Spontaneous and Partial Repair of Ribbon Synapse in Cochlear Inner Hair Cells After Ototoxic Withdrawal.

Ototoxicity is one of the major causes of sensorineural deafness. However, it remains unclear whether sensorineural deafness is reversible after ototoxic withdrawal. Here, we report that the ribbon synapses between the inner hair cells (IHCs) and spiral ganglion nerve (SGN) fibers can be restored after ototoxic trauma. This corresponds with hearing restoration after ototoxic withdrawal. In this study, adult mice were injected daily with a low dose of gentamicin for 14 consecutive days. Immunostaining for RIBEYE/CtBP2 was used to estimate the number and size of synaptic ribbons in the cochlea. Hearing thresholds were assessed using auditory brainstem responses. Auditory temporal processing between IHCs and SGNs was evaluated by compound action potentials. We found automatic hearing restoration after ototoxicity withdrawal, which corresponded to the number and size recovery of synaptic ribbons, although both hearing and synaptic recovery were not complete. Thus, our study indicates that sensorineural deafness in mice can be reversible after ototoxic withdrawal due to an intrinsic repair of ribbon synapse in the cochlea.

In vivo delivery of Atoh1 gene to rat cochlea using a dendrimer-based nanocarrier.

Gene therapy is a promising clinical solution to hearing loss. However suitable gene carriers for the auditory system are currently unavailable. Given the unique structure of the inner ear, the route of delivery and gene transfer efficiency are still not optimal at present. This study presented a non-viral delivery system of in vivo delivery of Atoh1 gene (a potentially therapeutic gene for hearing loss) to rat cochlea. We treated polyamidoamine (PAMAM) dendrimers by activating and modifying with Na-carboxymethyl-beta-cyclodextrins (CM-beta-CD) in sequence. A novel gene carrier (CM-beta-CD modified activated PAMAM dendrimers, CMAP) was then constructed. CMAP nanoparticles could bind pRK5-Atoh1-EGFP plasmids to form vector-DNA complexes (dendriplexes) with a mean particle size of 132 +/- 20 nm and zeta potential of 31 +/- 3 mV. These dendriplexes were locally applied on the round window membrane and delivered to the inner ear by passive gradient permeation. Results showed that the Atoh1 gene was successfully transferred into the cells as indicated by the green fluorescence detected in the inner ear. A relatively selective gene transfer with high efficiency was achieved in the auditory hair cells but not much in other cell types in the cochlea. Auditory brainstem response was determined seven days after inoculation, indicating good tolerance. This approach may provide a novel tool for inner ear gene therapy and initiate the applications of biomaterials to treat auditory disorders.

Structure-activity relationship of polypyridyl ruthenium(II) complexes as DNA intercalators, DNA photocleavage reagents, and DNA topoisomerase and RNA polymerase inhibitors.

To investigate the relationship between the molecular structure and biological activity of polypyridyl Ru(II) complexes, such as DNA binding, photocleavage ability, and DNA topoisomerase and RNA polymerase inhibition, six new [Ru(bpy)(2)(dppz)](2+) (bpy=2,2'-bipyridine; dppz=dipyrido[3,2-a:2,',3'-c]phenazine) analogs have been synthesized and characterized by means of (1)H-NMR spectroscopy, mass spectrometry, and elemental analysis. Interestingly, the biological properties of these complexes have been identified to be quite different via a series of experimental methods, such as spectral titration, DNA thermal denaturation, viscosity, and gel electrophoresis. To explain the experimental regularity and reveal the underlying mechanism of biological activity, the properties of energy levels and population of frontier molecular orbitals and excited-state transitions of these complexes have been studied by density-functional theory (DFT) and time-depended DFT (TDDFT) calculations. The results suggest that DNA intercalative ligands with better planarity, greater hydrophobicity, and less steric hindrance are beneficial to the DNA intercalation and enzymatic inhibition of their complexes.

Newborn hearing concurrent gene screening can improve care for hearing loss: a study on 14,913 Chinese newborns.

OBJECTIVE: Newborn hearing screening has been widely adopted and made an achievement to some degree. Current screening protocols rely solely on detecting existing auditory disorders at the time of screening and are unable to identify individuals susceptible to auditory disorders in later life. Even if the hearing loss newborn is referred, most cases could not be diagnosed until 6-12 months old with no etiology being elucidated. This study reports the first effort to combine traditional hearing screening with genetic screening to improve the efficacy of newborn hearing screening. METHODS: This study was undertaken in 12 regional hospitals located in 11 provinces of China. 14,913 newborn babies received hearing concurrent genetic screening. The hearing screening was performed with OAE or AABR. Blood sample was collected with a universal newborn genetic screening card. And three common gene, mtDNA 12S rRNA, GJB2 and SLC26A4 were screened with standard protocol. RESULTS: Among all the 14,913 newborns, 86.1% (12,837/14,913) individuals passed the first-step hearing screening, 7.8% (1168/14,913) babies passed only one side, and the other 6.1% (908/14,913) were bilaterally referred. Gene screening found 306 individuals had one or two mutant alleles, the carrier rate is 2.05% (306/14,913) among the entire newborn population. The risk for hearing loss was 100% (7/7) for those newborns carrying causative GJB2 or SLC26A4 mutations (homozygotes or compound heterozygotes), 14.4% (23/160) for GJB2 heterozygote carriers, 12.3% (15/122) for SLC26A2 heterozygous carriers, and the total prevalence of referral hearing screening was approximately 14.7% (45/306). However, 85.3% (261/306) newborns passed hearing screening among these carriers including 18 newborns with 12S rRNA mt.1555A>G pathogenic mutation, who would suffer from sudden hearing loss once applying aminoglycoside drugs. CONCLUSION: The cohort studies provided the essential population parameters for developing effective programs for hearing care of newborns in China. Hearing concurrent gene screening in newborns may confirm the abnormal results from hearing screening tests, help to find the etiologic of the hearing loss, and better recognize infants at risk for late-onset hearing loss occurring prior to speech and language development. In conclusion, a survey on 14,913 Chinese newborns proved that concurrent genetic screening could improve newborn hearing screening for hearing defects.

[Judgement of disproportionate loss between Mandarin monosyllable discrimination and pure tone hearing thresholds].

OBJECTIVE: To establish the criteria of the disproportionate loss of Mandarin monosyllable discriminative abilities to pure tone hearing thresholds. METHODS: Total of 165 patients with varying degrees of sensorineural hearing loss were recruited for routine audiological evaluations. The speech discrimination scores were obtained by Mandarin phonemic-balanced monosyllable lists via self-made speech audiometric software. The Performance-Intensity (P-I) function for individual ear was obtained by the same list which was administrated in ascending intensities, with 25 monosyllables presenting randomly. The lowest intensity was determined by the lowest pure tone threshold among all audiometric frequencies minus 5 dB. The intensities were increased in 5 dB step until the score was 100% or the intensity was reached to the patient's uncomfortable level. The PB(max) was obtained from the P-I plot. Three parameters about pure tone average hearing thresholds, including PTA(1) (average of 0.5, 1 and 2 kHz), PTA(2) (average of 1, 2 and 4 kHz) and PTA(3) (average of 0.5, 1, 2 and 4 kHz), as well as three parameters about audiogram slope, including Slope(0.5) (4 kHz minus 0.5 kHz), Slope(1) (4 kHz minus 1 kHz) and Slope(2) (4 kHz minus 2 kHz), were calculated respectively. The correlations between PB(max) and above parameters were analyzed by SPSS10.0 statistical software. RESULTS: The audiogram slopes were not shown any correlation with PB(max), while the pure tone average thresholds, especially PTA(3) (r = -0.595, P = 0.000) were confirmed to correlate with PB(max). In the scatter plot based on PB(max) and PTA(3), a linear boundary was constructed encompassing approximately 99% of observed data collected from the sensorineural hearing-impaired. CONCLUSION: Any PB(max) score falling below the boundary should be considered with high possibility and disproportionately poor comparison with pure tone hearing thresholds.

Effect of ancillary ligands on the topoisomerases II and transcription inhibition activity of polypyridyl ruthenium(II) complexes.

To explore the structure-activity relationship of polypyridyl ruthenium(II) complexes as topoisomerase II and T7 RNA polymerase inhibitors, four new complexes, [Ru(4dmb)(2)(ppd)](2+) (4dmb=4,4'-dimethyl-2,2'-bipyridine, ppd=pteridino[6,7-f][1,10] phenanthroline-1,13(10H,12H)-dione), [Ru(5dmb)(2)(ppd)](2+) (5dmb=5,5'-dimethyl-2,2'-bipyridine), [Ru(dip)(2)(ppd)](2+) (dip=4,7-diphenyl-1,10-phenanthroline), and [Ru(ip)(2)(ppd)](2+) (ip=imidazole[4,5-f][1,10]phenanthroline) have been synthesized and characterized in detail by (1)H NMR spectroscopy, mass spectrometry and elemental analysis. Their interaction with calf thymus DNA and the inhibitory activity towards topoisomerase II and T7 RNA polymerase were investigated. The results suggest that although all of these four Ru(II) complexes are potent DNA intercalators, topoisomerase II inhibitors and DNA transcription inhibitors, their DNA binding strength and inhibitory activities are quite different. The activity of ip- and dip-complexes are significantly higher than the dmb-complexes. To explain the experimental regularity and reveal the underlying quantum chemistry mechanism of the biological activity, the properties of energy levels and population of frontier molecular orbitals and excited state transitions of these complexes have been studied by density functional theory (DFT) and time-depended DFT (TDDFT) calculations. The results suggest that ancillary ligands bearing lower energy of the lowest unoccupied molecular orbitals (LUMOs), better hydrophobicity and less steric hindrance of are beneficial to the DNA intercalation and topoisomerase II and DNA transcription inhibition of their complexes.

[Analysis of clinical features of concomitant vertigo in idiopathic sudden deafness].

OBJECTIVE: To analyze the clinical characteristics of concomitant vertigo in patients with sudden deafness (SD). METHODS: Ninety-six cases of SD were reviewed retrospectively from January 2005 to July 2009. SD and benign paroxysmal positional vertigo (BPPV) were diagnosed according to the guides of China Medical Association. The characteristics of vestibular function and the order of the onset of cochlear and vestibular symptoms were analyzed. RESULTS: Of all 96 cases, 23 (24.0%) cases presented with BPPV; 58 (60.4%) cases took the form of unilateral vestibular hypofunction and 15 (15.6%) cases had normal vestibular function. Time interval between cochlear and vestibular symptoms was as follows: 46 patients could tell the exact time of onset of cochlear and vestibular symptoms, of which 6 (13.0%) cases occurred simultaneously; 4 (8.7%) cases presented vertigo within 1 hour after onset of cochlear symptom hypofunction; 21 (45.7%) cases showed time interval between 1 hour and 24 hours; and 13 (28.3%) cases presented vertigo at several days (less than 10 days) after cochlear symptoms. And only in 2 (4.3%) cases did vertigo occur before cochlear symptoms. CONCLUSIONS: Concomitant vertigo in idiopathic SD took the forms of normal or abnormal vestibular function, some of which were BPPV. Occurrence of vertigo was after cochlear symptoms.

[Complications of canalith repositioning procedure for benign paroxysmal positional vertigo].

OBJECTIVE: To investigate the incidence of complications of canalith repositioning procedure (CRP) for benign paroxysmal positional vertigo (BPPV) in order to recognize and intervene the complication. METHODS: Totally 430 cases of BPPV were treated by CRP between Jan., 2005 and Nov., 2007. The patients with complication were retreated with CRP according to the new canals otolith falling into. RESULTS: There were 313 patients with posterior canal BPPV, among which 5 had complications during CRP for posterior canal BPPV and 3 for horizontal canal BPPV. And 1 patient transformed from cupulolithiasis to canalithiasis during Semont CRP, which made CRP possible. Three patients had horizontal BPPV during CRP for posterior canal BPPV. Horizontal BPPV emerged during CRP for anterior canal BPPV in 1 patient. CRP for the posterior BPPV had more patients with complication than that of CRP for the anterior BPPV, but the percentage was on the contrary, and they were 1.9% (8/313) and 28.6% (2/7) respectively. The rate of complication during CRP was 3.3% (14/430) and all of them recovered well with CRP. CONCLUSIONS: There are possibility for canal otolith transferred from one canal to another. Careful observation of nystagmus and reevaluation of the patients with BPPV in case of unsuccessful treatments are crucial to determine the complications.

The large Chinese family with Y-linked hearing loss revisited: clinical investigation.

CONCLUSION: The DFNY1 phenotypes shared many characteristics with some autosomal dominant hearing loss, in the aspects of age of onset, severity and audiometric configuration. However, the typical, outstanding feature of this trait was its remarkable pattern of inheritance. Similar traits, if ever encountered, can be most easily identified by discerning this exceptional and rare pattern of inheritance. OBJECTIVES: To analyze the audiological features in Chinese Y-linked non-syndromic hearing impairment, the extended DFNY1 family. SUBJECTS AND METHODS: A nine-generation Chinese family (DFNY1) was ascertained and expanded from the year of 2000 to 2006. The audiometric evaluations included pure-tone audiometry, tympanometry, and auditory brainstem responses. Some subjects received computerized tomography scan of the temporal bone. RESULTS: 52 out of 276 members in this family received clinical examinations. 24 live subjects had hearing impairment consisting of 23 patrilineal males and one female. In the affected lineage, 92% patrilineal males were well characterized as having hearing loss and 2 children remained to be diagnosed. Based on the audiological examinations on the male members, the degree of hearing loss was from mild (3 patients), moderate (7 patients) to severe (11 patients). The audiometry displayed 48% subjects with sloping in high frequencies, 38% flat in all frequencies, and the rest (14%) the U-shape. The age of onset ranged from 5-27 years with the average of 11.5 years.

[Investigation and management of wound on head and neck from the disaster area in Wenchuan earthquake].

OBJECTIVE: To investigate and analyze the wounded's state of ear, nose, throat, neck and head injury in Wenchuan earthquake. METHODS: The 206 wounded cases, who was treated in No. 452 Hospital of People's Liberation Army, were investigated specially with emphasis on injury cause, severity and treatment. RESULTS: The injured 165 cases among the 206 were in hospital, while the cases who related to the injury of ear, nose and throat were 37 cases (22.4%). Among the inpatients, the trauma of otorhinolaryngology and head and neck included: ear injuries totally 13 cases (including hemotympanum 2 cases), extraneous matter 4 cases, haemorrhagic 4 cases, nasalis and the fracture of nasal bone and nasal sinuses 7 cases (including cerebrospinal rhinorrhea 1 case), zygomatic abscess 1 case, fracture of mandible 4 cases, lip injuries 2 cases and hoarse 2 cases. The inpatients were wounded mostly because of falling and stepping. All the inpatients recovered well after properly management by ENT doctors. CONCLUSIONS: Maxillofacial injury of the wounded those were medical evacuation in the earthquake area, was ignored more readily comparing to the injury of other spots, so specialist should examine early and treat properly the people as soon as possible.

[Electron microscopic observation of vocal fold polyps].

OBJECTIVE: The purpose of this study was to observe the ultrastructure of the fibroblasts, collagen and elastic fibers in vocal fold polyps. METHODS: Ten vocal fold polyps and 3 normal vocal fold specimens obtained from total laryngectomy were studied by means of transmission electron microscope and scanning electron microscope. RESULTS: The result showed that in vocal fold polyps, the quantity of fibroblasts increased and there were abundant organelles, suggesting that the fibroblast were in the status of activation. As the main cell to produce lamina propria extracellular matrix, the representation suggested that the extracellular matrix metabolism was active. Leucocytes soakage was observed, suggesting that the inflammation may play a role in the lesion. It was found by scanning electron microscopy that in case of lesions, collagen fibers and elastic fibers arrayed irregularly. CONCLUSIONS: Under pathologic circumstance, fibroblasts, collagen and elastic fibers altered in morphology, which possibly induced the functional alteration.

[Investigation of surgical managements of olfactory neuroblastoma].

OBJECTIVE: To evaluate the safety and efficacy of transnasal endoscopic resection and craniofacial resection through an external approach for olfactory neuroblastoma (ONB). METHODS: Thirty two patients with ONB treated between 1987 and 2006 were retrospectively reviewed. RESULTS: The patients were followed up for 8-135 months, the median follow-up time was 20 months. The longest follow-up time of patients treated by endoscope was 79 months, and patients treated by combined endoscope and transcranial surgery was 87 months. At Kadish stage B the 3-year survival rate of patients with transnasal endoscopic resection was 78.8% and at Kadish stage C it was 50.0%. At Kadish stage B the 3-year survival rate of patients with craniofacial resection through an external approach was 60.0% and at Kadish stage C it was 44.4%. The bleeding amounts in above two approaches were 140 ml and 450 ml. The average length of stay in hospital in transnasal endoscopic resection approach was markedly reduced (P < 0. 01). CONCLUSIONS: Olfactory neuroblastoma can be safely and effectively excised and reconstructed endoscopically with comparable degrees of tissue removal as with external approaches. The time of stay in hospital can be reduced and the surgical trauma can be diminished.

[Relevance between clinical behavior and bionomical findings of acoustic neuromas].

OBJECTIVE: To evaluate the relationship between labeling index (LI) Ki-67, proliferating cell nuclear antigen (PCNA) and transforming growth factor-beta1 (TGF-beta1) with the clinical behavior of acoustic neuroma. METHODS: Expression of Ki-67, PCNA and TGF-beta1 was detected by immunohistochemistry in 53 specimens of acoustic neuromas. The relationship among tumor proliferation, histological representation, size of tumor, clinical proliferation index of tumor and tumor proliferation activity were analyzed. RESULTS: In all 53 cases, the positive rate of Ki-67 was 77.4% (41/53) but the positive rate of PCNA was 84.9% (45/53). There was significant difference between the proliferate index, clinic growth rate and course of disease (t = 2.14, t = 2.70; P < 0.05). The positive rate of TGF-beta1 was 83.0% (44/53). The correlation of TGF-beta1 with LI (Ki-67) was significant difference (r = 0.36, P < 0.05). Cystic degeneration often occurred in large-size tumor (Z = 4.44, P < 0.05). There was no significant relationship between the expression of LI (Ki-67), LI (PCNA) and TGF-beta1 and the course of disease as well as between the cystic degeneration and the non-cystic degeneration. Although clinic growth rate of cystic degeneration was bigger than that of non-cystic degeneration, there was not statistically significant. CONCLUSIONS: Ki-67 and PCNA are reflected proliferation activities of tumor cells in acoustic neuromas. Cell proliferation-labeling index LI (PCNA) was related with clinical growth rates. TGF-beta1 might participate in the biological behavior of acoustic neuroma. Cystic degeneration was one of special pattern of acoustic neuroma, however, tumor enlargement might due to the volume of the cystic but unrelated to fast proliferation of parenchyma cell.

[Case-control survey on risk factors of benign vocal fold lesions].

OBJECTIVE: To investigate the risk factors that may relate with benign vocal fold lesions including vocal fold nodule, vocal fold polyp, chronic laryngitis and Reinke's edema METHODS: In present series, 321 cases who were performed laryngoscope were invited to participate the survey. Among them 168 cases with benign vocal fold lesions composed the case group. Another 153 cases with normal larynx composed the control group. Each case were undertook the same questionnaire. Logistic regression analysis was preformed to investigate the possible risk factors. RESULTS: The result demonstrated the occurring of benign vocal fold lesions positively correlated to five factors, including occupation, work or residence environment noise, alcohol-consuming, voice-using hours per day and abuse of voice. Occupations with intensive voice-use were more vulnerable to developing these disorders. Occurring risk of occupations type II with moderate voice-use was 1.934 times than that of occupations type I with lesser voice-use (OR = 1.934). And risk of occupations type III with upper voice-use was 2.633 times than that of type I. Risk raised 1.302 times with each more hour of voice use per day. OR of the following factors of voice abuse, environment noise, alcohol-consuming was 4.744, 2.115 and 2.177, respectively. CONCLUSIONS: The result suggested that people should abstain from alcohol, lowering the environment noise, prevent overuse and abuse of voice in order to decrease the prevalence of these disorders, which is especially important for the professional voice users, e. g. teachers or managers. The essential therapy for these disorders is to correct bad phonation habits.

[Visual evoked potentials in adults with migrainous vertigo].

OBJECTIVE: To investigate the visual evoked potentials in adults with migrainous vertigo (MV). METHODS: Totally 113 patients with MV were enrolled from vertigo clinic. Patients received necessary laboratory examinations as well as pattern visual evoked potential (PVEP) testing. RESULTS: Definite MV accounted for 46.9% (53/113) and probable MV accounted for 53.1% (60/113). Among 74 patients who received PVEP, the results were normal in 35 patients (47.3%) and abnormal in 39 patients (52.7%). The abnormal manifestations included lowered N75-P100 amplitude, elongated latency of P100, and lowered N75-P100 amplitude combined with delayed latency of P100. Seven patients with MV had unilateral lowered N75-P100 amplitude and 4 had bilateral abnormal amplitude. Nine patients had unilateral delayed latency of P100 and 11 had bilateral abnormal latency. Four patients had unilateral and 4 had bilateral abnormal N75-P100 amplitude and latency of P100. CONCLUSIONS: MV patients usually have abnormal PVEP. PVEP may become a useful electrophysiological test in the diagnosis of MV.

Nonsense mutations in the PAX3 gene cause Waardenburg syndrome type I in two Chinese patients.

BACKGROUND: Waardenburg syndrome type I (WS1) is an autosomal dominant disorder characterized by sensorineural hearing loss, pigmental abnormalities of the eye, hair and skin, and dystopia canthorum. The gene mainly responsible for WS1 is PAX3 which is involved in melanocytic development and survival. Mutations of PAX3 have been reported in familiar or sporadic patients with WS1 in several populations of the world except Chinese. In order to explore the genetic background of Chinese WS1 patients, a mutation screening of PAX3 gene was carried out in four WS1 pedigrees. METHODS: A questionnaire survey and comprehensive clinical examination were conducted in four Chinese pedigrees of WS1. Genomic DNA from each patient and their family members was extracted and exons of PAX3 were amplified by PCR. PCR fragments were ethanol-purified and sequenced in both directions on an ABI_Prism 3100 DNA sequencer with the BigDye Terminator Cycle Sequencing Ready Reaction Kit. The sequences were obtained and aligned to the wild type sequence of PAX3 with the GeneTool program. RESULTS: Two nonsense PAX3 mutations have been found in the study population. One is heterozygous for a novel nonsense mutation S209X. The other is heterozygous for a previously reported mutation in European population R223X. Both mutations create stop codons leading to truncation of the PAX3 protein. CONCLUSIONS: This is the first demonstration of PAX3 mutations in Chinese WS1 patients and one of the few examples of an identical mutation of PAX3 occurred in different populations.

[Mutation of GJB2 gene in nonsyndromic hearing impairment patients: analysis of 1190 cases].

OBJECTIVE: To analyze the sequence of GJB2 gene in nonsyndromic hearing impairment (NSHI) patients in China. METHODS: Peripheral blood samples were obtained from 1190 NSHI patients randomly selected from the Deaf and Mute Schools of Beijing, Hebei, Heilongjiang, Jilin, Inner Mongolia, Shanxi, Henan, Hubei, Shaanxi, Gansu, Ningxia, Qinghai, Anhui, Jiangsu, Shanghai, Fujian, Guangdong, and Guangxi, and 301 children with normal hearing level used as controls. Genomic DNA was extracted by extraction kits to undergo polymerase chain reaction and sequencing so as to detect the mutations of GJB2 gene. RESULTS: Sixteen pathogenic mutations of GJB2 gene were found, the most common of which included 235delC, 299-300delAT, and 176del16bp. 250 patients (21.05%) carried definite GJB2 mutations, 245 of which (98%) carried at least one of these 3 common mutations. 222 of the 250 patients (88.80%) carried the mutation 235delC with a detection rate of 18.66%. 62 of the 250 patients (24.80%) carried the mutation 299-300delAT with a detection rate of 5.21%. 19 of the 250 patients (7.60%) carried the mutation 176del16bp with a detection rate of 1.60%. The detection rates of these 3 mutations in the NSHI patients were all significantly higher than those among the controls (all P<0.01). CONCLUSION: The hot spot of GJB2 gene mutations in Chinese NSHI patients is 235delC, followed by 299-300delAT and 176del16bp. These results establish a fundamental basis for drawing a spectrum of GJB2 gene mutation among Chinese population.

[Benign paroxysmal positioning vertigo related to inner ear disorders].

OBJECTIVE: To investigate the incidence of benign paroxysmal positional vertigo(BPPV) and to further understand the possible mechanism of BPPV. METHODS: To observe the incidence of BPPV among vestibular neuritis, sudden deafness, Meniere's disease and Bell's palsy at vertigo clinic from January at 2004 to November at 2006 and to compare the therapeutic results with that of the primary BPPV. RESULTS: There are 4 types of inner ear disorders involved in the concomitant BPPV, ie, vestibular neuritis, sudden deafness, Meniere's disease and Bell's palsy and the incidence are 9.5% (5/53), 38.9% (35/90) and 0.3% (1/381) respectively; and there was 1 case of BPPV concomitant to Bell's palsy. Among the 42 concomitant BPPV, 5 cases were horizontal canal BPPV, 37 cases were posterior canal BPPV, and 1 cases had complicated anterior BPPV during repositioning maneuver. 39 cases of concomitant BPPV were canalithiasis and 3 cases were cupuliothiathitis, of which 75% (27/36) of concomitant BPPV emerged within 1/2 years after the onset of primary inner ear disorders. The therapeutic efficacy of the concomitant BPPV with canalith repositioning was similar to that of the primary type of BPPV. CONCLUSIONS: Following some inner ear disorder, BPPV could emerge, such as sudden deafness, vestibular neuritis and Meniere's disease. The most common type of BPPV was canalithiasis of posterior canal, and the cupulolithiasis of horizontal canal was uncommon. The anterior canal therapeutic efficacy of the concomitant BPPV with canalith repositioning was similar to that of the primary type of BPPV. The therapeutic efficacy of the concomitant BPPV with canalith repositioning was similar to that of the primary type of BPPV.