Electronystagmography findings in child unilateral sensorineural hearing loss of probable viral origin

Vestibular function of pediatric patients with sudden sensorineural hearing loss: based on vertigo symptom and vestibular function testing

BACKGROUND

This study aimed to evaluate the relationship between vestibular and auditory functions in pediatric patients with sudden sensorineural hearing loss (SSHL).

METHODS

A total of 30 pediatric patients experiencing unilateral SSHL between 5.9 and 13.0 years of age were enrolled in this study. Pure tone audiometry was evaluated prior to treatment initiation and again after one month of treatment. Prior to treatment initiation, vertigo symptoms were noted; then several vestibular function tests were conducted including caloric testing, ocular vestibular evoked myogenic potentials (o-VEMPs) and cervical vestibular evoked myogenic potentials (c-VEMPs). Associations between pre and post-treatment vestibular function and hearing threshold levels were analyzed.

RESULTS

Initial hearing thresholds of children with vertigo were higher than thresholds of children without vertigo (92 dB vs 79 dB, P = 0.033), while initial hearing thresholds of children with abnormal caloric test findings were higher than thresholds of children with normal caloric test findings (93 dB vs 67 dB, P = 0.014). Cutoff values of hearing thresholds for those with vertigo symptoms and abnormal vestibular test results were 86.000- and 89.583-dB HL, respectively. Regarding prognosis, children with vertigo exhibited lower recovery rates than children without vertigo (33% vs 75%, P = 0.025); recovery rates of children with abnormal caloric test results were lower than the overall recovery rate (25% vs 73%, respectively, P = 0.039).

CONCLUSION

Assessments of vertigo symptoms and vestibular function are useful tools in predicting pediatric SSHL patient disease severity and prognosis.

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

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.

Clinical significance of spontaneous nystagmus in pediatric patients

OBJECTIVE

To analyze spontaneous nystagmus recorded in pediatric patients and determine its diagnostic value.

MATERIALS AND METHODS

Retrospective review of 86 patients (mean age = 13.9 ± 4.7 years) with definitive spontaneous nystagmus recorded by videonystagmography (VNG). Spontaneous nystagmus was categorized and analyzed based on its characteristics. Correlations between spontaneous nystagmus and established clinical diagnoses were explored.

RESULTS

Among the patients seen in a period of three years at our pediatric vestibular clinic, 15.4% (86 out of 560) were found to have spontaneous nystagmus and half of them had horizontal nystagmus with a fixed-direction. The majority of cases with spontaneous nystagmus (77%, 66/86) were present without fixation only, while the presence of spontaneous nystagmus with and without fixation was found in 16 patients (19%). Most patients with spontaneous nystagmus without fixation only (68%) were diagnosed with a peripheral vestibular disorder (e.g., vestibular neuritis) or vestibular migraine. In contrast, vertical nystagmus was found in 15 patients, most of whom had central vestibular disorders. Other rare forms of nystagmus or abnormal eye movements, such as pendular nystagmus, ocular oscillation or flutter were recorded in only four patients.

CONCLUSIONS

Spontaneous nystagmus in children and young adults with possible vestibular impairments may vary in clinical presentation. Identification of its characteristics may help to make an accurate clinical diagnosis. While spontaneous nystagmus associated with peripheral vestibular disorders can be readily recognized, spontaneous nystagmus in pediatric patients with vestibular migraine appears to be more complex and variable in form.

Prognostic factors for vestibular impairment in sensorineural hearing loss

The clinical course and prognosis in sensorineural hearing loss (SNHL) may be even worse if vestibular system is also involved, especially due to near location of anatomical structures in the inner ear. The aim of the study was to determine prognostic value of some clinical, audiological and demographic factors associated with SNHL in predicting a possibility of vestibular impairment. The study was conducted on 124 consecutive patients (183 ears) diagnosed for sensorineural hearing loss during 1 year in our department. In all of them, audiological (pure-tone, speech and impedance audiometry, ABR) and ENG examinations (visual ocular-motor, positional, kinetic and caloric tests) were performed. The correlations between ENG outcome and the following variables associated with sensorineural hearing loss were investigated: audiological (degree and location of hearing loss, audiogram configuration), clinical (tinnitus, vertigo, dizziness) and demographic (age, sex) factors. Normal ENG was recorded in 26.6%, vestibular impairment of peripheral type in 38.7%, and central type in 34.7% of the patients. In a multivariate stepwise linear regression analysis, the degree of hearing loss was the main variable correlating with abnormal ENG result. Tinnitus and location of hearing loss were also found to be the two other variables which, to some minor extent, can influence the ENG outcome. Peripheral vestibular impairment was observed more frequently in patients with residual hearing/deafness. The degree of hearing loss, presence of tinnitus and location of hearing loss are factors predicting the possibility of abnormal ENG outcome in sensorineural hearing loss.

Improvement in hearing after chiropractic care: a case series

Background

The first chiropractic adjustment given in 1895 was reported to have cured deafness. This study examined the effects of a single, initial chiropractic visit on the central nervous system by documenting clinical changes of audiometry in patients after chiropractic care.

Case presentation

Fifteen patients are presented (9 male, 6 female) with a mean age of 54.3 (range 34–71). A Welch Allyn AudioScope 3 was used to screen frequencies of 1000, 2000, 4000 and 500 Hz respectively at three standard decibel levels 20 decibels (dB), 25 dB and 40 dB, respectively, before and immediately after the first chiropractic intervention. Several criteria were used to determine hearing impairment. Ventry & Weinstein criteria of missing one or more tones in either ear at 40 dB and Speech-frequency criteria of missing one or more tones in either ear at 25 dB.

All patients were classified as hearing impaired though greater on the right. At 40 dB using the Ventry & Weinstein criteria, 6 had hearing restored, 7 improved and 2 had no change. At 25 dB using the Speech-frequency criteria, none were restored, 11 improved, 4 had no change and 3 missed a tone.

Conclusion

A percentage of patients presenting to the chiropractor have a mild to moderate hearing loss, most notably in the right ear. The clinical progress documented in this report suggests that manipulation delivered to the neuromusculoskeletal system may create central plastic changes in the auditory system.

Electronystagmography finding in children with peripheral and central vestibular disorders

OBJECTIVE

Dizziness and imbalance are uncommon in children, but often alarming for their families: a detailed interview and otoneurological examination are important for reaching a specific diagnosis and treatment. Children with vestibular disorders are thought to be difficult to examine: vestibular tests (caloric test, roto-acceleratory test, electronystagmography, opto-kinetic nystagmus, cranio-corpography and posturography) are used less frequently for children than in adult patients. The aim of the study was to determine whether the results of electronystagmography testing improve an emergency physician's diagnosis of dizziness in children.

METHODS

Patients were selected on the basis of the following inclusion criteria: aged between 2 and 12 years and affected with vertiginous symptoms. All patients underwent the following instrumental examinations: blood tests, audiological screening, electronystagmography of spontaneous nystagmus or provoked by vestibular and optical stimulation and electroencephalogram.

RESULTS

The results underlines an high incidence of central vertigo (83%): 52% of the children presented a prevailing unidirectional nystagmus at labyrinth stimulation and 48% of the children an asymmetry in the response of nystagmus at optical kinetic stimulation with quality alteration of shocks.

CONCLUSIONS

Electronystagmography can register and evaluate the qualitative and quantitative characteristics of the nystagmic response and allow to distinguish between central or peripheric vertigo: different degrees and various combinations of the abnormal responses shown in optokinetic central test were the most characteristic of electronystagmography in patients with vestibular central vertigo.