Transmyringeal ventilation tube insertion for unilateral Menière's disease: a protocol for a prospective, sham-controlled, double-blinded, randomized, clinical trial.

Background: Menière's disease is an idiopathic disorder characterized by recurrent episodes of vertigo lasting more than 20 min, unilateral sensorineural hearing loss, and tinnitus. If vertigo attacks occur frequently, the patient is usually severely incapacitated. Currently, there is no consensus on the treatment of Menière's disease.

Short-Latency Covert Saccades - The Explanation for Good Dynamic Visual Performance After Unilateral Vestibular Loss?

Functional head impulse test (fHIT) tests the ability of the vestibulo-ocular reflex (VOR) to allow visual perception during head movements. Our previous study showed that active head movements to the side with a vestibular lesion generated a dynamic visual performance that were as good as during movements to the intact side. To examine the differences in eye position during the head impulse test when performed with active and passive head movements, in order to better understand the role of the different saccade properties in improving visual performance.

vHIT Testing of Vertical Semicircular Canals With Goggles Yield Different Results Depending on Which Canal Plane Being Tested.

The use of goggles to assess vertical semicircular canal function has become a standard method in vestibular testing, both in clinic and in research, but there are different methods and apparatus in use. The aim of this study was to determine what the cause of the systematic differences is between gain values in testing of the vertical semicircular canals with two different video head impulse test (vHIT) equipment in subjects with normal vestibular function. Retrospective analysis of gain values on patients with clinically deemed normal vestibular function (absence of a corrective eye saccade), tested with either Interacoustics or Otometrics system.

[Superior semicircular canal dehiscence syndrome].

Superior semicircular canal dehiscence syndrome (SCDS) is caused by a bony defect of the superior semicircular canal. The bony defect allows low-frequency acoustic stimuli of high intensity to travel to the vestibular organ. This can be induced by sound stimuli or pressure stimuli leading to vertigo, torsional nystagmus, pulsatile tinnitus, hyperacusis, hearing loss and autophony.

Dizziness and localized pain are often concurrent in patients with balance or psychological disorders.

Background and aims Symptoms of dizziness and pain are both common complaints and the two symptoms often seem to coincide. When symptoms appear concomitant for sustained periods of time the symptoms might maintain and even exacerbate each other, sometimes leading to psychological distress. In order to evaluate such comorbidity we studied patients referred to a vestibular unit and to a psychiatric outpatient clinic with respectively balance disorders and psychological issues.

Different Visual Weighting due to Fast or Slow Vestibular Deafferentation: Before and after Schwannoma Surgery.

Background: Feedback postural control depends upon information from somatosensation, vision, and the vestibular system that are weighted depending on their relative importance within the central nervous system. Following loss of any sensory component, the weighting changes, e.g.

[Bilateral loss of the horizontal vestibulo-ocular reflex in Wernicke encephalopathy - a specific and early clinical sign].

Wernicke encephalopathy is a condition in which thiamine deficiency causes cognitive dysfunction, ataxia and eye motor abnormalities. The condition is potentially reversible if treated with high doses of intravenous thiamine (vitamin B1). The video head impulse test, in which the vestibulo-ocular reflex is tested, can reveal an early specific sign of selective dysfunction in the medial vestibular nuclei by demonstrating selective dysfunction of the horisontal vestibulo-ocular reflex.

Steroids for Acute Vestibular Neuronitis-the Earlier the Treatment, the Better the Outcome?

Objective: To present findings that suggest steroid treatment within 24 hours of onset of vestibular neuronitis results in better restitution of vestibular function than treatment between 25 and 72 hours.

Patients: Thirty-three consecutive patients (17 men, 16 women, mean age 57 yr, range 17-85 yr) with acute vestibular neuronitis and treated with steroids within 72 hours after symptom onset. Patients were divided into two groups depending on if they were treated within the first 24 hours or not.

Functional Head Impulse Testing Might Be Useful for Assessing Vestibular Compensation After Unilateral Vestibular Loss.

Loss of the vestibulo-ocular reflex (VOR) affects visual acuity during head movements. Previous studies have shown that compensatory eye-saccades improve visual acuity and that the timing of the saccade is important. Most of the tests involved in testing VOR are made with passive head movement, that do not necessarily reflect the activities of daily living and thus not being proportionate to symptoms and distresses of the patients.

PREHAB vs. REHAB - presurgical treatment in vestibular schwannoma surgery enhances recovery of postural control better than postoperative rehabilitation: Retrospective case series.

Object: To evaluate post-surgical postural stability when treating patients with remaining vestibular function with intratympanic gentamicin (PREHAB) prior to schwannoma surgery.

Method: 44 consecutive patients with some form remaining vestibular function scheduled for vestibular schwannoma surgery. 20 were medically deafferented with intratympanic gentamicin before surgery and 24 were not.

Ataxia-pancytopenia syndrome with mutations.

Objective: We describe the neurologic, neuroradiologic, and ophthalmologic phenotype of 1 Swedish and 1 Finnish family with autosomal dominant ataxia-pancytopenia (ATXPC) syndrome and mutations.

Methods: Members of these families with germline c.2956C>T, p.

Hearing and Vestibular Function After Preoperative Intratympanic Gentamicin Therapy for Vestibular Schwanomma as Part of Vestibular Prehab.

Objective: To evaluate auditory and vestibular function after presurgical treatment with gentamicin in schwannoma patients.

Background: The vestibular PREHAB protocol aims at diminishing the remaining vestibular function before vestibular schwannoma surgery, to ensure less acute symptoms from surgery, and initiate a more efficient vestibular rehabilitation already before surgery. However, the potential cochleotoxicity of gentamicin is a concern, since modern schwannoma surgery strives to preserve hearing.

[Dizziness in the emergency room].

The majority of patients who present to the Emergency Department with vertigo suffer from benign conditions. However, a few percent of these patients have life-threatening conditions, such as a cerebellar stroke. The HINTS clinical decision rule (Head-Impulse test, Nystagmus, Test-of-Skew) allows the physician to identify patients with an acute vestibular syndrome of central origin.

Experimentally induced deep cervical muscle pain distorts head on trunk orientation.

Purpose: We wanted to explore the specific proprioceptive effect of cervical pain on sensorimotor control. Sensorimotor control comprises proprioceptive feedback, central integration and subsequent muscular response. Pain might be one cause of previously reported disturbances in joint kinematics, head on trunk orientation and postural control.

'PREHAB': Vestibular prehabilitation to ameliorate the effect of a sudden vestibular loss.

A sudden unilateral loss or impairment of vestibular function causes vertigo, dizziness and impaired postural function. In most occasions, everyday activities supported or not by vestibular rehabilitation programs will promote compensation and the symptoms subside. As the compensatory process requires sensory input, matching performed motor activity, both motor learning of exercises and matching to sensory input are required.

Treatment of acute vestibular neuronitis with glucocorticoids.

Objective: To report the effects of glucocorticoid treatment of acute vestibular neuronitis on recovery of vestibular function and length of hospital stay.

Study Design: Prospective, consecutive case series compared with historic controls.

Setting: Secondary referral academic hospital.

Influence of prolonged unilateral cervical muscle contraction on head repositioning--decreased overshoot after a 5-min static muscle contraction task.

The ability to reproduce a specified head-on-trunk position can be an indirect test of cervical proprioception. This ability is affected in subjects with neck pain, but it is unclear whether and how much pain or continuous muscle contraction factors contribute to this effect. We studied the influence of a static unilateral neck muscle contraction task (5 min of lateral flexion at 30% of maximal voluntary contraction) on head repositioning ability in 20 subjects (10 women, 10 men; mean age 37 years) with healthy necks.

Cervical proprioception is sufficient for head orientation after bilateral vestibular loss.

The aim was to investigate the relative importance of cervical proprioception compared to vestibular input for head movements on trunk. Subjects with bilateral vestibulopathy (n = 11) were compared to healthy controls (n = 15). We studied their ability to move the head accurately to reproduce four specified target positions in the horizontal yaw plane (neutral head position, 10 degrees target, 30 degrees target, and 30 degrees target with oscillating movements applied during target introduction).

Decreased postural adaptation in patients with phobic postural vertigo--an effect of an "anxious" control of posture?

Postural adaptability and responses elicited by vibratory stimulation to the calf muscles recorded on a force platform with eyes open or closed were analyzed in 39 patients suffering from Postural Phobic Vertigo (PPV) (17 men and 22 women, mean age 49 years) and 24 healthy subjects (14 men, 10 women, mean age 38 years). The vibration induced increased body sway in both groups, but the adaptation pattern differed significantly. With eyes open the PPV patients decreased their induced body sway over time (-32%, p<0.

Reduced postural differences between phobic postural vertigo patients and healthy subjects during a postural threat.

Phobic postural vertigo is characterized by subjective imbalance and dizziness while standing or walking, despite normal values for clinical balance tests. Patients with phobic postural vertigo exhibit an increased high-frequency sway in posturographic tests. Their postural sway, however, becomes similar to the sway of healthy subjects during difficult balance tasks.

Preoperative vestibular ablation with gentamicin and vestibular 'prehab' enhance postoperative recovery after surgery for pontine angle tumours--first report.

Conclusions: Preoperative gentamicin in combination with vestibular 'prehab' offers a possibility to reduce postoperative malaise and speed up recovery and may be used for patients undergoing such surgery when there is remaining vestibular function.

Objectives: Removal of pontine angle tumours in a patient with remaining vestibular function causes symptoms of acute vestibular loss. A simultaneous cerebellar lesion can cause a combined vestibule-cerebellar lesion.

One-year follow-up of cognitive behavioral therapy for phobic postural vertigo.

Background: Phobic postural vertigo is characterized by dizziness in standing and walking despite normal clinical balance tests. Patients sometimes exhibit anxiety reactions and avoidance behavior to specific stimuli. Different treatments are possible for PPV, including vestibular rehabilitation exercises, pharmacological treatment, and cognitive behavioral therapy.