Humans ; Cochlear Implants ; Cochlear Implantation ; Vestibule, Labyrinth ; Vestibular Function Tests ; Vestibular Diseases

Objective:To investigate the classification of head shaking nystagmus（HSN） and its clinical value in vestibular peripheral diseases. Methods:Clinical data of 198 patients with peripheral vestibular disorders presenting with HSN were retrospectively analyzed. Video Nystagmograph（VNG） was applied to detect spontaneous nystagmus（SN）, HSN, and Caloric Test（CT）. The intensity and direction of SN and HSN as well as the unilateral weakness（UW） and direction preponderance（DP） values in caloric test was analyzed in patients. Results:Among the 198 patients with vestibular peripheral disease, there were 105 males and 93 females, with an average age of（49.1±14.4） years （range: 14-87 years）. One hundred and thirty seven patients were diagnosed as Vestibular Neuritis（VN）, 12 as Meniere's Disease（MD）, 41 as sudden deafness（SD） and 8 as Hunt's syndrome accompanied by vertigo. Among them, there were 116 patients in the acute phase, including 68 cases（58.6%） with decreased HSN, 4 cases（3.4%） with increased HSN, 5 cases（4.3%） with biphasic HSN, 38 cases（32.8%） with unchanged HSN, and 1 case（0.9%） with perverted HSN. There were 82 cases in the non-acute phase, 51 cases（62.2%） with decreased HSN, 3 cases（3.6%） with increased HSN, 9 cases（11.0%） with biphasic HSN, and 19 cases（23.2%） with unchanged HSN. In biphasic HSN, the intensity of phase I nystagmus was usually greater than that of phase II, and the difference was statistically significant（P<0.01）. There was no correlation between HSN type and course of disease or DP value. The intensity of HSN was negatively correlated with the course of disease（r=-0.320, P<0.001） and positively correlated with DP value（r=0.364, P<0.001）, respectively. The intensity of unchanged nystagmus and spontaneous nystagmus were（8.0±5.7） °/s and（8.5±6.4）°/s, respectively. There was no statistically significant difference in the intensity of nystagmus before and after shaking the head. Conclusion:HSN can be classified into five types and could be regarded as a potential SN within a specific frequency range （mid-frequency）. Similarly, SN could also be considered as a common sign of unilateral vestibular impairment at different frequencies. HSN intensity can reflect the dynamic process of vestibular compensation, and is valuable for assessing the frequency of damage in peripheral vestibular diseases and monitoring the progress of vestibular rehabilitation.
Male ; Female ; Humans ; Adult ; Middle Aged ; Vestibular Function Tests ; Retrospective Studies ; Nystagmus, Pathologic/diagnosis* ; Vertigo/diagnosis* ; Electronystagmography ; Vestibular Diseases/diagnosis*

Objective: To explore the dynamic changes of vestibular autorotation test (VAT) before and after vestibular rehabilitation treatment in patients with unilateral vestibular hypofunction (UVH). Methods: A retrospective study was carried out,48 patients who were diagnosed with UVH and under vestibular rehabilitation in department of otorhinolaryngology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, from January 2019 to January 2021 were enrolled. Among them, there were 21 males and 27 females, with an average age of 46.9 years old, including 25 cases of Meniere's disease, 13 cases of sudden deafness with vertigo and 10 cases of vestibular neuritis. The course of disease ranged from 5 days to 10 years. Demographic characteristics, detailed case data and routine examination were collected for the patients. The horizontal gain/phase, vertical gain/phase, and asymmetry of VAT at different frequencies before and after vestibular rehabilitation were collected. The absolute value of the difference between the measured value of 2.0-5.9 Hz before and after rehabilitation and the standard value were statistically analyzed. Results: Before vestibular rehabilitation, the incidence of abnormal gain was 62.5% (30/48), the incidence of abnormal phase was 56.3% (27/48), and the incidence of asymmetry was 16.7% (8/48). After 4-6 weeks of vestibular rehabilitation, the incidence of gain abnormality was 22.9% (11/48), the incidence of phase abnormality was 31.3% (15/48), and the incidence of asymmetry was 12.5% (6/48).The horizontal gain at frequency of 2.0-3.9 Hz showed statistically significant difference compared with before vestibular rehabilitation (P<0.05), and the horizontal gain at frequency of 4.3-5.9 Hz showed that there was no significant difference (P>0.05); the horizontal phase at 5.9 Hz showed that the difference was statistically significant (P=0.043), and there was no significant difference before and after rehabilitation treatment at 2.0-5.5 Hz (P>0.05); the vertical gain at 4.3 Hz showed the difference was statistically significant (P=0.020), and the remaining frequency showed no significant difference (P>0.05); No frequency of asymmetry and vertical phase showed the difference before and after rehabilitation was statistically significant (P>0.05). Conclusion: VAT can be used to monitor the change trend of multiple frequency bands before and after vestibular rehabilitation in UVH, in order to provide reference for the formulation of personalized rehabilitation strategies.
Female ; Humans ; Male ; Meniere Disease/diagnosis* ; Middle Aged ; Retrospective Studies ; Vertigo/diagnosis* ; Vestibular Function Tests ; Vestibular Neuronitis

Objective: The aim of the study is to analyze the effects of vestibular spontaneous nystagmus(SN) on the smooth pursuit function of visual ocularmotor system. Methods: A total of 46 patients with acute unilateral peripheral vestibular syndrome with SN (26 cases of vestibular neuritis, 6 cases of Ramsay Hunt Syndrome (RHS) with vertigo, 14 cases of sudden deafness with vertigo) were included in this work. In the study group, the results of SPT and SN test with videonystagmography(VNG) were also reviewed. Taking SPT parameters, the influence of SN intensity on SPT gain, asymmetry and waveform and their correlation were analyzed.SPSS19.0 software was used for statistical analysis. Results: Among the 46 patients, there were 36 cases of SN pointing to the healthy side(SN intensity range of 2.68°/s-32.53°/s), and 10 cases of SN pointing to the affected side (SN intensity range of 2.66°/s-16.54°/s). SN intensity was divided into 3 groups, including light(0.50°/s-5.00°/s), medium(5.01°/s-10.00°/s) and strong(>10.01°/s), accounting for 14 cases(30.4%), 18 cases(39.1%) and 14 cases(30.4%), respectively. The differences of the gain of SPT to the fast phase and slow phase direction in the overall groups and light, medium and strong groups of SN intensity respectively were statistically significant(t_total=13.338, t_light=6.184, t_medium=8.436, t_strong=8.477, all of P<0.001). The difference of SPT gain in SN fast phase direction between groups with different SN intensity was statistically significant(F=9.639, P<0.001),there was no statistically significant difference in SPT gain between the groups on the SN slow phase direction(F=1.137, P=0.330).The SN intensity significantly negatively correlated with the SPT gain of the fast phase direction of SN (r=-0.433, P=0.003), that was, the SPT gain on the fast phase direction of SN decreased with the increase of SN intensity. There was no significant correlation between SN intensity and the gain of SPT on the slow phase direction of SN (r=-0.061, P=0.687). SPT waveform analysis showed that type I, type II and type III accounted for 8 cases(17.4%), 21 cases(45.6%) and 17 cases(37.0%), respectively. The corresponding mean values of SN intensity were (3.71±0.69)°/s, (7.44±1.88)°/s, (20.04±5.53)°/s, respectively, without type IV wave. The intensity of SN was positively correlated with the asymmetric value of the gain of SPT left and right(r=0.450,P=0.002). That was, with the increase of SN strength, the asymmetric value also increased, and the worse the asymmetry of the gain of SPT left and right pursuit was, the worse the SPT waveform was. Conclusion: SPT gain, asymmetry and SPT waveforms are all affected by SN, and the greater the intensity of SN, the greater the influence on the three. When SN is strong, type III waves may occur, suggesting that acute peripheral vestibular syndrome can also affect the visual ocularmotor systems.
Humans ; Nystagmus, Pathologic ; Pursuit, Smooth ; Vertigo ; Vestibular Diseases ; Vestibular Function Tests ; Vestibular Neuronitis

Brain ; Brain Abscess ; Humans ; Meniere Disease ; Vertigo/etiology* ; Vestibular Function Tests

OBJECTIVES: Despite patients with dizziness were reported of revealing gait problems, there is still lack of objective quantitative measurement of gait patterns of peripheral vestibular disorders. To demonstrate gait variability in acute unilateral peripheral vestibular deficit, we evaluated the differences in gait patterns between vestibular neuritis (VN) patients and healthy subjects by the use of shoe-type inertial measurement unit (IMU) with sensors mounted. METHODS: Between April 2017 and January 2019, 30 patients diagnosed with unilateral peripheral vestibular deficit presumed to be caused by VN were enrolled in this study. The shoe-type IMU was used to analysis subjects. We assessed gait speed, cadence, stride length, stance phase, normalized stride length, normalized step length, phase coordination index and gait asymmetry of data from shoe-type IMU sensors with the walking protocol. We tested 30 healthy volunteers as control group. RESULTS: We identified spatiotemporal parameters of human gait. The gait speed of patients with VN was decreased to 3.82±0.8 compared to 4.93±1.08 in control group. In addition, there were differences in normalized stride length, normalized gait speed and related gait parameters, when comparing VN group and control group. CONCLUSION: Gait analysis by the use of shoe-type IMU could provide important information regarding vestibular pathophysiology in patients with VN. Gait performance tests can examine gait variability quantitatively. It will be taken into consideration as a vestibular function test for patients with vertigo.
Dizziness ; Gait ; Healthy Volunteers ; Humans ; Vertigo ; Vestibular Function Tests ; Vestibular Neuronitis ; Walking

OBJECTIVE: To compare balance performance and lower limb muscle strength between older adults with type 2 diabetes mellitus (DM), with and without sensory impairments and non-DM groups. Influence of a number of sensory impairments, and muscle strength on balance performance were explored. METHODS: Ninety-two older adults with and without type 2 DM, were examined relative to visual function with the Snellen chart, Melbourne Edge test, and Howard-Dolman test, vestibular function with the modified Romberg test, proprioception of the big toe, and diabetic peripheral neuropathy with the Michigan Neuropathy Screening Instrument. Balance performances were evaluated with the Romberg test, Functional Reach Test (FRT), and Timed Up and Go test (TUG). Strength of knee and ankle muscles was measured. RESULTS: FRT of type 2 DM groups with at least two sensory impairments, was lower than the non-DM group (p<0.05). TUG of all DM groups, was worse than the non-DM group (p<0.01). Lower limb muscle strength of type 2 DM groups with two and three sensory impairments, was weaker than non-DM group (p<0.05). Regression analysis showed that type 2 DM with three sensory impairments, ankle dorsiflexors strength, and age were influential predictors of TUG. CONCLUSION: There were significant differences, of muscle strength and balance performance among groups. Poorer balance and reduced lower limb strength were marked in older adults with type 2 DM, even ones without sensory impairment. Muscle weakness seemed to progress, from the distal part of lower limbs. A greater number of sensory impairments, weaker dorsiflexors, and advanced age influenced balance performance.
Adult ; Aged ; Ankle ; Diabetes Mellitus, Type 2 ; Hallux ; Humans ; Knee ; Lower Extremity ; Mass Screening ; Michigan ; Muscle Strength ; Muscle Weakness ; Muscles ; Peripheral Nervous System Diseases ; Proprioception ; Vestibular Function Tests

BACKGROUND AND OBJECTIVES: One of the characteristics of Meniere’s disease is pure tone threshold shift at low frequencies in the lesion; although, in some patients, more pure tone threshold shifts were also shown at mid or high frequencies. Authors speculated that the most varied pure tone frequency may be related with diversity of clinical symptoms and other characteristics. SUBJECTS AND METHOD: We reviewed medical records of 85 patients who met the criteria of definite Meniere’s disease (1995 American Academy of Otolaryngology-Head and Neck Surgery). Patients were classified into 3 groups (high frequency, mid frequency, low frequency) depending on the frequency at which pure tone threshold changes encountered the most. The vestibular function tests and clinical characteristics were compared between the groups. RESULTS: Thirty-six patients (42.0%) showed pure tone threshold changes at 0.25 or 0.5 kHz (low frequency group). Twenty-five patients (30.0%) showed greatest pure tone threshold change at 1 or 2 kHz (mid frequency group). Twenty-four patients (28.0%) belonged to the high frequency group with most changes taking place not lower than 4 kHz. Frequency of vertigo attack, and duration of vertigo attack did not differ between the groups. Low frequency group showed more chance of tinnitus with statistical significance. Vestibular evoked myogenic potentials (VEMP) abnormality was more frequently encountered in the low frequency group. CONCLUSION: This study shows that changes in the pure tone threshold is not confined to low frequencies in definite Meniere’s disease. Patients with pure tone threshold changes at low frequencies have more chance of tinnitus and abnormal cVEMP.
Humans ; Medical Records ; Meniere Disease ; Methods ; Neck ; Tinnitus ; Vertigo ; Vestibular Evoked Myogenic Potentials ; Vestibular Function Tests

BACKGROUND AND OBJECTIVES: To analyze the difference in audiologic-vestibular and clinical characteristics between acute cochlea-vestibulopathy (ACV) and idiopathic sudden sensorineural hearing loss (ISSNHL). SUBJECTS AND METHOD: We retrospectively analyzed the clinical characteristics of 91 patients diagnosed as sudden hearing loss (ACV; n=20, ISSNHL; n=71). Patients with vestibular hypofunction were categorized as ACV and all others as ISSNHL. Demographics and clinical findings were compared. Audiologic features such as degree of hearing loss, type of audiometric configuration and hearing improvements were analyzed. In addition, vestibular function test results and hearing recovery were further analyzed among ACV group. RESULTS: Demographics and other clinical findings were not much different between groups. There was a significant difference with respect to audiologic features between the ACV group and ISSNHL group: the initial hearing threshold of the ACV group was higher than that of the ISSNHL group, and their treatment onset was also shorter. There was also a significant difference in the hearing outcome showing very low rate of complete recovery in ACV group. The final hearing threshold of the ACV group was higher than that of the ISSNHL group. Dizziness was the only significant variable in the multiple regression analysis. In the ACV group, the cervical vestibular evoked myogenic potential inter-aural amplitude difference (cVEMP IAD) ratio showed a correlation to the hearing recovery in some frequencies; patients with no cVEMP response showed poor outcome compared to those with cVEMP waveform. CONCLUSION: The ACV group shows a poor prognosis just as in the case of sudden hearing loss defined in the traditional sense of vertigo. The IAD value of the vestibular evoked myogenic potentials test will be helpful in assessing hearing improvement, especially when a high IAD value at the middle frequency is associated with a poor prognosis.
Demography ; Dizziness ; Hearing ; Hearing Loss ; Hearing Loss, Sensorineural ; Hearing Loss, Sudden ; Humans ; Methods ; Prognosis ; Retrospective Studies ; Vertigo ; Vestibular Evoked Myogenic Potentials ; Vestibular Function Tests

BACKGROUND: Cervical vestibular evoked myogenic potential (cVEMP) testing is a strong tool that enables objective determination of balance functions in humans. However, it remains unknown whether cVEMP correctly expresses vestibular disorder in mice. OBJECTIVE: In this study, correlations of cVEMP with scores for balance-related behavior tests including rotarod, beam, and air-righting reflex tests were determined in ICR mice with vestibular disorder induced by 3,3'-iminodipropiontrile (IDPN) as a mouse model of vestibular disorder. METHODS: Male ICR mice at 4 weeks of age were orally administered IDPN in saline (28 mmol/kg body weight) once. Rotarod, beam crossing, and air-righting reflex tests were performed before and 3-4 days after oral exposure one time to IDPN to determine balance functions. The saccule and utricles were labeled with fluorescein phalloidin. cVEMP measurements were performed for mice in the control and IDPN groups. Finally, the correlations between the scores of behavior tests and the amplitude or latency of cVEMP were determined with Spearman's rank correlation coefficient. Two-tailed Student's t test and Welch's t test were used to determine a significant difference between the two groups. A difference with p < 0.05 was considered to indicate statistical significance. RESULTS: After oral administration of IDPN at 28 mmol/kg, scores of the rotarod, beam, and air-righting reflex tests in the IDPN group were significantly lower than those in the control group. The numbers of hair cells in the saccule, utricle, and cupula were decreased in the IDPN group. cVEMP in the IDPN group was significantly decreased in amplitude and increased in latency compared to those in the control group. cVEMP amplitude had significant correlations with the numbers of hair cells as well as scores for all of the behavior tests in mice. CONCLUSIONS This study demonstrated impaired cVEMP and correlations of cVEMP with imbalance determined by behavior tests in a mouse model of vestibular disorder.
Animals ; Behavior, Animal ; drug effects ; physiology ; Disease Models, Animal ; Hair Cells, Vestibular ; pathology ; Male ; Mice ; Mice, Inbred ICR ; Nitriles ; adverse effects ; Postural Balance ; drug effects ; physiology ; Saccule and Utricle ; pathology ; Sensation Disorders ; chemically induced ; physiopathology ; Vestibular Diseases ; chemically induced ; diagnosis ; pathology ; physiopathology ; Vestibular Evoked Myogenic Potentials ; drug effects ; physiology ; Vestibular Function Tests