Editor’s choice :  Vestibular Issues & CI!

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VIN, Vestibular Neuritis & Relevance...?

This study from south Korea (Park, Shin, Lim & Shin, Audiol Neurotol 2008;13:182-186) added to the confusing spectrum of ORL literature on vibration induced nystagmus (VIN) by asserting that VIN has lesion localizing advantage in vestibular neuritis, but not in Meniere’s disease

January 28 2008

Vol 7, No 8

Otorhinolaryngology news

In this issue

· Vestibular Issue & CI…?

· VIN, Vestibular Neuritis & Relevance…?

· CT in SNHL—Any Relevance..?

· Case of The week

Journal Watch: Toward Feasible, Valid, and Reliable Video-Based Assessments of Technical Surgical Skills in the Operating Room, Aggarwal, Rajesh et al, 2008

 

 1. Home page of otolaryngologyinafrica.net re-designed for accessibility

2.    A new forum for ENT patients and clinicians launched, For Details, click HERE

3. Receive the latest newsletter info. On your cell phone. Simply point your phone browser HERE

4. Papers delivered at the 16th ORLSON Scientific Meeting held November 21—24, 2007 can be viewed  HERE

5. Forum topic : Chloramphenicol Ototoxicity. Read the preview HERE

6. Blog Topic: Cell phone and The Ear

 Till Next Week,

 Biodun

CT in SNHL—Any relevance...?

ABSTRACT: 

OBJECTIVE: To investigate whether normative inner ear measurements can assist in the evaluation of sensorineural hearing loss (SNHL). DESIGN: Retrospective cohort review. SETTING: A tertiary care hospital. PATIENTS: Computed tomography or magnetic resonance imaging was performed on 188 ears with SNHL and 220 ears without SNHL (204 children) between 2001 and 2004. INTERVENTION: Two readers measured the basal turn of cochlea (BTC) lumen, lateral semicircular canal (LSCC) bony island width, superior semicircular canal (SSCC) bony island width, and cochlear height (CH). MAIN OUTCOME MEASURES: A t test was performed comparing measurements in patients with and without SNHL. Interobserver variability was characterized by intraclass correlation coefficients and Bland-Altman plots. RESULTS: The t test results demonstrated no statistically significant differences between inner ear measurements in those with and without SNHL. The intraclass correlation coefficients for BTC lumen, CH, LSCC bony island width, and SSCC bony island width measurements was 0.612, 0.632, 0.869, and 0.912, respectively. Bland-Altman plots revealed systematic biases of 1%, 8%, 10%, and 21% for the BTC lumen, SSCC bony island width, LSCC bony island width, and CH measurements, respectively. CONCLUSIONS: Inner ear measurements in children with and without SNHL are not statistically different. Moreover, the measurements are difficult to interpret because while they demonstrate good reproducibility, they are susceptible to systematic biases. However, use of inner ear measurements is more sensitive in identifying vestibulocochlear dysplasias and should be considered to complement visual analysis.

 

 

Abstract:  OBJECTIVES: To determine the incidence of static and dynamic balance dysfunction in a group of children with profound sensorineural hearing loss receiving a cochlear implant and to assess the impact of cochlear implant activation on equilibrium. DESIGN: Observational cross-sectional study of children with single-sided implants, tested under 2 conditions: (1) implant on and (2) implant off in a random order. SETTING: Ambulatory setting within an academic, tertiary care children's hospital. PARTICIPANTS: Forty-one children (ages 4-17 years) with cochlear implants comprised the study group. Fourteen children with normal hearing served as controls. INTERVENTION: All participants performed a standardized test of static and dynamic balance function (Bruininks-Oseretsky Test of Motor Proficiency 2 [BOT2], balance subset). Children with implants performed the BOT2 under the 2 randomized conditions. MAIN OUTCOME MEASURES: Overall performance on the balance subset of the BOT2 and the influence of implant activation on performance. RESULTS: The mean (SD) age-adjusted scale score for our control group was 17 (5) points (95% confidence interval [CI], 14-20), which was not significantly different (P = .15) from the published age-adjusted mean for the BOT2 balance subset (15 [5] points). The group that had undergone implantation, however, performed significantly more poorly (12 [ 6] points; 95% CI, 10-14) than either the control group or the published test mean (P = .004). Children with implants performed better with their implants on than with their implants off (mean [SD] difference, 1.3 [2.7] points; 95% CI, 0.3-2.3; P = .01). CONCLUSIONS: Large differences exist in the balance ability of children with sensorineural hearing loss requiring cochlear implantation compared with age-matched controls. Implant activation, however, conferred a slight advantage in accomplishing balance-related tasks. These results substantiate the need to further quantify the baseline vestibular dysfunction of our study population of children with cochlear implants, as well as the impact of implant activation on the input and output of the vestibular system

© Copyright Dr 'Biodun Olusesi,  2005 - 2008

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Abstract: The aims of the study were to characterize the vibration-induced nystagmus (VIN) in patients with unilateral vestibular neuritis (VN) and Ménière's disease (MD), and to clarify the clinical significance of VIN by comparing it with caloric results in patients with VN and MD. We recorded eye movements from 22 VN patients and 24 MD patients using unilateral 100-Hz vibration on the mastoid bone. Eye movements were analyzed and the maximum value of slow-phase eye velocity was obtained during vibration on each mastoid. The average value of slow-phase velocities was calculated. Spontaneous nystagmus was subtracted from the slow-phase velocity, whenever it was present. A canal paresis (CP) greater than 25% was considered pathologic. All but one VN patient showed pathologic CP with the direction of the slow-phase eye movement of VIN toward the lesioned side. Fifteen (63%) out of 24 MD patients showed VIN with the slow-phase eye movement directed to the lesioned side. Pathologic CP was present in 9 (38%) out of 24 MD patients and 8 of them showed slow-phase eye movements of VIN directed to the lesioned side. There were also 8 other MD patients who showed slow-phase eye movement of VIN directed to the intact side. Among them, 3 patients with the slow-phase eye movement more than 5°/s showed CP on the intact side. The amplitude of slow-phase eye velocity showed a significant correlation with CP in patients with either VN or MD. There was no significant difference in the slope of the regression lines between the VN and MD groups. Our results suggest that VIN may probe imbalance of canal responses to low-frequency stimulation similar to the caloric test. It also shows that VIN can help in detecting vestibular imbalance using a stimulation mechanism different from the caloric test. The VIN test can be helpful in determining the lesioned side in patients with VN; however, it has some limitations in localizing the lesioned side in patients with MD.