Objective: To explore the feasibility and short-term effect of tensor tympani muscle Tenotomy in the treatment of Meniere's disease under otoscope. The possible pathogenesis was discussed and our views were put forward. Methods: The clinical data of 9 cases of Meniere's disease treated by otoscopic Tenotomy were analyzed retrospectively, including 2 males, 7 females, 5 right ones, 2 left ones and 2 bilateral ones. The average age was (56.33± 10.56) years, ranging from 38 to 75 years. We evaluated intraoperative findings and short-term postoperative efficacy, respectively evaluated postoperative aural fullness, tinnitus and hearing recovery, and evaluated postoperative vertigo attack in a short time. Results: Nine patients were completed the operation under general anaesthesia and otoscopy, and no serious complications occurred. We found new pathological changes in tympanic cavity in some cases during operation. There were rupture of round window membrane in 1 case, severe fibrous hyperplasia near the round window membrane and vestibular window and adhesion with ossicular chain in 1 case, fibrous cord and membranous hyperplasia near vestibular window and round window membrane in 1 case, fibrous hyperplasia and adhesion near the round window membrane in 2 cases, membranous hyperplasia and adhesion around vestibular window in 1 case. No fibrous hyperplasia was found in 3 cases in the tympanic cavity. The round window membrane can be exposed in 4 cases and failed in 5 cases. After 3 months of follow-up, we found that we found that 5/5 cases of aural fullness disappeared, 2/2 cases of earache disappeared, 3/8 cases of tinnitus improved, 5/8 cases presented with improvement and no aggravation, 3/3 cases of hearing allergy improved, 4/9 cases of hearing improved, and 5/9 cases showed no improvement or decrease. 9 patients were followed up for 3 months, of whom 8 patients had no vertigo, one patient suffered from vertigo twice within 3 months after operation, and the patient suffered from rupture of round window membrane. Conclusions: Endoscopic Tenotomy for Meniere's disease has obvious curative effect and quick recovery after operation. During the operation, we find that most of Meniere's patients have fibrous cord hyperplasia near the inner ear window membrane, which may be the pathological manifestation after repeated rupture and repair of the inner ear window membrane. The vertigo of Meniere's disease may be related to the destruction and repair of inner ear membrane structure caused by improper contraction or spasm of tympanic tensor muscle.
Aged ; Female ; Humans ; Hyperplasia/pathology* ; Male ; Meniere Disease/surgery* ; Middle Aged ; Otoscopes/adverse effects* ; Retrospective Studies ; Tenotomy/adverse effects* ; Tensor Tympani/surgery* ; Tinnitus/complications* ; Vertigo/etiology*

BACKGROUND AND OBJECTIVES: Dizziness is not uncommon in children. The etiology of dizziness varies according to different studies due to different methods of examination or characteristics of the dizziness center. To assess meaningful causes of dizziness in children, a multidisciplinary approach would be needed. The purpose of this study was to analyze the main pathologies associated with vertigo and dizziness in children, paying particular attention to recent diagnostic advances with a multidisciplinary approach. SUBJECTS AND METHOD: A total of 73 children, aged between 4-18 years, who visited the Pediatric Dizziness Clinic of the University Hospital from January 2016 to June 2016 were included in this study. Medical records were reviewed retrospectively. All of the subjects were examined by history, questionnaires, physical examinations, electrocardiogram, hematologic tests, brain MRI scan, audiogram and vestibular function tests. Patients who had orthostatic symptoms additionally underwent a tilt table test, and in selective cases, a caloric and vestibular evoked myogenic potential tests as well. RESULTS: Vestibular migraine (VM) and benign paroxysmal vertigo of childhood (BPVC) were found in 35.6% and 27.4% of the children with dizziness, respectively. The incidence of orthostatic hypotension and postural orthostatic tachycardia syndrome were 12.3% each, both of which are higher than other previous reports. Other causes were Meniere's disease, benign paroxysmal positional vertigo, vestibular neuritis and so on. CONCLUSION: VM and BPVC were the most common causes of pediatric dizziness. Also, the incidence of orthostatic dizziness was rather high in pediatric population. The evaluation of dizziness in children should include a thorough check of history (questionnaire), neurotological examination, vestibular function tests and a tilt table test.
Benign Paroxysmal Positional Vertigo ; Brain ; Child ; Dizziness* ; Electrocardiography ; Hematologic Tests ; Humans ; Hypotension, Orthostatic ; Incidence ; Magnetic Resonance Imaging ; Medical Records ; Meniere Disease ; Methods ; Migraine Disorders ; Pathology ; Physical Examination ; Postural Orthostatic Tachycardia Syndrome ; Retrospective Studies ; Tilt-Table Test ; Vertigo ; Vestibular Function Tests ; Vestibular Neuronitis

There are a number of reports on the pathologies of vestibular disorders. However, these studies included only a few examples, which were not quantitative but merely anecdotal or descriptive. However, a single tissue section may be relevant to a specific disease in multiple ways. The histopathological characteristics of common peripheral vestibulopathies, including benign paroxysmal positional vertigo, Ménière's syndrome, labyrinthitis, vestibular neuritis, and ototoxicity, have been described. A recent study validated a new quantitative method for determining vestibular otopathology. Detailed quantitative analyses of vestibular pathology are required to obtain a deeper understanding of the vestibular system. Such studies will likely reveal the pathophysiological causes of specific diseases by elucidating the correlations between structural and functional features. Therefore, histopathological studies of vestibular disorders should be performed.
Benign Paroxysmal Positional Vertigo ; Ear, Inner ; Labyrinthitis ; Methods ; Pathology ; Temporal Bone ; Vestibular Neuronitis

To assess the clinical application of video head impulse test (vHIT) for vestibular function in vestibular neuritis (VN) and benign paroxysmal positional vertigo (BPPV) patients.Thirty-three patients with VN and 43 patients with BPPV were enrolled from Sir Run Run Shaw Hospital and Ningbo Second Hospital from March 15 to September 10, 2015; and 50 healthy controls were also enrolled in the study. vHIT was used to quantitatively test the vestibulo-ocular reflex (VOR) gains of a pair of horizontal semicircular canals. VOR gains two pairs of vertical semicircular canals, and the corresponding asymmetrical value of three VOR gains. The saccades information was also recorded.Compared with the healthy control group and BPPV patients, the affected horizontal and vertical VOR gains were declined and the corresponding asymmetries were increased in VN patients (all<0.01). BPPV group also showed higher vertical VOR gain asymmetries compared with the healthy control group (all<0.01), but no significant difference was observed in VOR gains and horizontal VOR gain asymmetry (all>0.05). The sensibility of vHIT in diagnosis of VN was 87.9%. Among 33 VN patients, 22 were diagnosed with superior vestibular nerve dysfunction, 7 were found with inferior vestibular nerve dysfunction and 3 were with both dysfunction; and 1 case was not distinguished.Video head impulse test can quantitatively evaluate the vestibular dysfunction of VN and can help early diagnosis of VN, which may be widely used in clinic.
Benign Paroxysmal Positional Vertigo ; diagnosis ; Head Impulse Test ; Humans ; Reflex, Vestibulo-Ocular ; physiology ; Saccades ; physiology ; Semicircular Canals ; innervation ; physiopathology ; Sensitivity and Specificity ; Vestibular Diseases ; classification ; diagnosis ; Vestibular Nerve ; pathology ; Vestibular Neuronitis ; classification ; diagnosis

Effort to improve balance ability in the field of rehabilitation has been constantly issued and developed up to now. A variety of subcomponent of postural control including function and cognition should be needed in many body systems and be complicatedly linked to each system. In South Korea, although decreased postural dysfunction due to neurological or musculoskeletal disorders has been well documented, we do not have many experience and knowledge of vestibular rehabilitation for maintain and improve balance function. In the United States, vestibular physical therapy is already acknowledged as clinical subspecialty by American Physical Therapy Association. However, there is no curriculum subject related to vestibular rehabilitation in standard education of physical therapy and no specialist who has clinical experience and knowledge of this realm. Therefore, we reviewed general information and basic knowledge of vestibular rehabilitation such as current state of vestibular disorder in South Korea, pathology, major causes of vestibular dysfunction including peripheral vestibular disorders, vestibular neuritis, benign paroxysmal positional vertigo, and central disorder, evaluation of vestibular dysfunction, and treatment for vestibular dysfunction new approaches. We expect that physical therapist in South Korea recognize clinical significance of vestibular exercise and that clinical concern and research will be begun in near future.
Benign Paroxysmal Positional Vertigo ; Cognition ; Curriculum ; Dizziness ; Education ; Humans ; Korea ; Pathology ; Physical Therapists ; Rehabilitation ; Specialization ; United States ; Vestibular Neuronitis

BACKGROUND AND OBJECTIVES: The use of endoscope has led to new treatment options for middle ear pathologies. The aim of this study is to report on endoscopic ear surgeries for the removal of middle ear cholesteatoma and discuss about the usefulness of endoscopic approach to congenital cholesteatoma in children. SUBJECTS AND METHOD: Five pediatric patients with congenital cholesteatoma were enrolled in this study. Cholesteatoma was removed via transcanal endoscopic approach in all patients. Medical records were reviewed retrospectively. We analyzed the clinical characteristics, surgical management and treatment outcomes. RESULTS: The average age of patients was 3.7 years. Cholesteatoma was observed in the anterior portion of tympanic membrane in four patients, and in the posterior portion in one patient. Endoscopic techniques were used exclusively in four patients, but one patient was treated by microscopic approach using a combined technique. Cholesteatoma was fully removed and we confirmed by endoscopic examination that no remnant lesions remained. Surgical complications such as vertigo, sensorineural hearing loss, infection, or bleeding were not seen postoperatively. Average hospital stay was 1.2 days. CONCLUSION: Results showed that this technique was beneficial for treating cholesteatoma in limited cases. Endoscopic surgical techniques produced good intraoperative and postoperative results in removing pediatric congenital cholesteatoma and will gain importance in the otological surgery in the future.
Child* ; Cholesteatoma* ; Cholesteatoma, Middle Ear ; Ear ; Ear, Middle ; Endoscopes ; Hearing Loss, Sensorineural ; Hemorrhage ; Humans ; Length of Stay ; Medical Records ; Pathology ; Retrospective Studies ; Tympanic Membrane ; Vertigo

OBJECTIVETo explore the pathomorphological change of the atlanto-occipital segment of vertebral artery (V3 part) related with cervical vertigo.

METHODSFrom June 1999 to November 2011, the pathomorphological change of the atlanto-occipital segment of vertebral artery were observed in 1680 patients with cervical vertigo using 3D-CTA technology. The clinical data of these patients were analyzed. There were 783 males and 897 females, aged from 22 to 70 years old with an average of 52.8 years old. Doppler examination showed vertebral basilar artery flow velocity to speed up or slow down.

RESULTSThe blood vessel of 3360 branches were detected in 1680 patients and 2778 branches were detected out vascular anomaly. And 829 branches were in V1 segment, 421 were in V2, 328 were in V3, 1190 were in V4. The pathomorphological changes in the atlanto-occipital segment (V3) of vertebral artery included angiospasm, congenital absence, abnormal exit, localized stenosis.

CONCLUSIONThere are 4 kinds of pathomorphological changes in the atlanto-occipital segment of vertebral artery related with cervical vertigo. The 3D-CTA result can be used to judge prognosis and adopt reasonable treatment for the patients.

Adult ; Aged ; Atlanto-Occipital Joint ; Cervical Vertebrae ; Female ; Humans ; Male ; Middle Aged ; Tomography, X-Ray Computed ; Vertebral Artery ; diagnostic imaging ; pathology ; Vertigo ; pathology

This study looked into the efficacy of a modified titration protocol of intratympanic gentamicin injection (ITG) in the patients with unilateral intractable Ménière's disease (MD). Modified titration protocol of ITG at a low dose (20 mg/mL) was administered to 10 patients with definite unilateral intractable MD. After initial first two fixed ITGs on weekly basis, the patients might or might not be given any more injections, depending on the appearance of unilateral vestibular loss (UVL). ITG was terminated if the patients satisfied the criteria of UVL. All patients were followed-up for at least two years. The effects of ITG on the vertigo attack, functional level scores and postural balance were evaluated. Of the 10 cases, 8 showed the sign of UVL after receiving initial two ITGs and were not given any more intratympanic injections, and the other 2 patients were administered three ITGs. A two-year follow-up revealed that complete and substantial vertigo control was achieved in 9 cases, and limited vertigo control in 1 patient. Hearing level was lowered in 2 patients. The posture stability and functional level scores were improved. Our study showed that the modified titration protocol of ITG at a low dose could effectively control vertigo in patients with unilateral intractable MD.
Adult ; Drug Administration Schedule ; Ear, Inner ; drug effects ; microbiology ; pathology ; Female ; Follow-Up Studies ; Gentamicins ; therapeutic use ; Hearing ; drug effects ; physiology ; Humans ; Injection, Intratympanic ; Male ; Meniere Disease ; drug therapy ; microbiology ; pathology ; Middle Aged ; Postural Balance ; drug effects ; physiology ; Protein Synthesis Inhibitors ; therapeutic use ; Vertigo ; drug therapy ; microbiology ; pathology

OBJECTIVE: To compare the clinical features and outcomes of benign paroxysmal positional vertigo (BPPV) associated with Meniere's disease and idiopathic BPPV. METHOD: Reviewing the clinical records of 372 patients with BPPV, 289 patients with idiopathic BPPV and 36 patients with BPPV accompanied by Meniere's disease and were enrolled in this study. All patients were diagnosed by using the Dix-Hallpike test or roll test and treated with the canalith repositioning procedure. The outcomes were compared between the two groups. RESULT: The patients with BPPV associated with Meniere's disease presented the following features, in which they differed from the patients with idiopathic BPPV (P < 0.05): (1) a higher percentage of female patients; (2) a longer duration of symptoms; (3) frequent involvement of the horizontal semicircular canal; (4) a greater incidence of canal paresis; (5) more therapeutic sessions needed for cure and a higher rate of recurrence. CONCLUSION The BPPV associated with Meniere's disease differs from idiopathic BPPV in clinical features, treatment response recurrence tendency.
Benign Paroxysmal Positional Vertigo ; complications ; Female ; Humans ; Incidence ; Male ; Meniere Disease ; complications ; Paresis ; complications ; Patient Positioning ; Recurrence ; Retrospective Studies ; Semicircular Canals ; pathology

Hearing loss caused by cochlear damage is the main symptom of sudden deafness (SD). Some patients also suffer from vestibular symptoms. In recent years, more attention has been paid to the vestibular dysfunction in patients with SD. The lesions could involve the whole inner ear in SD patients with and without vertigo. Comprehensive evaluation of vestibular function may help us understand the extent of lesions in sudden deafness and analyze the pathogenesis of disease. A less involvement of inner ear lesion may indicate a better hearing recovery.
Cochlea ; injuries ; Hearing Loss, Sudden ; diagnosis ; pathology ; Hearing Tests ; Humans ; Vertigo ; Vestibule, Labyrinth ; physiopathology