Auditory brainstem function in women with vestibular migraine: a controlled study.

BACKGROUND: Vestibular migraine (VM) has been recognized as a diagnostic entity over the past three decades. It affects up to 1% of the general population and 7% of patients seen in dizziness clinics. It is still underdiagnosed; consequently, it is important to conduct clinical studies that address diagnostic indicators of VM. The aim of this study was to assess auditory brainstem function in women with vestibular migraine using electrophysiological testing, contralateral acoustic reflex and loudness discomfort level. METHODS: The study group consisted of 29 women with vestibular migraine in the interictal period, and the control group comprised 25 healthy women. Auditory brainstem response, frequency following response, binaural interaction component and assessment of contralateral efferent suppression were performed. The threshold of loudness discomfort and the contralateral acoustic reflex were also investigated. The results were compared between the groups. RESULTS: There was a statistically significant difference between the groups in the frequency following response and the loudness discomfort level. CONCLUSIONS: The current study suggested that temporal auditory processing and loudness discomfort levels are altered in VM patients during the interictal period, indicating that these measures may be useful as diagnostic criteria.

Subjective and objective vestibular changes that occur following paediatric cochlear implantation: systematic review and meta-analysis.

OBJECTIVE: Cochlear implantation can result in post-operative vestibular dysfunction of unknown clinical significance. The objective of this study was to characterize the presence, magnitude, and clinical significance of vestibular dysfunction that occurs after pediatric cochlear implantation. DATA SOURCES: The databases Embase, Medline (OvidSP), and PubMed were used. Only articles published in English were included. Grey literature and unpublished sources were also reviewed. STUDY SELECTION: Articles published from 1980 until the present which documented pre-operative and post-operative vestibular testing on children under the age of 18 were used. DATA EXTRACTION: Parameters that were assessed included number of patients, pre- and post-operative vestibular-evoked myogenic potentials (VEMPs), head impulse testing (HIT), calorics, and posturography, timing of pre- and post-operative testing, symptomatology, and other demographic data such as etiology of the hearing loss. DATA SYNTHESIS: Ten articles were included. Relative risk values evaluating the effect of cochlear implantation on vestibular function were calculated for VEMPs and caloric testing due to the availability of published data. I2 values were calculated and 95% confidence intervals were reported. Separate analyses were conducted for each individual study and a pooled analysis was conducted to yield an overall relative risk. Assessment on risk of bias in individual studies and overall was performed. CONCLUSION: Pediatric cochlear implantation is associated with a statistically significant decrease in VEMP responses post-operatively (RR 1.8, p < 0.001, I2 91.86, 95%CI 1.57-2.02). Similar results are not seen in caloric testing. Insufficient data is available for analysis of HIT and posturography. Further studies are necessary to determine the effect of cochlear implantation on objective vestibular measures post-operatively and whether any changes seen are clinically relevant in this population.

A closer look at subjective caloric sensations: Is there more to vertigo than spinning?

BACKGROUND: There is a prevailing opinion that spinning sensations signify a peripheral vestibular pathology while non-spinning sensations are not of vestibular origin. OBJECTIVES: 1) Characterize the subjective sensations reported by patients during caloric testing. 2) Assess if the sensation was correlated with the peak slow phase velocity (SPV). METHODS: Retrospective chart review at a Canadian adult tertiary-quaternary care balance centre for patients undergoing diagnostic caloric testing between December 2014 and September 2015. RESULTS: Of 163 patients included, 122 had normal calorics and 41 demonstrated unilateral weakness. Spinning/rotatory movements were the most commonly reported sensations (55-70%). No sensation was reported among 10-20% of patients. Other non-rotatory sensations were reported 20-25% of the time. Both lack of sensation and other sensations were more likely to be correlated with SPVs that were significantly lower than those associated with spinning/rotating sensations. However, 18% of patients with normal calorics and robust SPVs with warm irrigation still reported non-spinning sensations. CONCLUSIONS: During caloric irrigation, subjective sensations other than spinning and rotating are reported 20-25% of the time and these tend to be associated with lower peak SPV. Non-spinning vertigo is not uncommon as a subjective description of vestibular sensation even in normal patients with strong SPVs.

Diagnosis of Superior Semicircular Canal Dehiscence in the Presence of Concomitant Otosclerosis.

OBJECTIVE: To review three patients with concurrent otosclerosis and superior canal dehiscence identified before operative intervention and provide a practical diagnostic approach to this clinical scenario. STUDY DESIGN: Retrospective patient series. SETTING: Tertiary/quaternary referral center. PATIENTS: Individuals with confirmed diagnoses of concurrent otosclerosis and superior semicircular canal dehiscence syndrome. INTERVENTIONS: Detailed history and physical examinations were performed on these patients, as well as detailed audiovestibular testing and computed tomography imaging. MAIN OUTCOME MEASURES: Establishing a clear diagnosis of concurrent otosclerosis and superior semicircular canal dehiscence syndrome using a thorough diagnostic approach. RESULTS: Three patients presented with conductive hearing loss and normal tympanic membranes. When history and physical examination yielded suspicious third window symptoms/signs, more detailed audiovestibular testing and computed tomography scan imaging were performed. All three patients were ultimately identified to have concurrent otosclerosis and superior canal dehiscence. Conservative management was the option of choice for two of these patients (trial of a hearing aid) and surgical intervention was performed to treat the otosclerosis in the remaining patient.