Clinical features of multiple canal involvement in benign paroxysmal positional vertigo / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To describe a series of patients with multiple canal involvement in benign paroxysmal positional vertigo (BPPV), with respect to diagnosis and management.</p><p><b>METHODS</b>Ninety-five individuals with symptoms of BPPV and positional nystagmus were included in this study. The diagnosis was based on a history of brief episodes of vertigo and the presence of multiple positional nystagmus as confirmed by video-oculographic examination. Patients were treated by means of different particle repositioning manoeuvres according to the affected canal.</p><p><b>RESULTS</b>Ninety-five patients showed multiple positional nystagmus during the examination corresponding to simultaneous multi-canal BPPV. Fourteen patients (14.7%) had bilateral canal BPPV. Six patients had bilateral posterior canal. Six patients had bilateral horizontal canal, and two patients had bilateral anterior canal. Fifty-three patients (55.8%) had torsional, up-beating nystagmus with down-beating nystagmus, which suggested possible affected both of posterior and anterior canals. Twenty patients (21.1%) had torsional up-beating nystagmus and horizontal direction nystagmus, which suggested possible affected both of posterior and horizontal canals. Five patients had down-beating nystagmus with horizontal nystagmus, which suggested affected both of anterior and horizontal canals. Three patients had torsional up-beating with down-beating and horizontal nystagmus, which suggested possible affected multiple canals. Treatment given to the patients varied according to the canal affected, started with the canal that elicited a strong positional nystagmus and vertigo, and 93.7% (89/95) of patients were symptom free or improved.</p><p><b>CONCLUSIONS</b>It has been found that multi-canal BPPV is not a rate observation in clinic, and most of them affected posterior and anterior canals. Treatment of multi-canal BPPV can be effective using repositioning maneuver.</p>

Vestibular pathology associated with noise-induced inner ear impairment / 中国医学科学院学报

<p><b>OBJECTIVE</b>To evaluate the pathological status of the vestibular system associated with noise-induced inner ear impairment.</p><p><b>METHODS</b>Totally 68 patients with noise-induced hearing loss (NIHL) who presented with vestibular symptoms including vertigo, dizziness, and chronic disequilibrium were screened. All patients underwent a series of conventional vestibular function tests and vestibular autorotation test and the results were retrospectively reviewed and evaluated.</p><p><b>RESULTS</b>Sixty-eight (14.5%) patients with NIHL were identified among 469 patients with vertigo, dizziness, or imbalance. A pure tone hearing threshold of patients with vertigo and NIHL at 4000 Hz were between 30 dB HL and 80 dB HL with an average threshold of (46.7 +/- 17.6) dB HL in left ear and (37.3 +/- 16.7) dB HL in right ear. Patients with symmetrical hearing loss at 4000 Hz accounted for 41.7% and those with asymmetrical loss accounted for 58.3%. Vestibular pathologies included benign positional paroxysmal vertigo (45.7%), unilateral decreased caloric responses (20.0%), bilateral decreased caloric responses (26.7%), abnormal vestibulo-spinal reflex function (28.6%), vestibular function response hyperactivity (3.0%), and abnormal vestibulo-ocular reflex presentation at high frequencies (97.0%).</p><p><b>CONCLUSIONS</b>Loud acoustic stimulation not only damages the cochlea but also causes clear functional impairment to the vestibular end organs. Although the vestibular pathology is not correlated with the severity of the hearing loss, it correlates with the subjective symptoms of the vestibular system.</p>

Diagnosis and therapy for benign paroxysmal positional vertigo of the anterior semicircular canal / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To analyse the video-oculographic findings of positional tests and evaluate the efficacy of canalith repositioning procedure (CRP) in patients with paroxysmal positional vertigo ( BPPV) of the anterior semicircular canal (ASC).</p><p><b>METHODS</b>A retrospective study of 31 patients with ASC BPPV. Then the CRP was performed.</p><p><b>RESULTS</b>Twenty-two individuals (70.97%) presented a unilateral positional nystagmus during the Dix-Hallpike test, in 17 individuals had torsional nystagmus component, 5 individuals only had pure positional down beat nystagmus. Nine patients presented bilateral positional nystagmus, 7 individuals had torsional component positional nystagmus, in 2 patients the direction of the torsional component were the same during right and left Dix-Hallpike test, in 4 patients the torsional component were concurrent with positional down beat nystagmus but the direction could not be ascertained clinically, in 2 patients had pure positional down beat nystagmus. Nineteen patients (61.29%) had unilateral lesion, 11 patients had the left ASC BPPV, 8 patients had right ASC BPPV. Eleven patients had with both ASC and PSC BPPV in the ipsilateral. Twenty-one patients (67.74%) were cured, 29 patients (93.55%) were improved, 2 (6.45%) patients were inefficacy. CRP effectively resolved the nystagmus and vertigo in 14 patients (45.16%) when applied only once, The average number of CRP was 1.7 times, there were 5 patients recurrence during the follow-up.</p><p><b>CONCLUSIONS</b>ASC BPPV was not a common condition. The torsional nystagmus component of ASC BPPV might be weak during the Dix-Hallpike test. The positional nystagmus of ASC BPPV was triggered bilaterally. Based on these findings, CRP could be one of the most effective treatment methods for ASC BPPV.</p>

Functional localization of vestibular cerebral representations in human using functional magnetic resonance imaging / 中华耳鼻咽喉头颈外科杂志

<p><b>OBJECTIVE</b>To study human vestibular cerebral representations by combining right-sided ice-water stimulation at 0 degree C with blood oxygenation level dependent functional magnetic resonance imaging (BOLD-fMRI) and to evaluate the value of this method in the functional localization of human vestibular cortex.</p><p><b>METHODS</b>Twenty right-handed volunteers (12 men and 8 women) received unilateral irrigation of the right external auditory meatu for 15 s with 15 ml of water at 0 degrees C during fMRI in complete darkness. The functional imaging of brain cortex was acquired with a 1.5-T MRI scanner (Signa Infinity Twin + Excite; General Electric Co., USA). The successive functional images from each subject were analyzed as a group with statistical parametric mapping software (SPM 99).</p><p><b>RESULTS</b>Ultimately, data obtained from 17 subjects were analyzed (3 subjects were eliminated from data because of head movement exceeding 2 mm). The group analysis showed bilateral (particularly left-sided) cortical activation, associated with caloric stimulus involving in temporoparietal junction extending into the posterior insula, supramarginal gyrus in the inferior parietal lobe, precuneus, supplementary motor area (SMA), the ventrolateral portion of the occipital lobe, cuneus and lingual gyrus, superior temporal gyrus and cingular cortex.</p><p><b>CONCLUSIONS</b>Ice-water stimulation at 0 degree C in fMRI reveals a widespread cortical network involved in vestibular signal processing in human. As the functional localization of vestibular cortex could be determined precisely, ice-water stimulation at 0 degree C in fMRI would hold great promise as a sensitive and reproducible tool for the research in human vestibular cortex.</p>

Study on the causes and risk factors on vertigo and balance disorders in 118 elderly patients / 中华流行病学杂志

<p><b>OBJECTIVE</b>To understand the various factors causing vertigo and balance disorders in the elderly.</p><p><b>METHODS</b>118 elderly patients (aged equal or older than 60 years of age) with vertigo or balance disorders were retrospectively analyzed through clinical symptoms, audio-vestibular function tests, X-ray, CT scan or MRI in cervical vertebras, brain and inner ears, ultrasonography, transcranial doppler (TCD) or magnetic resonance angiography (MRA) in blood vessels on head and neck.</p><p><b>RESULTS</b>Of 118 patients, 70 (23%) of them suffered perip heral vestibular disorders while 29 (58%) having cerebral vertigo or dizzness, leaving 19 cases (16%) as unclassified.</p><p><b>CONCLUSION</b>For elderly patients, vertigo and balance disorders were commonly caused by many kinds of peripheral and cerebral vestibular pathological disfunctions while the functional weakness of vestibular organs and systems affected by the physiological process of ageing and different concommitant diseases as well as environmental, psychogenic factors should also be considered.</p>