman correlation on a subgroup of 30 control subjects and 40 VV patients after 1 week. Receiver operating characteristic curve was performed in order to select the optimal cut-off level.Results: showed a significantly good internal consistency (Cronbach’s alpha = 0.83 for patients group, and 0.73 for controls). A significant difference was found in AVVAS scores between both groups (p = < 0.001). Test- retest reproducibility confirmed reliability of AVVAS. The AVVAS total scores of patients with VV were significantly different than controls. The optimal cut-off score for AVVAS was 17 (sensitivity 80%, specificity82%).Conclusion: The AVVAS can be considered a reliable, valid and helpful screening tool to quantify self- perceived handicapped that result from visual vertigo.

Background: The ABC scale is a questionnaire to evaluate the risk of fall in people with imbalance.Objectives: Modify and validate the Arabic form of the ABC scale on the Egyptians with vestibular disorders.Methods: The Arabic version of the ABC scale has been revised and modified to replace the words that is ambiguous on the Egyptians. The revised version has been back translated and judged by expert committee to confirm its matching with the original English version.The final form is applied to the control group which is composed of 100 healthy Egyptians with age (18 - 45) years and a study group composed of 60 Egyptian patients having vestibular disorders (VD) that match the control group in age and sex.Results: The results gave excellent reliability with Cronbach’s alpha (0.94) among patients and (0.75) among controls and the corrected item-total correlation > 0.3 for all items. The repeatability was found high for control and VD group. The total scores for VD patients were significantly different from the controls.Conclusion: The modified Arabic ABC scale is reliable and valid subjective tool in the assessment and follow up of VD among Egyptiansز

Objectives: To develop and validate an Arabic version of the situational characteristic questionnaire (SCQ), which is the gold standard and easy method in diagnosing visual vertigo syndrome (VV).Me...

Objectives: The objective of this study is to assess the benefits of customized vestibular rehabilitation with visual desensitization in the management of visual vertigo (VV).Methods: This retrospe...

Objectives To develop an Arabic version of the hospital anxiety and depression scale (HADS) to detect and measure anxiety and depression prevalence in dizzy patients. Background Dizziness is a common complaint that has many causes and may be related to psychiatric disorders like anxiety and depression. Early detection of anxiety and depression in dizzy patients helps in proper management and a better outcome. The HADS is a valid screening tool, and having an Arabic version will be of great help. Patients and methods The original English HADS was translated following the cross-cultural adaptation guidelines into Arabic. The final Arabic version of HADS was administered to samples of 100 healthy control persons, 30 anxious patients, and 30 depressed patients. Reliability and validity of the translated Arabic HADS were examined. The prevalence of anxiety and depression in dizzy patients were assessed through 100 dizzy patients who were asked to complete the validated Arabic HADS. Results The translated Arabic HADS was found to be reliable with strong internal consistency (Cronbach's alpha was 0.811 for the anxiety group and 0.758 for the depression group). The test–retest reliability was high (Spearman's correlation was 0.980 for the anxiety group and 0.928 for the depression group). There was a good correlation between psychiatric assessment and HADS for anxiety and depression using the Mann–Whitney test, indicating its validity. We performed the receiver operating characteristics curve, and the most sensitive cutoff point for HADS anxiety subscale was 8.5 and for HADS depression subscale was 9.5. In the dizzy group, 32% gave positive HADS scores for anxiety subscale and 22% gave positive HADS scores for depression subscale. Conclusions This version of the Arabic HADS is a reliable and valid psychological screening tool for anxiety and depression. The anxiety and depression prevalence in the dizzy patients was 32% and 22%, respectively.

Several studies indicated the association between benign paroxysmal positional vertigo (BPPV) with osteoporosis and vitamin D deficiency implying that abnormal calcium metabolism may underlie BPPV. The aim of the present study is to confirm the correlation between BPPV and both decrease in bone mineral density (BMD) and vitamin D deficiency. The study group included 80 patients with idiopathic BPPV (52 females, 28 males), with age range 31–71 years (47.6 ± 9.1). The patients were divided into two groups; recurrent BPPV group including 36 subjects and non-recurrent group including 44 subjects. The control group included 100 healthy volunteers with age and gender distribution similar to the study group. All the subjects in the study were examined using Dual-energy X-ray absorptiometry to assess BMD, and serum 25-hydroxyvitamin D for vitamin D assessment. The accepted normal levels were T-score > −1, and 25-hydroxyvitamin D > 30 ng/ml. Twenty-six (26 %) subjects showed abnormal T-score in the control group; 26 (59 %) in the non-recurrent BPPV and 22 (61 %) in the recurrent BPPV group. Chi square test showed significant difference between the control group and both BPPV groups. The control group had significantly higher 25-hydroxyvitamin D levels than the BPPV subgroups (p < 0.05). Moreover, the 25-hydroxyvitamin D was significantly lower in the recurrent BPPV than it was in the non-recurrent subgroup (p < 0.05). The results of the current study associate between reduced BMD and development/recurrence of BPPV. Moreover, low levels of vitamin D were related to development of BPPV while very low levels were associated with recurrence of BPPV. The co-occurrence of two morbidities is not by itself supportive of a relationship, but the cumulating studies correlating between BPPV and both vitamin D deficiency and low BMD indicate the investigation and treatment of those disorders in cases with recurrent BPPV.

Objectives: The aim of this study was to study the ocular vestibular evoked myogenic potentials, cervical vestibular evoked myogenic potentials, and bithermal caloric test results in subjects with vestibular migraine and to discover whether they are correlated. Study design: The study group included 50 patients with vestibular migraine (32 females, 18 males), with age range 18–60 years (38 ± 12.2). The control group included 60 healthy volunteers of matched age and gender distribution. Audiovestibular evaluation in the form of pure tone audiometry, middle ear immittance, ocular and cervical vestibular evoked myogenic potentials, and a bithermal caloric test were performed after at least three days from the last migraine or vertiginous episode; none of the study group was kept on prophylactic treatment for migraine. Results: Normal vestibular evoked myogenic potentials and caloric responses were reported in the entire control group and 12 subjects (24%) of the study group. Unilateral canal paresis ...

Objectives Smoking plays major role in development of vascular and respiratory serious diseases. It has been reported that negative smoker children are prone for conductive hearing impairment due to repeated attacks of Eustachian tube dysfunction and middle ear effusion. This study aims to identify negative smoking as potential risk factor for development of sensorineural hearing loss. Study This study was done between January 2010 and November 2012. 411 children aged 5-11 years (8.2 ± 1.5) participated in this study; they were children attending the Ear, Nose, and Throat clinic of a tertiary care hospital and their siblings. The inclusion criteria were: (i) normal speech and language, (ii) absence of any disease or condition that may cause sensorineural hearing loss, and (iii) normal middle ear function on the day of hearing assessment. They were divided into three groups according to the exposure to second-hand smoke at home; group of “no exposure” whereas no smoker in the family (131 children), group of ‘mild exposure” whereas the father was the only smoking parent and smoking was prohibited at home (155 children), and group of “heavy exposure”, whereas the mother was smoking, or the father was freely smoking at home and in the presence of his children (125 children). Audiological evaluation in the form of pure tone and speech audiometry and immitancemetry was done for the study group. Results Audiological evaluation revealed that the prevalence of hearing loss was 3.8%, 4.5% and 12% in the “no exposure”, “mild exposure”, and “heavy exposure” groups, respectively. Significant difference was only detected between the high exposure group and the other two groups. All children had minimal sensorineural hearing loss, i.e. threshold of frequencies showing hearing loss was 20 or 25 dB HL. The risk ratios (95% confidence interval) for hearing loss in the study subgroups were 1.18 (0.38, 3.64) for mild exposure group ( p > 0.05), 3.14 (1.18, 8.3) for heavy exposure group ( p Conclusions Passive smoking in childhood correlates with sensorineural hearing loss, and it is an important risk factor for development of minimal hearing loss. Strict prevention of children exposure to second-hand smoke should be encouraged by every mean.

Objective: The involvement of the utricle and possibly the saccule in the pathogenesis of BPPV encouraged many investigators to study VEMP in patients with BPPV. The current study investigated VEMP results in patients with BPPV to determine different forms of VEMP abnormalities (if any) in patients with BPPV. Study design: The study group comprised 112 patients (52 males, 60 females; age range 26−60 years (46.2 ± 10.2)). The group was subdivided into a recurrent BPPV subgroup (32 patients) and a non-recurrent BPPV subgroup (80 patients). The control group included 100 healthy volunteers with matched age and gender distribution. Both ocular vestibular evoked myogenic potentials (oVEMP) and cervical vestibular evoked myogenic potentials (cVEMP) were registered in the different study subgroups. Abnormal VEMP was defined as: 1) VEMP pattern of ‘no response’; 2) VEMP asymmetry exceeding the mean + 2 SD of the control group; 3) delayed peak latency (P13 or N1) exceeding the mean + 2 SD of the control gr...

Otitis media with effusion (OME) is one of the most common disorders in childhood. Several investigators have reported central auditory processing disorders in children with recurrent attacks of OME. The aim was to study PSI in children with normal hearing and those with a history of recurrent OME. The study group consisted of 40 children, age range 5–8 years, with a previous history of three to five attacks of otitis media with effusion (OME). The average length of OME was 8.3 weeks/attack. The study group was divided into two equal subgroups, A and B; subgroup A had recently recovered from OME while subgroup B had recovered from OME at an earlier time. The control group consisted of 20 children with normal hearing. The control and study groups had matched age and gender distribution. A t-test was carried out to compare the different listening conditions of the PSI test in the control and the two study subgroups (CCM 0, CCM −20, ICM 0 and ICM +4). Non-statistically significant differences were found in a...

Several studies correlated between vitamin D deficiency and the development, and the recurrence of benign positional paroxysmal vertigo (BPPV), but none of them proved that treatment of vitamin D deficiency would reduce the recurrence rate of BPPV. This study aims to detect the effect of treatment of severe vitamin D deficiency on the recurrence rate of BPPV.The inclusion criteria of the study group were: (1) Unilateral, idiopathic, posterior canal BPPV with no history suggestive of secondary BPPV and (2) 25-hydroxyvitamin D3 level ≤10 ng/ml. All subjects enrolled in the current study underwent detailed clinical history, audiovestibular evaluation consisting of pure-tone audiometry, Immittancemetry, Videonystugmography, serum 25-hydroxyvitamin D3 assessment, and Dual-energy X-ray absorptiometry (DXA). Vitamin D therapy was prescribed for the study group. Serum 25-hydroxyvitamin D3 level was evaluated twice, on recruitment into the study group and 3 months after commencing vitamin D therapy. According to the results of the second evaluation of serum 25-hydroxyvitamin D3, the study group was subdivided into two subgroups: Subgroup (I): including 28 subjects who disclosed elevation of serum 25-hydroxyvitamin D3 level; improvement ≥10 ng/ml. Subgroup (II): including 65 patients who disclosed elevation of serum 25-hydroxyvitamin D3 levels10 ng/ml. The study group was followed up for 18 months in order to observe the recurrence of BPPV.The differences between both study subgroups (I)(II) regarding age, sex distribution, and bone mineral density were insignificant. The number of subjects who had recurrence of BPPV in subgroup (I) was 4 (14%) versus 28 subjects (43%) in subgroup (II). The mean values for recurrent attacks/subject in subgroups (I)(II) were 0.18, and 0.66 attack/subject respectively; these differences between both subgroups were of high statistical significance (p0.01). The Odds Ratio for development of recurrence of BPPV in subjects with severe vitamin D deficiency was 4.54 (95% CI: 1.41-14.58, p0.01). The relapse attacks of BPPV affected both ears irrespective of the ear showing the original BPPV attack.The present study indicates that improvement of serum 25-hydroxyvitamin D3 levels is associated with substantial decrease in recurrence of BPPV.

Minimal Hearing Loss (MHL) is a commonly overlooked clinical problem; it affects about 5% of children. Children with MHL may be at risk academically due to their poorer speech perception in the noisy classrooms [1]. MHL has generally been defined as a group of hearing disorders that include mild hearing loss, unilateral hearing loss, and high-frequency hearing loss. MHL may result from conductive disorders such as otitis media with effusion or different sensorineural disorders [2]. Recently, we investigated the effect of second–hand smoke on the hearing of children. Passive smoking was correlated with development of sensorineural MHL [3]. The study group consisted of 411 children, their aged ranged between 5 to 11 years. The inclusion criteria were: i) Normal speech and language, ii) Absence of any disease or condition that may cause sensorineural hearing loss, iii) Normal middle ear function on the day of hearing assessment. They were divided into three groups according to the exposure to secondhand smoke at home; Group of “no exposure” whereas no smoker in the family (131 children), group of “mild exposure” whereas the father was the only smoking parent and smoking was prohibited at home (155 children), and group of “heavy exposure” whereas the mother was smoking, or the father was freely smoking at home and in the presence of his children (125 children). Audiological evaluation revealed that the prevalence of hearing loss was 3.8%, 4.5% and 12% in the “no exposure”, “mild exposure”, and “heavy exposure” groups respectively. Significant difference was only detected between the high exposure group and the other two groups. All children with hearing loss had minimal sensorineural hearing loss i.e., threshold of frequencies showing hearing loss were 20 or 25 dB HL. The risk ratio (95% confidence interval) for development of hearing loss in the heavy exposure group compared to those none exposed children was 3.14 (1.18, 8.3) (p

Objectives Many studies confirmed the disappearance of otoacoustic emissions in some of the patients with auditory neuropathy spectrum disorder, yet the data about the incidence rate of such disappearance is scanty or even absent. This study aims to test the persistence of transient evoked otoacoustic emissions in patients with auditory neuropathy spectrum disorder over few years. Methods The study group consisted of 77 subjects (31 females and 46 males). Their ages ranged from 4 to 9 years (5.5 ± 1.5). All the subjects were previously diagnosed to have auditory neuropathy spectrum disorder affecting both ears. Transient evoked otoacoustic emissions test results of the recent follow up sessions were compared with their initial diagnostic evaluation sessions done 3–6 years ago (3.7 ± 0.8), in order to test the persistence of the emissions and the reduction of emissions level. Results The transient evoked otoacoustic emissions level was reduced in the follow up visit compared to the initial study group. The transient evoked otoacoustic emissions level showed insignificant reduction (less than 3 dB) in 77.3% of the ears in the study group, and significant reduction (i.e. 3 dB or more) in 20.8%, and was absent in 1.9%. The transient evoked otoacoustic emissions level reduction in the different study subgroups was homogenous; gender (males versus females) laterality (right versus left ears) incubated to neonatal intensive care unit versus those non incubated all showed no significant differences in transient evoked otoacoustic emissions level reduction. Moreover, the duration of auditory neuropathy spectrum disorder was not correlated to the degree of transient evoked otoacoustic emissions reduction. Those fitted with hearing aids had more reduction in their transient evoked otoacoustic emissions level compared with those not fitted with hearing aids. Conclusions (1) Transient evoked otoacoustic emissions was still detected in 98.1% of patients with auditory neuropathy spectrum disorder few years after the diagnosis. (2) Those fitted with hearing aids showed the most pronounced reduction in transient evoked otoacoustic emissions level.

Kawasaki disease is an acute self-limited vasculitis and is commonly seen in children. This case report is a rare complication of Kawasaki disease. A 5-year-old boy had persistent fever, associated with bilateral nonexudative conjunctivitis, cervical lymphadenopathy, and maculopapular erythema on his trunk. The patient was diagnosed as Kawasaki disease and was treated by intravenous immunoglobulins and aspirin. However, 3 days after recovery of the symptoms, he developed bilateral severe sensorineural hearing loss. Corticosteroid therapy of 40 mg/day was immediately administrated for 15 days; no improvement was noticed in the child's hearing as evidenced by serial audiometry follow-up.