Monitoring of vestibular function during cisplatin therapy

Cisplatin is considered an indispensable chemotherapeutic agent inspite of its known ototoxicity. There is no generally accepted vestibular monitoring protocol that is efficient, cost effective and suitable for patients treated with cisplatin. The aim of this work was to study the vestibulo-ocular reflex [VOR] changes in an attempt for early identification and prevention of vestibular toxicity in patients receiving cisplatin chemotherapy. The final study group consisted of 39 patients. The pretherapy vestibular tests included electronystagmography and rotary chair tests which should be within normal. The vestibular monitoring procedure was scheduled one week after each cisplatin dose. Patients were re-evaluated at approximately 3 months after termination of therapy to assess the possible delayed residual effects [delayed ototoxicity or recovery patients]. After the first cisplatin dose, seven patients revealed bilateral canal paresis, reduced total eye speed and reduction in VOR gain at 0.01 and 0.02Hz. With successive cisplatin doses, the VOR gain showed significant reduction at higher frequencies. Three months after termination of therapy canal paresis and total eye speeds showed no change in the measured values. On the other h and, VOR gain was relatively improved

Vestibular impairment and h and icap in visual preference patients

The objective of this work was to characterize the implications of vision preference derived from the sensory organization test of computerised dynamic posturography, in terms of impairment, disability and h and icap. This was a prospective assessment of 88 patients suffering from imbalance who denied experiencing any visually induced vertiginous symptoms. The evaluation of the vestibular system was done by a complete analysis of the caloric and rotary tests results. Disability and h and icap were determined by the Dizziness H and icap Inventory questionnaire [DHI]. It was found that the caloric test results in balance impaired patients were independent of the presence of vision preference. However, canal paresis was frequently recorded in patients having no visual preference. No differences were found in the results of rotary stimulation by means of sinusoidal harmonic acceleration test [SHA] at high velocity stimuli, in between patients with and without vision preference. Similarly, the responses in the DHI questionnaire for vestibular disability and h and icap were not able to differentiate either group of patients. Nevertheless, it was found that patients with vision preference tend to have poorer balance. Finally, vision preference in those subjects must be considered as a normal finding as this represents a normal CNS compensatory strategy in those subjects to substitute the impaired vestibular system by the visual system to control balance