Dizziness or vertigo is a common clinical symptom, and its underlying etiology is complex. Many clinicians are confused about its diagnosis and treatment. This article presents a case about chronic vestibular syndrome. And case appreciation and academic discussion are conducted by well-known domestic neurologists and otologists, so as to provide a good thinking model and basic ideas for the diagnosis and treatment of dizziness or vertigo, hoping to further improve the diagnosis and treatment level among clinicians.
Humans ; Dizziness/therapy* ; Vertigo/etiology* ; Vestibular Diseases/complications* ; Otolaryngologists

Low frequency sensorineural deafness is a common subtype of idiopathic sudden deafness. Certain patients suffered recurrent attacks without vertigo, much alike Meniere's disease. Few of them developed into definite Meniere's disease during long-term follow-up in many clinical studies. Although the pathophysiology of recurrent low frequency deafness is yet unknown, the desease is considered associated with early state of endolymphatic hydrops or migraine. Otologists shall be aware of its clinical course and careful explanation is necessary at time of initial informed consent.
Endolymphatic Hydrops ; complications ; Hearing Loss, Sensorineural ; complications ; diagnosis ; Hearing Loss, Sudden ; Humans ; Meniere Disease ; complications ; Vertigo

OBJECTIVE: By analysing the video-nystagmography findings of positional tests,to evaluate the therapeutic effect of the patients with horikontal semicircular canal cupulolithiasis (HSC-Cup). METHOD: A retrospective study of 36 patients with HSC-Cup. The induced nystagmus in roll tests was recorded by videonystagmography, whose direction, latency, intensity and time characteristics were analysed. All of the 36 patients were treated with lying position avoiding normal side and oral-taken betahistine mesilate tablets. A week later return visits and curative effects evaluation were made. RESULT: Horizontal apogeotropic nystagmus was induced by turning left or right in HSC-Cup roll tests. The time of latency and duration turning to normal and lesion side were(0. 93 ± 0. 65)s and(1. 01 ± 0. 78)s, (100.58 ± 36. 56)s and (118. 65 ± 143. 71)s, which showed no statistically significant difference (P>0. 05). The duration of nystagmus was more than 60 seconds. The intensity of nystagmus turning to normal and lesion side were(45.58 ± 28.71)°/s and (20.42 ± 16. 64)°/s. The intensity turning to normal side was greater than lesion side obviously. The difference was statistically significant (P<0. 05). Twenty-three patients withright HSC-Cup, and 13 patients with left HSC-Cup were taken in count. They were treated with above methods and return visit a week later. Twenty-eight patients (77. 77%) were cured, 36 patients (100. 00%) were improved. There were 4 patients recurrence during the follow-up. CONCLUSION The direction and duration time of induced nystagmus are available to diagnose the HSC-Cup. The lesion side may determined according to the intensity of induced nystagmus. Lying position avoiding normal side and oral-taken betahistine mesilate tablets is an effective treatment methods for HSC-Cup.
Benign Paroxysmal Positional Vertigo ; complications ; diagnosis ; Face ; Humans ; Nystagmus, Physiologic ; Retrospective Studies ; Semicircular Canals ; Treatment Outcome ; Vertigo

OBJECTIVE: To investigate and analyze the status of anxiety and depression among patients with four types of peripheral vertigo. METHOD: The clinical data of patients with one of the four types of peripheral vertigo, namely benign paroxysmal positional vertigo (BPPV), vestibular migraine (VM), Menière's disease (MD), and vestibular neuritis (VN), were collected. Thorough otological and neuro-otological examinations were performed on these patients, and their status of anxiety and depression were assessed using self-rating anxiety scale (SAS) and self-rating depression scale (SDS). RESULT: A total of 129 patients with one of the four types of peripheral vertigo(49 cases of BPPV, 37 cases of VM, 28 cases of MD and 15 cases of VN) were included in the study. The scores of SAS and SDS were higher in the patients with VM or MD than those with BPPV or VN (P < 0.05), and the incidence of anxiety (VM = 45.9% MD = 50.0%) and depression (VM = 27.0% MD = 28.6%) were higher in the patients with VM or MD than those with BPPV or VN (P < 0.05). Paired comparisons showed the differences between the incidences of BPPV and MV groups, BPPV and MD groups, and MD and VN groups were statistically significant (P < 0.05). CONCLUSION Among patients with different types of peripheral vertigo, anxiety/depression is more common in patients with VM or MD. This may be due to the different mechanisms involved in different types of vertigo, as well as differences in the prevention and self-control of the patients against the vertigo.
Anxiety ; complications ; Benign Paroxysmal Positional Vertigo ; Depression ; complications ; Ear, Inner ; Humans ; Incidence ; Meniere Disease ; Migraine Disorders ; Psychiatric Status Rating Scales ; Vertigo ; classification ; complications ; Vestibular Neuronitis ; Vestibule, Labyrinth

OBJECTIVE: To explore the severity index of Meniere's disease during acute phase by a statistical method of principal component analysis (PCA). METHOD: Ninety-five patients with Meniere's disease in the acute phase who saw the doctor with 24 hours after onset were included in this study and their clinical data were analyzed retrospectively. The subjective symptoms of hearing loss (X1) and ear stuffy plug (X4) were evaluated by VAS scoring system, and the impact of vertigo (X2) and tinnitus (X3) on the patients were evaluated by DHI and THI score. The principal component analysis (PCA) method was used to analyze the quantified data and construct a synthetic evaluate function of subjective symptoms. RESULT: (1) The quantitative results of subjective symptoms in patients with Meniere's disease were as follow: VAS score (X1) of hearing loss was 0-91 points, with an average of 46.23 ± 18.80, DHI score (X2) of vertigo was 8-98 points, with an average of 49.66 ± 15.67, THI score (X3) of tinnitus was 10-100 points, with an average of 47.53 ± 17.44, and ear VAS score (X4) of stuffy plug feeling was 0-82 points, with an average of 21.55 ± 27.54. (2) The eigenvalue of principal components Z1, Z2 and Z3 were 1.876, 0.984 and 0.703 respectively, and the variance contribution were 46.898%, 24.592% and 17.574% respectively. (3) The constructed synthetic evaluate function of the disease was as follow: The Meniere's disease severity index ƒ = 0.213ZX1 + 0.398ZX2 + 0.370ZX3 + 0.455ZX4. CONCLUSION The method of PCA for the subjective evaluation of symptoms in Meniere's disease can be constructed as a model of comprehensive evaluation system, which may provide relatively comprehensive information of clinical original variables included in the four main symptoms, reflecting the severity of the disease.
Hearing Loss ; complications ; Humans ; Meniere Disease ; complications ; diagnosis ; Principal Component Analysis ; Retrospective Studies ; Severity of Illness Index ; Tinnitus ; complications ; Vertigo ; complications

OBJECTIVE: This retrospective study compared clinical manifestations of idiopathic sudden hearing loss between children and the elderly. METHOD: 44 pediatric patients and 76 elderly patients diagnosed with idiopathic sudden deafness in our clinic from December 2009 to September 2014 were enrolled. Different clinical parameters were compared. RESULT: The incidence of initially profound hearing loss was highest and mild hearing loss was lowest in both groups (P < 0.05). There were no differences in the proportion with initially mild, moderate, severe, and profound hearing loss between both groups (P > 0.05). The number of patients was the most in initially profound type of audiogram pattern and the fewest in ascending type in both groups (P < 0.05). Hearing recovery rates in children (27/44, 61.4%) was higher than that in elderly patients (32/76, 42.1%) (P < 0.05). There were no differences in hearing recovery rates of the patients with initially level of hearing loss in both groups (P > 0.05). The highest recovery rate in children was in those with descending type and the lowest was in those with profound type (P < 0.05). There were no differences in hearing recovery rates in elderly patients with initially different types of audiogram pattern (P > 0.05). Hearing recovery rates of descending type in children were higher than that in elderly patients. Presence of tinnitus in pediatric patients was not relavent to the outcome (P > 0.05). Presence of tinnitus in elderly patients was associated with favorable outcomes. (P < 0.05). Presence of dizziness in pediatric patients was not relavent to the outcome (P > 0.05). Presence of dizziness in elderly patients was associated with poor outcomes (P < 0.05). Presence of initially different degrees of opposite side hearing loss in elderly patients was not relavent to the outcome (P > 0.05). Presence of chronic diseases in elderly patients was not associated with the outcome (P > 0.05). CONCLUSION The clinical manifestion of idiopathic sudden deafness is respective in Children and in elderly patients.
Aged ; Child ; Dizziness ; complications ; Hearing Loss, Sudden ; physiopathology ; Hearing Tests ; Humans ; Incidence ; Retrospective Studies ; Tinnitus ; complications ; Vertigo ; complications

Delayed endolymphatic hydrops （DEH） is a rare disease that causes vertigo and is often misdiagnosed as other vertigo diseases. This article reports on a patient with vertigo who was easily misdiagnosed. The patient was a middle ear cholesteatoma complicated by labyrinthine fistula （LF）; however, his vertigo was episodic vertigo, which could not be explained solely by LF causing labyrinthitis. The possibility of endolymphatic hydrops was suspected, which was confirmed by inner ear magnetic resonance gadolinium imaging. This is the first reported case of middle ear cholesteatoma complicated by LF and DEH. The patient underwent surgical resection of the cholesteatoma and three semicircular canal obstructions at the same time. During two years postoperative follow-up, the patient did not experience a recurrence of vertigo. When diagnosing vertigo diseases, a careful history of vertigo is of utmost importance.
Humans ; Endolymphatic Hydrops/diagnosis* ; Cholesteatoma, Middle Ear/complications* ; Vertigo/complications* ; Labyrinth Diseases/complications* ; Magnetic Resonance Imaging/adverse effects* ; Semicircular Canals

Humans ; Meniere Disease ; diagnosis ; etiology ; Vascular Diseases ; complications ; Vertigo ; diagnosis ; etiology

Benign Paroxysmal Positional Vertigo ; complications ; Humans ; Otologic Surgical Procedures ; adverse effects

BACKGROUND AND OBJECTIVES: The aim of this study was to analyze the results of malleostapedotomy as primary surgical procedure in stapes fixation. SUBJECTS AND METHOD: This study was a retrospective chart review of 12 patients who underwent primary malleostapedotomy for conductive hearing loss. The intraoperative findings, surgical outcomes including audiologic data and complications were analyzed. RESULTS: Nine patients had ossicular fixation with ossicular anomalies and 3 patients had ossicular fixation alone. The median length of piston wire was 5.5 mm in total length. The preoperative mean bone and air-conduction thresholds were 57.5+/-8.8 (mean+/-SD) dB, 19.7+/-10.3 dB, respectively, and the mean air-bone gap (ABG) was 44.6+/-13.2 dB. After malleostapedotomy, hearings were improved and mean postoperative ABG was 11.1+/-11.3 dB. In eight patients (66.7%), ABG was reduced to 20 dB or less. There was no intraoperative or postoperative complication except for mild postoperative vertigo for 1 or 2 days. CONCLUSION: Malleostapedotomy can be a safe and effective surgical procedure as an alternative of incus stapedotomy in certain cases of absence or anomalous incus long process, and/or immobile incus in patients with stapes fixation.
Hearing Loss, Conductive ; Humans ; Incus ; Postoperative Complications ; Retrospective Studies ; Stapes ; Stapes Surgery ; Vertigo