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Comparative utility of vestibular function tests in patients with peripheral and central vestibular dysfunction

Journal of Otology 2024年第1期19卷 5-9页

作者： Cameron B.Fattahi Christopher Zaro Janice J.Chung Richard F.Lewis Divya A.Chari Department of Otolaryngology-Head and Neck Surgery UMASS Memorial Medical CenterUniversity of Massachusetts Chan Medical SchoolWorcesterMAUSA Jenks vestibular Physiology Laboratory Massachusetts Eye and EarBostonMAUSA Department of Otolaryngology-Head and Neck Surgery Massachusetts Eye and EarHarvard Medical SchoolBostonMAUSA Department of Neurology Harvard Medical SchoolBostonMAUSA

Background: Bithermal caloric irrigation, video head impulse test(vHIT), and rotational testing are commonly used to assess peripheral vestibular function, but the relative clinical utility of each test in differentiating patients with peripheral vestibulopathy is ***: To determine whether(1) the combination of two or more vestibular tests enhances diagnostic utility over a single test;(2) abnormal test results on vestibular tests correlate with one ***: Retrospective analysis of data collected from multidisciplinary vestibular clinics at two academic medical centers from 2016 to ***: 150 patients(54.10 ± 15.09 years, 88 females) were included. No individual test was significantly better at predicting the presence of peripheral vestibular damage(p > 0.05). vHIT test results improved significantly when combined with either the caloric test(p = 0.007) or rotary chair test(p = 0.039). Caloric and rotational testing had high sensitivity(74.65% and 76.06%, respectively) and specificity(83.54% and 78.48%, respectively). vHIT demonstrated excellent specificity(89.87%) but poor sensitivity(47.89%). Caloric, vHIT, and rotary chair tests results did not correlate with one another(p > 0.05).Conclusions: vestibular function tests have comparable diagnostic utility, yet each offers unique advantages. Caloric and rotational testing may be best suited for screening peripheral damage and vHIT may function ideally as a confirmatory test.

关键词： vestibular patients specificity

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vestibular rehabilitation in cerebellar ataxia with neuropathy and vestibular areflexia syndrome(CANVAS)-A case report

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中华耳科学杂志:英文版 2023年第4期18卷 199-207页

作者： R.G.Harrell A.R.Cassidy B.N.Klatt P.Hovareshti S.L.Whitney School of Health and Rehabilitation Sciences Department of Physical TherapyUniversity of PittsburghPittsburghPA15219USA Rehabilitation Institute University of Pittsburgh Medical CenterPittsburghPA15219USA BlueHalo Intelligent AutomationRockvilleMD20855USA Department of Otolaryngology University of Pittsburgh Medical SchoolPittsburghPA15219USA The University of Pittsburgh Department of Physical Therapy100 Technology Dr.Pittsburgh PA 15219

Background and purpose:Cerebellar ataxia,neuropathy,and vestibular areflexia syndrome(CANVAS)is a neurodegenerative disease of the *** disease progression is slow,with up to 25%of people diagnosed needing to use a wheelchair after 15 years from *** symptoms arise from centrally-mediated ocular movement degradation and the reduced vestibular-ocular reflex functioning *** date,no report has shown an improvement in VOR gain or gait outcome measures in someone with CANVAS after a course of vestibular physical *** description:A 65-year-old male,Patient X,first noticed symptoms in his fourth decade of life and was diagnosed with(CANVAS)in his seventh *** X reported numbness and tingling in his hands and feet,decreased ability to perform daily activities,and several ***:Patient X completed a four-month course of vestibular physical therapy,including vestibular ocular reflex exercises,balance training,gait training,and the VestAid application for eye gaze compliance *** Vestaid application uses eyes and facial recognition software to record the percentage of time that the patient kept their eyes on the ***:After vestibular therapy,Patient X had a clinically meaningful improvement in gait speed:from 1.02 m/s to 1.13 m/s and in the Functional Gait Assessment from 20/30 to 27/*** X's eye gaze compliance improved from a median of 43%(range 25e68%)to a median of 67%(58e83%).Discussion:This case study demonstrates that vestibular rehabilitation improved eye gaze compliance and functional outcomes in a person living with CANVAS.

关键词： vestibular neuropathy meaningful

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vestibular evoked myogenic potentials in patients with diabetes mellitus

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Journal of Otology 2019年第3期14卷 89-93页

作者： Ali Bayram Department of ENT Kayseri City Hospital Seker Mah.Molu Village

Although the exact mechanism and most involved region of the vestibular system have not yet been fully clarified, vestibular dysfunction has been demonstrated in patients with diabetes mellitus (DM). vestibular evoked myogenic potential (VEMP) is a short latency electromyographic response to sound or vibration stimuli that may reflect otolith organ or related reflex functions. Since its first description in 1992, VEMP has become a significant part of the vestibular test battery as an objective measurement tool. In diabetic patients, VEMP responses have been studied in order to determine any otolith organ or related reflex dysfunctions. Here, we review the literature with regard to VEMP findings representing any peripheral vestibular end-organ dysfunction in patients with DM. Distinctive vestibular end-organ impairments seem to be demonstrated in patients with DM either with or without DNP via objective vestibular testing tools including VEMP recordings according to relevant studies. However, further studies with larger sample sizes are required to reveal the more definitive findings of VEMP recordings regarding the vestibular pathologies in patients with DM.

关键词： Diabetes mellitus vestibular diseases Cervical vestibular evoked myogenic potentials Ocular vestibular evoked myogenic potentials

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Multidisciplinary experts consensus for assessment and management of vestibular migraine

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Chinese Medical Journal 2019年第2期132卷 183-189页

作者： Stroke and Vertigo Association of Chinese Stroke Association Xiao-Kun Qi Xing-Quan Zhao 不详 Department of Neurology the Sixth Medical CenterChinese PLA General HospitalBeijing 100048China Department of Neurology Tiantan Hospital of Capital Medical UniversityBeijing 100050China

Introduction vestibular migraine (VM), a common disorder with familiar predisposition, is characterized by recurrent episode of dizziness or vertigo and accompanying symptoms of nausea, vomiting, and/or *** patients with VM may require neurologic, emergency, or otorhinolaryngologic services, and the disorder is often misdiagnosed with posterior circulation ischemia (PCI) or transient ischemic attack (TIA), peripheral vestibular vertigo, Meniere’s disease (MD), and multiple (lacunar) cerebral *** from population-based study showed that the prevalence of VM was up to 1%,^[1] which was one of the common disorders causing dizziness/vertigo, and the rate of misdiagnosis was up to 80%.[2] Thus, a multidisciplinary expert consensus about the definition, characteristics, related work-ups, and diagnostic criteria is needed for the accurate diagnosis and standardized management.

关键词： Introduction vestibular familiar predisposition characterized

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Robotic transoral vestibular parathyroidectomy:Two case reports and review of literature

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World Journal of Clinical Cases 2018年第12期6卷 542-547页

作者： Yasar Ozdenkaya Cenk Ersavas Naciye Cigdem Arslan Department of General Surgery Medipol University

Advances in preoperative localization studies and de-mands for scarless surgery have promoted the inves-tigation for remote techniques in parathyroid surgery. Transoral vestibular approach seems to provide the most comfortable and safest access to the neck. In this paper, we report our initial experience with robotic transoral ves-tibular parathyroidectomy(RTVP) in four patients with primary hyperparathyroidism. The surgery was perfor-med with the Da Vinci system through three trocars intro-duced from the lower lip vestibule. The procedure was converted to open in two patients due to inappropriate preoperative localization. The mean operative time was 169 min. No postoperative complications were seen. Patients were discharged on postoperative day 1. RTVP is a feasible and safe technique, which allows better surgical exposure and manipulation of the instruments. The advantages of transoral vestibular approach can be enhanced by robotics. Further studies are needed to analyze complications and costs.

关键词： Transoral vestibular surgery Parathyroid adenoma Natural orifice transendoluminal surgery Robotics Parathyroidectomy

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Ceftriaxone-induced immune hemolytic anemia in a case with large vestibular aqueduct syndrome after cochlear implant

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Chinese Medical Journal 2019年第1期132卷 100-102页

作者： Yu Wang Tao Pan Fu-Rong Ma Ji-Jun Wang Ke Zhang Wei-Wei Pan Jing-Hui Zhang Zhan-Miao Yi Ying-Qiu Ying Department of Otolaryngology Peking University Third HospitalBeijing 100191China Department of Hematology Peking University Third HospitalBeijing 100191China Department of Pediatrics Peking University Third HospitalBeijing 100191China Department of Pharmacy Peking University Third HospitalBeijing 100191China

To the Editor:Drug-induced immune hemolytic anemia (DIIHA)is a rare but severe ***,a third-generation cephalosporin with a wide antibacterial spectrum and effective antibacterial action,is one of the most common drugs causing DIIHA.^[1]Ceftriaxoneinduced immune hemolytic anemia (CIIHA)is a potentially fatal complication.^[2]Most of the patients were *** reported fatality rate of CIIHA was as high as 40%.

关键词： Ceftriaxone-induced immune hemolytic anemia large vestibular aqueduct syndrome cochlear implant

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“Wait and scan” management of patients with vestibular schwannoma and the relevance of non-contrast MRI in the follow-up

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Journal of Otology 2017年第4期12卷 174-184页

作者： Jing Zou Timo Hirvonen Department of Otolaryngology-Head and Neck Surgery Center for Otolaryngology-Head & Neck Surgery of Chinese PLA Changhai Hospital Second Military Medical University Department of Otorhinolaryngology-Head and Neck Surgery University of Helsinki and Helsinki University Hospital

vestibular schwannoma(VS) is a slow-growing benign neoplasm. There has been an evolution in the management of VS from active treatments(microsurgery and stereotactic radiotherapy) to conservative management(wait and scan). Regular MRI scanning is necessary to monitor tumor progression. Conservative management causes significantly less complications and offers a higher quality of life compared with active treatments. The mean growth rate of VS varies from 0.4 to 2.9 mm/year, and spontaneous shrinkage is observed in 3.8 percent of tumors during observation. If significant growth occurs, active treatment is considered. Significant growth is defined as an increase of at least 3 mm in the largest extrameatal diameter in any plane between the first and last available scans. The vestibulocochlear nerve is surrounded by cerebrospinal fluid, which provides natural contrast for MRI; thus, gadolinium may not be needed to detect VS. Specific sequences have high sensitivity, specificity, and accuracy for detection of progression. Hypointense signal in the ipsilateral inner ear fluid might be a useful sign to distinguish VS from meningioma. In this paper, we summarize the current status of research on conservative management and non-contrast MRI for the detection of VS.

关键词： vestibular schwannomas Treatment Magnetic resonance imaging Contrast Quality of life

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A study on vestibular-evoked myogenic potentials via galvanic vestibular stimulation in normal people

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Journal of Otology 2018年第1期13卷 16-19页

作者： Ying Cheng Yusuke Kimura Kimitaka Kaga National Institute of Sensory Organs Tokyo Medical Center Japan The Department of Otolaryngology Head and Neck Surgery in the Second Affiliated Hospital of Xi 'an Jiaotong University Shaanxi Province PR China

Objectives: The aim of our study is to examine vestibular-evoked myogenic potentials(VEMPs) elicited by the galvanic vestibular stimulation in the sternocleidomastoid muscle(SCM) in healthy subjects for clinical applications of auditory neuropathy or vestibular neuropathy in the ***: We enrolled sixteen healthy subjects to record the average responses of SCM to galvanic vestibular stimulation(GVS) [current 3 mA;duration 1 ms] by electromyography(EMG). SPSS 18.0 software was used to analyze the obtained data for mean and standard ***: In all healthy subjects mastoid-forehead galvanic vestibular stimulation produced a positive-negative biphasic EMG responses on SCM ipsilateral to the cathodal electrode. The latency of p13 was 11.7 ± 3.0 ms. The latency of n23 was 17.8 ± 3.4 ms. The amplitude of p13-n23 was147.0 ± 69.0 μV. The interaural asymmetry ratio(AR) of p13, n23 latency and the amplitude was respectively 0.12 ± 0.09, 0.08 ± 0.08 and0.16 ± ***: Galvanic vestibular stimulation could elicit biphasic EMG responses from SCM via the vestibular nerve but not from the otolith organs. Galvanic stimulation together with air conducted sound(ACS) or bone conducted vibration(BCV) can elicit VEMPs and may enable the differentiation of retrolabyrinthine lesions from labyrinthine lesions in vestibular system.

关键词： Galvanic vestibular stimulation vestibular nerve vestibular-evoked myogenic potentials Sternocleidomastoid muscle Interaural asymmetry ratio (AR)

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Static and dynamic visual vertical perception in subjects with migraine and vestibular migraine

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World Journal of Otorhinolaryngology-Head and Neck Surgery 2016年第3期2卷 -页

作者： Mark A. Miller Benjamin T. Crane School of Medicine and Dentistry University of Rochester Rochester NY 14642 USA Department of 0tolaryngology University of Rochester Rochester NY 14642 USA

Objective:To measure the static visual vertical and the effect of visual rotation on the perception of visual vertical in migraine and vestibular migraine subjects. By so doing, we may better understand the vestibular contribution to the pathophysiology of migraine, as well as the capacity for visual compensation. Methods:The perception of visual vertical in the presence of static and dynamic visual cues was prospectively studied in 10 subjects with migraine, 6 subjects with vestibular migraines, and 10 controls. Subjects used a dial to rotate a fluorescent green line to the vertical position. Static visual vertical (SVV) was measured with a black background, as well as with a static random-dot visual pattern. This pattern was then rotated at various velocities to measure dy-namic visual vertical (DVV). Results: Migraine subjects had greater deviation from true vertical than controls in SVV (Pvestibular migraine subjects did not deviate significantly from con-trols in SVV (Pvestibular migraine subjects demonstrated a wider range of vertical deviance when compared to controls (P Conclusions:This study demonstrates a significant deviation of the perceived static as well as dynamic visual vertical in migraine subjects. Moving stimuli may have a greater influence on migraine and vestibular migraine subjects, which suggests an underlying sensory integration disorder.

关键词： vestibular Visual Vertical Migraine

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Investigation of the usefulness of zaleplon at two doses to induce afternoon-sleep under noise interference and its effects on psychomotor performance and vestibular function

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Journal of Medical Colleges of PLA(China) 2016年第1期31卷 28-33页

作者： Liang-En Chen An-Dong Zhao Qing-Jun Zhang Feng Wu Zhao-Li Ge Hua Ge Hao Zhan Department of Pharmacology Institute of Aviation MedicineAir Force

Background:Military operation personnel often suffer from sleep difficulty because of their work *** this study,we investigated the efficacy of zaleplon at two doses to induce afternoon-sleep under noise interference and its effects on psychomotor performance and vestibular function; we subsequently established the optimal dosage regimen for military operation ***:Twenty-two healthy young male volunteers were recruited for the *** subjects took 10 mg or 15 mg of zaleplon and placebo alternately and then were exposed to *** in polysomnography(PSG) indices,including sleep latency(SL),sleep efficiency(SE) and sleep structure,were recorded after drug *** awakening,the volunteers' subjective judgments of sleep quality and sleepiness were *** volunteers underwent 3 psychomotor performance tests at a one-week interval,and the psychomotor performance tests were conducted before and after taking zaleplon and *** volunteers participated in the vestibular function test session,and parameters,including optokinetic nystagmus(OKN),vestibular ocular reflex(VOR),visualvestibular ocular reflex(VVOR) and vestibular ocular reflex fixation suppression(VOR-Fix),were detected by the same experimental design as described *** data of sleep observations were subjected to one-way variance ***:Compared with the placebo group,SL was shortened significantly,and the scores of subjective sleep quality and sleep depth were clearly increased in the zaleplon 10 mg group(P<0.05).Moreover,the SE and the percent of REM(rapid eye movement) sleep were increased remarkably in the zaleplon 15 mg group(P<0.01).Furthermore,the SE,percent of REM sleep and scores of subjective sleep depth in the zaleplon 15 mg group were significantly higher than in the zaleplon 10 mg group(P<0.05).The psychomotor performance did not change significantly after ingestion of 10 mg or 15 mg of zaleplon,whereas the OKN and VOR gains

关键词： Insomnia Sleep Hypnotic Zaleplon Psychomotor performance vestibular function

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