May 2022
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34 Reads
Medical Hypotheses
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May 2022
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34 Reads
Medical Hypotheses
May 2022
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34 Reads
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1 Citation
Hearing Balance and Communication
Introduction: Understanding the physiology of the caloric stimulation of the vestibular end organ was a seminal discovery in the history of neurotology. Robert Barany has been traditionally credited with this (1906). However, well before Barany, three scientists observed, qualified and quantified a similar phenomenon with different explanations. They were Charles Edouard Brown Sequard (1858), A Bornhardt (1876) and Benno Baginsky (1881). Materials and Methods: Articles with key words containing ‘caloric test’ and the ‘vestibular system’ were searched and studied from a historical perspective in scientific research repositories and the individual search facilities provided by journals on the history of medicine. Contemporaneous articles of the three scientists were analysed and inferences drawn. Results and Discussion: Charles Edouard Brown Sequard noticed the caloric effect on the ear causing giddiness in 1853, A Bornhardt observed nystagmus on application of ice cold water and a hot iron rod to the semi-circular canals in 1876 and Benno Baginsky in 1881 identified the correct pressure and temperature on the external or the middle ear to elicit a caloric response. In addition, they stumbled across several key observations of vestibular physiology which were later confirmed in the 20th century. Conclusions: This paper resurrects the works of these three forgotten pioneers and their contributions to our understanding of the physiology of the vestibular system.
May 2022
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362 Reads
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11 Citations
Neuroradiology
Purpose Heavily T2-weighted 3D FLAIR (hT 2 w-3D-FLAIR) sequence with constant flip angle (CFA) has been reported as being more sensitive to low concentrations of gadolinium (Gd) enabling endolymphatic hydrops (EH) visualization. The purpose of this study was to compare signal-to-noise (SNR) ratio, detection rate of EH, and increased perilymphatic enhancement (PE) as well as diagnostic accuracy in diagnosing definite Menière’s disease (MD), using 3D-SPACE FLAIR versus conventional 3D-TSE FLAIR. Methods This retrospective study included 29 definite MD patients who underwent a 4-h delayed intravenous (IV) Gd-enhanced 3D-TSE FLAIR and 3D-SPACE FLAIR MRI between February 2019 and February 2020. MR images were qualitatively and quantitatively analyzed twice by 2 experienced head and neck radiologists. Qualitative assessment included grading of cochlear and vestibular EH and visual comparison of PE. Quantitative assessment of PE was performed by placing a region of interest (ROI) and ratio calculation in the basal turn of the cochlea and the brainstem. Results The intra- and inter-reader reliability for grading of EH and PE was excellent (0.7 < kappa < 0.9) for 3D-SPACE FLAIR and exceeded the values for 3D-TSE FLAIR (0.5 < kappa < 0.9) The combination of EH and visual assessment of PE has the highest diagnostic accuracy in diagnosing definite MD on 3D-SPACE FLAIR with a sensitivity of 0.91 and a specificity of 0.98 resulting in a sensitivity raise of 6% compared to 3D-TSE FLAIR. Conclusion Four-hour delayed IV Gd-enhanced 3D-SPACE FLAIR sequence has a higher sensitivity and reproducibility than 3D-TSE FLAIR for the visualization of EH and increased PE in definite MD patients.
April 2022
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93 Reads
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2 Citations
The Journal of International Advanced Otology
Background: Vestibular co-stimulation is a side effect of cochlear implant stimulation. The electrical currents delivered by the cochlear implant can spread toward the vestibular system and thus stimulate it. The aim of the study is to evaluate whether it is feasible to functionally restore the balance by modifying the vestibular co-stimulation. Methods: Four adult patients, who had received a commercially available cochlear implant previously, were enrolled. Counterbalanced biphasic pulses were presented as bursts or as an amplitude-modulated biphasic pulse train (modulation frequencies ranging from 1 to 500 Hz) at the participant's upper comfortable level for electrical stimulation. Subjective sensations and vestibular-mediated eye movements were used for evaluating the possible effects of vestibular co-stimulation. Results: One participant experienced a cyclic tilting of his head in response to an amplitude-modulated biphasic pulse train with a modulation frequency of 2 and 400 Hz. However, during a follow-up visit, the sensation could not be replicated. Conclusion: Subjective vestibular sensations or vestibular-mediated eye movements could not be electrically evoked with a commercially available cochlear implant in 4 adult patients with almost normal vestibular function. Therefore, customized design of the hard-, firm-, and/or software of the commercially available cochlear implant might be necessary in order to electrically restore vestibular performance.
February 2022
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48 Reads
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6 Citations
Journal of Vestibular Research
Background: Avoidance of activities that trigger dizziness in persons with vestibular disorders may inhibit dynamic vestibular compensation mechanisms. Objective: To determine the reliability of the Vestibular Activities Avoidance Instrument (VAAI) 81 and 9 item tool and to compare the VAAI scores in Dutch-speaking healthy adults and in patients with vestibular disorders. Methods: A prospective cohort study was conducted including 151 healthy participants and 106 participants with dizziness. All participants completed the 81-item VAAI. Within 7 days, the VAAI was completed a second time by 102 healthy adults and 43 persons with dizziness. Results: The average 81-item VAAI scores [54.8(47.1) vs. 228.1(78.3)] and 9-item VAAI scores [2.4(5.9) vs. 28.1(12)] were significantly different between healthy adults and participants with dizziness (p < 0.001). In participants with dizziness the ICC for the 81-item VAAI was 0.95 (95% CI: 0.91, 0.97) and for the 9-item VAAI was 0.92 (95% CI: 0.85, 0.95). Cronbach's alpha for the 81-item VAAI was 0.97 and 0.85 for the 9-item VAAI. The minimal detectable change was 47.8 for the 81-item VAAI and 8.9 for the 9-item VAAI. Conclusions: Persons with dizziness have a greater tendency to avoid movements. Both test-retest reliability and internal consistency of the Dutch version of the VAAI were excellent.
January 2022
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181 Reads
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2 Citations
Medical Hypotheses
Vincent Van Gogh (1853-1890) was a creative genius and one of the greatest painters in history. He was a troubled soul plagued with an inner turmoil driven by his social, financial, personality and medical/ psychiatric afflictions. His life has fascinated academic scholars of many disciplines who have researched extensively on his life and works. From his voluminous correspondences and contemporary medical records, his medical/psychiatric illnesses have been analysed in detail and several diagnostic formulations proposed. These include temporal lobe epilepsy, intermittent acute porphyria, Meniere’s disease, lead poisoning, sexually transmitted diseases, terpene/absinthe/alcohol abuse, ophthalmological disorders in addition to chronic bipolar disorder, schizophrenia, personality and anxiety disorder and narcissism/neuroticism. We hypothesized a new diagnosis in the form of vestibular migraine for Van Gogh which is a migraine variant but distinct from the classical migraine variety. Our hypothesis is unique as it also considers that this condition due to its recognised associations with Van Gogh’s proposed illnesses could have influenced his other conditions and thus offers a common unifying factor to explain his illness symptoms. We tested our hypothesis by individually analysing all of Van Gogh’s correspondences in the original French and Dutch as well as English translations. Further, we considered the existing literature on Van Gogh’s other illnesses and contemporary medical records. Van Gogh fulfilled all the criteria for vestibular migraine as formulated by Barany Society and International Classification of Headache Disorders (ICHD) 3 with episodic dizziness, present or past history of classical migraine, headache, photophobia, phonophobia and visual and position triggered vertigo with no other otologial cause to explain his symptoms (including Meniere’s disease). Furthermore, it appears that vestibular migraine could have interacted with most of his other proposed illnesses. We also observed that this condition influenced his art following onset for example, in his use of colours and depiction of his subject matter with a consistent vertical tilt on the left. It is anticipated that our hypothesis will add a new dimension to the understanding of his illnesses and increase the awareness of the complex condition of vestibular migraine that to this day has limited awareness amongst the medical and general fraternity.
December 2021
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117 Reads
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7 Citations
The Journal of International Advanced Otology
Objectives: Traumatic brain injury occurs frequently worldwide. Half of traumatic brain injuries are related to falls or motor vehicle accidents. The term "concussion" is often used to describe a minor form of traumatic brain injury. These often involve decelerative events to the head (e.g., flexion/extension injury) and can also cause damage to the vestibular system of the inner ear. Materials and methods: The European Society for Clinical Evaluation of Balance Disorders meets yearly and has proposed an investigation and analysis of the vestibular consequences of traumatic brain injury. This review paper outlines these discussions. Results: The Society discussed all aspects of trauma-induced vestibular disorders along with diagnosis and management. They also assessed the diagnostic tests available to investigate these disorders. Conclusion: Trauma-induced vestibular disorders are difficult to manage, as our level of understanding of the pathology can be poor and anatomical localization can also be difficult. Accordingly, a definitive diagnosis cannot be pinpointed in many patients, but an extensive history taking is crucial to determine the nature and extent of vestibular involvement. Trauma can not only result in microtrauma to the central nervous system but can also significantly affect peripheral vestibular structures, particularly the otolith organs. The committee hopes that better understanding of trauma to the vestibular system, along with improvements in the field of radiology and vestibular assessments, will aid in more precise techniques of pinpointing pathology in order to develop an adapted treatment plan.
December 2021
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225 Reads
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14 Citations
European Archives of Oto-Rhino-Laryngology
Purpose In this retrospective study the relationship between cochleovestibular function and a magnetic resonance imaging (MRI-) based classification system of endolymphatic hydrops was investigated. Methods Seventy-eight patients with unilateral definite Menière’s disease who underwent MRI were included. The parameters of Pure Tone Audiometry (PTA), caloric irrigation test, cervical vestibular evoked myogenic potentials, and video Head Impulse Test were compared between the grades of endolymphatic hydrops (EH) and perilymphatic enhancement (PE) on MRI. Results The low-frequency PTA was significantly different between cochlear EH grades I and II (p = 0.036; Grade I: mean (Standard Deviation, SD) = 51 decibel Hearing Level (dB HL) (18 dB HL); Grade II: mean (SD) = 60 dB HL (16 dB HL)), and vestibular EH grades 0 and III (p = 0.018; Grade 0: mean (SD) = 43 dB HL (21 dB HL); Grade III: mean = 60 dB HL (10 dB HL)). The ipsilateral caloric sum of ears with vestibular EH grade I (n = 6) was increased with regards to vestibular EH grades 0 (p = 0.001), II (p < 0.001), and III (p < 0.001) (Grade 0: mean (SD) = 24°/s (15°/s); Grade I: mean (SD) = 47°/s (11°/s); Grade II: mean (SD) = 21°/s (13°/s); Grade III: mean (SD) = 16°/s (8°/s)). Conclusion According to these results we can conclude that only the highest grades of cochlear and vestibular EH seem to be associated with decreased cochleovestibular functioning
December 2021
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159 Reads
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1 Citation
European Archives of Oto-Rhino-Laryngology
Objective The MO-meatocanalplasty is the oblique modification of the M-meatoplasty. The MO-meatocanalplasty was designed to address the superior quadrants of the meatus and the bony canal without the need for a retro-auricular incision. This retrospective analysis was performed to evaluate the long-term results of the MO-meatocanalplasty in patients with a narrow external auditory canal (EAC) with recurrent otitis externa or in patients unable to wear a hearing aid.Methods Twenty-two ears in twenty consecutive patients who received a MO-meatocanalplasty for a narrow EAC with recurrent otitis externa or the inability to wear a hearing aid were analysed retrospectively. There were no patients included with any type of previous or planned second stage tympanoplasty procedures. A follow-up period of 3 years was analysed for postoperative recurrent narrowing, the self-cleaning capacity of the EAC, the recurrence of otitis externa, the inability to wear a hearing aid, change in hearing level and for all types of aesthetical complaints.ResultsThe MO-meatocanalplasty procedure was effective in 82% (n = 18). Postoperative recurrent narrowing was detected in 9% (n = 2). Insufficient self-cleaning capacity of the EAC was 9.1% (n = 2). The ability to wear a hearing aid was restored in all patients with the need for a hearing aid. No aesthetical complaints were reported.Conclusion The MO-meatocanalplasty is an effective, safe and aesthetical accepted procedure to address the narrow meatus and external auditory canal. With this procedure, there is no need for a retro-auricular incision in order to create a well aerated, dry and self-cleaning EAC in patients with a narrow EAC with recurrent otitis externa or in patient with the inability to wear a hearing aid.
August 2021
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49 Reads
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5 Citations
Electrical stimulation with cochlear implants is able to significantly suppress the tinnitus sensations in 25–72% of implanted patients. Up to this point, no clear predictors for the effectiveness of tinnitus suppression with cochlear implants have been found and this substantially limits the possibility of the application of cochlear implants for this purpose. The objective of the study was to investigate if a trial electrical round window stimulation (RWS) could be used as a diagnostic tool for identifying candidates in whom electrical stimulation would be successful as treatment for tinnitus. Thirty-four patients with unilateral severe tinnitus and ipsilateral moderate to severe sensorineural hearing loss underwent a trial RWS under local anesthesia. Thirteen patients received a cochlear implant. All patients qualified for cochlear implantation on the basis of the trial RWS showed tinnitus suppression with the implant switched on. Complete or almost complete tinnitus suppression was obtained in 77% and partial in 23%. The mean tinnitus loudness reduction was 68% (VAS score reduction from 7.7 to 2.5). False negative results are estimated not to exceed 10–15%. We conclude that significant tinnitus suppression achieved during trial RWS under local anesthesia is a simple procedure allowing the efficient identification of candidates in whom electrical stimulation with a cochlear implant would be successful as treatment for intractable tinnitus.
... He attributed this sensation to the auditory nerve 23 . This was subsequently followed up by A Bornhardt (late 19 th century, St Petersburg) who accurately described irritant and paralytic nystagmus following application of hot and cold temperatures in the ear canal respectively 24,25 . Benno Baginsky (1848-1919, Berlin - Figure 9) not only replicated Bornhardt's observed nystagmus but also quantified the exact optimal temperature, fluid and pressure which were comfortable to the subject and elicited a clinical response paving the way for the eventual methodology of the caloric test 24,26 . ...
May 2022
Hearing Balance and Communication
... Some studies investigated eye movements due to direct stimulation by a CI. 11,12 In other studies, e-VEMPs using direct electrical input via the CI were recorded. [13][14][15] Acoustic stimuli delivered through an audio processor, i.e., acoustic stimulation converted to electric stimulation, was used in another study 16 to elicit e-VEMPs. ...
April 2022
The Journal of International Advanced Otology
... Fear avoidance beliefs were objectified using the total score of the Dutch 9-item version of the VAAI. 6,16 The questionnaire consists of 9 statements scored on a 7-point Likert scale regarding 3 categories: work, fear, and activity and participation. The higher the score (range 0-54), the higher the likelihood of the presence of fear avoidance beliefs. ...
February 2022
Journal of Vestibular Research
... Since initial reports of EH visualisation with delayed post-intravenous GBCA MRI [2], there has been an evolution of methods used to optimise the signal from lowconcentration GBCA within the perilymph. Altered parameterisation of three-dimensional fast spin echo (3D FSE) inversion recovery (IR) sequences has achieved increased perilymphatic signal through both the use of a long repetition time (TR) [3] and the application of modified 3D FSE sequences with very long echo trains and increased echo time (TE) [3][4][5]. A further development has been the ability to differentiate the endolymphatic signal from that of the surrounding temporal bone on MRI. ...
May 2022
Neuroradiology
... 11 Loose otoconia in the posterior semicircular canal (85-95% of cases) is the most common form of BPPV. 11,12 Posterior canal BPPV is usually caused by otoconia dislodged from the macula beds that becomes trapped in the posterior semicircular canal. 11 As the patient moves their head, gravity causes the otoconia to move in the plane of the affected canal. ...
December 2021
The Journal of International Advanced Otology
... In 2 other patients, stimulation with a cochlear implant produced sub-total/moderate tinnitus suppression. 27 Acoustic stimulation with classical hearing aids/noise generators or electrical stimulation with cochlear implants can effectively suppress tinnitus in selected groups of patients. However, a large group of patients with high-pitched tinnitus only presented with high-frequency hearing loss. ...
August 2021
... Most recently, a group at the University of Las Palmas de Gran Canaria has described a CI/VI, the CI24RE(VEST), as a modified version of Cochlear's CI24RE system, designed with a single vestibular electrode array with three electrode contacts and a 19-contact perimodiolar intracochlear array [24,25]. Developed by Cochlear Ltd., that device's VI array is intended to target the otolith organs for implantation near the saccule via an oval window insertion. ...
Reference:
Vestibular Implantation
May 2021
... The most common EAC disease is otitis externa, with potential developing acquired aural atresia when left untreated. The inflammatory response provoked by bacterial or viral infections was the common pathological process of otitis externa [11]. Acquired aural atresia can be a result of ineffective treatment for advancing otitis externa. ...
December 2021
European Archives of Oto-Rhino-Laryngology
... The bony labyrinth is the densest and hardest bone of the human body; therefore, access to its contents requires a surgical approach (an invasive procedure), making it challenging for diagnostic purposes [3]. Magnetic Resonance Imaging (MRI) has been used to analyze the characteristics of endolymphatic hydrops [4,5]; however, details about the pathological changes in the membranose labyrinth were hard to detect. In fact, MRI can only focus on the structural characteristics of the endolymphatic hydrops in Meniere's disease. ...
December 2021
European Archives of Oto-Rhino-Laryngology
... The vestibular screening could be incorporated into wellestablished neonatal hearing screening programs, with the aim of assessing the function of the two organs of the inner ear, especially in children with severe and profound SNHL. This has already been started in Flanders, in the north of Belgium [41], and has successfully identified vestibular disorders at an early stage in babies [42,43], favoring early auditory and motor intervention, being an example to be followed by other countries. ...
December 2020