Vestibular rehabilitation for migraine-associated dizziness

The purpose of this study was to investigate the effects of a vestibular rehabilitation program on patients with the diagnosis of migraine-associated dizziness. Subjects were placed in four groups as follows: idiopathic migraine-associated dizziness; idiopathic migraine-associated dizziness and associated benign positional vertigo; posttraumatic migraine-associated dizziness; and posttraumatic migraine-associated dizziness and benign positional vertigo. Vestibular rehabilitation therapy was administered to all patients. Criterion measurements included the dizziness handicap inventory, activities-specific balance confidence scale, computerized dynamic posturography performance, and dynamic gait index. After vestibular physical therapy, all subjects showed significant improvement in the dizziness handicap, activities-specific balance confidence, dynamic gait, and computerized dynamic posturography measures. Patients with migraine-associated dizziness can benefit from physical therapy intervention. The results of this study are important in considering the approach to vertiginous migraine patients with and without head injury.     

Audiometric findings in 34 patients with Waardenburg's syndrome.

The dominant hereditary form of deafness as part of Waardenburg's syndrome was found in 12 (35%) of 34 patients never previously described with Waardenburg's syndrome among 5 families in the Netherlands. Extensive audiometric examination could be performed in 11 patients, 5 patients with deafness on both sides and 6 patients with hearing deficiency on one side. The hearing loss could be divided into 4 types: (type I) (sub) total deafness on both sides; (type II) serious lack of hearing on both sides; (type III) (sub) total deafness on one side; (type IV) moderate hearing deficiency on one side, particularly in the low frequencies. An extensive review was made of the more than 1,000 patients with Waardenburg's syndrome described in the literature. This revealed that deafness in both ears (the most serious expression of the syndrome) occurred in about 25% of the patients with Waardenburg's syndrome type I (including dystopia canthorum) and in 50% of the patients with Waardenburg's syndrome type II (without dystopia canthorum). This striking difference is connected with the close relationship between deafness and pigmentary disorders.     

Audiometric findings in patients with acoustic neuroma

OBJECTIVE: Hearing loss remains the most common symptom associated with acoustic neuroma. This study documents the audiometric findings from 721 acoustic neuroma procedures. STUDY DESIGN: This was a retrospective study. The preoperative audiometric data were compiled and were analyzed by patient age, gender, tumor size, time of surgery, and neurofibromatosis Type 2 (NF 2). Postoperative audiometric data were arranged and compiled in the same way. The hearing classification proposed by the AAO-HNS was applied to all preoperative and postoperative cases. SETTING: Tertiary referral center. PATIENTS: Surgically confirmed acoustic neuroma patients who had not previously received surgical or radiosurgical therapy. Patients underwent surgery by the retrosigmoid approach. INTERVENTION: Surgical removal of an acoustic neuroma. MAIN OUTCOME RESULT: Provision of pure tone and speech data from a group of acoustic neuroma patients, including application of the recently introduced and accepted AAO-HNS hearing classification system. RESULTS: Preoperative audiometric data were obtained from 694 of 721 patients (96%), of whom 619 had measurable hearing. Postoperative audiometry was performed on 606 patients; 152 had usable data. The combined preoperative audiometric data revealed a high frequency sensorineural hearing loss. Word recognition was servicable. The postoperative pure tones and word recognition scores were worse than preoperative scores. Age, gender, tumor size, and time of surgery had some impact on the preoperative hearing and the postoperative result; NF 2 did not. CONCLUSIONS: The study confirms that hearing alteration is almost universal in acoustic neuroma patients. Hearing preservation is possible in a significant number of cases; however, the postoperative auditory function tends to be worse.     

Neuro-otological findings in patients with migraine- and nonmigraine-related dizziness

This study presents the neuro-otological findings of 523 patients attending a tertiary vestibular clinic with migraine- and nonmigraine-related dizziness. Subjects were categorized into one of 4 groups, definite migrainous vertigo, probable migrainous vertigo, vestibular disorder coexisting with migraine and nonmigraine-related dizziness. No notable relationship was found between the numbers of abnormal findings between the groups for the majority of the neuro-otological tests. However, there was a significant trend in emetic response to caloric testing. The definite migrainous vertigo group were at least 4 times more likely to be nauseous to caloric testing than any other migraine category. This difference was independent of the magnitude of caloric responses between the emetic migraine groups. While further investigation is required, this study has potentially identified that nauseous/emetic response to caloric stimulation may be a distinguishing factor between migrainous vertigo and other vestibular disorders including those with a coexisting history of migraine.     

Electronystagmographic findings among 127 dizzy patients: correlation with the aetiology of dizziness

Electronystagmography (ENG) was performed on 127 dizzy patients and the findings were compared with the diagnosis obtained with a comprehensive neurological test battery. ENG was found to be abnormal in 49 (39%) of the patients: 19 with unilateral vestibular hyporeactivity, eight with directional preponderance, 12 with spontaneous or undirectional positional nystagmus, eight with abnormal smooth pursuit, and 13 with other abnormalities. Among the patients with abnormal ENGs, established central nervous system lesions were found in 28 cases (19 of these infratentorial lesions); nine peripheral vestibular lesions and five undefined vestibular lesions were found. Patients with normal ENGs showed fewer peripheral vestibular lesions and more dizziness of psychogenic aetiology. Almost half the patients with infratentorial lesions had normal ENGs. Patients with rotatory vertigo had fewer ENG abnormalities than those with other types of dizziness. These results suggest that ENG alone is of limited value in the diagnosis of dizziness. A comprehensive test battery is needed to establish the diagnosis.     

Audiometric findings in children with chronic suppurative otitis media without cholesteatoma

Chronic suppurative otitis media without cholesteatoma (CSOMWC) is usually associated with an increase in air conduction thresholds. However, only a few investigations reported on loss of cochlear function in the pediatric population. We undertook a prospective study in order to further delineate air and bone conduction levels in children with CSOMWC and the possible relationship between sensorineural hearing loss (SNHL) and other clinical characteristics that might reflect the extent of disease. Eighty-seven children were enrolled, 40 of which had bilateral disease. Hence, the total number of diseased ears tested was 127. Audiometric studies were performed three days after achieving a ‘dry’ ear following medical treatment. We found no statistically significant differences between the bone conduction threshold tested in ears with CSOMWC and control ears. This was also the case in 47 children with unilateral disease when cochlear function was investigated in the diseased and uninvolved ear in the same patient. Clinical correlation showed no association between age, sex, duration of otorrhea and presence of granulation or polyps and the degree of cochlear loss. Our study shows that CSOMWC in children has little effect on cochlear function.     

Cisplatin-induced ototoxicity: Audiometric findings and experimental cochlear pathology

Summary Twenty-four (48%) out of a group of 50 patients treated with one to three single doses of cisplatin compound (cis-DDP), at a dosage of 60 mg/ m² body surface, were found to have deterioration of post-treatment pure tone audiometric threshold levels. Statistical analysis of pre- and post-treatment hearing losses by means of the paired t-test, however, did not show any significant hearing loss associated with cis-DDP-toxicity, nor could hearing loss following treatment be correlated to ages of the patients, pre-treatment hearing impairments, specific frequencies, or the number of treatment courses given. In contrast, cochlear damage was studied in the guinea pig model by daily administration of high cumulative doses of cis-DDP, and was found to be dose-dependent and selectively restricted to the outer hair cells of the inner ear and corresponding nerve fibers. Hair cell degeneration was most severe in the basal turn of the cochlea, and progressed in an apical direction so that the cells in the first row were the most affected.     

Electronystagmogrpahic findings among 127 dizzy patients: correlation wiht the aetiology of dizziness

Electronystagmography (ENG) was performed on 127 dizzy patients and the findings were compared with the diagnosis obtained with a comprehensive neurological test battery. ENG was found to be abnormal in 49 (39%) of the patients: 19 with unilateral vestibular hyporeactivity, eight with directional preponderance, 12 with spontaneous or unidirectional positional nystagmus, eight with abnormal smooth pursuit, and 13 with other abnormalities. Among the patients with abnormal ENGs, established central nervous system lesions were found in 28 cases (19 of these infratentorial lesions); nine peripheral vestibular lesions and five undefined vestibular lesions were found. Patients with normal ENGs showed fewer peripheral vestibular lesions and more dizziness of psychogenic aetiology. Almost half the patients with infratentorial lesions had normal ENGs. Patients with roatory vertigo had fewer ENG abnormalities than those with other types of dizziness.     

Middle ear pressure in patients with dizziness

The middle ear pressure was analyzed in 112 patients with dizziness. In 37 patients with Meniere's disease, the middle ear pressure on the low-pressure side was significantly lower, the middle ear pressure difference (between the high and low sides) was significantly larger, and the maximum compliance on the low-compliance side was significantly lower than in normal volunteers. The middle ear pressure difference was significantly larger during periods of dizziness or recurrent dizziness than at the time of remission. In patients with Meniere's disease, a middle ear pressure difference of more than 50 decapascals was significantly more common among those with abnormal blood gas levels than among those with normal blood gas levels. In 27 patients with cervical vertigo and 15 patients with vertebrobasilar insufficiency, the middle ear pressure difference was also significantly larger than in normal volunteers. These results suggest that the middle ear pressure difference might be closely related to dizziness in Meniere's disease and less closely related in cervical vertigo or vertebrobasilar insufficiency. The middle ear pressure difference might also be related to abnormal blood gas levels in patients with dizziness.     

Clinical characteristics of patients with persistent postural-perceptual dizziness

IntroductionPersistent postural-perceptual dizziness is the dizziness that lasts for over three months with no clinical explanation for its persistence. The patient's motor response pattern presents changes and most patients manifest significant anxiety.ObjectiveTo evaluate the clinical characteristics of patients with persistent postural and perceptual dizziness.Methodsstatistical analysis of clinical aspects of patients with persistent postural-perceptual dizziness.Results81 patients, average age: 50.06 ± 12.16 years; female/male ratio: 5.7/1; main reasons for dizziness: visual stimuli (74%), body movements (52%), and sleep deprivation (38%). The most prevalent comorbidities were hypercholesterolemia (31%), migraine headaches (26%), carbohydrate metabolism disorders (22%) and cervical syndrome (21%). DHI, State-Trait Anxiety Inventory – Trait, Beck Depression Inventory, and Hospital Anxiety and Depression Scale questionnaires were statistically different (p < 0.05) when compared to controls. 68% demonstrated clinical improvement after treatment with serotonin reuptake inhibitors.ConclusionPersistent postural-perceptual dizziness affects more women than men, with a high associated prevalence of metabolic disorders and migraine. Questionnaires help to identify the predisposition to persistent postural-perceptual dizziness. The prognosis is good with adequate treatment.