Humans ; Vertigo ; diagnosis ; Vestibular Function Tests

Humans ; Vertigo ; diagnosis

Humans ; Meniere Disease ; surgery

Objective:To explore the clinical value of dynamic posturography in the diagnosis of peripheral vertigo. Method:One hundred and sixty peripheral vertigo patients with full clinical documents in vertigo clinic of our hospital from May 2007 to May 2008 were retrospectively analyzed in this study. All the patients firstly underwent the inspection of static and dynamic posturography and then were subjected to caloric test using videonystagmogra-phy. The results were conducted a comparative analysis. Surface of the statokinesigram (SSKG) was selected as assessment parameter of static posturography. The result of sensory organization test (SOT) were selected as assessment parameters of dynamic posturography. The unilateral weakness was selected as assessment parameter of caloric test. Twenty normal subjects were selected as control. Result: Among the 160 cases with peripheral vertigo, results of SOT in dynamic posturography were abnormal in 144 cases, with a sensitivity of 90. 0%; caloric test was abnormal in 110 cases, with a sensitivity of 68. 8%; static posturography was abnormal in 76 cases, with a sensitivity of 47. 5%. There existed a statistically significant difference between dynamic posturography and caloric test or static posturography. There were 40 patients(25. 0%) who had normal caloric test results in which dynamic posturograph findings were abnormal. Among the 20 cases of normal people, results of SOT in dynamic posturography were abnormal in only one case(5. 0%). Conclusion:With its superior sensitivity and specificity, dynamic posturography has been an objective and reliable approach in the diagnosis of peripheral vertigo. It can help to confirm the presence of abnormalities in some peripheral vertigo patients whose caloric results are normal.

ObjectiveAfter intratympanic gadolinium administration through the tympanic membrane,three-dimensional fluid-attenuated inversion recovery magnetic resonance imaging (3D-FLAIR MRI) was performed to evaluate endolymphatic visualization and its diagnostic value in Meniere's disease.MethodsTwenty-four hours after intratympanic gadolinium administration through the tympanic membrane,19 patients with unilateral Meniere's disease diagnosed clinically underwent 3D-FLAIR and 3D-Balance-FFE imaging at 3.0 T MR scanner.The enhanced imaging of perilymphatic space in bilateral cochlea,vestibular and (or) canal were observed.Scala tympani and scala vestibule of bilateral cochlear basal turn were scored respectively.The enhanced range of bilateral vestibule and the signal intensity ratio (SIR) between the vestibule and the brain stem were measured. Wilcoxon tests and paired t tests were used.ResultsThe gadolinium appeared in almost all parts of the perilymph in cochlea,vestibular and (or) canal,so the endolymphatic space was clearly visualized on 3D-FLAIR imaging.The score of scala vestibuli between the affected side (3 cases scored 2,9 cases scored 1,7 cascs scored 0) and the healthy side ( 15 cases scored 2,2 cases scored 1,2 cases scored 0 ) were significantly different ( U =3.090,P ＜ 0.05 ).The area of enhanced vestibular were (5.77 ± 2.33) mm2 and (8.11 ± 3.32) mm2 for the affected side and the healthy side,which were significantly different ( U =3.090,P ＜ 0.05 and t =2.638,P ＜ 0.05 ).Conclusions According to 3D-Balance-FFE MRI and the enhancement of perilymphatic space,3D-FLAIR MRI with intratympanic gadolinium injection through the tympanic membrance can be used to show the border between the perilymph and the endolymph and confirm endolymphatic hydrops,thus providing radiographic evidence for the diagnosis of Meniere's disease.

OBJECTIVE: To explore the clinical value of dynamic posturography in the diagnosis of peripheral vertigo. METHOD: One hundred and sixty peripheral vertigo patients with full clinical documents in vertigo clinic of our hospital from May 2007 to May 2008 were retrospectively analyzed in this study. All the patients firstly underwent the inspection of static and dynamic posturography and then were subjected to caloric test using videonystagmography. The results were conducted a comparative analysis. Surface of the statokinesigram (SSKG) was selected as assessment parameter of static posturography. The result of sensory organization test (SOT) were selected as assessment parameters of dynamic posturography. The unilateral weakness was selected as assessment parameter of caloric test. Twenty normal subjects were selected as control. RESULT: Among the 160 cases with peripheral vertigo, results of SOT in dynamic posturography were abnormal in 144 cases, with a sensitivity of 90.0%; caloric test was abnormal in 110 cases, with a sensitivity of 68.8%; static posturography was abnormal in 76 cases, with a sensitivity of 47.5%. There existed a statistically significant difference between dynamic posturography and caloric test or static posturography. There were 40 patients (25.0%) who had normal caloric test results in which dynamic posturography findings were abnormal. Among the 20 cases of normal people, results of SOT in dynamic posturography were abnormal in only one case (5.0%). CONCLUSION With its superior sensitivity and specificity, dynamic posturography has been an objective and reliable approach in the diagnosis of peripheral vertigo. It can help to confirm the presence of abnormalities in some peripheral vertigo patients whose caloric results are normal.
Adolescent ; Adult ; Aged ; Caloric Tests ; methods ; Case-Control Studies ; Child ; Female ; Humans ; Male ; Middle Aged ; Nystagmus, Physiologic ; Posture ; Retrospective Studies ; Sensitivity and Specificity ; Vertigo ; diagnosis ; Young Adult

OBJECTIVEWe aimed to determine whether blood lipid parameters were related to the severity and the prognosis of idiopathic sudden sensorineural hearing loss (ISSNHL) patients.

METHODSA retrospective cohort study of 258 patients with ISSNHL from December 2013 to February 2015. The distribution characteristics of lipids [total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), Non-high-density lipoprotein cholesterol (Non-HDL-C), et al] in different degree of deafness (mild, moderate, severe, and profound), hearing curve types (low frequency, high frequency, full range frequency, and completely deafness type) and prognosis of recovery (complete, partial, slight, and no recovery) were analyzed by IBM SPSS 22.0 ANOVA analysis, chi square test and multiple regression analysis.

RESULTSTG level in mild hearing loss group was significantly lower than that in severe and profound hearing loss group (P = 0.017 and P = 0.007). There were no correlation between curve types and lipid indexes (P > 0.05). Non-HDL-C level was elevated in no recovery and slight recovery groups (P = 0.026 and 0.021). TC levels in partial recovery group and no recovery group were significantly higher than that in the complete recovery group (P = 0.049 and 0.042), TG was higher in slight recovery group (P = 0.014).

CONCLUSIONSTG has significant correlation with the severity of hearing loss. There are negative correlations between hearing recovery and Non-HDL-C, TC and TG levels. Non-HDL-C, TC and TG might be a prognostic factor for treatment outcome in ISSNHL patients.

Cholesterol, HDL ; blood ; Cholesterol, LDL ; blood ; Deafness ; Hearing Loss, Sensorineural ; blood ; diagnosis ; physiopathology ; Hearing Loss, Sudden ; blood ; diagnosis ; physiopathology ; Humans ; Lipids ; blood ; Prognosis ; Retrospective Studies ; Treatment Outcome ; Triglycerides ; blood

OBJECTIVETo investigate the effect and mechanism of endolymphatic sac-mastoid shunt surgery for intractable Meniere's disease of different stages according to hearing level.

METHODSData from 240 patients diagnosed with unilateral MD strictly meeting the criteria issued by Chinese Academy of Otolaryngology-Head and Neck Surgery Committee (2006) from January 1983 to January 2012 were analyzed in this study. Endolymphatic sac-mastoid shunt surgery was performed in affected ear for each patient. The evaluation of therapy followed the guidelines issued by Chinese Academy of Otolaryngology Head and Neck Surgery Committe. Vertigo control and auditory function were measured in two-year's follow-up.

RESULTSAccording to the preoperative staging of hearing, among these 240 patients, there were 12 cases in stage I (with an average hearing threshold < 25 dB), 130 cases in stage II (with an average hearing threshold of 25-40 dB), 85 in stage III (41-70 dB) and 13 cases in stage IV(with an average hearing threshold > 70 dB). Overall control rate of vertigo was 77.9% (187/240) in two-year's follow-up, with total control 49.2% (118/240) and substantial control 28.7% (69/240). The hearing was improved in 25.0% (60/240) of cases, no change in 59.2% (142/240) of cases, and worse in 15.8% (38/240) of cases. According to different stages, vertigo control rate was 83.3% (10/12) in stage I, 82.3% (107/130) in stage II, 75.3% (64/85) in stage III and 46.2% (6/13) in stage IV. Vertigo control rate of stage IV patients was significantly lower than that of stage II and III patients (χ(2) = 9.318 and 4.692, P < 0.05), while vertigo control rate of stage I, II, III patients had no significant difference with each other (P > 0.05).

CONCLUSIONEndolymphatic sac-mastoid shunt operation is an effective method in the treatment of intractable Meniere's disease, but the effect was poor in stage IV patients.

Endolymphatic Sac ; surgery ; Hearing ; Humans ; Mastoid ; surgery ; Meniere Disease ; surgery ; Otologic Surgical Procedures ; Vertigo ; therapy

OBJECTIVETo investigate the therapeutic effect of topical corticosteroids injection and systemic application in the treatment of typing idiopathic sudden sensorineural hearing loss (ISSNHL).

METHODSTotal of 438 patients with ISSNHL, including 76 with hearing loss in low-middle frequencies, 43 in middle-high frequencies, 162 in all frequencies and 157 in total deafness, were randomly divided into two groups, the systemic application group: dexamethasone (DEX) was applied by intravenous injection in dose of 10 mg×3 d followed by 5 mg×4 d, and the topical injection group: methylprednisolone sodium succinate of 40 mg was injected into cortical bone of mastoid region every three days. According to the results of pure-tone threshold audiometry, the curative effect among ISSNHL with low-middle frequencies, middle-high frequencies, all frequencies hearing loss, and total deafness were evaluated. SPSS 18.0 software was used to analyze the data.

RESULTSAmong 220 patients with systemic application of DEX, 66 subjects (30.0%) cases were recovery, 51 (23.2%) were excellent better, 39 (17.7%) better, 64 (29.1%) were poor, and the total effective rate was 70.9% (156/220) . There was no statistical difference in total effective rate of four typing subgroups (χ(2) = 1.60, P > 0.05). And the recovery rate in total deafness subgroup was significant lower than that in low-middle and all frequencies subgroups (χ(2) = 10.63 and 15.94 respectively, both P < 0.05). In the topical injection group, the recovery rate was 30.3% (66 cases), excellent better 18.8% (41), better 15.6% (34), poor 35.3% (77), and the total effective rate was 64.7% (141/220) . There were statistical differences of total effective rate in low-middle frequencies in comparison with that in all frequencies (χ(2) = 8.38) and total deafness (χ(2) = 7.28) subgroups (both P < 0.05). Regarding recovery rate, there were significant differences between each two typing subgroups, except middle-high frequencies subgroup vs. all frequencies (χ(2) = 1.60) and total deafness (χ(2) = 2.29) subgroups (both P < 0.05). In 76 ISSNHL with hearing loss in low-middle frequencies, the recovery rate in cases with local corticosteroids injection(65.0%) was significantly increased in comparison with that with systemic application (41.7%), χ(2) = 4.15, P < 0.05. There were increasing tendencies of curative effect in other three typing groups by systemic corticosteroids application when compared with local injection, but no statistical significances (all P > 0.05).

CONCLUSIONSFor low-middle frequencies ISSNHL, the corticosteroids administration of local injection should be the optimization. Systemic application would be applied for middle-high frequencies, all frequencies and total deafness.

Adult ; Aged ; Female ; Glucocorticoids ; administration & dosage ; therapeutic use ; Hearing Loss, Sudden ; drug therapy ; Humans ; Injections ; Male ; Middle Aged ; Treatment Outcome

OBJECTIVETo explore the long-term efficacy and safety of triple semicircular canal occlusion (TSCO) in the treatment of intractable Meniere's disease (MD) so as to provide an alternative surgical procedure for treating this disorder.

METHODSData from Forty-nine patients, who were referred to our hospital and diagnosed with unilateral MD strictly meeting the criteria issued by Chinese Academy of Otolaryngology-Head and Neck Surgery Committee (2006) from Dec. 2010 to Jul. 2012, were retrospectively analyzed in this work. Forty-nine patients, in whom the standardized conservative treatment was given at least one year and frequent vertigo still occurred, received TSCO. Vertigo control and auditory function were measured. Pure tone audiometry, caloric test, and cervical vestibular evoked myogenic potential (cVEMP) were performed for evaluation of audiological and vestibular function. Magnetic resonance hydrograph of inner ear was performed in patients received TSCO after 2 years for the observation of morphology of membranous labyrinth. Postoperative follow-up period was more than 2 years.

RESULTSAccording to the preoperative staging of hearing, among these 49 patients, there were 2 cases in stage II (with an average hearing threshold of 25-40 dBHL), 40 in stage III (41-70 dBHL) and 7 in stage IV (over 70 dBHL). Vertigo was controlled effectively in all 49 cases in two-year follow-up, of which 40 cases (81.6%) were completely controlled and 9 cases (18.4%) were substantially controlled after surgery. The rate of hearing preservation was 69.4% and the rate of hearing loss was 30.6%. Post-operatively, all patients suffered from temporary vertigo and balance disorders. Vertigo was disappeared in all patients within 3-5 days, while averagely recovered after 13.5 days. Two years afer treatment, loss of semicircular canal function by caloric test was found in the operation side of all patients and no change in cVEMP test was noted. All patients had no facial paralysis, cerebrospinal fluid leakage, and other complications. Magnetic resonance hydrograph of inner ear showed that endolymph fluid in the position of plugging had no water after 2-years of TSCO.

CONCLUSIONSTSCO, which can reduce vertiginous symptoms effectively in patients with intractable MD in long-term follow-up, represents an effective and safe therapy for this disorder. TSCO is expected to be used as an alternative procedure for the treatment of MD in selected patients suffering from severe hearing loss or recurrence after endolymphatic sac surgery.

Audiometry, Pure-Tone ; Caloric Tests ; Endolymph ; Follow-Up Studies ; Hearing ; Hearing Loss ; therapy ; Humans ; Meniere Disease ; surgery ; Otologic Surgical Procedures ; methods ; Recurrence ; Retrospective Studies ; Semicircular Canals ; surgery ; Vertigo ; therapy ; Vestibular Evoked Myogenic Potentials