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Dumas G, Curthoys I, Castellucci A, Dumas L, Peultier-Celli L, Armato E, Malara P, Perrin P, Schmerber S. Skull Vibration-Induced Nystagmus in Superior Semicircular Canal Dehiscence: A New Insight into Vestibular Exploration-A Review. Audiol Res 2024; 14:96-115. [PMID: 38391766 PMCID: PMC10886119 DOI: 10.3390/audiolres14010009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Revised: 12/21/2023] [Accepted: 01/10/2024] [Indexed: 02/24/2024] Open
Abstract
The third window syndrome, often associated with the Tullio phenomenon, is currently most often observed in patients with a superior semicircular-canal dehiscence (SCD) but is not specific to this pathology. Clinical and vestibular tests suggestive of this pathology are not always concomitantly observed and have been recently complemented by the skull-vibration-induced nystagmus test, which constitutes a bone-conducted Tullio phenomenon (BCTP). The aim of this work was to collect from the literature the insights given by this bedside test performed with bone-conducted stimulations in SCD. The PRISMA guidelines were used, and 10 publications were included and analyzed. Skull vibration-induced nystagmus (SVIN), as observed in 55 to 100% of SCD patients, usually signals SCD with greater sensitivity than the air-conducted Tullio phenomenon (ACTP) or the Hennebert sign. The SVIN direction when the test is performed on the vertex location at 100 Hz is most often ipsilaterally beating in 82% of cases for the horizontal and torsional components and down-beating for the vertical component. Vertex stimulations are more efficient than mastoid stimulations at 100 Hz but are equivalent at higher frequencies. SVIN efficiency may depend on stimulus location, order, and duration. In SCD, SVIN frequency sensitivity is extended toward high frequencies, with around 400 Hz being optimal. SVIN direction may depend in 25% on stimulus frequency and in 50% on stimulus location. Mastoid stimulations show frequently diverging results following the side of stimulation. An after-nystagmus observed in 25% of cases can be interpreted in light of recent physiological data showing two modes of activation: (1) cycle-by-cycle phase-locked activation of action potentials in SCC afferents with irregular resting discharge; (2) cupula deflection by fluid streaming caused by the travelling waves of fluid displacement initiated by sound or vibration at the point of the dehiscence. The SVIN direction and intensity may result from these two mechanisms' competition. This instability explains the SVIN variability following stimulus location and frequency observed in some patients but also discrepancies between investigators. SVIN is a recent useful insight among other bedside examination tests for the diagnosis of SCD in clinical practice.
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Affiliation(s)
- Georges Dumas
- Department of Oto-Rhino-Laryngology Head and Neck Surgery, University Hospital, 38043 Grenoble, France
- Research Unit 3450 DevAH-Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, 54500 Vandoeuvre-lès-Nancy, France
| | - Ian Curthoys
- Vestibular Research Laboratory, School of Psychology, University of Sydney, Sydney, NSW 2006, Australia
| | - Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL, IRCCS di Reggio Emilia, 42123 Reggio Emilia, Italy
| | - Laurent Dumas
- INSERM UMR 1039 Bioclinic Radiopharmaceutics Laboratory, University Grenoble Alpes, 38700 La Tronche, France
| | - Laetitia Peultier-Celli
- Research Unit 3450 DevAH-Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, 54500 Vandoeuvre-lès-Nancy, France
| | - Enrico Armato
- Research Unit 3450 DevAH-Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, 54500 Vandoeuvre-lès-Nancy, France
- Department of Neurosciences, University of Padova, 35100 Padova, Italy
| | - Pasquale Malara
- Audiology & Vestibology Service, Centromedico, 6500 Bellinzona, Switzerland
| | - Philippe Perrin
- Research Unit 3450 DevAH-Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, 54500 Vandoeuvre-lès-Nancy, France
- Department of Paediatric Oto-Rhino-Laryngology, University Hospital of Nancy, 54500 Vandoeuvre-lès-Nancy, France
| | - Sébastien Schmerber
- Department of Oto-Rhino-Laryngology Head and Neck Surgery, University Hospital, 38043 Grenoble, France
- INSERM UMR 2015, Brain Tech Laboratory, 38700 La Tronche, France
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Raciti FM, Morales Y, Snapp HA, Rajguru SM. A reliable and reproducible protocol for sound-evoked vestibular myogenic potentials in rattus norvegicus. Front Integr Neurosci 2023; 17:1236642. [PMID: 37731913 PMCID: PMC10508189 DOI: 10.3389/fnint.2023.1236642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Accepted: 08/21/2023] [Indexed: 09/22/2023] Open
Abstract
Introduction Cervical vestibular evoked myogenic potentials (cVEMPs) provide an objective measure of the integrity of the sacculo-collic pathway leading to their widespread use as a clinical tool in the diagnostic vestibular test battery. Though the application of cVEMPs in preclinical models to assess vestibular function, as performed in relevant clinical populations, remains limited. The present study aimed to establish a rodent model of cVEMP with standardized methods and protocols, examine the neural basis of the responses, and characterize and validate important features for interpretation and assessment of vestibular function. Methods We compared air-conducted sound (ACS)-evoked VEMPs from the sternocleidomastoid muscles in naïve Brown Norway rats. A custom setup facilitated repeatable and reliable measurements which were carried out at multiple intensities with ACS between 1 and 16 kHz and over 7 days. The myogenic potentials were identified by the presence of a positive (P1)-negative (N1) waveform at 3-5 ms from the stimulus onset. Threshold, amplitude, and latency were compared with intensity- and frequency-matched responses within and between animals. Results cVEMP responses were repeatedly evoked with stimulus intensities between 50-100 dB SPL with excellent test-retest reliability and across multiple measurements over 7 days for all frequencies tested. Suprathreshold, cVEMP responses at 90 dB SPL for 6-10 kHz stimuli demonstrated significantly larger amplitudes (p < 0.01) and shorter latencies (p < 0.001) compared to cVEMP responses for 1-4 kHz stimuli. Latency of cVEMP showed sex-dependent variability, but no significant differences in threshold or amplitude between males and females was observed. Discussion The results provide a replicable and reliable setup, test protocol, and comprehensive characterization of cVEMP responses in a preclinical model which can be used in future studies to elucidate pathophysiological characteristics of vestibular dysfunctions or test efficacy of therapeutics.
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Affiliation(s)
- Federica M. Raciti
- Department of Otolaryngology, University of Miami, Miami, FL, United States
- Department of Biomedical Engineering, University of Miami, Miami, FL, United States
| | - Yasniary Morales
- Department of Otolaryngology, University of Miami, Miami, FL, United States
- Department of Biomedical Engineering, University of Miami, Miami, FL, United States
| | - Hillary A. Snapp
- Department of Otolaryngology, University of Miami, Miami, FL, United States
- Department of Biomedical Engineering, University of Miami, Miami, FL, United States
| | - Suhrud M. Rajguru
- Department of Otolaryngology, University of Miami, Miami, FL, United States
- Department of Biomedical Engineering, University of Miami, Miami, FL, United States
- Bruce W. Carter Department of Veterans Affairs Medical Center, Miami, FL, United States
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Dumas G, Curthoys IS, Castellucci A, Dumas L, Perrin P, Schmerber S. A bone-conducted Tullio phenomenon-A bridge to understand skull vibration induced nystagmus in superior canal dehiscence. Front Neurol 2023; 14:1183040. [PMID: 37360355 PMCID: PMC10288865 DOI: 10.3389/fneur.2023.1183040] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2023] [Accepted: 05/02/2023] [Indexed: 06/28/2023] Open
Abstract
Nystagmus produced in response to air-conducted sound (ACS) stimulation-the Tullio phenomenon-is well known in patients with a semicircular canal (SCC) dehiscence (SCD). Here we consider the evidence that bone-conducted vibration (BCV) is also an effective stimulus for generating the Tullio phenomenon. We relate the clinical evidence based on clinical data extracted from literature to the recent evidence about the physical mechanism by which BCV may cause this nystagmus and the neural evidence confirming the likely mechanism. The hypothetical physical mechanism by which BCV activates SCC afferent neurons in SCD patients is that traveling waves are generated in the endolymph, initiated at the site of the dehiscence. We contend that the nystagmus and symptoms observed after cranial BCV in SCD patients is a variant of Skull Vibration Induced Nystagmus (SVIN) used to identify unilateral vestibular loss (uVL) with the major difference being that in uVL the nystagmus beats away from the affected ear whereas in Tullio to BCV the nystagmus beats usually toward the affected ear with the SCD. We suggest that the cause of this difference is a cycle-by-cycle activation of SCC afferents from the remaining ear, which are not canceled centrally by simultaneous afferent input from the opposite ear, because of its reduced or absent function in uVL. In the Tullio phenomenon, this cycle-by-cycle neural activation is complemented by fluid streaming and thus cupula deflection caused by the repeated compression of each cycle of the stimuli. In this way, the Tullio phenomenon to BCV is a version of skull vibration-induced nystagmus.
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Affiliation(s)
- Georges Dumas
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital, Grenoble, France
- EA 3450 DevAH–Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, Nancy, France
| | - Ian S. Curthoys
- Vestibular Research Laboratory, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Andrea Castellucci
- ENT Unit, Department of Surgery, AUSL–IRCCS di reggio Emilia, Reggio Emilia, Italy
| | - Laurent Dumas
- Laboratoire Radiopharmaceutiques Biocliniques (LRB), INSERM U1039, Faculté de Médecine La Tronche, Université Grenoble Alpes, Grenoble, France
| | - Philippe Perrin
- EA 3450 DevAH–Development, Adaptation and Handicap, Faculty of Medicine, University of Lorraine, Nancy, France
- Department of Paediatric Oto-Rhino-Laryngology, University Hospital of Nancy, Vandovuvre-lés-Nancy, France
| | - Sébastien Schmerber
- Department of Oto-Rhino-Laryngology, Head and Neck Surgery, University Hospital, Grenoble, France
- Brain Tech Laboratory, INSERM UMR 2015, Grenoble, France
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Curthoys IS, Smith CM, Burgess AM, Dlugaiczyk J. A Review of Neural Data and Modelling to Explain How a Semicircular Canal Dehiscence (SCD) Causes Enhanced VEMPs, Skull Vibration Induced Nystagmus (SVIN), and the Tullio Phenomenon. Audiol Res 2023; 13:418-430. [PMID: 37366683 DOI: 10.3390/audiolres13030037] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2023] [Revised: 05/24/2023] [Accepted: 05/30/2023] [Indexed: 06/28/2023] Open
Abstract
Angular acceleration stimulation of a semicircular canal causes an increased firing rate in primary canal afferent neurons that result in nystagmus in healthy adult animals. However, increased firing rate in canal afferent neurons can also be caused by sound or vibration in patients after a semicircular canal dehiscence, and so these unusual stimuli will also cause nystagmus. The recent data and model by Iversen and Rabbitt show that sound or vibration may increase firing rate either by neural activation locked to the individual cycles of the stimulus or by slow changes in firing rate due to fluid pumping ("acoustic streaming"), which causes cupula deflection. Both mechanisms will act to increase the primary afferent firing rate and so trigger nystagmus. The primary afferent data in guinea pigs indicate that in some situations, these two mechanisms may oppose each other. This review has shown how these three clinical phenomena-skull vibration-induced nystagmus, enhanced vestibular evoked myogenic potentials, and the Tullio phenomenon-have a common tie: they are caused by the new response of semicircular canal afferent neurons to sound and vibration after a semicircular canal dehiscence.
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Affiliation(s)
- Ian S Curthoys
- Vestibular Research Laboratory, School of Psychology, University of Sydney, Sydney, NSW 2006, Australia
| | - Christopher M Smith
- Center for Anatomy and Functional Morphology, Icahn School of Medicine at Mount Sinai, Annenberg Building, Room 12-90, 1468 Madison Ave., New York, NY 10029, USA
| | - Ann M Burgess
- Vestibular Research Laboratory, School of Psychology, University of Sydney, Sydney, NSW 2006, Australia
| | - Julia Dlugaiczyk
- Department of Otorhinolaryngology, Head and Neck Surgery & Interdisciplinary Center of Vertigo, Balance and Ocular Motor Disorders, University Hospital Zurich (USZ), University of Zurich (UZH), CH-8091 Zürich, Switzerland
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Nagururu NV, Jung D, Hui F, Pearl MS, Carey JP, Ward BK. Cochlear Aqueduct Morphology in Superior Canal Dehiscence Syndrome. Audiol Res 2023; 13:367-377. [PMID: 37218843 DOI: 10.3390/audiolres13030032] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2023] [Revised: 05/07/2023] [Accepted: 05/10/2023] [Indexed: 05/24/2023] Open
Abstract
The cochlear aqueduct (CA) connects the scala tympani to the subarachnoid space and is thought to assist in pressure regulation of perilymph in normal ears, however, its role and variation in inner ear pathology, such as in superior canal dehiscence syndrome (SCDS), is unknown. This retrospective radiographic investigation compared CA measurements and classification, as measured on flat-panel computerized tomography, among three groups of ears: controls, n = 64; anatomic superior canal dehiscence without symptoms (SCD), n = 28; and SCDS, n = 64. We found that in a multinomial logistic regression adjusted for age, sex, and BMI, an increase in CA length by 1 mm was associated with a lower odds for being in the SCDS group vs. control (Odds ratio 0.760 p = 0.005). Hierarchical clustering of continuous CA measures revealed a cluster with small CAs and a cluster with large CAs. Another multinomial logistic regression adjusted for the aforementioned clinical covariates showed an odds ratio of 2.97 for SCDS in the small CA cluster as compared to the large (p = 0.004). Further, no significant association was observed between SCDS symptomatology-vestibular and/or auditory symptoms-and CA structure in SCDS ears. The findings of this study lend support to the hypothesis that SCDS has a congenital etiology.
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Affiliation(s)
- Nimesh V Nagururu
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Diane Jung
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Ferdinand Hui
- Department of Radiology, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Monica S Pearl
- Department of Radiology, Children's National Hospital, Washington, DC 20010, USA
| | - John P Carey
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
| | - Bryan K Ward
- Department of Otolaryngology-Head and Neck Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21205, USA
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A Single Fast Test for Semicircular Canal Dehiscence—oVEMP n10 to 4000 Hz—Depends on Stimulus Rise Time. Audiol Res 2022; 12:457-465. [PMID: 36136853 PMCID: PMC9498918 DOI: 10.3390/audiolres12050046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Revised: 08/14/2022] [Accepted: 08/21/2022] [Indexed: 11/17/2022] Open
Abstract
As previously reported, a single test measuring oVEMP n10 to 4000 Hz stimuli (bone-conducted vibration (BCV) or air-conducted sound (ACS)) provides a definitive diagnosis of semicircular canal dehiscence (SCD) in 22 CT-verified patients, with a sensitivity of 1.0 and specificity of 1.0. This single short screening test has great advantages of speed, minimizing testing time, and the exposure of patients to stimulation. However, a few studies of the 4000 Hz test for SCD have reported sensitivity and specificity values which are slightly less than reported previously. We hypothesized that the rise time of the stimulus is important for detecting the oVEMP n10 to 4000 Hz, similarly to what we had shown for 500 and 750 Hz BCV. We measured oVEMP n10 in 15 patients with CT-verified SCD in response to 4000 Hz ACS or BCV stimuli with rise times of 0, 1, and 2 ms. As a result, increasing the rise time of the stimulus reduced the oVEMP n10 amplitude. This outcome is expected from the physiological evidence of guinea pig primary vestibular afferents, which are activated by sound or vibration. Therefore, for clinical VEMP testing, short rise times are optimal (preferably 0 ms).
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Morrison M, Korda A, Wagner F, Caversaccio MD, Mantokoudis G. Case Report: Fremitus Nystagmus in Superior Canal Dehiscence Syndrome. Front Neurol 2022; 13:844687. [PMID: 35614919 PMCID: PMC9124807 DOI: 10.3389/fneur.2022.844687] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 03/17/2022] [Indexed: 11/21/2022] Open
Abstract
Superior canal dehiscence syndrome (SCDS) is a structural bony defect of the roof of the superior semi-circular canal into the middle cranial fossa and is responsible for the creation of a third window, which alters the dynamics of the inner ear. During humming, vibratory waves entering the vestibulum and cochlea are re-routed through the dehiscence, leading to stimulation of the otolithic and ampullary vestibular organs. This is responsible for the torsional-vertical nystagmus known as “fremitus nystagmus”. In this case report, we video-document a rare case of fremitus nystagmus and its resolution after plugging of the superior semi-circular canal.
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Affiliation(s)
- Miranda Morrison
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and the University of Bern, Bern, Switzerland
| | - Athanasia Korda
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and the University of Bern, Bern, Switzerland
| | - Franca Wagner
- University Institute of Diagnostic and Interventional Neuroradiology, Inselspital, University Hospital Bern and the University of Bern, Bern, Switzerland
| | - Marco Domenico Caversaccio
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and the University of Bern, Bern, Switzerland
| | - Georgios Mantokoudis
- Department of Otorhinolaryngology, Head and Neck Surgery, Inselspital, University Hospital Bern and the University of Bern, Bern, Switzerland
- *Correspondence: Georgios Mantokoudis
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Huang J, Tang X, Xu Y, Zhang C, Chen T, Yu Y, Mustain W, Allison J, Iversen MM, Rabbitt RD, Zhou W, Zhu H. Differential Activation of Canal and Otolith Afferents by Acoustic Tone Bursts in Rats. J Assoc Res Otolaryngol 2022; 23:435-453. [DOI: 10.1007/s10162-022-00839-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2021] [Accepted: 01/31/2022] [Indexed: 01/08/2023] Open
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Kabel AEMH, Afifi KH, ElFakhrany SM, Moaty AS. Cervical and ocular vestibular evoked myogenic potentials in epileptic patients. THE EGYPTIAN JOURNAL OF OTOLARYNGOLOGY 2021; 37:51. [DOI: 10.1186/s43163-021-00114-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 05/06/2021] [Indexed: 09/02/2023]
Abstract
Abstract
Background
Vertigo and dizziness are very common complaints that may be related to epilepsy. The purpose of this study was to assess vestibulo-spinal and linear vestibulo-ocular function in epileptic patients in the inter ictal period. The current observational study was carried out in audio-vestibular unit Menoufia University. Subjects in the current study were divided into two groups: The control group included 30 normal individuals not complaining from any dizzy symptoms and the epileptic cases group included 30 epileptic patients. All subjects in the study were submitted to cervical and ocular vestibular evoked myogenic potential.
Results
There was no significant difference between the control and epileptic group regarding the age and sex distribution. Sixty-seven percent of epileptic cases had dizzy symptoms. There was statistically significant difference in the latency and amplitude of c and o VEMP between the control and the epileptic group, 39/60 ears (65%) in the study group had cVEMP abnormalities, 32/60 ears (53%) had oVEMP abnormalities. Abnormal c and o VEMP were reported in 28/60 ears (46.7%). There was statistically significant relationship between VEMP abnormalities and duration of seizures, frequency of epileptic attacks, and type of therapy.
Conclusion
Vestibular abnormalities were frequently reported in epileptic patients in the current study which may be related to the severity and control of epilepsy.
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Liang J, Ke Z, Welch PV, Gan RZ, Dai C. A comprehensive finite element model for studying Cochlear-Vestibular interaction. Comput Methods Biomech Biomed Engin 2021; 25:204-214. [PMID: 34641759 DOI: 10.1080/10255842.2021.1946522] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
We present a 3-D finite element (FE) model of the chinchilla's inner ear consisting of the entire cochlea structure and the vestibular system. The reaction of the basilar membrane to the head rotation and the reaction of ampulla to the stapes movement were investigated. These results demonstrate the existence of hearing-vestibular system interaction. They provide an explanation to the clinical finding on the coexistence between hearing loss and equilibration dysfunction. It is a preliminary, yet critical step toward the development of a comprehensive FE model of an entire ear for mechano-acoustic analysis.
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Affiliation(s)
- Junfeng Liang
- Aerospace & Mechanical Engineering, University of Oklahoma, Norman, OK, USA
| | - Zhang Ke
- Aerospace & Mechanical Engineering, University of Oklahoma, Norman, OK, USA
| | - Paige V Welch
- Aerospace & Mechanical Engineering, University of Oklahoma, Norman, OK, USA
| | - Rong Z Gan
- Aerospace & Mechanical Engineering, University of Oklahoma, Norman, OK, USA
| | - Chenkai Dai
- Aerospace & Mechanical Engineering, University of Oklahoma, Norman, OK, USA
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Investigating Performance of cVEMP and oVEMP in the Identification of Superior Canal Dehiscence in Relation to Dehiscence Location and Size. Audiol Res 2021; 11:452-462. [PMID: 34562880 PMCID: PMC8482095 DOI: 10.3390/audiolres11030042] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 08/19/2021] [Accepted: 09/07/2021] [Indexed: 01/18/2023] Open
Abstract
Compare the sensitivity and specificity of cVEMP (500 Hz), oVEMP (500 Hz and 4 kHz) in the identification of SSCD. A secondary objective was to identify the influence of dehiscence size and location on cVEMP and oVEMP responses. Methods: Individuals with unilateral (n = 16) and bilateral (n = 10) scan confirmed SSCD were assessed using air-conducted cVEMP and oVEMP Results: For cVEMP, an amplitude cutoff of 286.9 μV or a threshold cutoff of 67.5 dBnHL revealed, respectively, a sensitivity of 75% and 70.6% and a specificity of 69.4% and 100%. For oVEMP (500 Hz), an amplitude cutoff of 10.8 μV or a threshold cutoff of 77.5 dBnHL revealed a sensitivity of 83.33% and a specificity of 87.5% and 80%, respectively. oVEMP (4 kHz), an amplitude cutoff of 3.1 μV, revealed a high specificity of 100% but a low sensitivity of 47.2%. A positive correlation was noted between the length of the SSCD and the cVEMP and oVEMP (500 Hz) thresholds and cVEMP amplitude. Conclusions: Our results support the use of oVEMP in the identification of SSCD. The presence of oVEMP (500 Hz) with an amplitude higher or equal to 10.8 μV, a threshold lower or equal to 77.5 dBnHL or oVEMP (4 kHz) amplitude of 3.1 μV represents the most useful to identify SSCD.
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Curthoys IS, Grant JW, Pastras CJ, Fröhlich L, Brown DJ. Similarities and Differences Between Vestibular and Cochlear Systems - A Review of Clinical and Physiological Evidence. Front Neurosci 2021; 15:695179. [PMID: 34456671 PMCID: PMC8397526 DOI: 10.3389/fnins.2021.695179] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2021] [Accepted: 07/12/2021] [Indexed: 12/04/2022] Open
Abstract
The evoked response to repeated brief stimuli, such as clicks or short tone bursts, is used for clinical evaluation of the function of both the auditory and vestibular systems. One auditory response is a neural potential - the Auditory Brainstem Response (ABR) - recorded by surface electrodes on the head. The clinical analogue for testing the otolithic response to abrupt sounds and vibration is the myogenic potential recorded from tensed muscles - the vestibular evoked myogenic potential (VEMP). VEMPs have provided clinicians with a long sought-after tool - a simple, clinically realistic indicator of the function of each of the 4 otolithic sensory regions. We review the basic neural evidence for VEMPs and discuss the similarities and differences between otolithic and cochlear receptors and afferents. VEMPs are probably initiated by sound or vibration selectively activating afferent neurons with irregular resting discharge originating from the unique type I receptors at a specialized region of the otolithic maculae (the striola). We review how changes in VEMP responses indicate the functional state of peripheral vestibular function and the likely transduction mechanisms allowing otolithic receptors and afferents to trigger such very short latency responses. In section "ELECTROPHYSIOLOGY" we show how cochlear and vestibular receptors and afferents have many similar electrophysiological characteristics [e.g., both generate microphonics, summating potentials, and compound action potentials (the vestibular evoked potential, VsEP)]. Recent electrophysiological evidence shows that the hydrodynamic changes in the labyrinth caused by increased fluid volume (endolymphatic hydrops), change the responses of utricular receptors and afferents in a way which mimics the changes in vestibular function attributed to endolymphatic hydrops in human patients. In section "MECHANICS OF OTOLITHS IN VEMPS TESTING" we show how the major VEMP results (latency and frequency response) follow from modeling the physical characteristics of the macula (dimensions, stiffness etc.). In particular, the structure and mechanical operation of the utricular macula explains the very fast response of the type I receptors and irregular afferents which is the very basis of VEMPs and these structural changes of the macula in Menière's Disease (MD) predict the upward shift of VEMP tuning in these patients.
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Affiliation(s)
- Ian S. Curthoys
- Vestibular Research Laboratory, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - John Wally Grant
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, VA, United States
| | - Christopher J. Pastras
- The Menière’s Research Laboratory, Sydney Medical School, The University of Sydney, Sydney, NSW, Australia
| | - Laura Fröhlich
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle, Germany
| | - Daniel J. Brown
- School of Pharmacy and Biomedical Sciences, Curtin University, Bentley, WA, Australia
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Castellucci A, Martellucci S, Malara P, Botti C, Del Vecchio V, Brandolini C, Ferri GG, Ghidini A, Armato E. Possible pathomechanisms accounting for both sound/pressure-induced eye movements and video head impulse test data in superior canal dehiscence. Acta Otolaryngol 2021; 141:749-753. [PMID: 34236943 DOI: 10.1080/00016489.2021.1944664] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Affiliation(s)
- Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | | | - Pasquale Malara
- Audiology and Vestibology Service, Centromedico, Bellinzona, Switzerland
| | - Cecilia Botti
- PhD Program in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Valeria Del Vecchio
- UOC Audiology and Vestibology, University Hospital Federico II, Naples, Italy
| | - Cristina Brandolini
- ENT and Audiology Unit, DIMES, S.Orsola - Malpighi University Hospital, Bologna, Italy
| | - Gian Gaetano Ferri
- ENT and Audiology Unit, DIMES, S.Orsola - Malpighi University Hospital, Bologna, Italy
| | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL - IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Enrico Armato
- ENT Unit, SS Giovanni e Paolo Hospital, Venice, Italy
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14
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Mukherjee P, Chiarovano E, Cheng K, Manzari L, McGarvie LA, MacDougall HG. Video-head impulse test in superior canal dehiscence. Acta Otolaryngol 2021; 141:471-475. [PMID: 33641579 DOI: 10.1080/00016489.2021.1884287] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
BACKGROUND Superior Canal Dehiscence is classically diagnosed with typical abnormalities on Vestibular Evoked Myogenic Potentials (VEMPs) and Computed Tomography (CT) scans. AIM This paper discusses the utility of the video Head Impulse Test (vHIT) in SCD. METHODS Data from 11 ears (8 patients) with SCD were retrospectively reviewed. Results from vHIT, VEMPs and CT and when possible, MRI scans were correlated. An audit of 300 vHIT from patients undergoing routine testing for any neurotological complaint was also conducted to look at the incidence of isolated abnormal superior canal function. RESULTS 82% of patients (9 ears) with SCD showed abnormal vHIT (reduced gain and catch-up saccades) isolated to the affected superior semicircular canal. CONCLUSION Correlation of the CT and VEMPs are important in forming a diagnosis of SCD. However, if isolated superior canal vHIT abnormalities are demonstrated, it is suggestive of SCD and such patients should be referred for further investigations.
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Affiliation(s)
- Payal Mukherjee
- School of Psychology, University of Sydney, Sydney, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Kai Cheng
- School of Psychology, University of Sydney, Sydney, Australia
- Institute of Academic Surgery, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Leigh A. McGarvie
- Neurology Department, Royal Prince Alfred Hospital, Sydney, Australia
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15
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Dlugaiczyk J. Rare Disorders of the Vestibular Labyrinth: of Zebras, Chameleons and Wolves in Sheep's Clothing. Laryngorhinootologie 2021; 100:S1-S40. [PMID: 34352900 PMCID: PMC8363216 DOI: 10.1055/a-1349-7475] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The differential diagnosis of vertigo syndromes is a challenging issue, as many - and in particular - rare disorders of the vestibular labyrinth can hide behind the very common symptoms of "vertigo" and "dizziness". The following article presents an overview of those rare disorders of the balance organ that are of special interest for the otorhinolaryngologist dealing with vertigo disorders. For a better orientation, these disorders are categorized as acute (AVS), episodic (EVS) and chronic vestibular syndromes (CVS) according to their clinical presentation. The main focus lies on EVS sorted by their duration and the presence/absence of triggering factors (seconds, no triggers: vestibular paroxysmia, Tumarkin attacks; seconds, sound and pressure induced: "third window" syndromes; seconds to minutes, positional: rare variants and differential diagnoses of benign paroxysmal positional vertigo; hours to days, spontaneous: intralabyrinthine schwannomas, endolymphatic sac tumors, autoimmune disorders of the inner ear). Furthermore, rare causes of AVS (inferior vestibular neuritis, otolith organ specific dysfunction, vascular labyrinthine disorders, acute bilateral vestibulopathy) and CVS (chronic bilateral vestibulopathy) are covered. In each case, special emphasis is laid on the decisive diagnostic test for the identification of the rare disease and "red flags" for potentially dangerous disorders (e. g. labyrinthine infarction/hemorrhage). Thus, this chapter may serve as a clinical companion for the otorhinolaryngologist aiding in the efficient diagnosis and treatment of rare disorders of the vestibular labyrinth.
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Affiliation(s)
- Julia Dlugaiczyk
- Klinik für Ohren-, Nasen-, Hals- und Gesichtschirurgie
& Interdisziplinäres Zentrum für Schwindel und
neurologische Sehstörungen, Universitätsspital Zürich
(USZ), Universität Zürich (UZH), Zürich,
Schweiz
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16
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Castellucci A, Botti C, Bettini M, Fernandez IJ, Malara P, Martellucci S, Crocetta FM, Fornaciari M, Lusetti F, Renna L, Bianchin G, Armato E, Ghidini A. Case Report: Could Hennebert's Sign Be Evoked Despite Global Vestibular Impairment on Video Head Impulse Test? Considerations Upon Pathomechanisms Underlying Pressure-Induced Nystagmus due to Labyrinthine Fistula. Front Neurol 2021; 12:634782. [PMID: 33854475 PMCID: PMC8039292 DOI: 10.3389/fneur.2021.634782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2020] [Accepted: 02/23/2021] [Indexed: 12/26/2022] Open
Abstract
We describe a case series of labyrinthine fistula, characterized by Hennebert's sign (HS) elicited by tragal compression despite global hypofunction of semicircular canals (SCs) on a video-head impulse test (vHIT), and review the relevant literature. All three patients presented with different amounts of cochleo-vestibular loss, consistent with labyrinthitis likely induced by labyrinthine fistula due to different temporal bone pathologies (squamous cell carcinoma involving the external auditory canal in one case and middle ear cholesteatoma in two cases). Despite global hypofunction on vHIT proving impaired function for each SC for high accelerations, all patients developed pressure-induced nystagmus, presumably through spared and/or recovered activity for low-velocity canal afferents. In particular, two patients with isolated horizontal SC fistula developed HS with ipsilesional horizontal nystagmus due to resulting excitatory ampullopetal endolymphatic flows within horizontal canals. Conversely, the last patient with bony erosion involving all SCs developed mainly torsional nystagmus directed contralaterally due to additional inhibitory ampullopetal flows within vertical canals. Moreover, despite impaired measurements on vHIT, we found simultaneous direction-changing positional nystagmus likely due to a buoyancy mechanism within the affected horizontal canal in a case and benign paroxysmal positional vertigo involving the dehiscent posterior canal in another case. Based on our findings, we might suggest a functional dissociation between high (impaired) and low (spared/recovered) accelerations for SCs. Therefore, it could be hypothesized that HS in labyrinthine fistula might be due to the activation of regular ampullary fibers encoding low-velocity inputs, as pressure-induced nystagmus is perfectly aligned with the planes of dehiscent SCs in accordance with Ewald's laws, despite global vestibular impairment on vHIT. Moreover, we showed how pressure-induced nystagmus could present in a rare case of labyrinthine fistulas involving all canals simultaneously. Nevertheless, definite conclusions on the genesis of pressure-induced nystagmus in our patients are prevented due to the lack of objective measurements of both low-acceleration canal responses and otolith function.
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Affiliation(s)
- Andrea Castellucci
- ENT Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Cecilia Botti
- ENT Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
- PhD Proam in Clinical and Experimental Medicine, University of Modena and Reggio Emilia, Modena, Italy
| | - Margherita Bettini
- Audiology and Ear Surgery Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Ignacio Javier Fernandez
- Department of Otolaryngology-Head and Neck Surgery, University Hospital of Modena, University of Modena and Reggio Emilia, Modena, Italy
| | - Pasquale Malara
- Audiology and Vestibology Service, Centromedico, Bellinzona, Switzerland
| | | | | | - Martina Fornaciari
- ENT Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Francesca Lusetti
- ENT Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Luigi Renna
- ENT Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giovanni Bianchin
- Audiology and Ear Surgery Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Enrico Armato
- ENT Unit, SS Giovanni e Paolo Hospital, Venice, Italy
| | - Angelo Ghidini
- ENT Unit, Department of Surgery, Azienda USL—IRCCS di Reggio Emilia, Reggio Emilia, Italy
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17
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Chow MR, Ayiotis AI, Schoo DP, Gimmon Y, Lane KE, Morris BJ, Rahman MA, Valentin NS, Boutros PJ, Bowditch SP, Ward BK, Sun DQ, Treviño Guajardo C, Schubert MC, Carey JP, Della Santina CC. Posture, Gait, Quality of Life, and Hearing with a Vestibular Implant. N Engl J Med 2021; 384:521-532. [PMID: 33567192 PMCID: PMC8477665 DOI: 10.1056/nejmoa2020457] [Citation(s) in RCA: 49] [Impact Index Per Article: 16.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
BACKGROUND Bilateral vestibular hypofunction is associated with chronic disequilibrium, postural instability, and unsteady gait owing to failure of vestibular reflexes that stabilize the eyes, head, and body. A vestibular implant may be effective in alleviating symptoms. METHODS Persons who had had ototoxic (7 participants) or idiopathic (1 participant) bilateral vestibular hypofunction for 2 to 23 years underwent unilateral implantation of a prosthesis that electrically stimulates the three semicircular canal branches of the vestibular nerve. Clinical outcomes included the score on the Bruininks-Oseretsky Test of Motor Proficiency balance subtest (range, 0 to 36, with higher scores indicating better balance), time to failure on the modified Romberg test (range, 0 to 30 seconds), score on the Dynamic Gait Index (range, 0 to 24, with higher scores indicating better gait performance), time needed to complete the Timed Up and Go test, gait speed, pure-tone auditory detection thresholds, speech discrimination scores, and quality of life. We compared participants' results at baseline (before implantation) with those at 6 months (8 participants) and at 1 year (6 participants) with the device set in its usual treatment mode (varying stimulus pulse rate and amplitude to represent rotational head motion) and in a placebo mode (holding pulse rate and amplitude constant). RESULTS The median scores at baseline and at 6 months on the Bruininks-Oseretsky test were 17.5 and 21.0, respectively (median within-participant difference, 5.5 points; 95% confidence interval [CI], 0 to 10.0); the median times on the modified Romberg test were 3.6 seconds and 8.3 seconds (difference, 5.1; 95% CI, 1.5 to 27.6); the median scores on the Dynamic Gait Index were 12.5 and 22.5 (difference, 10.5 points; 95% CI, 1.5 to 12.0); the median times on the Timed Up and Go test were 11.0 seconds and 8.7 seconds (difference, 2.3; 95% CI, -1.7 to 5.0); and the median speeds on the gait-speed test were 1.03 m per second and 1.10 m per second (difference, 0.13; 95% CI, -0.25 to 0.30). Placebo-mode testing confirmed that improvements were due to treatment-mode stimulation. Among the 6 participants who were also assessed at 1 year, the median within-participant changes from baseline to 1 year were generally consistent with results at 6 months. Implantation caused ipsilateral hearing loss, with the air-conducted pure-tone average detection threshold at 6 months increasing by 3 to 16 dB in 5 participants and by 74 to 104 dB in 3 participants. Changes in participant-reported disability and quality of life paralleled changes in posture and gait. CONCLUSIONS Six months and 1 year after unilateral implantation of a vestibular prosthesis for bilateral vestibular hypofunction, measures of posture, gait, and quality of life were generally in the direction of improvement from baseline, but hearing was reduced in the ear with the implant in all but 1 participant. (Funded by the National Institutes of Health and others; ClinicalTrials.gov number, NCT02725463.).
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Affiliation(s)
- Margaret R Chow
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Andrianna I Ayiotis
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Desi P Schoo
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Yoav Gimmon
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Kelly E Lane
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Brian J Morris
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Mehdi A Rahman
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Nicolas S Valentin
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Peter J Boutros
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Stephen P Bowditch
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Bryan K Ward
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Daniel Q Sun
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Carolina Treviño Guajardo
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Michael C Schubert
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - John P Carey
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
| | - Charles C Della Santina
- From the Departments of Otolaryngology-Head and Neck Surgery (M.R.C., A.I.A., D.P.S., Y.G., K.E.L., B.J.M., P.J.B., S.P.B., B.K.W., D.Q.S., C.T.G., M.C.S., J.P.C., C.C.D.S.) and Biomedical Engineering (M.R.C., A.I.A., B.J.M., P.J.B., C.C.D.S.), Johns Hopkins University School of Medicine, and Labyrinth Devices (M.A.R., N.S.V., C.C.D.S.) - both in Baltimore
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18
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Taylor RL, Magnussen JS, Kwok B, Young AS, Ihtijarevic B, Argaet EC, Reid N, Rivas C, Pogson JM, Rosengren SM, Halmagyi GM, Welgampola MS. Bone-Conducted oVEMP Latency Delays Assist in the Differential Diagnosis of Large Air-Conducted oVEMP Amplitudes. Front Neurol 2020; 11:580184. [PMID: 33193031 PMCID: PMC7658177 DOI: 10.3389/fneur.2020.580184] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2020] [Accepted: 09/28/2020] [Indexed: 02/01/2023] Open
Abstract
Background: A sensitive test for Superior Semicircular Canal Dehiscence (SCD) is the air-conducted, ocular vestibular evoked myogenic potential (AC oVEMP). However, not all patients with large AC oVEMPs have SCD. This retrospective study sought to identify alternate diagnoses also producing enlarged AC oVEMPs and investigated bone-conducted (BC) oVEMP outcome measures that would help differentiate between these, and cases of SCD. Methods: We reviewed the clinical records and BC oVEMP results of 65 patients (86 ears) presenting with dizziness or balance problems who underwent CT imaging to investigate enlarged 105 dB nHL click AC oVEMP amplitudes. All patients were tested with BC oVEMPs using two different stimuli (1 ms square-wave pulse and 8 ms 125 Hz sine wave). Logistic regression and odds ratios were used to determine the efficacy of BC oVEMP amplitudes and latencies in differentiating between enlarged AC oVEMP amplitudes due to dehiscence from those with an alternate diagnosis. Results: Fifty-three ears (61.6%) with enlarged AC oVEMP amplitudes were identified as having frank dehiscence on imaging; 33 (38.4%) had alternate diagnoses that included thinning of the bone covering (near dehiscence, n = 13), vestibular migraine (n = 12 ears of 10 patients), enlarged vestibular aqueduct syndrome (n = 2) and other causes of recurrent episodic vertigo (n = 6). BC oVEMP amplitudes of dehiscent and non-dehiscent ears were not significantly different (p > 0.05); distributions of both groups overlapped with the range of healthy controls. There were significant differences in BC oVEMP latencies between dehiscent and non-dehiscent ears for both stimuli (p < 0.001). A prolonged n1 125 Hz latency (>11.5 ms) was the best predictor of dehiscence (odd ratio = 27.8; 95% CI:7.0-111.4); abnormal n1 latencies were identified in 79.2% of ears with dehiscence compared with 9.1% of ears without dehiscence. Conclusions: A two-step protocol of click AC oVEMP amplitudes and 125 Hz BC oVEMP latency measures optimizes the specificity of VEMP testing in SCD.
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Affiliation(s)
- Rachael L Taylor
- Department of Physiology and Center for Brain Research, The University of Auckland, Auckland, New Zealand.,Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - John S Magnussen
- Macquarie Medical Imaging, Macquarie University Hospital, Sydney, NSW, Australia
| | - Belinda Kwok
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,The Balance Clinic and Laboratory, Sydney, NSW, Australia
| | - Allison S Young
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia
| | - Berina Ihtijarevic
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,The Balance Clinic and Laboratory, Sydney, NSW, Australia
| | - Emma C Argaet
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,The Balance Clinic and Laboratory, Sydney, NSW, Australia
| | - Nicole Reid
- Neurology Department and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Cheryl Rivas
- The Balance Clinic and Laboratory, Sydney, NSW, Australia
| | - Jacob M Pogson
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Neurology Department and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Sally M Rosengren
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Neurology Department and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - G Michael Halmagyi
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,Neurology Department and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia
| | - Miriam S Welgampola
- Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, NSW, Australia.,The Balance Clinic and Laboratory, Sydney, NSW, Australia.,Neurology Department and Institute of Clinical Neurosciences, Royal Prince Alfred Hospital, Sydney, NSW, Australia
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19
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Fröhlich L, Curthoys IS, Kösling S, Obrist D, Rahne T, Plontke SK. Cervical and Ocular Vestibular-Evoked Myogenic Potentials in Patients With Intracochlear Schwannomas. Front Neurol 2020; 11:549817. [PMID: 33192980 PMCID: PMC7655125 DOI: 10.3389/fneur.2020.549817] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/07/2020] [Accepted: 09/22/2020] [Indexed: 12/14/2022] Open
Abstract
Objective: To evaluate ocular and cervical vestibular evoked myogenic potentials (oVEMPs and cVEMPs) in patients with solely intracochlear localization of an intralabyrinthine schwannoma (ILS). Study Design: Retrospective analysis of a series of cases. Setting: Monocentric study at a tertiary referral center. Patients: Patients with intracochlear schwannoma (ICS) and VEMP measurements. Outcome Measures: Signed asymmetry ratio (AR) of cVEMPs and oVEMPs to air conducted sound with AR cut-offs considered to be asymmetrical when exceeding ±30% for cVEMPs and ±40% for oVEMPs with respect to the side affected by the tumor (reduced amplitudes on the affected side indicated by negative values, enhanced amplitudes by positive values); VEMP amplitudes and latencies; tumor localization in the cochlear turn and scala. Results: Nineteen patients with a solely intracochlear tumor (ICS patients) [10 males, 9 females, mean age 57.1 (SD: 13.4) years] were included in the study. On the affected side, cVEMPs were absent or reduced in 47% of the patients, normal in 32%, and enhanced in 21%. Ocular VEMPs on the affected side were absent or reduced in 53% of the patients, normal in 32% and enhanced in 15%. Latencies for cVEMPs and oVEMPs were not significantly different between the affected and non-affected side. In all patients with enhanced VEMPs, the tumor was located in the scala tympani and scala vestibuli. Conclusions: As a new and unexpected finding, VEMP amplitudes can be enhanced in patients with intracochlear schwannoma, mimicking the third window syndrome.
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Affiliation(s)
- Laura Fröhlich
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Ian S Curthoys
- Vestibular Research Laboratory, School of Psychology, The University of Sydney, Sydney, NSW, Australia
| | - Sabrina Kösling
- Department of Radiology, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Dominik Obrist
- ARTORG Center for Biomedical Engineering Research, University of Bern, Bern, Switzerland
| | - Torsten Rahne
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Stefan K Plontke
- Department of Otorhinolaryngology, Head and Neck Surgery, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Abstract
Third window syndrome describes a set of vestibular and auditory symptoms that arise when a pathological third mobile window is present in the bony labyrinth of the inner ear. The pathological mobile window (or windows) adds to the oval and round windows, disrupting normal auditory and vestibular function by altering biomechanics of the inner ear. The most commonly occurring third window syndrome arises from superior semicircular canal dehiscence (SSCD), where a section of bone overlying the superior semicircular canal is absent or thinned (near-dehiscence). The presentation of SSCD syndrome is well characterized by clinical audiological and vestibular tests. In this review, we describe how the third compliant window introduced by a SSCD alters the biomechanics of the inner ear and thereby leads to vestibular and auditory symptoms. Understanding the biomechanical origins of SSCD further provides insight into other third window syndromes and the potential of restoring function or reducing symptoms through surgical repair.
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Affiliation(s)
- Marta M. Iversen
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
| | - Richard D. Rabbitt
- Department of Biomedical Engineering, University of Utah, Salt Lake City, UT, United States
- Department of Otolaryngology, University of Utah, Salt Lake City, UT, United States
- Neuroscience Program, University of Utah, Salt Lake City, UT, United States
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21
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Pogson JM, Taylor RL, Thompson EO, Magnussen JS, Welgampola MS, Halmagyi GM. A Window Into the Whole Story: Temporal Bone Plasmacytoma Presenting With a Mobile Third Window. Laryngoscope 2020; 131:E966-E969. [PMID: 32750153 DOI: 10.1002/lary.28951] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/27/2019] [Revised: 05/21/2020] [Accepted: 06/14/2020] [Indexed: 11/09/2022]
Abstract
A 63-year-old man presented with imbalance when coughing due to a respiratory tract infection. He had a history of multiple myeloma with a plasmacytoma of the left temporal bone. Examination revealed a positive leftward head impulse test, no spontaneous nystagmus, left-beating positional nystagmus, and left-beating Valsalva-induced nystagmus. Videonystagmography, audiology, and comprehensive vestibular function tests revealed a subtotal left peripheral audio-vestibular loss. Temporal bone computed tomography showed an unchanged bony erosion of the left labyrinth from 2 years prior. Vertigo subsided after treatment of the respiratory tract infection. Although no tumor progression was evident, coughing had triggered a preexisting third mobile window to declare itself. Laryngoscope, 131:E966-E969, 2021.
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Affiliation(s)
- Jacob M Pogson
- Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - Rachael L Taylor
- Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia.,Faculty of Medical and Health Sciences, Department of Physiology and Centre for Brain Research, The University of Auckland, Auckland, New Zealand
| | - Elizabeth O Thompson
- Radiology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - John S Magnussen
- Faculty of Medicine and Health Sciences, Macquarie University, North Ryde, New South Wales, Australia
| | - Miriam S Welgampola
- Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
| | - G Michael Halmagyi
- Neurology Department, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia.,Sydney Medical School, University of Sydney, Camperdown, New South Wales, Australia
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22
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Physiology, clinical evidence and diagnostic relevance of sound-induced and vibration-induced vestibular stimulation. Curr Opin Neurol 2020; 33:126-135. [DOI: 10.1097/wco.0000000000000770] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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23
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Curthoys IS, Grant JW, Pastras CJ, Brown DJ, Burgess AM, Brichta AM, Lim R. A review of mechanical and synaptic processes in otolith transduction of sound and vibration for clinical VEMP testing. J Neurophysiol 2019; 122:259-276. [DOI: 10.1152/jn.00031.2019] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Older studies of mammalian otolith physiology have focused mainly on sustained responses to low-frequency (<50 Hz) or maintained linear acceleration. So the otoliths have been regarded as accelerometers. Thus evidence of otolithic activation and high-precision phase locking to high-frequency sound and vibration appears to be very unusual. However, those results are exactly in accord with a substantial body of knowledge of otolith function in fish and frogs. It is likely that phase locking of otolith afferents to vibration is a general property of all vertebrates. This review examines the literature about the activation and phase locking of single otolithic neurons to air-conducted sound and bone-conducted vibration, in particular the high precision of phase locking shown by mammalian irregular afferents that synapse on striolar type I hair cells by calyx endings. Potassium in the synaptic cleft between the type I hair cell receptor and the calyx afferent ending may be responsible for the tight phase locking of these afferents even at very high discharge rates. Since frogs and fish do not possess full calyx endings, it is unlikely that they show phase locking with such high precision and to such high frequencies as has been found in mammals. The high-frequency responses have been modeled as the otoliths operating in a seismometer mode rather than an accelerometer mode. These high-frequency otolithic responses constitute the neural basis for clinical vestibular-evoked myogenic potential tests of otolith function.
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Affiliation(s)
- Ian S. Curthoys
- Vestibular Research Laboratory, School of Psychology, the University of Sydney, New South Wales, Australia
| | - J. Wally Grant
- Department of Biomedical Engineering and Mechanics, Virginia Tech, Blacksburg, Virginia
| | - Christopher J. Pastras
- The Meniere’s Laboratory, Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Daniel J. Brown
- The Meniere’s Laboratory, Sydney Medical School, University of Sydney, New South Wales, Australia
| | - Ann M. Burgess
- Vestibular Research Laboratory, School of Psychology, the University of Sydney, New South Wales, Australia
| | - Alan M. Brichta
- School of Biomedical Sciences and Pharmacy, The University of Newcastle and Hunter Medical Research Institute. Newcastle, New South Wales, Australia
| | - Rebecca Lim
- School of Biomedical Sciences and Pharmacy, The University of Newcastle and Hunter Medical Research Institute. Newcastle, New South Wales, Australia
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Rabbitt RD. Semicircular canal biomechanics in health and disease. J Neurophysiol 2019; 121:732-755. [PMID: 30565972 PMCID: PMC6520623 DOI: 10.1152/jn.00708.2018] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Revised: 12/11/2018] [Accepted: 12/11/2018] [Indexed: 12/12/2022] Open
Abstract
The semicircular canals are responsible for sensing angular head motion in three-dimensional space and for providing neural inputs to the central nervous system (CNS) essential for agile mobility, stable vision, and autonomic control of the cardiovascular and other gravity-sensitive systems. Sensation relies on fluid mechanics within the labyrinth to selectively convert angular head acceleration into sensory hair bundle displacements in each of three inner ear sensory organs. Canal afferent neurons encode the direction and time course of head movements over a broad range of movement frequencies and amplitudes. Disorders altering canal mechanics result in pathological inputs to the CNS, often leading to debilitating symptoms. Vestibular disorders and conditions with mechanical substrates include benign paroxysmal positional nystagmus, direction-changing positional nystagmus, alcohol positional nystagmus, caloric nystagmus, Tullio phenomena, and others. Here, the mechanics of angular motion transduction and how it contributes to neural encoding by the semicircular canals is reviewed in both health and disease.
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Affiliation(s)
- R. D. Rabbitt
- Department of Biomedical Engineering, University of Utah, Salt Lake City, Utah
- Otolaryngology-Head Neck Surgery, University of Utah, Salt Lake City, Utah
- Neuroscience Program, University of Utah, Salt Lake City, Utah
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25
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Curthoys I, Burgess AM, Goonetilleke SC. Phase-locking of irregular guinea pig primary vestibular afferents to high frequency (>250 Hz) sound and vibration. Hear Res 2019; 373:59-70. [DOI: 10.1016/j.heares.2018.12.009] [Citation(s) in RCA: 26] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2018] [Revised: 12/07/2018] [Accepted: 12/21/2018] [Indexed: 12/28/2022]
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