OVEMP as an objective indicator of successful repositioning maneuver / Potencial miogénico evocado vestibular ocular (oVEMP) como indicador objetivo de las maniobras de reposicionamiento exitoso en el vértigo posicional paroxístico benigno

BACKGROUND AND OBJECTIVE: Benign paroxysmal positioning vertigo (BPPV) is the most common peripheral vestibular disorder. Canalolithiasis in the posterior semi-circular canal is the most common underlying pathology that can be treated effectively by repositioning maneuvers. Our hypothesis suggested that successful maneuvers can lead to repositioning of dislodged otoconia to the utricle. MATERIALS AND METHODS: Air conducted oVEMP, which is thought to originate from the contra-lateral utricular organ was measured in twenty patients with unilateral BPPV and we compared n1-p1 peak to peak amplitude of the affected ears in 3 separate intervals: on pre-treatment when typical nystagmus was confirmed, immediately after, and 1 week after repositioning maneuvers to assess change, if any, in amplitude. RESULTS: This study showed significant increase of oVEMP amplitude in the affected ears after successful repositioning maneuver that was more significant after 1 week. CONCLUSIONS: oVEMP can be used as a reliable objective test for ensuring a successful maneuver rather than subjective dependence on the patient's symptoms, which may be misleading due to a remission

ANTECEDENTES Y OBJETIVO: El vértigo posicional paroxístico benigno es el trastorno vestibular periférico más común. La canalolitiasis en el canal semicircular posterior es la enfermedad subyacente más común, que puede tratarse eficazmente mediante maniobras de reposicionamiento. Nuestra hipótesis sugiere que las maniobras exitosas pueden originar un reposicionamiento de la otoconia desplazada hacia el utrículo. MATERIALES Y MÉTODOS: El potencial miogénico evocado vestibular ocular (oVEMP) con conducción de aire, cuyo origen se piensa que se halla en el utrículo contralateral, se midió en 20 pacientes con vértigo posicional paroxístico benigno unilateral comparando la amplitud n1-p1 de pico a pico de los oídos afectados en 3 intervalos separados: previamente al tratamiento cuando se confirmó el nistagmo típico, inmediatamente después y transcurrida una semana de las maniobras de reposicionamiento, para confirmar el cambio de amplitud, de haberse producido. RESULTADOS: Este estudio reflejó un incremento considerable de la amplitud del oVEMP en los oídos afectados, tras las maniobras exitosas de reposicionamiento, que fue más significativa trascurrida una semana. CONCLUSIONES: El oVEMP puede utilizarse como prueba objetiva fiable para garantizar una maniobra exitosa, en lugar de la dependencia subjetiva de la sintomatología del paciente, que puede resultar engañosa debido a su remisión

oVEMP as an objective indicator of successful repositioning maneuver.

BACKGROUND AND OBJECTIVE: Benign paroxysmal positioning vertigo (BPPV) is the most common peripheral vestibular disorder. Canalolithiasis in the posterior semi-circular canal is the most common underlying pathology that can be treated effectively by repositioning maneuvers. Our hypothesis suggested that successful maneuvers can lead to repositioning of dislodged otoconia to the utricle. MATERIALS AND METHODS: Air conducted oVEMP, which is thought to originate from the contra-lateral utricular organ was measured in twenty patients with unilateral BPPV and we compared n1-p1 peak to peak amplitude of the affected ears in 3 separate intervals: on pre-treatment when typical nystagmus was confirmed, immediately after, and 1 week after repositioning maneuvers to assess change, if any, in amplitude. RESULTS: This study showed significant increase of oVEMP amplitude in the affected ears after successful repositioning maneuver that was more significant after 1 week. CONCLUSIONS: oVEMP can be used as a reliable objective test for ensuring a successful maneuver rather than subjective dependence on the patient's symptoms, which may be misleading due to a remission.

Screening for auditory processing performance in primary school children.

BACKGROUND: A deficit in the processing of auditory information may underlie problems in understanding speech in the presence of background noise, degraded speech, and in following spoken instructions. Children with auditory processing disorders are challenged in the classroom because of ambient noise levels and maybe at risk for learning disabilities. PURPOSE: 1) Set up and execute screening protocol for auditory processing performance (APP) in primary school children. 2) Construct database for APP in the classroom. 3) Set critical limits for deviant performance. Our hypothesis is that screening for APP in the classroom identifies pupils at risk for auditory processing disorders. RESEARCH DESIGN, SAMPLE, AND METHODS: Study consisted of two phases. Phase 1: 2,015 pupils were selected from fourth-, fifth-, and sixth-graders using stratified random sampling with the proportional allocation method. Male and female students were equally represented. Otoscopic examination, screening audiometery, and screening tests for auditory processing (AP) abilities (Pitch Pattern Sequence Test [PPST], speech perception in noise [SPIN] right, SPIN left, and Dichotic Digit Test) were conducted. A questionnaire emphasizing auditory listening behaviors (ALB) was answered by classroom teacher. Phase 2 included 69 pupils who were randomly selected based on percentile scores of phase 1. Students were examined for the corresponding full version AP tests in addition to Auditory Fusion Test-Revised and masking level difference. Intelligence quotient and learning disabilities were evaluated. RESULTS: Phase 1: Results are displayed in frequency polygons for10th, 25th, 50th, 75th, and 90th percentiles score for each AP test. Fourth-graders scored significantly lower than fifth- and sixth-graders on all tests. Males scored lower than females on PPST. A composite score was calculated to represent a summed score performance for PPST, SPIN right ear, SPIN left ear, and Dichotic Digit Test. Scores <10th percentile were chosen to describe the poorest performance on screening. Performance was graded from 0 to 4 according to composite score; a score of 4 refers to scores <10th percentile on all four tests, while a 0 score designates performance ≥ the 10th percentile on all tests. ALB questionnaire scores of the sample screened varied significantly with sex and grade. Statistical analysis of phase 2 showed no statistical difference between mean score for Group 0 and clinic norms on all AP tests. Group 1 showed consistent poor performance in both the screening and full version SPIN test. Group 2 scored significantly lower on all screening tests, but not significantly different in some of the full version tests. Groups 3 and 4 showed significantly worse performance than clinic norms on all screening and full version tests. Auditory Fusion Test-Revised mean thresholds were statistically higher for groups with composite scores from 1 to 4. Masking level difference mean score was only significantly different for Group 4. ALB questionnaire results correlated to composite score categories. Dyslexia was a comorbid condition with Groups 2-4. CONCLUSION: AP skills in primary education maybe classified as robust abilities that endure challenging listening conditions, vulnerable abilities that manifest in challenging conditions, and poor abilities that manifest in even the best listening conditions. Composite score concept provides adequacy in grading AP skills.

Screening for the mitochondrial A1555G mutation among Egyptian patients with non-syndromic, sensorineural hearing loss.

BACKGROUND & AIM: Hearing loss is the most frequent form of neurosensory deficit in humans. Although the majority of hereditary hearing loss is due to nuclear gene mutations, it has become clear the significant contribution of mitochondrial genes. The first mitochondrial mutation shown to cause non-syndromic hearing loss in humans was the A1555G mutation in the small ribosomal RNA gene (12S rRNA). It has been detected in hundreds of families of different ethnic backgrounds, making it one of the prevalent genetic causes of hearing loss currently identified. However, there are major differences between ethnic groups regarding the frequency of this mutation. Few studies have been made in Arab countries, especially in Egypt. Here we report the prevalence of the mitochondrial mutation A1555G among patients with non-syndromic hearing loss (NSHL) and in healthy individuals with normal hearing in the Egyptian population. SUBJECTS & METHODS: The study was conducted on 97 patients with SNHL and 300 unrelated healthy Egyptian individuals, with normal hearing, as normal control subjects. Polymerase chain reaction followed by restriction enzyme digestion was used to screen the DNA samples of all subjects for the A1555G mutation. RESULTS: Participants included 97 cases with SNHL, 46 males and 51 females. Their ages ranged from 1 month to 65 years with the mean age 6.2 years (SD ± 8.2). Paternal consanguinity was reported in 46% (35/76) of the studied families. The A1555G mutation was found in one of the 97 patients (1.3%), while it has not been detected in the 300 control samples. CONCLUSION: Our findings indicate that, even in absence of exposure to aminoglycosides, the mitochondrial A1555G mutation is one of the potential causes of non-syndromic SNHL in the Egyptian population.