Nystagmus Findings and Hearing Recovery in Idiopathic Sudden Sensorineural Hearing Loss Without Dizziness

Abstract

Objectives: To investigate the incidence of nystagmus in patients with sudden sensorineural hearing loss (SSNHL) without dizziness, and to evaluate the correlation of the presence of nystagmus with hearing recovery in those patients. Study Design: Retrospective study. Setting: Tertiary referral academic medical center. Patients: Thirty-eight patients with SSNHL who did not complained of dizziness were enrolled. Main Outcome Measure: The presence of nystagmus was evaluated by recording eye movements, and if present, nystagmus was classified as direction-fixed or positional nystagmus. Vestibular function tests were performed, including caloric test. Results: Of 33 idiopathic SSNHL patients without dizziness, nystagmus was observed in 22 patients (67%), of which 14 patients exhibited direction-fixed nystagmus, and 8 patients exhibited direction-changing nystagmus. Among the 14 patients with direction-fixed nystagmus, 9 displayed the paretic type, and 5 displayed the irritative type. Direction-changing nystagmus (n = 8) was defined as that in which the direction of nystagmus was changed in a supine head-roll test, and the geotropic type and apogeotropic type were observed in two and six patients, respectively. The mean initial pure tone threshold was 58.2 ± 28.1 dB and 57.3 ± 20.0 dB in SSNHL patients with and without nystagmus, respectively, which was not significantly different (p = 0.925). When hearing improvement was compared according to the presence of nystagmus, 39% (8 of 21) of patients with nystagmus were found to belong in the good prognosis group, and 72% (8 of 11) of patients without nystagmus were found to belong in the good prognosis group, which showed marginal statistical significance (p = 0.063). Conclusion: Nystagmus was observed in two-thirds of idiopathic SSNHL patients without dizziness, and the pattern of nystagmus was either direction fixed or direction changing. Because hearing recovery was worse in patients with nystagmus than those without it, the diagnosis of nystagmus, even in SSNHL patients without dizziness, may be important in evaluating the hearing prognosis.

Positional Nystagmus after Acute Vertiginous Attack in Meniere’s Disease

“…Our patients showed very weak, persistent positional direction-changing nystagmus, of which the direction was geotropic in Case 1 and apogeotropic in Case 2. This type of positional nystagmus has been reported in other inner ear disorders [19][20][21][22][23][24], and it could not be clearly explained by typical BPPV [25]. The change in chemical composition and/or electrolyte concentration in the inner ear fluid, although still unclear, may underlie the production of this characteristic nystagmus in these patients.…”

Nystagmus in adult patients with acute otitis media or otitis media with effusion without dizziness

“…The present study further revealed that OME or AOM patients without dizziness exhibited both irritative- or paretic-type direction-fixed nystagmus and direction-changing positional nystagmus. These various patterns of nystagmus have also been observed in various inner ear disorders such as Meniere’s disease, Ramsay Hunt syndrome, and sudden sensorineural hearing loss [ 23 , 28 – 30 ]. In AOM or OME, inflammatory mediators in the middle ear may penetrate into the inner ear space through the natural membranous barriers, which may cause damages to the hair cells or blood-perilymph barrier [ 3 , 31 ].…”

“…Findings of vestibular dysfunction including bithermal caloric results, spontaneous and positional nystagmus have been reported in limited number of adult AOM patients with vertigo [ 3 , 22 ], and the presence of dizziness or vertigo is considered indicative of one of the intratemporal complications of AOM. However, because dizziness is a subjective symptom defined as “a sensation of unsteadiness accompanied by a feeling of movement within the head” [ 23 ], the symptom threshold of dizziness may depend on individual’s sensitivity. Thus, patients with OME or AOM complicated by mild vestibular disturbance may not complain of dizziness symptom.…”

Relationship between the results of the head‐shaking test and short‐term prognosis of hearing impairment in patients with unilateral Ménière’s disease: A retrospective analysis of 157 cases

“…According to these studies, MD has various conditions of vestibular function in each stage of the illness, and HSN may reflect their reversibility. In ISSNHL, the presence of both vertigo 7 and nystagmus 8 can predict poor prognosis of hearing outcome. We examined HSN in cases of MD, which varied at different times according to the condition of the disease, and which may contribute to hearing prognosis.…”