Acoustic neuroma presenting as exercise-induced vertigo.

We present two subjects with previously undiagnosed acoustic neuromas who complained of vertigo whenever they ran. One had normal hearing while the other already had a unilateral sensorineural deafness. Hyperventilation for 30 seconds provoked an ipsilateral beating nystagmus and reproduced the vertiginous sensation in both subjects. Hyperventilation is a simple bedside test that should be performed when assessing a subject with vertigo or when there is a clinical suspicion of an acoustic neuroma.

Impact of cochlear implants on the functional health status of older adults.

OBJECTIVES: To assess the impact of cochlear implantation on quality of life changes in older adults aged 50 years and above. STUDY DESIGN: Retrospective study by questionnaire and chart review. METHODS: Forty-seven patients aged 50 to 80 years (mean age, 63.4 y [SD = 8.6 y]), who have multiple-channel cochlear implants received at The Listening Center at Johns Hopkins Hospital, completed the Ontario Health Utilities Index Mark 3 survey and a questionnaire on quality of life changes. Health utility scores before and after cochlear implantation were measured, and audiologic data before implantation and at 6 months and 1 year after implantation were analyzed. RESULTS: Cochlear implantation in older adults is associated with a mean gain in health utility(P <.0001) of 0.24 (SD = 0.33), which corresponds to a favorable cost-utility of $9530 per quality-adjusted life-year. Improvements in hearing and emotional health attributes were primarily responsible for this increase in health-related quality of life measure. There was a significant increase in speech perception scores at 6 months after surgery (P <.0001 for both CID sentence and monosyllabic word tests) and a strong correlation between the magnitude of health utility gains and the postoperative increase in speech perception scores (r = 0.45, P <.05). CONCLUSIONS: Cochlear implants have a significant impact on the quality of life of older deaf patients, and are a cost-effective intervention in this population. Improvements in speech perception are predictive of gains in health-related quality of life and associated emotional benefits after cochlear implantation.