Objective To explore the role of ocular vestibular evoked myogenic potential (oVEMP) and unilateral centrifugation subjective visual vertical (UC-SVV) tests in evaluating the utricular function of patients with Meniere’s disease (MD) at different clinical stages. Methods A total of 97 unilateral MD patients at Shandong Provincial ENT Hospital from July 2019 to September 2021 were selected. All patients underwent oVEMP, UC-SVV, and pure tone audiometry tests. MD patients were classified into clinical stages 1, 2, 3, and 4, with stages 1 and 2 defined as early stage and stages 3 and 4 as late stage. The results of utricular function tests (abnormal rates of oVEMP, UC-SVV, and oVEMP＋UC-SVV) were compared among patients at different stages. Spearman correlation analysis was used to evaluate the correlation between utricular function and clinical staging. Results Among the 97 MD patients, the abnormal rate of oVEMP was 66.0% (64/97), and the abnormal rate of UC-SVV was 55.7% (54/97). The abnormal rates of oVEMP and oVEMP＋UC-SVV in early-stage patients were significantly lower than those in late-stage patients (P＜0.05), while the difference in UC-SVV abnormal rates between the two groups was not statistically significant. Intra-group comparisons showed that the abnormal rate of oVEMP＋UC-SVV in stage 1 patients was significantly lower than that in stage 2 patients (P＜0.05), without significant difference in the other indices. There were no significant differences among the three indices in stages 3 and 4 patients. Spearman correlation test results indicated that the abnormal rate of oVEMP (r＝0.336, P＝0.001) and the abnormal rate of oVEMP＋UC-SVV (r＝0.301, P＝0.003) were weakly positively correlated with clinical staging, while there was no correlation between the abnormal rate of UC-SVV and clinical staging (r＝0.022, P＝0.832). Conclusions Both oVEMP and UC-SVV tests can assess utricular function in MD patients at different clinical stages. Their combination is helpful of early-stage (stages 1 and 2) MD diagnosis.

Vestibular rehabilitation is an effective means of treating vestibular dysfunction. Ensuring compliance and effectiveness of rehabilitation exercises is the key to rehabilitation. Telemedicine is unrestricted by time and space, convenient, accessible, and easy to spread, and has application value and practical significance in vestibular rehabilitation. This paper summarizes the research status and applications of telemedicine, providing a reference for medical and nursing staff to research telemedicine.

Objective:To analyze the characteristics of pulse-step-sine (PSS) test in healthy people of different ages and to discuss its clinical value.Methods:From July 10, 2018 to December 9, 2020, a total of 78 healthy volunteers, including 40 males and 38 females, were enrolled and divided into youth group, middle age group and old age group. The I Portal NOTC rotational-chair system (NKI) was applied for PSS detection to analyze the clinical characteristics of gain, phase, asymmetry, and slope of step and sinusoidal components. Statistical analysis was performed using SPSS17.0 software.Results:In the same age group, there were no statistically significant differences in left and right step gain, slope gain and sine gain (All P values were greater than 0.05). Pairwise comparison between different age groups showed that there was no significant difference in the corresponding parameters between the youth group and the middle age group. Compared with young group, the old age group had a significantly lower step gain value in their left side ( P<0.01) but not in the right side ( P>0.05).The left and right slopes of the old age group were significantly lower than those of the young group and the middle group, and the differences were statistically significant (All P values<0.05). Conclusion:The PSS test can detect bilateral and unilateral horizontal semicircular canal function with good tolerance in different age groups, better than the traditional rotational chair examination to determine the well-compensated unilateral vestibular function. PSS test is a new vestibular detection method.

Objective: To evaluate the feasibility of combining simultaneous triple semicircular canal plugging (TSCP) and cochlear implantation (CI) to treat vertigo and hearing loss in advanced Meniere's disease(MD) patients, so as to provide an alternative surgical procedure for treating this disorder. Methods: Data from seven 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 Jan. 2015 to Jan. 2016, were retrospectively analyzed in this work. Seven patients, in whom the standardized conservative treatment had been given for at least one year and frequent vertigo still occurred, underwent simultaneous TSCP and CI under general anesthesia via mastoid approach. Postoperative follow-up time was more than six months. Vertigo control and auditory function were measured. Pure tone audiometry, speech perception scores, caloric test, head impulse test (HIT), and vestibular evoked myogenic potential (VEMP) were performed for evaluation of audiological and vestibular functions. Results: All patients had bilateral severe sensorineural hearing loss preoperatively. One side hearing loss was due to MD and another side was due to reasons including sudden sensorineural hearing loss, mumps and other unknown reason. The total control rate of vertigo in seven MD patients was 100.0% in the six-month follow-up, with complete control rate of 85.7% (6/7) and substantial control rate of 14.3% (1/7). Improved hearing threshold and speech perception scores were observed in all study participants. Postoperative average aided hearing threshold was 32.5 dBHL, the average monosyllabic word score was 42.6% and speech perception scores of sentences tested in quiet was 52.3%. Tinnitus improved in five cases, and no significant change in two patients. Post-operatively, all patients suffered from temporary vertigo and balance disorders. Vertigo was disappeared in all patients within 3-5 days, while, an average recovery time of balance disorders was 19.7 days. Six months after treatment, loss of semicircular canal function by caloric test was found in the operation side of all patients and no change in cVEMP or oVEMP test was noted. All patients had no facial paralysis, cerebrospinal fluid leakage, and other complications. Conclusions A combined approach of TSCP and CI which could control vertigo effectively and improve hearing loss and tinnitus represents an effective and safe therapy for some advanced MD patients.

Objective:To investigate frequency and position characteristics of the vestibular dysfunction in vestublar neuritis patients. Method:Colaric test (CT), head impulse test (HIT), cervical vestibular evoked myogenic potential (cVEMP) and ocular vestibular evoked myogenic potential (oVEMP) were applied in 43 vestublar neuritis patients to assess their vestublar dysfunction. Superior vestublar nerve (S-VN), inferior vestibular nerve (I-VN), total vestibular nerve (T-VN) and each vestibular end organ incidence rate were calculated and statistically analyzed. Result:CT incidence rate (93.0%) was statistically higher than that of HIT (72.1%) (P<0.01). Total frequency incidence rate (72.1%) was statistically higher than that of low frequency (20.9%) (P<0.01). No high frequency only case was observed. The incidence rate of S-VN only, I-VN only and T-VN was 44.2%, 4.7% and 51.2% respectively. Among them, the incidence rate of I-VN was significantly lower than the others (P<0.01). The incidence rate of vestibular end organs was 17.4% (S-SCC), 44.2% (H-SCC), 20.9% (P-SCC), 39.5% (utricule) and 26.7% (saccule) respectively. The incidence rate of H-SCC was remarkably higher than the other semicircular canals (P<0.01). The difference between utricule and saccule was not statistically significant. Conclusion:The semicricular canal dysfunction in vestibular neuritis patients mainly involves total frequency of vestibular function, low frequency is more common than high frequency. Total vestibular nerve and single S-VN are mostly involved in vestibular neuritis.

Objective:To explore the clinical value of vestibular autorotation test (VAT) in the treatment for otogenic vertigo patients. Method:One hundred and twenty-nine definite otogenic vertigo patients were included. All patients underwent the VAT and caloric test (CT). The results were analyzed statistically. Result:In VAT examination, 89 (69.0%) cases were abnormal. In CT examination, 56 (43.4%) cases were abnormal. In the contrast test of VAT and CT, VAT results were abnormal in 47 (36.4%) patients and CT results were abnormal in 14 (10.9%) patients. The number of patients whose both VAT and CT results were abnormal was 42 (32.6%). The total number of patients with various abnormal results was 103 (79.8%). According to statistical analysis, the abnormal result rate of VAT was higher than that of CT. The abnormal result rate of both VAT and CT was higher than that of each single test. There was statistic significance in the difference (χ²=1.670, P<0.05). Conclusion:For otogenic vertigo patients, their abnormal result rate of VAT is higher than that of CT. VAT and CT can be mutually complementary. The combination of VAT and CT can help to understand the function of semicircular canal in the general and provide reference for the treatment of otogenic vertigo diseases.

Objective To 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.Methods Data 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.Results According 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.Conclusions TSCO,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.

Objective We aimed to determine whether blood lipid parameters were related to the severity and the prognosis of idiopathic sudden sensorineural hearing loss(ISSNHL) patients.Methods A 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.Results TG 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).Conclusions TG 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.

Objective To investigate the therapeutic effect of topical corticosteroids injection and systemic application in the treatment of typing idiopathic sudden sensorineural hearing loss (ISSNHL).Methods Total 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 puretone 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.Results Among 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 (x2 =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 (x2 =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(x2 =8.38) and total deafness (x2 =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 (x2 =1.60) and total deafness (x2 =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％),x2 =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).Conclusions For 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.

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.