Normal Serum Levels of Otolin-1 in Patients with Meniere Disease in Remission

Abstract Introduction Degenerative changes in the otolithic organs have been theorized to be caused by the mechanical obstruction to endolymphatic flow, possibly resulting in endolymphatic hydrops (ELH). Otolin-1 is an otoconial matrix protein that crosses the blood labyrinth barrier and has been found in the serum of healthy and diseased patients. Objective To measure the serum levels of Otolin-1 in Meniere disease (MD) patients and compared them with the healthy individuals. Methods This pilot, cross-sectional study was performed at our tertiary care referral center to compare the serum Otolin-1 levels of healthy individuals with those of MD patients. The blood samples were obtained during patients' visit to the vertigo clinic following remission of an acute episode. The data was analyzed using the Stata/SE version 12.0 (StataCorp. College Station, TX, USA). Comparison between the serum Otolin-1 levels in the two groups was performed using the unpaired t-test. A p-value of 0.05 was considered to be statistically significant. Results The participants were divided into two groups, with 31 MD patients, and 30 age and gender-matched members of the control group. The serum levels of Otolin-1 in MD patients (247.6, ± 44.2 pg/ml) were not found to be significantly different from those of the control group (236.2, ± 43.5 pg/ml) (p = 0.31). Conclusion The current study reveals that the serum levels of Otolin-1 are not significantly different between the patients with MD in the interictal phase and the control group's healthy ones.

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.

Subjective visual vertical with the bucket method in Brazilian healthy individuals / Vertical visual subjetiva com o método do balde em indivíduos brasileiros hígidos

ABSTRACT INTRODUCTION: The capacity of a healthy individual to estimate the true vertical in relation to the Earth when a fluorescent line is aligned in a completely dark room is called the subjective visual vertical. OBJECTIVE: To evaluate subjective visual vertical using the bucket method in healthy Brazilian individuals. METHODS: Binocular subjective visual vertical was measured in 100 healthy volunteers, 50 females and 50 males. The volunteers indicated the estimated position in which a fluorescent line inside a bucket reached the vertical position. A total of ten repetitions were performed, five clockwise and five counterclockwise. Data were tabulated and analyzed statistically. RESULTS: It was observed that the highest concentration of absolute values of vertical deviation was present up to 3°, regardless of gender, and the vertical deviation did not increase with age. The analysis of the mean of the absolute values of deviations from the vertical of 90% of the sample showed a maximum value of 2.6°, and at the analysis of 95%, the maximum value was 3.4° deviation from the vertical. CONCLUSION: The bucket method is easy to perform and interpret when assessing the deviation of the subjective visual vertical in relation to the true vertical in healthy Brazilian individuals.

Resumo Introdução: A capacidade que um indivíduo hígido tem em estimar a vertical verdadeira em relação à Terra, quando alinha uma linha fluorescente em uma sala completamente escura é denominada de Vertical Visual Subjetiva (VVS). Objetivo: Avaliar a VVS com o método do balde em indivíduos brasileiros hígidos. Método: A VVS binocular foi medida em 100 voluntários hígidos, 50 do gênero feminino e 50 do masculino. Os voluntários indicaram a posição estimada em que uma linha fluorescente no interior de um balde alcançou a posição vertical. Foram realizadas 10 repetições, cinco no sentido horário e cinco no anti-horário. Os dados foram tabulados e submetidos à análise estatística. Resultados: Observou-se que a maior concentração dos valores absolutos dos desvios da vertical esteve presente até 3º, independente do gênero e o desvio da vertical não aumentou conforme a idade. À análise da média dos valores absolutos dos desvios da vertical de 90% da amostra, foi encontrado o valor máximo de 2,6º e à análise de 95% o valor máximo foi de 3,4 de desvio da vertical. Conclusão: O método do balde é fácil de realizar e de interpretar na avaliação do desvio da vertical visual subjetiva em relação à vertical verdadeira de indivíduos brasileiros hígidos.

Evaluation of anti anxiety treatment in residual dizziness after successful canalith repositioning procedure in benign paroxysmal positional vertigo / 中国基层医药

Objective To study the effect of anti anxiety treatment in residual dizziness after successful canalith repositioning procedure in benign paroxysmal positional vertigo.Methods 68 cases of benign paroxysmal position vertigo patients with residual dizziness after successful canalith repositioning procedure were collected,who visit department of Neurology..They were randomly assigned to anti anxiety group and the control group according to randomized controlled method.Deanxit (0.5mg/10mg,1times/day)combined with betahistine mesilate tablets (6mg, 3 times/day)were taken by patients in the anti anxiety group;take betahistine mesilate tablets (6mg,3 times/day) were taken in the control group.Follow up 3 months,the duration of residual dizziness and the changes of symptoms between the two groups were compared.The symptoms of all patients were evaluated before and after treatment by dizziness handicap inventory.Results The duration of residual dizziness in the control group was (16.38 ±8.83)days, and that in the anti anxiety group was (10.13 ±5.10)days.The duration of residual dizziness in the anti anxiety group was significantly shorter than that in the control group (t =3.440,P 0.05)in the treatment of first week.In second week and third week,the scores of the anti anxiety group were lower than those of the control group,the differences were statistically significant (t =3.378,4.935,all P <0.05).After 3 weeks of treatment,the scores of the anti anxiety group were significantly decreased in the functional,emotional and physical scores (t =5.297,4.537,4.451,all P <0.01 ).Conclusion Deanxit can shorten residual dizziness duration of benign paroxysmal position vertigo patients after successful canalith repositioning procedure,and can reduce the degree of residual dizziness.

Significance of the 'bow and lean test' for the diagnosis of benign horizontal semicircular canal paroxysmal positional vertigo / 解放军医学杂志

Objective To observe and assess the positive rate and accuracy of 'bow and lean test' in the horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV). Methods Ninety-two HSC-BPPV patients who were diagnosed by head roll test (HRT) were enrolled, and then further tested with 'bow and lean test' (BLT) between Oct 1, 2010 and Sep 30, 2011. They were treated by Barbecue maneuver or Brandt-Daroff exercise on the basis of HRT and BLT tests. The positive rate of BLT test was analyzed, and its accuracy for diagnosis and success rate for treatment of HSC-BPPV were compared between HRT and BLT. Results Among the 92 patients, 83(90.2%) of them showed BLT nystagmus. Fifty-seven of 83 (68.7%) patients showed both bowing nystagmus and leaning nystagmus, and 18(21.7%) and 8(9.6%) respectively showed bowing nystagmus alone or leaning nystagmus alone. Among 92 patients, 74(80.4%) of them the affected side could be determined by HRT with 69 BLT positive and 5 BLT negative. Among the 69 BLT-positive patients, 60 patients showed the same result of HRT, and successful result was achieved by manipulation. 9 patients showed different result between BLT and HRT, in whom manipulation failed according to the result of HRT, but succeeded when manipulation was performed according to BLT. In 18 patients(19.6%) it was not able to determine the affected side by HRT, but in 14 patients manipulation was successful when BLT result was applied. In 4 patients BLT failed to evoke nystagmus, but after practicing Brandt-Daroff exercise, vertigo and HRT nystagmus disappeared 3 days later. Among the 92 patients, 65(70.7%) were cured according to HRT, while 83(90.2%) got successful result according to BLT(P<0.05). Conclusion The positive rate and accuracy for HSC-BPPV by BLT are high. It is a useful method for determining the affected side in HSC-BPPV, and to provide the basis for selecting effective manipulation treatment.

Clinical analysis of benign paroxysmal positional vertigo in youth / 解放军医学杂志

Objective To explore the clinical features of benign paroxysmal positional vertigo (BPPV) in patients of 40 years old or younger. Methods The clinical features of 40 patients (age ≤40 years) with BPPV admitted from August 2009 to July 2011 were retrospectively analyzed, and compared with that of 286 middle and old-aged patients (age >40 years) with BPPV admitted in the same period. Results The incidence of BPPV in young patients showed a relatively higher incidence (12.3%), with the sex ratio of male to female 1:3 and a mean age of 32.1±6.2 years. The mean latent period of vertigo attack was 1.2±1.3 seconds, and 10 patients (25%) showed no obvious latent period. The median duration of vertigo was 10s. The posterior semicircular canal was involved in 27 patients (67.5%). Cupulolithiasis was found in 6 patients, and all the otolithiasis was found to involve the posterior semicircular canal. The proportion of BPPV with no obvious latency was higher in the young patients than in the middle and old-aged patients (25.0% vs 11.5%, χ2=5.554, P=0.018), but no significant difference in sex ratio, the course of disease, the ratio of involved semicircular canal, the latency and the duration of vertigo attack was found between two groups (P>0.05). Conclusions The incidence of BPPV is relatively higher in youth, more common in females, and the posterior semicircular canal is commonly involved. Compared with the middle and old-aged patients with BPPV, the proportion patients with no obvious latency of vertigo attack in young patients is higher, and the incidence of cupulolithiasis involving posterior semicircular canal is higher in the youth.

Significance of the 'bow and lean test' for the diagnosis of benign horizontal semicircular canal paroxysmal positional vertigo / 解放军医学杂志

Objective To observe and assess the positive rate and accuracy of 'bow and lean test' in the horizontal semicircular canal benign paroxysmal positional vertigo (HSC-BPPV). Methods Ninety-two HSC-BPPV patients who were diagnosed by head roll test (HRT) were enrolled, and then further tested with 'bow and lean test' (BLT) between Oct 1, 2010 and Sep 30, 2011. They were treated by Barbecue maneuver or Brandt-Daroff exercise on the basis of HRT and BLT tests. The positive rate of BLT test was analyzed, and its accuracy for diagnosis and success rate for treatment of HSC-BPPV were compared between HRT and BLT. Results Among the 92 patients, 83(90.2%) of them showed BLT nystagmus. Fifty-seven of 83 (68.7%) patients showed both bowing nystagmus and leaning nystagmus, and 18(21.7%) and 8(9.6%) respectively showed bowing nystagmus alone or leaning nystagmus alone. Among 92 patients, 74(80.4%) of them the affected side could be determined by HRT with 69 BLT positive and 5 BLT negative. Among the 69 BLT-positive patients, 60 patients showed the same result of HRT, and successful result was achieved by manipulation. 9 patients showed different result between BLT and HRT, in whom manipulation failed according to the result of HRT, but succeeded when manipulation was performed according to BLT. In 18 patients(19.6%) it was not able to determine the affected side by HRT, but in 14 patients manipulation was successful when BLT result was applied. In 4 patients BLT failed to evoke nystagmus, but after practicing Brandt-Daroff exercise, vertigo and HRT nystagmus disappeared 3 days later. Among the 92 patients, 65(70.7%) were cured according to HRT, while 83(90.2%) got successful result according to BLT(P<0.05). Conclusion The positive rate and accuracy for HSC-BPPV by BLT are high. It is a useful method for determining the affected side in HSC-BPPV, and to provide the basis for selecting effective manipulation treatment.

Clinical analysis of benign paroxysmal positional vertigo in youth / 解放军医学杂志

Objective To explore the clinical features of benign paroxysmal positional vertigo (BPPV) in patients of 40 years old or younger. Methods The clinical features of 40 patients (age ≤40 years) with BPPV admitted from August 2009 to July 2011 were retrospectively analyzed, and compared with that of 286 middle and old-aged patients (age >40 years) with BPPV admitted in the same period. Results The incidence of BPPV in young patients showed a relatively higher incidence (12.3%), with the sex ratio of male to female 1:3 and a mean age of 32.1±6.2 years. The mean latent period of vertigo attack was 1.2±1.3 seconds, and 10 patients (25%) showed no obvious latent period. The median duration of vertigo was 10s. The posterior semicircular canal was involved in 27 patients (67.5%). Cupulolithiasis was found in 6 patients, and all the otolithiasis was found to involve the posterior semicircular canal. The proportion of BPPV with no obvious latency was higher in the young patients than in the middle and old-aged patients (25.0% vs 11.5%, χ2=5.554, P=0.018), but no significant difference in sex ratio, the course of disease, the ratio of involved semicircular canal, the latency and the duration of vertigo attack was found between two groups (P>0.05). Conclusions The incidence of BPPV is relatively higher in youth, more common in females, and the posterior semicircular canal is commonly involved. Compared with the middle and old-aged patients with BPPV, the proportion patients with no obvious latency of vertigo attack in young patients is higher, and the incidence of cupulolithiasis involving posterior semicircular canal is higher in the youth.

Clinical features of 326 patients with benign paroxysmal positional vertigo / 中华神经科杂志

Objective To explore the clinical features and repositioning maneuver effects of benign paroxysmal positional vertigo ( BPPV ).Method The clinical features of 326 patients with BPPV from August 2009 to July 2011 were analyzed retrospectively.Different types of BPPV were compared.Results BPPV was more common in female and the peak period of onset was between the ages of 50 and 60.The average latency of vertigo attack was ( 1.52 ± 1.22) s and 43 patients ( 13.2％ ) had no obvious latency.The median duration of vertigo attack was 10 s,with less than 60 s in 312 patients (95.7％) and between 60—180 s in 13 patients (4.0％).The latency of vertigo attack of posterior semicircular canal-BPPV ( ( 1.74 ± 1.21 ) s) was longer than that of horizontal semicircular canal-BPPV ( ( 0.96 ± 1.06 ) s,t =5.546,P ＜0.01 ).But there were no differences in the gender,the course of disease and the duration of vertigo attack.The patients with posterior semicircular canal-cupulolithiasis were younger than those with posterior semicircular canal-canalithiasis.The duration of vertigo attack of posterior semicircular canalcupulolithiasis was longer than that of posterior semicircular canal-canalithiasis.The latency and the duration of vertigo attack of horizontal semicircular canal-cupulolithiasis were longer than that of horizontal semicircular canal-canalithiasis and the age was older.Conclusions The posterior semicircular canal is more involved in BPPV.The latency of vertigo attack of posterior semicircular canal-BPPV is longer than that of horizontal semicircular canal-BPPV.The latency and the duration of vertigo attack of horizontal semicircular canal-cupulolithiasis are longer than that of horizontal semicircular canal-canalithiasis and the age is older.

Effect of canalith repositioning procedure on the postural stability in patients with benign paroxysmal positional vertigo / 中国耳鼻咽喉头颈外科

OBJECTIVE To investigate the effect of canalith repositioning procedure(CRP)on the postural stability in patients with benign paroxysmal positional vertigo of the posterior semicircular canal(BPPV-PSC).METHODS 25 patients with BPPV-PSC were taken the posturography before and after the CRP.The posturography test has four conditions including①firm surface with eyes open(EO);②firm surface with eyes closed(EC);③foam surface with EO;④foam surface with EO.The body sway velocity(SV)recorded by the posturography was analyzed as parameter of postural stability.The postural stability of the patients with BPPV-PSC was compared with that of the matched control group.RESULTS ①The SVs of the BPPV-PSC patients before the CRP were greater than those of control group(P

The effect of Brandt-Daroff exercises on positional vertigo with atypical positioning nystagmus / 中国耳鼻咽喉头颈外科

OBJECTIVE Identify the effect of Brandt-Daroff exercises for positional vertigo with atypical positioning nystagmus.METHODS 11 cases of positional vertigo during 2006～2007 with atypical positioning nystagmus when carrying Dix-Hallpike and roll test,the nystagmus had the follwing characters:poly-positions,atypical direction,long lasting(more than 3 mins),no fatigue.After ruling out centrul neural system disorders,the patients were instructed to do Brandt-Daroff exercises 2-3 times/day,and 6-10 times every time.RESULTS After doing the exercises for 3-4 days,the vertigo of all the 11 cases were all relieved.After 1-2 weeks,10 cases were cured,syptom of the other 1 was relieved significantly,and the nystagmus was alleviated.CONCLUSION Cases with atypical positioning nystagmus may present a different kind of BPPV related with the otolith and vestibular nerve disease.Brandt-Daroff exercises was a good method for the atypical positioning nystagmus cases.