Correlation between magnetic resonance imaging classification of endolymphatic hydrops and clinical manifestations and audiovestibular test results in patients with definite Ménière's disease.

OBJECTIVES: The purpose was to evaluate magnetic resonance imaging (MRI) classification of endolymphatic hydrops with clinical features, audiological and vestibular tests in patients with definite unilateral Ménière's disease (MD). METHODS: Thirty-eight patients were enrolled in this study. The severity of the main clinical symptoms, audiovestibular tests, and MRI, performed 4 hours after intravenous injection of gadobutrol to visualize inner ear compartments, were evaluated. Endolymphatic space dilatation was assessed using Barath and Bernaerts grading systems, and the correlation between the grade of the hydrops and clinical features was evaluated. RESULTS: Using the Barath system, cochlear hydrops was visualized in 81.6% of affected ears, while vestibular was 63.2%. Sensitivity increased to 94.7% using Bernaerts' modification. Vestibular hydrops involving the utricle was present only among patients with cochlear and saccular endolymphatic space dilatation. There was a significant relationship between the hearing level and the vestibular hydrops degree in the Bernaerts scale. The grade of the hydrops correlated neither with the duration of MD nor with the severity of main clinical symptoms. Our study proved MRI to be a sensitive diagnostic tool in MD. The endolymphatic hydrops' grade correlates with the hearing level, which confirms endolymphatic space dilatation's role in hearing loss. CONCLUSIONS: In our study, two similar MRI grading systems were used; however, several differences were found compared to one another. The Bernaerts scale was more sensitive than the Barath scale, and several relationships between the radiological and clinical data were found. Therefore, several MRI evaluating scales and correlating them with the clinical features are needed. The increased perilymphatic enhancement of the cochlea and an extra low-grade vestibular hydrops distinguished in the Bernaerts scale may increase MD diagnosis sensitivity. Magnetic resonance findings in MD support the clinical diagnosis and may help to understand MD pathophysiology better. This study adds to the knowledge and diagnostics in MD for healthcare to improve patients' treatment.

Evaluation of the Sensory Organization Test to differentiate non-fallers from single- and multi-fallers.

BACKGROUND: Among the elderly, instability leading to falls (and consequences of them) is one of the most important problems. The etiology of falls is usually complex, but balance, posture and gait problems are considered to be the most important risk factors. OBJECTIVES: The objective of this study was to assess the usefulness of the Sensory Organization Test (SOT) in differentiating multi-fallers from single-fallers. MATERIAL AND METHODS: The studied group included 92 patients aged >60 years with balance disorders and falls in their history. The patients were divided into 2 groups: multi-fallers and single-fallers. The control group (non-fallers) included 21 individuals. The SOT was performed on the 1st day (SOT1) and on the last day (SOT2) of rehabilitation. Mean equilibrium score (ES) of 1-3 and 4-6 sensory conditions and composite score (CS) of the SOT1 and SOT2 were analyzed. The falls were analyzed as a total number of falls while performing SOT and a number of falls in all 3 repetitions of both conditions 5 and 6 separately. In SOT conditions 1-4 there were no falls observed. RESULTS: The importance of SOT to differentiate fallers from non-fallers and single-fallers from multi-fallers is ambiguous. CONCLUSIONS: The SOT may or may not indicate the differences between the groups - it does not fully explain those differences. It shows only postural dysfunction without indicating any localization in particular part of vestibular organ. The basic diagnostic evaluation in the elderly with a proneness to falls should include clinical examination and the Dix-Hallpike maneuver, supplemented with a videonystagmography (VNG), which would assess the structure of damage in vestibular organ. Posturography is of less validity in the differentiation of fallers from non-fallers.

Clinical use of skull tap vestibular evoked myogenic potentials for the diagnoses of the cerebellopontine angle tumor patients.

OBJECTIVE: To document our experiences using a new skull tapping induced Vestibular Evoked Myogenic Potentials (tap VEMPs) technique combined with standard Auditory Vestibular Evoked Myogenic Potentials (AC VEMPs) for advanced clinical assessment of cerebellopontine angle tumor (CPAT) patients. DESIGN AND STUDY SAMPLE: Three patients were selected in order to highlight observations shown in a larger patient population and to show the variability of the findings. Both tap VEMPs and AC VEMPs were acquired from the sternocleidomastoid muscle (SCM) with EMG-based biofeedback and monitoring. RESULTS: The usefulness of VEMPs was demonstrated, indicating the presence of a tumor and contributing additional information as to the involved nerve bundles in two out of the three cases. CONCLUSION: Due to the sensory organ dependency and related innervations differences, acquiring both AC VEMPs and tap VEMPs is likely to increase the probability of diagnosing CPATs and provide more information on the involved vestibular nerve bundles. This study demonstrates the feasibility of the possible expansion and combination of tap VEMPs and AC VEMPs techniques into a clinical diagnostic battery for advanced assessment of CPAT patients and its contribution as a guideline for the use of tap VEMPs in general.

Second stage of Universal Neonatal Hearing Screening - a way for diagnosis and beginning of proper treatment for infants with hearing loss.

PURPOSE: To analyze retrospectively the results of hearing testing in infants at the second stage of the Polish Universal Neonatal Hearing Screening Program carried out in the Department of Otolaryngology at the Medical University of Warsaw. MATERIAL/METHODS: A total of 351 infants referred to our Department for the second stage of UNHS were included in the study. There were 39.60% infants referred due to positive result of hearing screening at the first stage of the Program performed in neonatal units, 55.27% with negative screening but risk factors present, and 5.13% without any tests due to equipment failure in the maternity unit. RESULTS: Risk factors were identified in 86.61% of the infants. The most frequent ones were hyperbilirubinemia (71.51%), premature birth (63.25%), and ototoxic medication (62.11%). Otoacoustic emission test showed fail results in 17.66% of the infants, and auditory brainstem responses confirmed hearing loss in 16.81%. Correlation between risk factors and confirmed hearing loss was found for hyperbilirubinemia, low birth weight, intensive therapy for at least 7 days, low Apgar scores, and craniofacial abnormalities. CONCLUSIONS: The early identification of infants with hearing loss is essential for early intervention. Not only infants who fail the initial screening but also the ones with risk factors of hearing impairment should be referred to the centers that are capable of providing the necessary diagnostic services required for the second stage of the UNHSP. Those two steps are needed to both minimize the risk of overlooking a child with hearing loss and properly diagnose hearing impairment.

Does effect of rehabilitation based on sensory conflicts in patients with vestibular deficits exceed learning effect?

OBJECTIVE: The purpose was to assess learning and rehabilitation effect and their influence on Sensory Organization Test results in young and elderly patients with peripheral, central and mixed vestibular pathology. MATERIAL AND METHODS: 26 patients with different vestibular system deficits participated in this study. Rehabilitation was held five days a week, for two weeks. To assess learning effect, SOT was administered to each patient twice and compared: 1) on the day preceding the beginning of rehabilitation (SOT1), and 2) on the first day of rehabilitation (SOT2). To evaluate rehabilitation effect, results of SOT2 were compared to SOT3 (administered on the last day of rehabilitation). RESULTS: Learning effect showed similar improvement in CS in all groups but young. Rehabilitation caused further improvement in CS in all groups but central pathology. This improvement was similar between those groups. There was no significant difference found between learning and rehabilitation effect in CS. CONCLUSIONS: The results of our study indicate that none of the groups achieved significant benefit from rehabilitation based on sensory conflicts that would overcome the learning effect. However, the lack of significant advantage of rehabilitation over learning does not mean that it does not exist.

[Sensory Organization Test outcomes in young, older and elderly healthy individuals--preliminary results]. / Analiza parametrów Testu Organizacji Zmyslowej w grupie normy otoneurologicznej na materiale wlasnym--wyniki wstepne.

The goal of this study was to examine healthy young, mature, old and elderly using Computerized Dynamic Posturography (Smart EquiTest, Neurocom Int,), to collect their data and assess if balance differs significantly with age. Subjects were divided into four age groups: 20-30, 40-50, 60-69, 70-80 years. Their dynamic balance was tested using Sensory Organization Test under various sensory conditions and the data from this test were evaluated. Our data show that overall equilibrium score and strategy score differ significantly mainly between young and mature versus old and elderly individuals, but in some SOT conditions, significant differences are present within both younger between both older age groups. It means, that balance performance declines not only between young and elderly, but also from decade to decade. Analysis of our data also suggests, that balance performance depends on multiple factors and age is probably only one of them.

[The significance of electrophysiologic examinations in vestibular schwannomas diagnosis]. / Znaczenie badan elektrofizjologicznych w diagnostyce guzów nerwu VIII.

UNLABELLED: The most important for the diagnosis of vestibular schwannoma is MRI technic, which allows assessing its size and shape. The gold diagnostic standard includes also PTA, SD and ABR, nystagmography with calorics and VEMP. Nystagmography with calorics reflects the status of superior vestibular nerve. The sensitivity of calorics amounts to 61-87%. VEMPs reflect the status of interior vestibular nerve; its sensitivity is about 80%. The greatest diagnostic sensitivity shows ABR method, which is estimated for about 96-99%. AIM: analysis of PTA, ABR, VEMP and calorics results in smaller G1(≤10mm) and greater G2 (>11mm) tumors, and assessement of influence of the size of the tumor for auditory and vestibular function. MATHERIAL: PTA, ABR, VEMP and calorics results performed in 33 patients with CPA tumors. RESULTS: CPA tumors originate from inferior vestibular nerve in most cases; there is no statistical PTA differences in G1 and G2 groups; sensitivity of calorics (G1 53%, G2 95%), and ABR (G1 75%, G2 100%) depend on tumor size and tumor size has significant influence on results of both of these methods; sensitivity of VEMPs is similar in G1 and G2 groups (83% and 89%). CONCLUSIONS: there is no strict correlation between tumor origin and calorics and ABR results; greatest sensitivity in our material show VEMP, what is probably results of frequent tumors origin from inferior vestibular nerve.

[Possibility of hearing preservation treatment by patient suffered from neurofibromatosis type 2: case report]. / Mozliwosci zachowania sluchu u pacjenta z neurofibromatoza typu 2--opis przypadku.

The main tumor of cerebellopontine angle are vestibular schwannoma (80-90%). Most of them are unilateral lesion but 5% of them are bilateral pathological mass. There are genetic disease like neurofibromatosis type 1 and 2. According to National Institute of Heath Consensus Development Conference the best treatment method is microsurgery. The possibility of hearing preservation surgery give middle fossa approach and suboccipital approach, radiotherapy or auditory brainstem implants and cochlear implants. The aim of the study is case report of the patient suffered from bilateral vestibular schwannoma. Early diagnosis and therapy enable hearing preservation and good facial nerve function.

[Vestibular function in cochlear implant candidates]. / Narzad równowagi--ocena uszkodzenia w procesie diagnostycznym do operacji wszczepu slimakowego.

INTRODUCTION: The main problem of a deaf patient is per se communication process. Some of the patients, who are candidates to cochlear implantation report vertigo or imbalance in some everyday situations. The relation of patients' complaints to vestibular loss was evaluated. The authors used electronystagmography which was realized in diagnostic process to cochlear implantation. The results come from the patients diagnosed in our department in 2006-2007. In accordance to the literature, the true vertigo, was rather rare. MATERIAL AND METHODS: Medical history, caloric tests as electronystagmography results were evaluated retrospectively in 47 patients qualified for cochlear implantation in 2006-2007. RESULTS: In the study group, 25 patients did not complain of vertigo; with symmetrical calorics in 10 subjects (40%). The true vertigo reported 6 subjects; 8 subjects had imbalance and unsteadiness on walking. In the group of 47 subjects 8 of them complainted the both- vertigo and imbalance. In the ENG of this group the results of symmetrical responces were evaluated in 57% cases and vestibular hypofunction in 43% subjects. In the group with vertigo (6), 4 subjects (66%) had diagnosed unilateral hypofunction, 1 (17%) bilateral areflexion, 1 subject (17%) had symmetrical responses. CONCLUSIONS: The necessity of the confrontation ENG results to additional examination in audiological part of diagnostic process to cochlear implantation is underlined.

[Natural history of otosclerosis--from tinnitus to deafness]. / Naturalny rozwój otoskleroy--od szumu do gluchoty.

Authors review the most important data about natural history, signs and symptoms and clinical stages of otosclerosis. Development of otosclerosis is long-lasting and involves several decades of lives. First symptoms already appear in teenagers in about 20% of cases. In advanced cases there are irreversible sensorineural hearing loss. When total deafness occurs cochlear implantation is nowadays the treatment of choice.

[Results of hearing perception after cochlear implantation in patients with auditory neuropathy]. / Ocena percepcji sluchowej po wszczepieniu implantu slimakowego u pacjenta z neuropatia sluchowa.

INTRODUCTION: Results of hearing perception with patient with auditory and visual neuropathy combined with peripheral polyneuropathy one year after cochlear implantation are presented in this article. Visual problems and hearing loss were progressing during recent years leading to social problems and communication disability. Speech discrimination was much worse than could be suspected based on pure tone audiometry. Lack of benefit from hearing aids was also stated. METHODOLOGY: As the examination method free field speech audiometry was used based on Pruszewicz word tests and set of modified speech therapy tests TAPS II. Simple sentences, monosyllables and polysyllables words as well as logotoms perception and identification of music instruments sounds were estimated. MAIN RESULT: Progress of speech intelligibility in monosyllables test according to Pruszewicz in free field speech audiometry was stated, as well as better understanding of sentences, monosyllables and polysyllables words, and more precise recognition of music instruments sounds. MAIN CONCLUSION: In many sensory-neural profound hearing losses as well as auditory neuropathy cases good results may be obtained by cochlear implantation. Early diagnosis of auditory neuropathy is important because of proper management. Lack of benefit from hearing aids in such cases seems to be indication to cochlear implantation. In described case cochlear implantation improved hearing perception one year after using speech processor.

[Long-term results of transtympanic gentamicin treatment in Meniere's disease]. / Odlegle wyniki transtympanalnego leczenia gentamycyna w chorobie Meniere'a.

OBJECTIVE: To determine the long-term hearing and vestibular outcomes in patients with intractable vertigo caused by unilateral Meniere's disease, who were treated with transtympanic injection of gentamicin. STUDY DESIGN: the study was a long-term analysis of hearing and control of vertigo in patients with unilateral Meniere's disease who received transtympanic gentamicin. METHODS: Pure-tone thresholds and ENG, along with the control of vertigo. Criteria described in 1995 by the American Academy of Otolaryngology - Head and Neck Surgery were used. Patients treated with transtympanic gentamicin had definite Meniere's disease and had intractable vertigo despite optimal medical therapy, no symptoms suggestive of Meniere's disease in the contralateral ear, and serviceable hearing in the contralateral ear. The study analyzed the outcomes of 9 patients for whom follow-up data were available for periods greater than 24 months after transtympanic gentamicin. RESULTS: Complete control of vertigo was obtained in all 9 patients. Profound sensorineural hearing loss occurred only in 1 patient. Hearing was improved in 6 patients, and in 2 was unchanged. CONCLUSIONS: Transtympanic gentamicin therapy is a good method of controlling vertigo and the risk of hearing loss is low.