Bilateral vestibulopathy

Brandt, Thomas

doi:10.1007/978-1-4471-0527-5_8

Cited by 8 publications

(9 citation statements)

References 77 publications

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“…Redundancy of the two labyrinths and plasticity of the central nervous system create a faulttolerant system, so that even after unilateral labyrinthectomy, most patients regain a nearly normal vestibulo-ocular reflex (VOR) for all head movements except quick rotations and translations toward the injured labyrinth (9). In contrast, acute loss of bilateral vestibular function can cause significant disability due to VOR failure, postural instability, and chronic disequilibrium (10,11). Driving becomes difficult or impossible to do safely.…”

Section: Introductionmentioning

confidence: 99%

The Effects of Cochlear Implantation on Vestibular Function

Melvin¹,

Migliaccio²,

Carey³

et al. 2008

Otolaryngol.--head neck surg.

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Objective-Determine the risk posed by cochlear implantation (CI) to the labyrinth.Study Design-Prospective cohort study. Setting-Academic tertiary referral center.Patients-Thirty-six ears belonging to 35 adult CI candidates (mean: 46, range: 23-69 years old). Intervention-Cochlear implantation.Main Outcome Measures-Vestibular function was assessed using the quantitative 3D head impulse test (qHIT), clinical head impulse test (cHIT), post-headshake nystagmus (HSN), caloric electronystagmography (ENG), vestibular-evoked myogenic potentials (VEMP), dynamic visual acuity (DVA), and Dizziness Handicap Inventory (DHI).Results-All 36 ears were tested using qHIT before CI, and 28 ears were tested 4-8 weeks after CI. Quantitative HIT showed 1/28 of ears suffered reduced function. Clinical HIT was 44% sensitive and 94% specific for identification of severe-to-profound vestibular hypofunction confirmed by qHIT. HSN was unchanged in 11/11 subjects. New hyporeflexia was found in 1/16 of ENG-tested ears. VEMP showed either a disappearance of response or an increase in threshold by >10dB in 5/16 ears. Passive DVA showed no change in 16/16 ears. DHI scores worsened in 3/28 and improved in 4/28 subjects.Conclusions-Although small, the observed rate of labyrinthine injury was comparable to that for other risks of CI. Thus, it is important to educate CI candidates about possible risk to balance function, particularly when CI of an "only balancing ear" is contemplated. Clinical HIT is useful for detecting severe high-frequency vestibular hypofunction and should be part of the pre-CI physical examination.

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Section: Introductionmentioning

confidence: 99%

The Effects of Cochlear Implantation on Vestibular Function

Melvin¹,

Migliaccio²,

Carey³

et al. 2008

Otolaryngol.--head neck surg.

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“…31 Among the complaints that are reported, oscillopsia -the perception in which objects within the visual field appear to oscillate while walking -appears to be the most distressing. 41 This condition results from loss of the VOR, which is necessary for stabilizing vision during movement. 4,5 Ototoxic drugs, such as gentamicin, may cause bilateral arreflexia.…”

Section: Arreflexiamentioning

confidence: 99%

Interpretação e utilidade da prova calórica

Gonçalves¹,

Felipe²,

Lima³

2008

Rev. Bras. Otorrinolaringol.

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Cal oric testing is an otoneurologic evaluation of the status of the vestibular-ocular reflex; it allows an evaluation of each labyrinth separately. The main aspects on the use and interpretation of caloric testing are reviewed. Method: A systematic review of papers published in the past one hundred years on caloric testing was undertaken. The inclusion criteria were: cross-sectional, longitudinal, original articles, reviews and meta-analyses. Reviews of patient charts, case reports and editorials were excluded. The key-words were: caloric testing, nystagmus, vestibular system, directional preponderance, labyrinth predominance, monothermal caloric test, ice water caloric testing, Bell´s phenomenon. The databases were: COCHRAINE, MEDLINE, LILACS, CAPES. Results: Ninety-three of 818 abstracts fulfilled the inclusion criteria. After reading these articles, 55 were selected for this study. These papers discussed the basics of caloric testing, the types of stimulation, the interpretation of results, variables, artifacts, and the monothermal and ice water caloric test. Final comments: Caloric testing reference values may vary according to each unit; the the cutoff point is defined based on local studies. Attention to the technique is essential to maximize test sensitivity.

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“…Complete bilateral vestibular loss was defined by the absence of both caloric and rotational responses (e.g. gain=peak-slow phase eye velocity/peak chair velocity <10% of the mean normal value [7]). Incomplete severe BV was defined by a calorically elicited nystagmus of <5°/s and a postrotatory nystagmus of less than 10 s duration.…”

Section: Patientsmentioning

confidence: 99%

“…Key symptoms of bilateral vestibulopathy (BV) are unsteadiness of gait, particularly in the dark, and oscillopsia during locomotion or head movements [4,7,16]. Ototoxic antibiotics, meningitis, tumours, bilateral endolymphatic hydrops and systemic autoimmune disorders (e.g.…”

Section: Introductionmentioning

confidence: 99%

Serum antibodies against membranous labyrinth in patients with „idiopathic“ bilateral vestibulopathy

Arbusow¹,

Strupp²,

Dieterich³

et al. 1998

J Neurol

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To investigate the possibility of an autoimmune mechanism in idiopathic bilateral vestibulopathy (IBV), we screened patients' sera for antibodies against inner ear structures. IgG antibodies against membranous labyrinth (ampulla, semicircular canals, saccule and utricle) were detected in 8 of 12 patients by immunofluorescence on rat inner ear cryosections. All but one serum of 22 healthy controls and the sera of 6 patients with known autoimmune disorders showed only background staining. Low-titre anti-nuclear IgM antibodies were present in three control sera and one IBV serum. High-titre anti-nuclear IgM was found in a patient with lupus erythematosus and in one with scleroderma. Anti-nuclear IgM was not organ-specific. No human serum used contained detectable anti-vascular preformed antibodies. Cross-reactivity to sections of liver, kidney, cornea, brain and skeletal muscle was absent. Double-staining for IgG and F-actin, the primary constituent of hair cell cilia, did not show predominant Ig-coating of sensory hair cells. Immunosuppressive therapy in 3 IBV patients did not improve the disorder, probably owing to irreversible loss of sensory and neural structures. These data suggest that the bulk of anti-labyrinthine autoantibodies may be an epiphenomenon, yet a small subgroup of organ-specific autoantibodies may synergize with a cellular response in the development of vestibular lesions.

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Bilateral vestibulopathy

Cited by 8 publications

References 77 publications

The Effects of Cochlear Implantation on Vestibular Function

The Effects of Cochlear Implantation on Vestibular Function

Interpretação e utilidade da prova calórica

Serum antibodies against membranous labyrinth in patients with „idiopathic“ bilateral vestibulopathy

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