Age predicts the absence of caloric-induced vertigo

Introduction

The absence of vertigo during the caloric test, despite a robust response, has been suggested to represent a central vestibular system phenomenon. The purpose of this investigation was to determine the prevalence of absent caloric-induced vertigo perception in an unselected group of patients and to assess possible predicting variables.

Vestibular evoked myogenic potentials in benign paroxysmal positional vertigo and Meniere’s disease

The objective was to investigate vestibular evoked myogenic potentials (VEMP) in benign paroxysmal positional vertigo (BPPV) and Meniere’s disease, and to determine if this type of testing is valuable for assessing the vestibular system. A prospective controlled clinical study was designed in a tertiary referral center setting. The 62 participants included 17 healthy controls and 45 other subjects selected from patients who presented with the complaint of vertigo (25 diagnosed with BPPV and 20 diagnosed with Meniere’s disease). The main outcome measures of VEMP were recorded in all subjects and findings in each patient group were compared with control findings. The VEMP for the 30 affected ears in the 25 BPPV patients revealed prolonged latencies in eight ears and decreased amplitude in one ear (nine abnormal ears; 30% of total). The recordings for the 20 affected ears in the Meniere’s disease patients revealed four ears with no response, six ears with prolonged latencies (ten abnormal ears; 50% of total). Only two (5.9%) of the 34 control ears had abnormal VEMP. The rate of VEMP abnormalities in the control ears was significantly lower than the corresponding rates in the affected BPPV ears and the affected Meniere’s ears that were studied (P=0.012 and P<0.001, respectively). The results suggest that testing of VEMP is a promising method for diagnosing and following patients with BPPV paroxysmal positional vertigo and Meniere’s disease. Further investigations with this method in other neurotologic pathologies might also be informative.     

眩晕头晕主诉患者中良性阵发性位置性眩晕的占比分析

研究分析良性阵发性位置性眩晕（BPPV）在眩晕头晕主诉患者的占比。     

Lidocaine for the relief of incapacitating tinnitus

Tinnitus is tolerated by most patients, but in others it is enough of a problem that they seek medical attention. Results of treatment have been mixed. On occasion, a patient is so distressed by tinnitus that he or she is incapacitated and seeks help in an emergency department. We describe what we believe is the first reported case of recurrent incapacitating tinnitus secondary to inner ear tertiary syphilis in which a patient successfully responded to emergency treatment with intravenous lidocaine.     

Dyscalculia in patients with vertigo.

This paper reports a hitherto undescribed relationship between vertigo of central origin and dyscalculia. Subjects with vertigo skipped and displaced decades when counting backwards by two. The error is not recognized when presented visually. The subjects also display decrements in ability to do mental arithmetic and in central auditory processing. The results are discussed in light of the relationship between the central vestibular/auditory system and structures involved in higher cognitive function. The relationship between balance disorders and children with learning disabilities is also examined.     

Gait analysis in patients with vertigo

Summary Gait analysis utilizing foot switches and electromyography of antigravity muscles was performed on 31 patients with vertigo. Twenty-one cases had peripheral vestibular lesions (such as vestibular neuronitis, Meniere's disease, traumatic labyrinthitis, small acoustic neuroma), and 10 cases had central lesions (such as spinocerebellar degeneration, pontine glioma, cerebellar tumor and giant acoustic neuroma). Parameters employed for analysis included time from heel strike to forefoot strike (HA-I), time from heel off to forefoot off (HA-II) as well as durations of stance, swing and (initial) double supports (DS). Fourteen healthy adults served as controls. The overall incidence of abnormality was highest in HA-1, followed by stance and swing. The occurrence of abnormalities in stance, swing and DS was higher in the central lesion when compared with the group having peripheral lesions. The significance and usefulness of gait analysis for dizzy patients are discussed.     

1888例眩晕患者生活质量的调查分析

目的 评估1888例眩晕患者的生活质量,探讨其临床意义.方法 采用患者自评的方法 对1888例眩晕患者(包括良性阵发性位置性眩晕、梅尼埃病和偏头痛性眩晕)的生活质量进行评估.结果 良性阵发性位置性眩晕、梅尼埃病和偏头痛性眩晕患者中,抑郁症状的发生率分别为31.7%、21.5%和59.5%,焦虑症状的发生率分别为17.5%、33.2%和31.8%.眩晕的发生频度和严重程度与日常活动和生活质量有关.结论 眩晕对患者有相当严重的负面影响,医护人员应为患者提供良好的心理疏导,减轻眩晕患者的心理负担.     

眩晕症患者跌倒发作的病因分析

目的分析眩晕症患者跌倒发作的病因,为临床诊疗提供借鉴。方法回顾性分析眩晕门诊10年内跌倒发作的眩晕症的病因分布,年龄趋势及就诊规律。结果眩晕症患者跌倒发作共35例,梅尼埃病耳石危象16例,无一在首次就诊时被问及;良性阵发性位置性眩晕跌倒发作7例;梅尼埃病与血管迷走神经性晕厥共患5例;继发于心源性晕厥后的BPPV 7例。随着年龄的增长,跌倒的发生率呈增长趋势。结论眩晕症患者跌倒发作的发生率被低估,病史采集不全是主要原因;难治性BPPV可能为晕厥后继发,诊疗过程需要关注患者心血管病史及相关检查;关注耳源性眩晕与晕厥的共患,进行及时正确的诊断与处理。     

Chronic nasal obstruction causes daytime sleepiness and decreased quality of life even in the absence of snoring

BACKGROUND: There has been a growing awareness that nasal obstruction may impair various daily and social activities. We performed a questionnaire survey in a working population to clarify the contribution made by snoring concomitant with nasal obstruction to daytime sleepiness and quality of life (QOL). METHODS: Seven thousand nine hundred eighty daytime workers were asked to complete questionnaires, 7702 responded, and the data from 3442 subjects were finally analyzed. Nasal obstruction and snoring were graded into three and four categories, respectively. Daytime sleepiness and QOL were assessed by the Epworth Sleepiness Scale (ESS) and the Medical Outcomes Study 36-Item Short-Form Health Survey, respectively. RESULTS: Subjects with chronic nasal obstruction, even if snoring was absent, reported significantly higher ESS scores and lower QOL scores than control subjects, and the presence of habitual snoring had an additive influence on these changes. The ESS and mental QOL scores adjusted for age, sex, and body mass index showed the same tendency. CONCLUSION: Induction of sleep-disordered breathing (SDB) is a possible cause of excessive daytime sleepiness and impaired QOL in subjects with nasal obstruction. A variant of SDB such as silent upper respiratory resistance syndrome may participate in this phenomenon in the absence of snoring.     

前庭诱发肌源性电位对眩晕患者的诊断价值

目的通过记录、分析眩晕患者的前庭诱发肌源性电位(VEMP),了解眩晕患者的球囊功能。方法对15例梅尼埃病患者和16例突聋伴眩晕患者行VEMP检查,分析其VEMP的不同表现形式,并将该结果与冷热试验结果比较。结果正常双侧短纯音刺激p13波和n23波出现率为100%,30%梅尼埃病患者、50%突聋伴眩晕患者VEMP不能正常引出,VEMP患侧有3种表现形式：无反应,振幅正常,振幅低。结论VEMP检查有助于客观评价眩晕患者球囊功能。