Patients' subjective evaluations of quality of life related to disease-specific symptoms, sense of coherence, and treatment in Ménière's disease.

OBJECTIVE: To evaluate the self-rated quality of life associated with vertigo, hearing loss, and tinnitus in Ménière's patients, and to identify potential relationships between these findings, treatment regimens, and sense of coherence in comparison to the classification of the American Academy of Otolaryngology-Head and Neck Surgery (AAO/HNS). STUDY DESIGN: Cross-sectional. SETTING: Tertiary referral hospital centers. PATIENTS: 112 patients with Méniére's disease, who had undergone endolymphatic sac surgery or intratympanic gentamicin injections, or were surgically untreated. MAIN OUTCOME MEASURE: Questionnaires concerning quality of life aspects and symptom-specific instruments: the Vertigo Symptom Scale (VSS), the Hearing Disability Handicap scale (HDHS), the Tinnitus Severity Questionnaire (TSQ), the AAO/HNS criteria for reporting results of treatment of Ménière's disease, and the Sense of Coherence Scale. RESULTS: A majority of the patients reported their quality of life in general as very good or good. There was no difference in general quality of life, present hearing loss, or tinnitus between the three treatment groups, but the gentamicin-treated patients had less vertigo than did the other groups. Sense of coherence showed a strong correlation to reported quality of life in all measurements. CONCLUSIONS: Even though the gentamicin-treated patients had less vertigo, no difference in overall quality of life was found between the surgically treated and untreated patients. The sense of coherence seems to be an important factor in the patient's experience of quality of life. Quality of life instruments can measure both specific symptoms and related aspects on quality of life and may give complementary information to the AAO/HNS classification in evaluating the treatment of patients with Ménière's disease.

Auditory function in whiplash-associated disorders.

This was a consecutive, prospective clinical study on 153 ambulatory patients in a tertiary referral center (i.e., a county hospital). All patients had whiplash-associated disorders (WAD) of at least grade II, according to the Quebec classification. All patients underwent pure-tone audiometry, and their audiograms were compared with ISO standards. Fourteen percent of patients with WAD had a hearing impairment exceeding the 90th percentile of the ISO standards. However, in most cases the hearing was not associated with whiplash injury. A subgroup (33 patients)--with normal hearing or slight hearing impairment according to the audiogram--was selected from the total group of patients with WAD. The 33 selected patients and 33 matched controls were tested with the speech-in-noise test (SRN test). However, 40% of this subgroup of patients with WAD reported hearing problems. As many as 30% of the patients with WAD had an abnormal SRN test result, as against 5% of the controls. Significant relations were found between the SRN test and self-assessed hearing loss, but not between the SRN test and tinnitus.

Smooth pursuit neck torsion test: a specific test for cervical dizziness.

OBJECTIVE: This study aimed to determine how the smooth pursuit neck torsion (SPNT) test is affected by various diseases associated with disturbances in balance and arising in the neck, in the posterior intracranial fossa, and in the labyrinth in patients having such conditions, and to compare the findings with those in healthy subjects. STUDY DESIGN: This study was a consecutive, prospective, double-blind clinical study. SETTING: This study was conducted with ambulatory patients in a tertiary referral center (i.e., a county hospital). PATIENTS: Studied were 75 patients with whiplash-associated disorders (WAD) of at least grade II, according to the Quebec classification, all of whom had been injured in car accidents. Of these, 50 patients reported dizziness and 25 did not. CONTROL SUBJECTS: Twenty patients had vertigo of central origin with positive central nervous system findings, 20 patients had Meniere's disease, and 30 subjects were healthy. INTERVENTION: The SPNT test is a smooth pursuit eye movement test. The subjects are placed in a neutral position, and then they turn 45 degrees to the right and to the left. The difference between the average gain in neutral and torsion positions is the test parameter. In addition to the SPNT test, the authors performed saccade tests, auditory brain stem response, and the caloric test. MAIN OUTCOME MEASURES: In the two WAD groups, neck torsion reduced the SP gain (p < 0.001), but in control patients with central and peripheral vertigo and in the healthy control subjects, it did not. RESULTS: The sensitivity of the SPNT test in the WAD group with dizziness was 90% and the specificity was 91%. The sensitivity in the WAD group without dizziness was 56%. CONCLUSION: The SPNT test seems to be useful for diagnosing cervical dizziness, at least in patients with WAD having symptoms of dizziness, because it has a high sensitivity and specificity.

Reduced cognitive functions in a group of whiplash patients with demonstrated disturbances in the posture control system.

Past studies examining whether or not cognitive changes actually have occurred as a result of a whiplash (WL) accident have produced varying results. The aim of this study was to identify possible cognitive dysfunctions in a group with persistent problems after whiplash due to injuries to the posture control system and related structures. The whiplash subjects (n = 23) were selected on the basis of their reduced gain in the Smooth Pursuit Neck Torsion test (SPNT). The WL group differed significantly from a closely matched control group on tests of learning and memory, and prolonged divided attention and concentration. After attempting to rule out other ways of interpreting these differences (such as pain, depression, medication, and premorbid health problems), these data were interpreted as lending support to the notion of a causal connection between the disturbed posture control system and some cognitive malfunctions.

Disturbed eye movements after whiplash due to injuries to the posture control system.

Self-reports after whiplash often indicate associations with vertigo and reading problems. Neuropsychological and otoneurological tests were applied to a group of whiplash patients (n = 26) and to a carefully matched control group. The whiplash group deviated from the control group on measures of eye movements during reading, on smooth pursuit eye movements with the head in normal position, and with the body turned to the left or to the right. Clinical, caloric, and neurophysiological tests showed no injury to the vestibular system or to the CNS. Test results suggest that injuries to the neck due to whiplash can cause distortion of the posture control system as a result of disorganized neck proprioceptive activity.

Otoneurophysiologic diagnosis of vascular disturbances in the central nervous system.

103 consecutive patients attending the Visby County Hospital due to vertiginous symptoms were included in the present study. All patients underwent conventional audiometric investigation, brainstem audiometry (ABR), electronystagmography including spontaneous, -gaze-, and positional nystagmus in darkness and under fixation, caloric tests with and without ocular fixation, pendular smooth pursuit test and saccade analyses. Optokinetic nystagmus-test and visual evoked potential recording were performed in some of the patients. Half of the patients underwent CT brain-scan. Abnormal otoneurophysiologic findings suggesting a central origin (pons, mesencephalon, cerebellum) was noted in 55% of the cases. CT brainscan displayed acoustic neuromas in three patients and a cerebellar affection in three patients. Otherwise the CT-scan was normal in the examined patients. In the present investigation the most sensitive tests for diagnosing disorders of central origin resulting in vertiginous symptoms were found to be the brainstem audiometry and smooth pursuit testing. In only two patients the results of the otoneurophysiologic examinations was found to be normal despite a convincing history suggesting a central nervous system disorder.