Rapid Subjective Vertigo and Psychological Improvement Post Gans Reposition Manoeuvre in 3 Days Duration

@#Benign paroxysmal positional vertigo (BPPV) is one of the most common vestibular disorder worldwide. Management of this pathology is not complicated and can be done in a short period of time with a proper diagnosis and treatment technique. There are several established methods for treatment of this disease includes Epley’s maneuver, Gans Canal Repositioning maneuver (Gans CRM) and others. This study reported a 38-year-old female presented with dizziness and vertigo, which is severely altered her daily activity, showed 90% improvement using the psychological effect assessment tool after three days of treatment with Gans CRM.

The Test-Retest Reliability of Subjective Visual Horizontal Testing:Comparisons between Solid and Dotted Line Images

The present study aimed to determine the test-retest reliability of subjective visual horizontal(SVH) testing when tested with solid and dotted line images. In this repeated measures study,36 healthy young Malaysian adults (mean age=23.3±2.3 years, 17 males and 19 females)were enrolled. All of them were healthy and had no hearing, vestibular, balance, or vision problems.The SVH angles were recorded from each participant in an upright body position using acomputerized device. They were asked to report their horizontality perception for solid and dottedline images (in the presence of a static black background). After 1 week, the SVH procedurewas repeated. The test-retest reliability of SVH was found to be good for both solid line[intraclass correlation (ICC)=0.80] and dotted line (ICC=0.78). As revealed by Bland-Altmanplots, for each visual image, the agreements of SVH between the two sessions were within theclinically accepted criteria (±2°). The SVH testing was found to be temporally reliable, which canbe clinically beneficial. Both solid and dotted lines in the SVH testing are reliable to be usedamong young adults. J Audiol Otol 2020;24(2):107-111

The effectiveness of psychological interventions amongtinnitus sufferers: A review

SUMMARY Introduction: The aim of this article was to review the types of psychological interventions for patients with tinnitus, professionals involved in giving the intervention, the effectiveness of each method of interventions and comparisons with non-psychological approaches in treating tinnitus. Materials and Methods: PubMed database searched. Results: Twenty one articles that employed randomized controlled trials design were included. Cognitive behavioural therapy (CBT) was the most common intervention conducted by the researchers. Clinical psychologists and trainee psychologists were the most professionals involved in the therapy. The length of therapy ranged from six weeks to three months. Discussion: Psychological interventions were more effective in reducing psychological impacts of tinnitus than non-psychological interventions such as the use of tinnitus maskers. Nevertheless, the combination of the treatments yielded more superior outcomes. Conclusion: A simplified version of psychological intervention that can be implemented by other clinical professionals should be developed to treat tinnitus holistically to overcome the shortage number of clinical psychologists.

Sensitivity and Specificity of Vestibular Evoked Myogenic Potential Elicited By Different Tone Bursts to Diagnose Peripheral Vestibular Disordered

Peripheral vestibular disorder (PVD) is serious and common. Clinically, giving an accurate diagnosis of PVD can be challenging. Vestibular evoked myogenic potential (VEMP) is an objective test to evaluate the integrity of vestibular organs, particularly saccule and/or inferior vestibular nerve. This study was performed to determine the sensitivity and specificity of VEMP using different stimuli. Fourty normal and 65 PVD subjects who fulfilled the inclusion criteria were recruited. While sitting comfortably, VEMP waveforms were recorded with active electrode on sternocleidomastoid muscle and negative electrode on upper forehead. Tone bursts (500, 750 and 1000 Hz) were delivered via headphones at 90 dBnHL and 5/s presentation rate. VEMP parameters for each stimulus (amplitude and latency of P1 and N1 peak) were analyzed accordingly. Receiver operating characteristic (ROC) was performed to determine the sensitivity and specificity of VEMP at different test frequencies. N1 amplitude of 750 Hz stimulus produced the most ideal sensitivity (65% on right and 63% on left) and specificity (83% on right and 78% on left). The importance of using a few tone bursts in VEMP test in order to minimize the false negative in cases might be encountered in clinics as the certain tone burst had inadequate sensitivity in detecting PVD cases. The 750 Hz stimulus produced the most ideal VEMP with adequate values of sensitivity and specificity, at least in this study.

Clinical use of Malay Version of Vertigo Symptom Scale (MVVSS) in Patients with Peripheral Vestibular Disorder (PVD)

Introduction:The Vertigo symptom scale (VSS) is a well established tool for the evaluation of vestibular disorders and the associated symptoms of autonomic arousal and somatosensation. By using a validated Malay version of vertigo symptom scale (MVVSS) questionnaire, the severity of the vertigo from patients’ perspective can be determined and rated. Before MVVSS can be applied clinically among Malaysians, it was of interest to determine its clinical value in identifying vestibular disorders. Method: Forty normal and 65 PVD subjects participated in this cross-sectional study. Normal subjects were recruited amongst Universiti Sains Malaysia (USM) staff and students who had no history of ear and vestibular disorders. Results: Mean total score of MVVSS in normal and PVD subjects were 13.9 ± 11.1 and 30.1 ± 20.9, respectively. When the total scores of normal and PVD group were compared, the Mann-Whitney U test showed that there was a significant difference between the two groups (p<0.05). This is consistent with previous studies. It was also of interest to see if subtypes of PVD [benign paroxymal positional vertigo (BPPV), Meniere’s disease, labyrinthitis and unknown] have different MVVSS results. However, analysis of variance (ANOVA) found no significant difference in term of outcomes of MVVSS among the different PVD pathologies. Using receiver operating characteristic curve (ROC) method, the sensitivity and specificity of MVVSS were 71% and 60%, respectively. Conclusion: MVVSS is able to discriminate clinically among the normal and PVD subjects. However, it is not a good indicator for differential diagnosis of PVD subtypes, at least in this study. Its sensitivity and specificity in clinical diagnosis are reasonably high. Perhaps a bigger sample size would be useful to further study the clinical usefulness of MVVSS.