High Cardio-Ankle Vascular Index Values in Idiopathic Sudden Sensorineural Hearing Loss Patients Indicate Better Prognosis.

OBJECTIVE: Vascular disorders and viral infections are the presumed etiologies of idiopathic sudden sensorineural hearing loss (ISSNHL) and acute sensorineural hearing loss, with no identifiable cause. However, no clinical test for estimating the extent of vascular involvement in ISSNHL has been reported despite its potential impact on prognosis and treatment. We investigated the correlation between the cardio-ankle vascular index (CAVI), which reflects arterial stiffness and elasticity, and hearing improvement to ascertain its usefulness as an additional indicator of ISSNHL prognosis and etiology. METHODS: We enrolled 182 patients diagnosed with definite ISSNHL. The percentage of mild ISSNHL patients and that of patients experiencing no change were compared between the high-CAVI and low-CAVI groups. Age, initial and final pure-tone average (PTA) values, CAVI, presence or absence of vertigo, and medical histories were retrospectively reviewed and included in univariate and multivariate analyses. RESULTS: The percentage of mild ISSNHL patients was smaller in the high-CAVI group than in the low-CAVI group, whereas the percentage of patients experiencing no change was smaller in the high-CAVI group than in the low-CAVI group, although patients in the high-CAVI group were significantly older than those in the low-CAVI group. The Cox proportional hazard model revealed that high CAVI, hypertension, younger age, and initial PTA <90 dB were associated with hearing improvement. CONCLUSIONS: ISSNHL in patients with high CAVI was more severe but had a better prognosis than that in those with low CAVI. CAVI may help evaluate diseases of vascular and other etiologies, as well as ISSNHL.

Higher Cardio-Ankle Vascular Index Values in Patients With Vestibular Neuritis May Indicate a Better Prognosis.

BACKGROUND: The presumed etiology of vestibular neuritis (VN), a sudden onset of spontaneous vertigo without auditory or cranial nerve symptoms, includes viral infections and vascular disorders. However, no clinical test for estimating vascular disorders in VN has been reported. Moreover, estimating the etiology of VN is important to predict the prognosis and select appropriate treatment. This study aimed to evaluate the cardio-ankle vascular index (CAVI), which reflects arterial stiffness and elasticity, as an additional indicator for estimating the prognosis and etiology of VN. MATERIALS AND METHODS: Among 207 consecutive patients with suspected VN, 88 patients diagnosed with definite VN were enrolled. Age, initial and final percent canal paresis (CP) in the caloric test, CAVI, presence or absence of vestibular-evoked myogenic potential asymmetry, and medical history were evaluated using univariate and multivariate analyses. RESULTS: Patients with VN with high CAVI had a better prognosis than those with low CAVI. High CAVI was a factor for improvement in percent CP, in addition to younger age and less severe initial percent CP in the Cox proportional hazard model. CONCLUSION: CAVI can be an additional indicator for estimating the prognosis and etiology of VN. This indicator can potentially be applied to other diseases, including vascular disorders with other etiologies.

Clinical Efficiencies of Stabilometry and Visual Feedback Test for Differentiating the Patients with Psychogenic Vertigo from Healthy Subjects.

The psychogenic vertigo has been diagnosed based on subjective dizzy symptom without abnormal findings of oculomotor tests and vestibular tests. We investigated the characteristics of the postural control system in patients with psychogenic vertigo using stabilometry and Body Tracking Tests with a visual feedback test to assess the dynamic body balance. This study consisted of 14 patients with psychogenic vertigo and 92 aged-match healthy subjects. They were instructed to keep the center of pressure constantly in the target circle displayed on the screen in front of the subjects. The dynamic body balance was evaluated by the proportion of the center of pressure (COP) including in the target circle during the test. The psychogenic vertigo group showed a larger area and a smaller locus length per unit area in comparison with the healthy subject group (p<0.01). In spectral analysis with the maximum entropy method (MEM), the power of the medio-lateral and antero-posterior positional power spectrum under eyes open condition were significantly largest at around 0.125 Hz in the psychogenic vertigo group. No significant difference in the result of Body Tracking Tests with a visual feedback test was found between both groups. Our results suggest that the patients with psychogenic vertigo maintain body balance with extremely slowly and large movements for quiet stance during eyes open condition. The results of Body Tracking Tests with a visual feedback test may indicate that the spontaneous postural control itself in patients with psychogenic vertigo does not differ from that in healthy individuals. We believe that this test could be useful as one of the significant diagnostic tests for psychogenic vertigo.

The dominant foot affects the postural control mechanism: examination by body tracking test.

CONCLUSION: The antero-posterior (AP) body tracking test (BTT) showed that the dominant foot could affect the tilt angle of the sway movement, delineated by primary component analysis. Differences associated with the dominant foot could represent the difference in space perception of each person. OBJECTIVES: To examine whether the dominant foot could affect the postural control mechanism using the BTT. METHODS: Ninety-seven healthy participants enrolled in the study were classified into right-foot and left-foot dominance groups, and their performances were compared. For the BTT, each participant stood on a stabilometer and caught the movement of a visual target moving vertically (anterior-posterior) or horizontally by the center of pressure movement, displayed on a 14-inch screen monitor at 100 cm in front of the subject. The mean displacement angle of the obtained stabilogram was evaluated by principal component analysis. RESULTS: The AP BTT in the right-foot dominance group showed a clockwise tilt with a mean displacement angle of 3.022 ± 3.761°, whereas the group with left-foot dominance had a modest counter-clockwise tilt with a mean displacement angle of -0.694 ± 4.497°. This difference was found to be significant by the independent t test (p < 0.0001). In the lateral BTT, the mean displacement angles were not significant.

[Tracking axis of the body tracking test(BTT)].

We report herein on the use of the body tracking test (BTT), which is a method for quantitatively evaluating dynamic body balancing function, and how the body center moves during tracking by healthy subjects. We investigated 779 healthy subjects with no history of vertigo or balance disorder and a mean age of 37.9 years. Breakdown is as follows. Under 10 years old is 81 (37 boy and 44 girl), 10 years of age is 162 (73 boy and 89 girl), 20 years of age is 110 (43 men and 67 women), 30 years of age is 73 (44 male, 29 female), 40 years of age is 79 (49 men and 30 women), 50 years of age is 77 (40 men and 37 women), 60 years of age is 100 (53 men and 47 women), 70 years of age is 73 (27 men and 46 women), 80 years of age is 24 (15 men and 9 women). For the visual stimulus, we used a constant-speed antero-posterior (A-P) stimulus BTT and a constant-speed lateral BTT. BTT analysis involved principal axis analysis, in which the principal axis was the first principal component according to a principal component analysis technique. The axis tilt in the principal axis direction was assessed by calculating the coordinate Y-axis and X-axis tilt. In the anteroposterior (A-P) BTT, subjects of all ages exhibited an angle of tilt in the clockwise direction (the "plus" direction), together with the position vector and velocity vector. In the lateral BTT, we observed that the subjects tracked with a tilt in the counter-clockwise direction (the "minus" direction), together with the position vector and velocity vector. In terms of the subjects' ages, the angle of tilt from 0 degree in the antero-posterior (A-P) BTT showed the clockwise direction (the "plus" direction). In the lateral BTT, subjects 10 to 30 years of age exhibited tracking along the X-axis, with no observable tilt. Movement of the center of gravity may be a major acquired ability (practice) with respect to the direction of tilt of the tracking axis. Spatial sensory ability primarily involves the right parietal lobe of the brain, and somatosensory information from the left side of the body is believed to be used more for the positional relationships between the legs and the torso. Deviation of the principal axis appears to be related to the relationship between the dominant foot and the pivot foot, as well as to the functions of the parietal lobe that are involved in spatial sensing.