The Effect of Repositioning Maneuver Applied with the TRV Chair on Residual Dizziness after Benign Paroxysmal Positional Vertigo.

OBJECTIVE: This study aims to investigate the effect of TRV chair on residual dizziness (RD) after idiopathic posterior semicircular canal benign paroxysmal positional vertigo (BPPV) successfully treated with canalith repositioning maneuver (CRM). STUDY DESIGN: Prospective case-control study. SETTING: Hospital. PATIENTS: Thirty-three patients with posterior canal BPPV were included in the study. These patients were divided into two identical groups. CRM was applied to the first group with a TRV chair (TRV group) and manually to the second group (manual group). INTERVENTIONS: Dizziness Handicap Inventory (DHI), Beck Anxiety Inventory (BAI), and video head impulse test were applied to the patients. Patients in both groups were asked to report the RD developed after successful CRM daily by visual analog scale (VAS). RESULTS: The TRV group's first-day RD rate was 94.1% with VAS, and the RD duration was 2.47 ± 1.77 (0-7) days. The manual group's first-day RD rate was 100%, and the RD duration was 3.38 ± 1.70 (1-7) days. There was no difference between the groups in terms of RD duration ( p > 0.05). Mean RD severity and severity in the first 3 days were lower in the TRV group compared with the manual group ( p < 0.05). There was no difference between the groups on other days ( p > 0.05). In addition, there was a positive correlation between RD and DHI and BPPV duration ( p < 0.05). CONCLUSION: RD is a multifactorial symptom associated with how the repositioning maneuver is performed, BPPV duration, and DHI. Performing the repositioning maneuver with the TRV chair can reduce the severity of RD.

Sound energy absorbance changes in the elderly with presbycusis with normal outer and middle ear.

OBJECTIVE: This study aimed to investigate the wideband tympanometry (WBT) findings in the elderly with presbycusis who have normal outer and middle ears according to otoscopic examination and traditional tympanometry, and to determine whether there is a relationship between the middle ear wideband absorbance value and the pure tone air-bone gap (ABG) observed especially at mid-high frequencies in the elderly. METHODS: The study included 30 elderly with presbycusis (> 65 years old, presbycusis group) and 30 healthy individuals (control group) between the ages of 18 and 55. Pure tone air conduction and bone conduction thresholds of all participants were determined and WBT was applied to all participants. Resonance frequency (RF), absorbance ratios at peak pressure (PPAR) and ambient pressure (APAR) values were analyzed. RESULTS: The RF value of the presbycusis group was lower than the control group (p < 0.05). APAR and PPAR values at 2000 and 4000 Hz and mean absorbance values of the presbycusis group were lower than the control group (p < 0.05). APAR was higher at 500 Hz in males than females (p < 0.05), but there was no difference between genders in RFs (p > 0.05). A moderate negative correlation was observed between ABG and both PPAR and APAR at 4000 Hz in presbycusis group (p < 0.05). CONCLUSION: it was determined that there was a decrease in RF and absorbances at 2000 and 4000 Hz in the elderly with presbycusis. Aging affects not only the inner ear but also the conduction mechanism of the middle ear. Our findings may be effective in a more accurate and reliable interpretation of WBT in the elderly with presbycusis.

Chronic Noise Affects Middle Ear Resonance and Absorbance in Industrial Workers.

BACKGROUND: The effect of chronic noise on the middle ear is not fully known. This study aimed to evaluate the middle ear functions of metal workers exposed to chronic noise using wideband tympanometry. METHODS: In this study, 62 male workers exposed to chronic noise and 30 healthy men were included. Workers exposed to chronic noise were divided into 2 groups according to their pure tone averages. Totally 30 workers (60 ears) with pure tone average less than 20 dB were included in group I, and 32 workers (64 ears) with pure tone average more than 20 dB were included in group II. All individuals were subjected to wideband tympanometry. Tympanometric peak pressure, equivalent ear canal volume, static acoustic admittance, resonance frequency, and absorbance ratios at peak pressure and ambient pressure values were analyzed. RESULTS: There was no difference between the groups in terms of traditional tympanometric parameters such as tympanometric peak pressure, equivalent ear canal volume, and static acoustic admittance (P >.05). Resonance frequency of workers exposed to chronic noise (group I and group II) was lower than the control group (P <.05). The absorbance ratios of workers exposed to chronic noise at approximately 4 kHz were lower in both peak pressures and ambient pressures (P <.05). CONCLUSION: Chronic noise does not only damage the inner ear but also causes changes in the middle ear structures. Wideband tympanometry can be used to detect minor auditory damage due to noise that cannot be detected by audiogram early. In this way, necessary measures can be taken in the early period before noise-induced hearing loss occurs.

Effectiveness of hearing protection apparatus in preventing noise induced vestibular loss.

Hearing protection apparatus (HPAs) are frequently used to prevent the detrimental effect of noise on the hearing system. However, it is not known exactly whether wearing HPAs in workers protects the vestibular system. This study aims to investigate the effectiveness of wearing HPAs in preventing vestibular loss caused by noise. Eighty-one workers exposed to chronic noise were divided into three groups according to their HPAs wearing status. Pure-tone audiometry test was used to evaluate the hearing. Caloric test and visual analogue scale were used to evaluate their vestibular systems. The pure-tone average of the workers who constantly wore HPAs was better than that of the other groups (p< 0.05). There was no difference between the groups in the vestibular tests (p > 0.05). This study demonstrated that HPAs do not protect the vestibular system but protect the hearing system in the inner ear from the harmful effects of noise.

There is no evidence of cochlear and vestibular melanocyte damage in patients with alopecia areata.

PURPOSE: Follicular melanocytes are known to be damaged in alopecia areata (AA). However, it is not clear whether melanocytes are the primary target of autoimmunity and whether melanocytes in the inner ear are affected. This study aimed to detect possible cochlear and/or vestibular melanocyte damage in AA patients. METHODS: Thirty-two AA patients and 35 sex- and age-matched healthy volunteers were evaluated between November 2018 and March 2020 at the Karabük University Training and Research Hospital. The conventional pure tone audiometry test and distortion product otoacoustic emission test were performed to evaluate hearing. To evaluate the vestibular function, the following tests were performed: the vestibulospinal reflex tests (Romberg test, tandem stance test and tandem walking test); positional balance tests (Dix-Hallpike test, supine roll test and head hanging test); vestibulo-ocular reflex tests (caloric test, head shake test) and oculomotor tests (saccade, smooth pursuit and optokinetic). RESULTS: The mean age of AA patients was 31.94 ± 11.86 years (range, 15-67 years). There were no significant differences in the results of the hearing and balance tests between the groups. Furthermore, disease parameters (duration of the last attack, recurrence, positive family history, positive pull test, the severity of the disease, etc) were not associated with hearing loss and vestibular damage. CONCLUSION: AA patients did not exhibit hearing loss or balance abnormalities that would indicate cochlear and vestibular melanocyte damage. The lack of damage to the inner ear melanocytes in AA patients may indicate that follicular melanocytes are affected secondary to autoimmune damage in the hair bulb, and melanocytes are not the primary target in the pathogenesis of AA.

Dual-task performance and vestibular functions in individuals with noise induced hearing loss.

PURPOSE: The aim of this study was to evaluate the vestibular functions and dual-task performances of individuals with noise induced hearing loss. MATERIALS AND METHODS: Fifty individuals with noise induced hearing loss and 25 healthy individuals were included in the study. Individuals with noise induced hearing loss were divided into 2 groups according to the pure tone average. Twenty-five patients with bilateral pure tone average between 20 dB HL and 40 dB HL were included in group I and 25 patients with bilateral pure tone average higher than 40 dB HL were included in group II. One-leg standing test, functional reach test, timed-up and go test, head impulse test, head shaking test, spontaneous nystagmus test and caloric test were carried out to evaluate the vestibular systems of all individuals. Visual analog scale was used to evaluate the imbalance intensity of individuals. In order to evaluate the dual-task performances of the individuals, individuals were given cognitive and motor tasks simultaneously with timed up and go test. RESULTS: Individuals in group II had more abnormal caloric responses than the control group and individuals in group I. Also, individuals with higher hearing loss exhibited worse performance than other groups in eyes-closed one-leg standing test and dual-task situations. CONCLUSION: Individuals with higher hearing loss (>40 dB) had more abnormal vestibular test results and worse dual-task performance than other groups. Vestibular evaluation and dual-task performance evaluation of factory workers with noise induced hearing loss can provide useful information to determine the risk of falling and fall prevention strategies in these individuals.

Investigation of hearing and outer hair cell function of the cochlea in patients with vitiligo.

Vitiligo is a systemic disease that affects not only the skin but also other areas that contain melanocytes, such as the inner ear. Studies of the effect of vitiligo on hearing loss have shown inconsistent results, and it is not clear which parameters related to the disease affect hearing. The aim of this study was to determine which disease-related parameters trigger damage to cochlear melanocytes in vitiligo patients and the effect of vitiligo on the outer hair cells and hearing. Thirty-one vitiligo patients and 40 sex- and age-matched healthy volunteers were evaluated. The conventional pure tone audiometry (C-PTA) test and the distortion product otoacoustic emission (DPOAE) test were performed. There was no significant difference between vitiligo patients and controls in C-PTA test results, but the DPOAE test results were abnormal in vitiligo patients. The duration of the disease was significantly related to hypoacusis. As the duration of the disease increases, cochlear dysfunction may increase. Especially in patients with longer disease duration, otoacoustic emission tests should be performed in addition to conventional audiometry tests for early detection of damage to the outer hair cells.

Evaluation of audiovestibular system in psoriasis patients without joint involvement.

Inner ear involvement may occur in systemic autoimmune diseases. Although there are studies evaluating hearing in psoriasis patients, its effect on the balance system is not clear. The aim of the present study was to evaluate the audiovestibular system in psoriasis patients without joint involvement. In this prospective study, the audiovestibular system of 32 psoriasis patients without joint involvement and 35 healthy volunteers were evaluated. The severity of the disease was determined by the psoriasis area severity index (PASI). There was no significant difference between the groups in terms of hearing test results, while the abnormal caloric test response was significantly higher in the psoriatic patients. PASI scores of psoriasis patients with abnormal caloric test results were higher than those with normal caloric test response. In psoriasis patients without joint involvement, the hearing was not affected, but the vestibular system was. The severity of the disease was associated with vestibular involvement. Particularly in patients with severe psoriasis, it must be considered that the vestibular system might be affected, and vestibular evaluations should be performed.

Potential Risk of Benign Paroxysmal Positional Vertigo Due To Traumatic Effect of Osteotomy in Septorhinoplasty Patients.

PURPOSE: We investigated the effect of osteotomy on the vestibular system in septorhinoplasty patients and determined the potential risk of benign paroxysmal positional vertigo (BPPV) in these patients. PATIENTS AND METHODS: In the present prospective study, 47 primary septorhinoplasty patients were evaluated as the study group and 50 septoplasty patients as the control group. Osteotomy was performed in all septorhinoplasty patients. No hammer and osteotomes were used in the control group. All patients underwent static balance tests (tandem stance test, 1-leg standing test, and Romberg test), dynamic balance tests (tandem walking test and Fukuda test), positional balance tests (Dix-Hallpike test and supine roll test), head impulse test, and the adult dizziness handicap inventory (ADHI) preoperatively and during the first postoperative week. RESULTS: No significant differences were found between the 2 groups in terms of the static balance tests, dynamic balance tests, positional balance tests, or head impulse test results. The postoperative ADHI scores were significantly worse in the septorhinoplasty patient group than in the control group. Posterior semicircular canal BPPV was observed in 2 patients in the septorhinoplasty group but none in the control group. CONCLUSIONS: BPPV is one of the possible early postoperative complications of rhinoplasty. In patients with vertigo after rhinoplasty, surgeons should evaluate the semicircular canals using the Dix-Hallpike and supine roll tests. To avoid the traumatic effect of osteotomy reflected on the inner ear, attention should be given to the applied force, and sharp osteotomes should be used.

Vestibular functions in patients with tinnitus only.

OBJECTIVE: Tinnitus is the perception of sound in the ears or head without any external or internal acoustic stimulation, and it is usually associated with hearing loss. In addition, it has been reported that there is a relationship between vestibular problems and sensorineural hearing loss. The aim of this study was to evaluate the vestibular function in patients with tinnitus without hearing loss. METHODS: A total of 32 patients who complained only of tinnitus without hearing loss and 30 control subjects without tinnitus or hearing loss were included in this study. Oculomotor and caloric tests were performed on all subjects with videonystagmography. The tinnitus handicap inventory questionnaire, side and duration of tinnitus were recorded in all patients. RESULTS: The caloric test was abnormal in 13 of 32 (40.6%) patients in the tinnitus group and was normal in all of the control group. Abnormal caloric responses in patients with severe tinnitus were more frequent than in patients with mild or moderate tinnitus. There was a statistically significant difference in the optokinetic gain values between the tinnitus and control groups. CONCLUSION: A relationship between tinnitus and abnormal caloric responses was determined. Tinnitus may be the first symptom of vestibular dysfunction.

Assessment of balance skills and falling risk in children with congenital bilateral profound sensorineural hearing loss.

OBJECTIVE: To evaluate the balance skills and falling risk in children with a congenital bilateral profound sensorineural hearing loss (CBPSNHL). METHODS: 25 children with CBPSNHL and healthy 25 children with similar age and gender were included in the study. The flamingo balance test, the tandem stance test, and the one-leg standing test were performed to assess the patients' static balance skills. The pediatric balance scale (PBS) was used to evaluate the dynamic balance. Visual analog scale (VAS) was applied to the patients assess the frequency of falls. RESULTS: The flamingo balance test, the tandem stance test, and the one-leg standing test in the children with CBPSNHL were all significantly worse than the control group. Although the scores of PBS in patients with CBPSNHL were significantly lower than the control group (p < 0.001), the results of both groups were consistent with a low risk of falls. There was no significant difference between the VAS scores indicating the frequency of falls among the groups (p = 0.552). CONCLUSION: Static and dynamic balance skills of the children with CBPSNHL are significantly impaired compared to their healthy peers. Children with CBPSNHL also have a lower risk of falling just like their healthy peers and there is no significant difference between their falling frequencies. Balance skills of children with CBPSNHL can be assessed quickly and effectively on a hard floor (eyes closed), with a tandem standing test or a one-leg standing test.

Evaluation of vestibular system with vHIT in industrial workers with noise-induced hearing loss.

PURPOSE: Industrial workers are frequently exposed to noise and the noise can cause hearing loss. The relationship between vestibular abnormalities and long-term exposure to occupational noise has been reported. The aim of this study was to use vHIT (video head impulse test) to evaluate the semicircular canal's function in industrial workers with noise-induced hearing loss. METHODS: In the present study, we included 36 male patients (aged 28-55 years, mean 44.4 ± 6.1 years) with hearing loss due to noise exposure from working in the steel and metal industry for at least 4 years, and a control group of 30 healthy men (aged 34-50 years, mean 41.1 ± 4.5 years) without hearing loss. The gain of the vestibulo-ocular reflex for all 6 semicircular canals was examined by vHIT in 66 patients. RESULTS: Canal deficit was detected in 20 (55.5%) of 36 patients in the noise exposure hearing loss group and was detected in 2 (6.6%) of 30 participants in the control group. There was significant loss of capacity for VOR gain in patients with noise exposure hearing loss. CONCLUSIONS: In the present study we found that exposure to noise can cause vestibular dysfunction. And the vHIT is easily applicable, quick and practical and can individually evaluate all semicircular channels. Therefore, to evaluate vestibular function with vHIT is quick and practical.