Subjective Visual Vertical and Vestibular Evoked Myogenic Potential in Meniere's disease,

Abstract Objective To evaluate otolith function by comparing the findings of the Subjective Visual Vertical, the cervical Vestibular Evoked Myogenic Potential and the ocular Vestibular Evoked Myogenic Potential tests in patients in the inter-crisis period of unilateral definite Meniere's disease. Methods The sample consisted of an experimental group (n = 22; 10 men and 12 women, mean age 47.32 ± 12.82 years) with definite unilateral Meniere's disease and a control group (n = 14; 5 men and 9 women, with a mean age of 41.64 ± 13.45 years). They all underwent vestibular evaluation by means of Subjective Visual Vertical with the bucket method and, cervical and ocular Vestibular Evoked Myogenic Potential tests. The data were collected and subjected to statistical analysis. Results The results of the comparison of the Subjective Visual Vertical, the cervical Vestibular Evoked Myogenic Potential, the ocular Vestibular Evoked Myogenic Potential and, the association of cervical Vestibular Evoked Myogenic Potential with the ocular Vestibular Evoked Myogenic Potential showed no significant difference, indicating concordance among the tests. Conclusion The identified abnormalities and the concordance between the combined proportion of the Subjective Visual Vertical, the cervical Vestibular Evoked Myogenic Potential and the ocular Vestibular Evoked Myogenic Potential findings indicate that the association of these three tests contributes to the identification of sustained and transient otolith dysfunction in the inter-crisis of unilateral definite Meniere's disease. Level of evidence 2.

Comparative study of quantitative methods based on intravenous enhancement of 3D-FLAIR sequence for evaluation of endolymphatic hydrops / 中华放射学杂志

Objective:To compare the diagnostic value of three quantitative evaluation methods based on three-dimensional rapid fluid attenuation inversion recovery sequence (3D-FLAIR) vein-enhanced labyrinth images in endolymphatic hydrops.Methods:From October 2017 to April 2019, a retrospective study was conducted on 86 patients with unilateral otogenic vertigo who were admitted to Beijing Tongren Hospital, Capital Medical University. MRI was performed 8 h after the single-dose Gd-DTPA intravenously injection in all patients. Three evaluation methods were used to calculate the ratio of the endolymphatic area to the total lymphatic area, the ratio of the saccule to utricle area, and the ratio of the endolymphatic volume to the total lymphatic volume, respectively. The paired t test was used to compare the three ratios between the affected and healthy ears. With clinical diagnosis as the gold standard, the receiver operating characteristic (ROC) curve analysis was used to analyze the efficacy of three methods in diagnosing endolymphatic hydrops. Results:Totally 65 cases were finally diagnosed endolymphatic hydrops clinically. There were statistically significant differences of all the 3 ratios between the affected and healthy ears ( t=9.93, 7.22, 8.20, all P<0.001). The ROC curve showed that the area under the curve (AUC) of endolymph/total lymph area ratio, saccule/utricle area ratio, endolymph/total lymph volume ratio for diagnosis of endolymphatic hydrops were 0.882, 0.768, 0.884 (all P<0.001). And there were no significant differences between each paired AUCs (all P>0.05). Conclusions:All three methods of endolymph/total lymph area ratio, saccule/utricle area ratio, endolymph/total lymph volume ratio can quantitatively evaluate endolymphatic hydrops. The endolymphatic/total lymphatic area ratio method is still the most convenient method at present.

Análise das respostas do VEMP cervical e ocular em indivíduos hígidos / Analysis of cervical and ocular VEMP responses in healthy individuals / Análisis de las respuestas VEMP cervicales y oculares en individuos sanos

Introdução: os potenciais evocados miogênicos vestibulares (VEMP) são respostas eletrofisiológicas que conseguem fornecer informações dos órgãos otolíticos sáculo, utrículo e do nervo vestibular. O VEMP é um exame complementar à avaliação vestibular, consistindo num exame rápido, de fácil aplicação e objetivo. Objetivo: analisar os parâmetros de latência, amplitude, limiar e índice de assimetria das respostas do VEMP cervical (cVEMP) e ocular (oVEMP) de indivíduos sem queixas vestibulares. Métodos: estudo transversal realizado com 53 indivíduos de ambos os sexos, sem queixas auditivas e vestibulares. Resultados: encontrou-se simetria de respostas nas latências, amplitudes e limiares de respostas do exame cVEMP. Entretanto, verificou-se diferença entre orelhas da latência P15 do exame oVEMP, sendo maior à direita no sexo feminino. Conclusão: Encontrou-se simetria nas respostas de todos os parâmetros avaliados do cVEMP. Houve assimetria apenas na latência de P15 do oVEMP no sexo feminino. Os limiares de resposta encontrados nos exames cVEMP e oVEMP foram iguais ou maiores que 75 dBNA.

Introduction: Vestibular evoked myogenic potentials (VEMP) are electrophysiological responses that can provide information on the otolithic organs saccule, utricle and of the vestibular nerve. VEMP is a complementary exam to the vestibular assessment; it is a quick exam, easy to apply and objective. Purpose: to analyze the parameters of latency, amplitude, threshold and asymmetry index of the cervical (cVEMP) and ocular VEMP (oVEMP) responses of individuals without vestibular complaints. Methods: cross-sectional study carried out with 53 individuals of both genders without hearing and vestibular complaints. Results: response symmetry was found in the latencies, amplitudes and thresholds of cVEMP test responses. However, there was a difference between the ears of the P15 latency of the oVEMP exam, and this was greater on the right ear in females. Conclusion: symmetry was found in the responses of all cVEMP evaluated parameters. There was asymmetry in oVEMP P15 latency only in female patients. The response thresholds found in the cVEMP and oVEMP tests were equal or greater than 75 dBHL.

Introducción: los potenciales miogénicos evocados vestibulares (VEMP) son respuestas electrofisiológicas que pueden proporcionar información sobre los órganos otolíticos el sáculo, el utrículo y el nervio vestibular. El VEMP es un examen complementario a la evaluación vestibular; es un examen rápido, fácil de aplicar y objetivo. Objetivo: analizar los parámetros de latencia, amplitud, umbral e índice de asimetría de las respuestas VEMP cervical (cVEMP) y ocular (oVEMP) de individuos sin quejas vestibulares. Métodos: estudio transversal realizado con 53 individuos de ambos sexos, sin quejas auditivas y vestibulares. Resultados: Se encontró simetría de respuestas en las latencias, amplitudes y umbrales de respuestas en el examen cVEMP. Sin embargo, hubo una diferencia entre los oídos de la latencia P15 del examen oVEMP, siendo mayor a la derecha en el sexo femenino . Conclusión: se encontró simetría en las respuestas de todos los parámetros evaluados de cVEMP. Hubo asimetría solo en la latencia P15 de oVEMP en el sexo femenino. Los umbrales de respuesta encontrados en las pruebas cVEMP y oVEMP fueron iguales o superiores a 75 dBHL.

Comparação das respostas do VEMP cervical e ocular em indivíduos com e sem doenças otoneurológicas / Comparison of cervical and ocular VEMP responses in individuals with and without otoneurological diseases / Comparación de respuestas VEMP cervicales y oculares en individuos con y sin enfermedades otoneurológicas

Introdução: a avaliação vestibular é realizada tradicionalmente por meio da prova calórica para avaliação do labirinto em indivíduos com tonturas, porém este exame não avalia toda a via vestibular. Os potenciais evocados miogênicos vestibulares (VEMP) consistem em um exame de rápida execução, considerado método de escolha para avaliação dos órgãos otolíticos e do nervo vestibular. Objetivo: analisar as respostas do exame VEMP cervical (cVEMP) e ocular (oVEMP) em indivíduos com doenças vestibulares e compará-las àquelas obtidas em indivíduos de mesma faixa etária e sexo sem queixas de tontura pregressas e atuais. Métodos: Estudo observacional, transversal e analítico. Os participantes foram divididos em dois grupos: grupo com tontura (GT), composto por indivíduos com diversas doenças vestibulares e o grupo sem queixa de tontura (GC). Ambos os grupos foram submetidos à meatoscopia, ao VEMP cervical e ocular. Resultados: A amostra foi composta por 45 indivíduos com a idade entre 23 e 68 anos, sendo 27 indivíduos do grupo GC e 18 do grupo GT. No exame cVEMP as latências, amplitudes, índice de assimetria e o índice de assimetria corrigido foram iguais no GT quando comparado com o GC. No exame oVEMP encontrou-se a amplitude esquerda maior e a latência N10 menor estatisticamente no grupo GT quando comparado ao grupo GC. Dentre as doenças do grupo GT os indivíduos com deiscência de canal superior tiveram valores maiores na amplitude esquerda, o que pode ter interferido nos resultados. Conclusão: Não foram evidenciadas diferenças nas respostas do cVEMP entre os grupos neste estudo. Encontrou-se aumento da amplitude esquerda e o valor menor da latência N10 direita no grupo com tontura na análise do exame oVEMP. Acredita-se que a heterogeneidade de doenças vestibulares no grupo com tontura e o reduzido número de participantes em ambos os grupos tenham contribuído para esse desfecho.

Introduction: The vestibular assessment is traditionally carried out with the caloric test to evaluate the labyrinth in individuals with dizziness. However, this examination does not evaluate the entire vestibular pathway. The vestibular evoked myogenic potentials (VEMP) are a quick test, considered a choice method to assess the otolith organs and the vestibular nerve. Purpose: To analyze the responses of the cervical (cVEMP) and ocular VEMP (oVEMP) examinations in individuals with vestibular diseases and compare them with the results obtained in individuals of the same age group and gender without previous and current complaints of dizziness. Methods: In this observational, cross-sectional, analytical study, the participants were divided into two groups: the dizziness group (DG), composed of individuals with several vestibular diseases, and the group without complaints of dizziness (CG). Both groups underwent meatoscopy, and cervical and ocular VEMP. Results: The sample comprised 45 individuals aged 23 to 68 years ­ 27 individuals in the CG and 18 in the DG. In the cVEMP exam, the latencies, amplitudes, asymmetry index, and the corrected asymmetry index were the same in the GT when compared to the GC. In the cVEMP examination, the latencies, amplitudes, asymmetry index, and corrected asymmetry index were equal in the DG when compared with the CG. In the oVEMP examination, the left amplitude was statistically greater and the N10 latency, smaller in the DG when compared with the CG. Of the diseases in the DG, individuals with superior canal dehiscence had higher left amplitude values, which may have interfered with the results.Conclusion: There were no differences in cVEMP responses between the groups in this study. An increase in the left amplitude and the lower value in the right N10 latency were found in the DG in the analysis of the oVEMP examination. It is believed that the heterogeneity of vestibular diseases in the DG and the small number of participants in both groups have contributed to this outcome.

Introducción: La evaluación vestibular se lleva a cabo tradicionalmente a través de la prueba calórica para evaluar el laberinto en individuos con mareos, sin embargo, este examen no evalúa toda la vía vestibular. Los potenciales miogénicos evocados vestibulares (VEMP) consisten en una prueba de funcionamiento rápido, considerada el método de elección para evaluar los órganos otolíticos y el nervio vestibular. Objetivo: Analizar las respuestas del examen VEMP cervical y ocular en individuos con enfermedades vestibulares y compararlas con las obtenidas en individuos del mismo grupo de edad y sexo sin quejas de mareos previas y actuales. Métodos:Estudio observacional, transversal y analítico. Los participantes se dividieron en dos grupos: grupo con mareos (GT), compuesto por individuos con varias enfermedades vestibulares y el grupo sin quejas de mareos (CG). Ambos grupos se sometieron a meatoscopia, VEMP cervical y ocular. Resultados: La muestra consistió en 45 individuos con edades comprendidas entre 23 y 68 años, 27 individuos del grupo GC y 18 del grupo GT. En el examen cVEMP, las latencias, amplitudes, índice de asimetría y el índice de asimetría corregido fueron los mismos en el GT en comparación con el CG. En el examen oVEMP, la amplitud izquierda fue mayor y la latencia N10 fue estadísticamente menor en el grupo GT en comparación con el grupo CG. Entre las enfermedades en el grupo GT, los individuos con dehiscencia del canal superior tenían valores más altos en la amplitud izquierda, lo que puede haber interferido con los resultados. Conclusión: No hubo diferencias en las respuestas de cVEMP entre los grupos en este estudio. Se encontró un aumento en la amplitud izquierda y un valor más bajo de la latencia N10 derecha en el grupo con mareos en el análisis del examen oVEMP. Se cree que la heterogeneidad de las enfermedades vestibulares en el grupo de mareos y el pequeño número de participantes en ambos grupos contribuyeron a este resultado.

The role of magnetic resonance imaging in Ménière disease: the current state of endolymphatic hydrops evaluation / O papel da ressonância magnética na doença de Ménière: a avaliação da hidropsia endolinfática nos dias atuais

ABSTRACT Technical advances in magnetic resonance imaging have allowed to accurately detect and grade endolymphatic space distension in Ménière disease; this was only possible in post-mortem histological studies until a few years ago. Magnetic resonance imaging rules out other causes of vertigo and hearing loss, and is able to evaluate the cochlear and vestibular compartments of the endolymphatic space using a dedicated protocol.

RESUMO Os avanços técnicos na ressonância magnética têm permitido detectar e classificar com acurácia a distensão do espaço endolinfático na doença de Ménière; isso só era possível nos estudos histológicos post-mortem até poucos anos atrás. Além de afastar outras causas de vertigem e de perda auditiva, a ressonância magnética é capaz de avaliar os compartimentos coclear e vestibular do espaço endolinfático por meio de um protocolo dedicado.

Avaliação da vertical visual subjetiva em adultos jovens / Evaluation of subjective visual vertical in young adults

RESUMO Objetivo Avaliar a vertical visual subjetiva em indivíduos adultos jovens sem queixas vestibulares e/ou alterações do equilíbrio corporal. Método Estudo do tipo observacional, descritivo, analítico, de delineamento transversal, no qual foram avaliados 50 adultos jovens, com idade entre 18 e 30 anos. Foram excluídos do estudo indivíduos com alteração neurológica, alteração cognitiva evidente, deficiência física que influenciasse no equilíbrio corporal, alteração visual sem uso de lentes corretivas, uso de medicamentos com ação sobre o sistema nervoso central e/ou vestibular, relato de ingestão alcoólica 24 horas antes da avaliação e indivíduos com alterações e/ou queixas vestibulares. Os participantes foram submetidos à anamnese e à avaliação da vertical visual subjetiva, por meio do teste do balde. O teste foi realizado em três condições sensoriais diferentes: 1- Indivíduo sentado, com os dois pés sobre superfície estável (piso de paviflex); 2- Indivíduo sentado, com os pés em cima de uma espuma; 3- Indivíduo em pé sobre uma espuma. Resultados A vertical visual subjetiva não apresentou diferença significativa (p= 0,93) entre as condições sensoriais estudadas. Conclusão Em adultos jovens hígidos, o sistema proprioceptivo não influenciou significativamente a avaliação da vertical visual subjetiva, realizada por meio do teste do balde.

ABSTRACT Objective To evaluate subjective visual vertical in young adults without vestibular complaints and/or body balance problems. Methods This was a descriptive cross-sectional, observational and analytical study that assessed 50 young adults aged 18 to 30 years. Adult were excluded from the study if they had neurological and cognitive disorders, physical disability that affected their balance, visual impairment with no use of corrective lenses, use of drugs with effects on the central nervous system and/or the vestibular system and self-report of alcoholic use 24 hours before the assessment, and adults with vestibular problems and/or complaints The participants answered questions in a medical history interview and underwent subjective visual vertical assessment with the bucket method. The test was performed under three different sensory conditions: 1 - Subjects sitting with both feet on a stable surface (Paviflex® flooring); 2- Subjects sitting with their feet on top of foam; 3- Subjects on top of foam. Results The subjective visual vertical did not show a significant difference (p = 0.93) among the study sensory conditions. Conclusion The proprioceptive system did not significantly influence the measurement of the subjective visual vertical in young healthy adults.

Combined ocular and cervical vestibular evoked myogenic potential in individuals with vestibular hyporeflexia and in patients with Ménière's disease / Potencial evocado miogênico vestibular ocular e cervical simultâneo em indivíduos com hiporreflexia vestibular e em indivíduos com doença de Ménière

Abstract Introduction: The vestibular evoked myogenic potential is a potential of mean latency that measures the muscle response to auditory stimulation. This potential can be generated from the contraction of the sternocleidomastoid muscle and also from the contraction of extraocular muscles in response to high-intensity sounds. This study presents a combined or simultaneous technique of cervical and ocular vestibular evoked myogenic potential in individuals with changes in the vestibular system, for use in otoneurologic diagnosis. Objective: To characterize the records and analyze the results of combined cervical and ocular VEMP in individuals with vestibular hyporeflexia and in those with Ménière's disease. Methods: The study included 120 subjects: 30 subjects with vestibular hyporeflexia, 30 with Ménière's disease, and 60 individuals with normal hearing. Data collection was performed by simultaneously recording the cervical and ocular vestibular evoked myogenic potential. Results: There were differences between the study groups (individuals with vestibular hyporeflexia and individuals with Ménière's disease) and the control group for most of wave parameters in combined cervical and ocular vestibular evoked myogenic potential. For cervical vestibular evoked myogenic potential, it was observed that the prolongation of latency of the P13 and N23 waves was the most frequent finding in the group with vestibular hyporeflexia and in the group with Ménière's disease. For ocular vestibular evoked myogenic potential, prolonged latency of N10 and P15 waves was the most frequent finding in the study groups. Conclusion: Combined cervical and ocular vestibular evoked myogenic potential presented relevant results for individuals with vestibular hyporeflexia and for those with Ménière's disease. There were differences between the study groups and the control group for most of the wave parameters in combined cervical and ocular vestibular evoked myogenic potential.

Resumo Introdução: O potencial evocado miogênico vestibular é um potencial de média latência que avalia a resposta muscular decorrente de estimulação auditiva. Pode ser gerado a partir da contração do músculo esternocleidomastóideo e também a partir da contração de músculos extraoculares em resposta a sons de elevada intensidade. Este estudo apresenta uma técnica combinada ou simultânea de potencial evocado miogênico vestibular cervical e ocular em indivíduos com alterações no sistema vestibular para que possa ser usada no diagnóstico otoneurológico. Objetivo: Caracterizar o registro e analisar os resultados do potencial evocado miogênico vestibular cervical e ocular combinado em indivíduos com hiporreflexia vestibular e em indivíduos com doença de Ménière. Método: Participaram do estudo 120 indivíduos, 30 com hiporreflexia vestibular, 30 com doença de Ménière e 60 com audição dentro dos padrões de normalidade. A coleta de dados foi feita por meio do potencial evocado miogênico vestibular cervical e ocular registrados simultaneamente. Resultados: Houve diferença entre o grupo de estudo (indivíduos com hiporreflexia vestibular e indivíduos com doença de Ménière) e o grupo controle para a maioria dos parâmetros das ondas no potencial evocado miogênico vestibular cervical e ocular combinado. Para o potencial evocado miogênico vestibular cervical observou-se que o prolongamento da latência das ondas P13 e N23 foi a alteração mais encontrada no grupo de indivíduos com hiporreflexia vestibular e no grupo de indivíduos com doença de Ménière. Para o potencial evocado miogênico vestibular ocular o prolongamento da latência das ondas N10 e P15 foi a alteração mais encontrada no grupo de estudo. Conclusão: O potencial evocado miogênico vestibular cervical e ocular combinado apresentou resultados relevantes para os indivíduos com hiporreflexia vestibular e para os indivíduos com doença de Ménière. Houve diferença entre o grupo de estudo e o grupo controle para a maioria dos parâmetros das ondas no potencial evocado miogênico vestibular cervical e ocular combinado.

Pilot study on the functional evaluation of vestibular otolith-organ pathway in the stage of patients with Meniere disease / 中华耳鼻咽喉头颈外科杂志

Objective@#To observe the features of air-conducted sound elicited ocular vestibular-evoked myogenic potential(ACS-oVEMP) and cervical vestibular-evoked myogenic potential(ACS-cVEMP) in patients with Meniere disease (MD). To analyze the relationship between air-conducted sound elicited vestibular-evoked myogenic potentials (ACS-VEMP) responses and clinical stages of disease, as well as its clinical application of cervical and ocular vestibular evoked myogenic potentials in MD.@*Method@#Fifty six patients with MD and 50 normal subjects (100 ears) were recruited for conventional cVEMP and oVEMP examinations. Grades of vestibular function were also collected for patients with MD. The relationship between VEMPs abnormity, grades of vestibular function and clinical stages of MD were analyzed.@*Results@#The abnormal rates of cVEMP and oVEMP in MD patients were 57.1% (32/56) and 64.3% (36/56), which were significantly higher than those in normal subjects respectively (χ2=22.286, P=0.000; χ2=15.217, P=0.000). The abnormal rates of cVEMP and oVEMP in MD patients of stage Ⅰ to stage Ⅳ were 20.0% (1/5) and 40.0% (2/5), 50.0% (9/18) and 50.0% (9/18), 59.3% (16/27) and 70.4% (19/27), and 100.0% (6/6) and 100.0% (6/6) respectively. There was a significant difference in cVEMP abnormity between four stages of MD patients (P=0.046). Significant correlation was found between clinical stages and the grades of vestibular dysfunction (rs=0.417, P=0.001).@*Conclusions@#Dysfunction of vestibular otolithic organs and their input pathways in patients with MD can be detected by cVEMP and oVEMP tests. The abnormal rates of VEMP could show an gradually increasing trend with the development of MD stages. And the extent of vestibular lesions could be detected by cVEMP and oVEMP tests, which may provide a reference for clinical staging of MD.

The ultrastructure of utricular maculae of mouse / 中华耳鼻咽喉头颈外科杂志

Objective@#Using scanning electron microscope to observe the ultrastructure of utricular maculae of mouse.@*Methods@#Ten young (6 to 8 weeks) and ten old (>12 months) mice were executed, and their utricles were harvested and the specimens were processed, using scanning electron microscope to observe the structures of the utricles from the surface of otoconia layer to the roots of hair cell cilia.@*Results@#Under the scanning electron microscope, several ultrastructures were observed, including otoconia layer, unstructured gelatinous extracellular matrix layer, honeycomb-like gelatinous extracellular matrix layer, inter-cilia otoconia and hair cell cilia associated with these structures. When compared with young mouse, the otoconia surface of aged mouse was smoother, the gelatinous extracellular matrix between the adjacent otoconias was thinner.@*Conclusions@#Using SEM, ultrastructures can be clearly observed from surface otoconia layer to the roots of hair cell cilia. By the analysis of the ultrastructure of utricular maculae, it is helpful for investigation of the pathological mechanisms of vestibular diseases, such as otolith diseases.

Potencial evocado miogênico vestibular ocular e cervical simultâneo em indivíduos normais / Ocular and cervical vestibular evoked myogenic potential simultaneous in normal individuals

RESUMO Objetivo: Caracterizar o registro e analisar os resultados do potencial evocado miogênico vestibular cervical e ocular combinado em indivíduos sem queixas auditivas e vestibulares. Métodos: Participaram da pesquisa 30 indivíduos sem queixa auditiva e com audição dentro dos padrões de normalidade. A coleta de dados foi realizada por meio do potencial evocado miogênico vestibular cervical e ocular registrados simultaneamente. Resultados: Houve diferença entre as orelhas direita e esquerda para a amplitude das ondas P13 e N23 do potencial evocado miogênico vestibular cervical e para a latência da onda N10 do potencial evocado miogênico vestibular ocular. No gênero feminino não houve diferença entre as orelhas direita e esquerda para a amplitude das ondas P13, N23, N10, P15, interamplitude no potencial evocado miogênico vestibular cervical e interamplitude no potencial evocado miogênico vestibular ocular e para a latência das ondas P13, N23, N10 e P15. No gênero masculino houve diferença entre as orelhas direita e esquerda para a amplitude da onda P13. Conclusão: Os resultados do potencial evocado miogênico vestibular cervical e ocular combinado foram consistentes, uma vez que as respostas geradas pelos potenciais evocados miogênicos vestibulares apresentaram morfologia, latência e amplitude adequadas, o que permite a avaliação da via vestibular ipsilateral descendente e da via vestibular contralateral ascendente.

ABSTRACT Purpose: To characterize the recording and analyze the results of the combined cervical and ocular vestibular evoked myogenic potential in individuals without hearing and vestibular complaints. Methods: In this study, 30 individuals without hearing complaints and hearing within normal limits were evaluated. Data were collected through the simultaneous recording of cervical and ocular vestibular evoked myogenic potential. Results: Differences were observed between the right and left ears for the amplitude of waves P13 and N23 of the cervical vestibular evoked myogenic potential and the latency of wave N10 of the ocular vestibular evoked myogenic potential. For female subjects, there was no difference between the right and left ears for the amplitude of waves P13, N23, N10, and P15; interamplitude in cervical vestibular evoked myogenic potential and interamplitude in ocular vestibular evoked myogenic potential; and latency in waves P13, N23, N10, and P15. For male subjects, there was a difference between the right and left ears for the amplitude of wave P13. Conclusion: The results of the combined cervical and ocular vestibular evoked myogenic potentials were consistent, because the responses generated by the vestibular evoked myogenic potentials presented an adequate morphology, latency, and amplitude, allowing for the evaluation of the ipsilateral descending vestibular pathways and the contralateral ascending vestibular pathways.

Potencial evocado miogênico vestibular ocular: revisão de literatura / Ocular vestibular evoked myogenic potential: literature review

RESUMO Objetivo Identificar e sistematizar os principais estudos sobre o potencial evocado miogênico vestibular ocular e suas aplicações no diagnóstico das diversas doenças vestibulares. Estratégia de pesquisa Foram localizados artigos que descrevem a utilização do potencial evocado miogênico vestibular ocular na avaliação de doenças vestibulares nas bases PubMed, Web of Science, MEDLINE, Scopus, LILACS e SciELO. Critérios de seleção Foram incluídos estudos originais, com resumo disponível, publicados no período de janeiro de 2010 a março de 2016. Análise dos dados Foi realizada a descrição do delineamento do estudo e elencados os achados para a avaliação de potencial evocado miogênico vestibular ocular. Resultados Foram encontrados 265 estudos, dos quais 14 contemplaram os critérios de seleção propostos. Em relação à população/amostra de pacientes com alterações vestibulares incluída nos estudos, observou-se que as doenças mais investigadas foram a neurite vestibular, a vertigem posicional paroxística benigna, o Schwanoma vestibular e a doença de Ménière. Conclusão A maior parte das pesquisas realizadas nos últimos anos e publicadas nas bases de dados PubMed, Web of Science, MEDLINE e Scopus revelou que o potencial evocado miogênico vestibular ocular representa um método eficaz para avaliar a função utricular nas mais diversas doenças vestibulares.

ABSTRACT Purpose To identify and systematize the main studies on the ocular vestibular evoked myogenic potentials and their applications in the diagnosis of various vestibular diseases. Research strategy Articles that describe the use of ocular vestibular evoked myogenic potentials the evaluation of vestibular diseases were located in PubMed, Web of Science, MEDLINE, Scopus, LILACS e SciELO. Selection criteria Original studies, with available abstract, published in the period 2010 to March 2016 were included. Data analysis The study design was described, and the characteristics for the evaluation of ocular vestibular evoked myogenic potentials were listed. Results 265 studies were found, but just 14 contemplated the proposed selection criteria. In relation to the population / sample of patients with vestibular disorders included in the study, it was observed that the most researched diseases were the vestibular neuritis, benign paroxysmal positional vertigo, vestibular Schwanoma and Meniere's disease. Conclusion The most of the research realized in recent years and published in the databases PubMed, Web of Science, MEDLINE and Scopus revealed that the ocular vestibular evoked myogenic potentials is an effective method to evaluate the utricular function in various vestibular disorders.

Safety of interventional of high pressure balloon expansion catheter applicated in benign and malignant airway stenosis lesions treatment / 中国基层医药

Objective To explore the security and its influencing factors on benign airway stenosis treated with interventional of high pressure balloon expansion catheter.Methods Clinial data of 39 cases of inpatients suffered from benign airway stenosis were chosen.17 cases were male,and 22 cases were female.The ages of them ranged from 15 to 83 years old.According to the clinical symptoms,HRCT 3D reconstruction,and the results of bron-choscope,all patients were treated with balloon expansion catheter at different criterions.The balloon catheter with size that slightly smaller than the targeted normal bronchial tube was chosen,expansion for average 1 -4 times,single balloon expansion time ranged from 0.5 to 4 min,the pressures were kept at 3 -6 atmosphere,and the highest pres-sure did not exceed 8 atmospheric pressure.The efficacy and complications were retrospectively analyzed.Results 19 cases were completely effective,14 cases were basically effective,6 cases were completely ineffective,and the total effective rate was 84.6% (33 /39 ),the incidence of complications was 35.8% (14 /39 ),moreover,no deaths occurred.Conclusion High pressure balloon catheter expansion is one of commonly used technology in breathing interventional treatment;it has the characteristics of easy operation,and immediate curative effect,and so on.But if the improper operation,incorrect selection of the case,or inaccurate evaluation of the stenosis during operation,serious complications and unnecessary iatrogenic injury can be occurred.Therefore,it is worthy of attention and further summarizing by breathing interventional physicians.

The Principle and Methodology of Vestibular Evoked Myogenic Potential / 대한평형의학회지

Vestibular evoked myogenic potential (VEMP) has developed as a broadly applied vestibular function test in clinics from its introduction in 1992. In the past, there was only one well known VEMP protocol, which is cervical VEMP, however recently ocular VEMP is also popular. Therefore, clarifying the VEMP recording protocol (cervical VEMP or ocular VEMP) before discussing the VEMP result has become essential. There is considerable difference regarding this VEMP test from other vestibular function tests. VEMP is thought to be assessing the functions of the otolith organs (utricle and saccule) which are evoked by acoustic stimulus. Cervical VEMP is valuable since this is the only available test method which could speculate the function of the saccule and inferior vestibular nerve. Still, there's less clearly understood part regarding the central pathway of VEMP. However, many clinicians and researchers participating in vestibular research speculate that this functional test will have a more dominant role in the near future. Here we describe the basic principles and methodological considerations regarding VEMP recording.

Performance testing of biodegradable mesh-like microporous balloon combined with calcium phosphate cement for vertebroplasty / 中国组织工程研究

BACKGROUND:Vertebroplasty and kyphoplasty for osteoporotic vertebral compression fractures can result in many complications, such as bone cement leakage and adjacent-level fractures. OBJECTIVE:To verify the possibility of biodegradable mesh-like microporous polymer bal oon for the treatment of osteoporotic vertebral compression fractures. METHODS:Biodegradable mesh-like microporous P(DLLA-CL) bal oons were fabricated by electrospinning technique. Coated bal oons with the same specification was fabricated by coating P(DLLA-CL) onto the same mould. Morphology of the bal oons was observed by scanning electron microscopy. The bal oon leakage was observed by eyes after the injection of water or cement. The initial strength and stiffness were measured by a universal testing machine. The proliferation of MC3T3-E1 cel s on the bal oons was determined by laser confocal microscope and cel counting kit-8 assays. The biodegradation of bal oons in simulated body fluid, porcine pancreatic lipase, and fresh human serum was studied by residual weighing and scanning electron microscopy observation. Burst pressure of bal oons was measured after the bal oon was placed into a hole in the vertebral bone. For the in vitro calcium release tests, the bal oons were fil ed with calcium cement, tied, placed into 6atm ultrapure water, and then the calcium concentration was regularly determined. RESULTS AND CONCLUSION:Mesh-like microporous bal oons presented with good fiber morphology, thickness distribution, and the presence of pores;on the coated bal oon surface, there was absence of specific morphology and porosity. Compared with the coated bal oon, the mesh-like microporous bal oon showed better mechanical properties, liquid permeability and burst pressure, to prevent leakage of bone cement and promote osteoblast adhesion and proliferation. In addition, the degradation of the mesh-like microporous bal oons was more uniform and stable than the coated bal oons, which may increase the calcium concentration in the injured vertebrae and wil be beneficial to the new bone growth and fracture healing.

Potencial miogênico evocado vestibular e suas implicações no domínio das frequências / Vestibular evoked myogenic potential and its implications in the frequency domain

OBJETIVO: Verificar a existência de associação entre o VEMP no domínio do tempo e no domínio das frequências. MÉTODOS: A amostra foi composta por 18 indivíduos (36 orelhas), sendo seis do gênero masculino e 12 do gênero feminino. No exame de VEMP no domínio do tempo, foram promediados 200 estímulos tone burst na frequência de 500 Hz, com taxa de estimulação de 5,1 estímulos/s na intensidade de 95 dBNAn. Seguiu-se com a captação no domínio das frequências, onde foram promediados 200 estímulos constituídos por tons puros de 500 Hz (frequência portadora), modulados na frequência de 40 Hz. Foi realizado o cálculo do Odds ratio e aplicado o teste Qui-quadrado para a comparação entre as respostas dos dois domínios. Estudo de coorte contemporânea com corte transversal. RESULTADOS: O VEMP no domínio do tempo foi registrado por meio da estimulação e captação unilateral, com morfologia adequada, em 88,88% das orelhas. Na realização do exame no domínio das frequências, foi registrada a presença de pico de estado estável em 30 (83,33%) dos 36 exames. Quando realizado o teste Qui-quadrado e o cálculo do Odds ratio, foi possível observar a existência de forte relação entre os dois domínios. CONCLUSÃO: Conclui-se que existe forte associação entre os exames de VEMP no domínio do tempo e no domínio das frequências, o que habilita sua utilização na prática clínica.

PURPOSE: Determine whether there is an association between VEMP in the time domain and the frequency domain. METHODS: The sample was composed of 18 individuals (36 ears), six men and 12 women. In the VEMP test in the time domain, 200 tone burst stimuli were promediated at a frequency of 500 Hz, with 5.1 stimulations/s at an intensity of 95 dBNAn. This was followed by capture in the frequency domain, where 200 stimuli consisting of 500 Hz (carrier frequency) pure tones were promediated and modulated at a frequency of 40 Hz. Odds ratio was calculated and the chi-squared test was applied to compare the responses of two domains. This is a cross-sectional contemporary cohort study. RESULTS: VEMP in the time domain was recorded by unilateral stimulation and capture, with adequate morphology, in 88.88% of the ears. In the frequency domain test, a steady-state peak was found in 30 of the 36 tests (83.33%). The chi-squared test and odds ratio calculation showed a strong relationship between the two domains. CONCLUSION: There is a significant association between the VEMP tests in the time and frequency domains, a finding that suppports its use in clinical practice.

Software para avaliação da subjetiva vertical visual: um estudo transversal observacional / Software for subjective visual vertical assessment: an observational cross-sectional study

A orientação espacial em relação ao eixo gravitacional é de suma importância para a manu tenção da postura, marcha e para a maioria das atividades motoras realizadas pelo ser humano. A subjetiva vertical visual é um exame que avalia a percepção individual de verticalidade. OBJETIVOS: Os objetivos deste estudo foram: (1) desenvolver um sistema virtual para avaliar a subjetiva vertical visual, (2) produzir uma ferramenta simples para a prática clínica e (3) medir os valores da subjetiva vertical visual em indivíduos saudáveis usando a nova ferramenta. Forma de estudo: estudo obser vacional transversal. MÉTODO: Trinta voluntários saudáveis realizaram a subjetiva vertical visual em ambas as condições, estática e dinâmica. O exame consistia em ajustar uma linha virtual na posição vertical usando o mouse do computador. Na condição estática, a linha virtual foi projetada em uma tela branca. Na condição dinâmica, círculos pretos giravam no sentido horário e anti-horário. Seis medidas foram feitas e o desvio médio em relação a vertical real, calculado. RESULTADOS: Os desvios médios da subjetiva vertical visual foram: estática -0,372º ± 1,21; dinâmica sentido horário 1,53º ± 1,80 e dinâmica sentido anti-horário -1,11º ± 2,46. CONCLUSÃO: Este software mostrou ser prático e preciso para ser inserido na rotina de exames clínicos.

Spatial orientation in relation to the gravitational axis is significantly important for the maintenance of the posture, gait and for most of the human's motor activities. The subjective visual vertical exam evaluates the individual's perception of vertical orientation. OBJECTIVES: The aims of this study were (1) to develop a virtual system to evaluate the subjective visual vertical exam, (2) to provide a simple tool to clinical practice and (3) to assess the subjective visual vertical values of healthy subjects using the new software. Study Design: observational cross-sectional study. METHODS: Thirty healthy volunteers performed the subjective visual vertical exam in both static and dynamic conditions. The exam consisted in adjusting a virtual line in the vertical position using the computer mouse. For the static condition, the virtual line was projected in a white background. For the dynamic condition, black circles rotated in clockwise or counterclockwise directions. Six measurements were taken and the mean deviations in relation to the real vertical calculated. RESULTS: The mean values of subjective visual vertical measurements were: static -0.372º; ± 1.21; dynamic clockwise 1.53º ± 1.80 and dynamic counterclockwise -1.11º ± 2.46. CONCLUSION: This software showed to be practical and accurate to be used in clinical routines.

Avaliação dos potenciais evocados cocleares após lesão do utrículo por eletrocauterização / Assessing cochlear evoked potentials after electrocautery-induced trauma to the utricle

A utriculostomia é uma nova alternativa cirúrgica para a doença de Ménière. A hipótese cirúrgica desse procedimento é a de que o desfecho de uma lesão do utrículo por eletrocauterização não interfere na função coclear. Contudo, a hipótese de que essa abordagem do utrículo preserva a audição ainda não foi comprovada. OBJETIVO: Determinar se ocorrem mudanças nos potenciais elétricos evocados na cóclea e no nervo auditivo antes, durante e 1 mês após o procedimento cirúrgico no utrículo em modelo animal. MATERIAIS E MÉTODOS: Estudo experimental: Oito ovelhas foram submetidas à lesão do utrículo por eletrocauterização e sua função coclear foi avaliada por meio de eletrococleografia, registrando-se os potenciais elétricos evocados nos períodos pré-operatório, pós-operatório imediato e pós-operatório de médio prazo. Os resultados foram analisados estatisticamente. RESULTADOS: Não houve variação estatisticamente significativa na amplitude (p = 0,099) e na latência (p = 0,591) antes e 1 mês após o procedimento cirúrgico. Houve alteração estatisticamente significativa na razão entre potencial de somação/potencial de ação (p = 0,0122), representando uma perda calculada de 11,8 dB. CONCLUSÃO: A intervenção realizada no utrículo neste estudo permite concluir que, tendo em conta respostas eletrofisiológicas deficientes observadas durante e 1 mês após o procedimento cirúrgico, houve preservação da audição nas ovelhas operadas.

Utriculostomy is a new surgical alternative for Ménière's disease. The basis of this procedure is that the outcome of an electrocautery-induced utricular trauma does not affect cochlear function. However, a demonstration of the hypothesis that this approach to the utricle would preserve hearing is still pending. OBJECTIVE: To determine whether any changes would occur in the electrical potentials evoked in the cochlea and auditory nerve before, during, and 1 month after a surgical procedure in the utricule in an animal model. MATERIALS AND METHODS: An experimental study. Eight sheep underwent electrocautery-induced utricular trauma, and their cochlear function was assessed by electrocochleography - recording of electrical evoked potentials, in the preoperative, immediate postoperative and medium-term postoperative periods. The results were analyzed statistically. RESULTS: There were no statistically significant variations in amplitude (p = 0.099) and latency (p = 0.591) before and 1 month after the surgical procedure. There was a statistically significant change in the summation of the potential/action potential area ratio (p = 0.0122), a calculated loss of 11.8 dB. CONCLUSION: The intervention performed in this study enabled us to conclude that, taking into account the impaired electrophysiological responses observed during and 1 month after the surgical procedure, hearing was preserved in the operated sheep.

The Efficiency of Simultaneous Binaural Ocular Vestibular Evoked Myogenic Potentials: A Comparative Study with Monaural Acoustic Stimulation in Healthy Subjects

OBJECTIVES: To evaluate the test-retest reliability and convenience of simultaneous binaural acoustic-evoked ocular vestibular evoked myogenic potentials (oVEMP). METHODS: Thirteen healthy subjects with no history of ear diseases participated in this study. All subjects underwent oVEMP test with both separated monaural acoustic stimulation and simultaneous binaural acoustic stimulation. For evaluating test-retest reliability, three repetitive sessions were performed in each ear for calculating the intraclass correlation coefficient (ICC) for both monaural and binaural tests. We analyzed data from the biphasic n1-p1 complex, such as latency of peak, inter-peak amplitude, and asymmetric ratio of amplitude in both ears. Finally, we checked the total time required to complete each test for evaluating test convenience. RESULTS: No significant difference was observed in amplitude and asymmetric ratio in comparison between monaural and binaural oVEMP. However, latency was slightly delayed in binaural oVEMP. In test-retest reliability analysis, binaural oVEMP showed excellent ICC values ranging from 0.68 to 0.98 in latency, asymmetric ratio, and inter-peak amplitude. Additionally, the test time was shorter in binaural than monaural oVEMP. CONCLUSION: oVEMP elicited from binaural acoustic stimulation yields similar satisfactory results as monaural stimulation. Further, excellent test-retest reliability and shorter test time were achieved in binaural than in monaural oVEMP.