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Karaketir S, Berkiten G, Tutar B, Akan O, Kumral TL, Sari H, Atar Y, Göker AE, Ahmed İA, Çelik C, Uyar Y. Evaluation of the audiovestibular system before and after treatment in patients with Idiopathic intracranial hypertension. Acta Otolaryngol 2024:1-8. [PMID: 39225671 DOI: 10.1080/00016489.2024.2395868] [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: 06/11/2024] [Revised: 08/15/2024] [Accepted: 08/15/2024] [Indexed: 09/04/2024]
Abstract
BACKGROUND Idiopathic intracranial hypertension (IIH) can affect both hearing and balance due to increased inner ear pressure. AIMS/OBJECTIVES This study aimed to evaluate the impact of increased inner ear pressure on hearing and balance in patients with IIH using auditory and vestibular tests. MATERIAL AND METHODS Twenty-four IIH patients and 28 healthy controls underwent oVEMP, pure tone audiometry, tympanometry, and acoustic reflex tests pre-lumbar punctures. IIH patients received acetazolamide. Pre- and post-treatment results, tinnitus, and vertigo scores were compared. Post-treatment oVEMP and audiometry results were compared between groups. RESULTS Pre-treatment oVEMP showed a significant left N1 latency difference (p = 0.049). Post-treatment, left ear amplitude (p = 0.035) and both ear amplitude ratios (p = 0.044 and p = 0.047) increased significantly. Audiometry had no significant changes (p < 0.05). Tinnitus and vertigo scores decreased significantly (p ≤ 0.001). CONCLUSION Prolonged oVEMP latency suggests IIH may impact the brain stem and vestibular nerve, while increased amplitude values indicate peripheral vestibular involvement. IIH affects hearing across all frequencies, especially at 4000 Hz, impacting both hearing and balance. SIGNIFICANCE Understanding the effects of IIH on auditory and vestibular functions can guide effective treatments, improving quality of life for patients by addressing both hearing and balance issues.
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Affiliation(s)
- Semih Karaketir
- Department of Otorhinolaryngology, Kozyatağı Central Hospital, Istanbul, Turkey
| | - Güler Berkiten
- Department of Otorhinolaryngology, University of Health Sciences, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Belgin Tutar
- Department of Otorhinolaryngology, University of Health Sciences, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Onur Akan
- Department of Neurology, University of Health Sciences, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Tolgar Lütfi Kumral
- Department of Otorhinolaryngology, University of Health Sciences, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Hüseyin Sari
- Department of Otorhinolaryngology, University of Health Sciences, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Yavuz Atar
- Faculty of Medicine, Department of Otorhinolaryngology, Üsküdar University, Istanbul, Turkey
| | - Ayşe Enise Göker
- Department of Otorhinolaryngology, University of Health Sciences, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | | | - Cem Çelik
- Department of Otorhinolaryngology, University of Health Sciences, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
| | - Yavuz Uyar
- Department of Otorhinolaryngology, University of Health Sciences, Prof. Dr. Cemil Taşçıoğlu City Hospital, Istanbul, Turkey
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Li Y, Li J, Wang P, Yu D, Chen Z, Shi Z, Wu Y, Qi W, Lu W, Shi H. Electroencephalography microstate alterations reflect potential double-edged cognitive adaptation in Ménière's disease. CNS Neurosci Ther 2024; 30:e14896. [PMID: 39107944 PMCID: PMC11303265 DOI: 10.1111/cns.14896] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2024] [Revised: 07/11/2024] [Accepted: 07/19/2024] [Indexed: 08/10/2024] Open
Abstract
PURPOSE To explore the microstate characteristics and underlying brain network activity of Ménière's disease (MD) patients based on high-density electroencephalography (EEG), elucidate the association between microstate dynamics and clinical manifestation, and explore the potential of EEG microstate features as future neurobiomarkers for MD. METHODS Thirty-two patients diagnosed with MD and 29 healthy controls (HC) matched for demographic characteristics were included in the study. Dysfunction and subjective symptom severity were assessed by neuropsychological questionnaires, pure tone audiometry, and vestibular function tests. Resting-state EEG recordings were obtained using a 256-channel EEG system, and the electric field topographies were clustered into four dominant microstate classes (A, B, C, and D). The dynamic parameters of each microstate were analyzed and utilized as input for a support vector machine (SVM) classifier to identify significant microstate signatures associated with MD. The clinical significance was further explored through Spearman correlation analysis. RESULTS MD patients exhibited an increased presence of microstate class C and a decreased frequency of transitions between microstate class A and B, as well as between class A and D. The transitions from microstate class A to C were also elevated. Further analysis revealed a positive correlation between equilibrium scores and the transitions from microstate class A to C under somatosensory challenging conditions. Conversely, transitions between class A and B were negatively correlated with vertigo symptoms. No significant correlations were detected between these characteristics and auditory test results or emotional scores. Utilizing the microstate features identified via sequential backward selection, the linear SVM classifier achieved a sensitivity of 86.21% and a specificity of 90.61% in distinguishing MD patients from HC. CONCLUSIONS We identified several EEG microstate characteristics in MD patients that facilitate postural control yet exacerbate subjective symptoms, and effectively discriminate MD from HC. The microstate features may offer a new approach for optimizing cognitive compensation strategies and exploring potential neurobiological markers in MD.
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Affiliation(s)
- Yi‐Ni Li
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Jie Li
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Peng‐Jun Wang
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Dong‐Zhen Yu
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Zheng‐Nong Chen
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Zheng‐Yu Shi
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Ya‐Qin Wu
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Wei‐Dong Qi
- Department of Otolaryngology Head and Neck SurgeryHuashan Hospital Fudan UniversityShanghaiChina
| | - Wen Lu
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
| | - Hai‐Bo Shi
- Department of Otolaryngology‐Head and Neck SurgeryShanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of MedicineShanghaiChina
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Goswami A, Ruhina Rahman SN, Ponneganti S, Gangipangi V, Vavialala H, Radhakrishnanand P, Selvaraju S, Mutheneni SR, Bharti S, Shunmugaperumal T. Intratympanic injections of emulsion-like dispersions to augment cinnarizine amount in a healthy rabbit inner ear model. Nanomedicine (Lond) 2024:1-25. [PMID: 39041668 DOI: 10.1080/17435889.2024.2373042] [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: 03/15/2024] [Accepted: 06/24/2024] [Indexed: 07/24/2024] Open
Abstract
Aim: To investigate eutectic liquid-based emulsion-like dispersions for intratympanic injections to augment cinnarizine permeability across round window membrane in a healthy rabbit inner ear model. Methods: Two-tier systematic optimization was used to get the injection formula. The drug concentrations in perilymph and plasma were analyzed via. Ultra-performance liquid chromatography-tandem mass spectrometry method after 30-, 60-, 90- and 120-min post intratympanic injection time points in rabbits. Results: A shear-thinning behavior, immediate drug release (∼98.80%, 10 min) and higher cell viability (>97.86%, 24 h) were observed in dispersions. The cinnarizine level of 8168.57 ± 1236.79 ng/ml was observed in perilymph at 30 min post intratympanic injection in rabbits. Conclusion: The emulsion-like dispersions can augment drug permeability through round window membrane.
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Affiliation(s)
- Abhinab Goswami
- Department of Pharmaceutics, National Institute of Pharmaceutical Education & Research- Guwahati, Sila Katamur (Halugurisuk), Changsari, Kamrup, Assam 781101, India
| | - Syed Nazrin Ruhina Rahman
- Department of Pharmaceutics, National Institute of Pharmaceutical Education & Research- Guwahati, Sila Katamur (Halugurisuk), Changsari, Kamrup, Assam 781101, India
| | - Srikanth Ponneganti
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education & Research- Guwahati, Sila Katamur (Halugurisuk), Changsari, Kamrup, Assam 781101, India
| | - Vijayakumar Gangipangi
- Department of Biotechnology, National Institute of Pharmaceutical Education & Research- Guwahati, Sila Katamur (Halugurisuk), Changsari, Kamrup, Assam 781101, India
| | - Hariprasad Vavialala
- Bioinformatics Group, Applied Biology Division, CSIR-Indian Institute of Chemical Technology, Tarnaka, Hyderabad, Telangana 500007, India
| | - Pullapanthula Radhakrishnanand
- Department of Pharmaceutical Analysis, National Institute of Pharmaceutical Education & Research- Guwahati, Sila Katamur (Halugurisuk), Changsari, Kamrup, Assam 781101, India
| | - Sudhagar Selvaraju
- Department of Biotechnology, National Institute of Pharmaceutical Education & Research- Guwahati, Sila Katamur (Halugurisuk), Changsari, Kamrup, Assam 781101, India
| | - Srinivasa Rao Mutheneni
- Bioinformatics Group, Applied Biology Division, CSIR-Indian Institute of Chemical Technology, Tarnaka, Hyderabad, Telangana 500007, India
| | - Shreekant Bharti
- Department of Pathology/Lab Medicine, All India Institute of Medical Sciences Patna, Phulwarisarif, Patna, Bihar 801507, India
| | - Tamilvanan Shunmugaperumal
- Department of Pharmaceutics, National Institute of Pharmaceutical Education & Research- Guwahati, Sila Katamur (Halugurisuk), Changsari, Kamrup, Assam 781101, India
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Huang Y, Tang R, Xu N, Ding H, Pu W, Xie J, Yang Z, Liu Y, Gong S, Wang Z, Zhao P. Association Between Vestibular Aqueduct Morphology and Meniere's Disease. Laryngoscope 2024; 134:3349-3354. [PMID: 38366775 DOI: 10.1002/lary.31339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/27/2023] [Revised: 01/11/2024] [Accepted: 01/23/2024] [Indexed: 02/18/2024]
Abstract
OBJECTIVE To investigate the relationship between vestibular aqueduct (VA) morphology and Meniere's disease (MD) using ultrahigh-resolution computed tomography (U-HRCT). METHODS Retrospective data were collected from 34 patients (40 ears) diagnosed with MD in our hospital who underwent temporal bone U-HRCT with isotropic 0.05-mm resolution, magnetic resonance with gadolinium-enhanced, and pure-tone audiometry; 34 age- and sex-matched controls (68 ears) who underwent U-HRCT were also included. VA patency was qualitatively classified as locally not shown (grade 1), locally faintly shown (grade 2), or clearly shown throughout (grade 3). The width of the outer orifice and VA length and angle were quantitatively measured. Differences in VA morphology between the MD and control groups were analyzed. The correlations between VA morphology and the degrees of hearing loss and endolymphatic hydrops (EH) were also analyzed. RESULTS VA was classified as grades 1-3 in 11, 17, and 12 ears in the MD group and 5, 26, and 37 ears in the control group, respectively. The patency differed significantly between the groups (p < 0.01). The width of the outer orifice and length of VA were significantly smaller in the MD group than those in the control group (p < 0.05). Both VA patency and length were correlated with the degree of EH in the cochlea and the vestibule (p < 0.05). No difference was found between VA morphology and the degree of hearing loss (p > 0.05). CONCLUSION The morphological characteristics of VA were found to be associated with the occurrence of MD and the degree of EH. LEVEL OF EVIDENCE 4 Laryngoscope, 134:3349-3354, 2024.
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Affiliation(s)
- Yan Huang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ruowei Tang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Ning Xu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Heyu Ding
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Wei Pu
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
- Department of Medical Imaging, Guizhou Provincial People's Hospital, Guiyang, China
| | - Jing Xie
- Department of Otolaryngology, Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenghan Yang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Yuhe Liu
- Department of Otolaryngology, Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Shusheng Gong
- Department of Otolaryngology, Head and Neck Surgery, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Zhenchang Wang
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
| | - Pengfei Zhao
- Department of Radiology, Beijing Friendship Hospital, Capital Medical University, Beijing, China
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Cao X, Zhou Y, Li T, Wang C, Wu P. Symptom networks analysis among people with Meniere's disease: Application for nursing care. Int J Nurs Sci 2024; 11:214-221. [PMID: 38707681 PMCID: PMC11064586 DOI: 10.1016/j.ijnss.2024.03.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Revised: 02/29/2024] [Accepted: 03/08/2024] [Indexed: 05/07/2024] Open
Abstract
Objectives This study aimed to explore and visualize the relationships among multiple symptoms in patients with Meniere's disease (MD) and aid clinical nurses in the design of accurate, individualized interventions. Methods This study included 790 patients with MD at the Eye and ENT Hospital of Fudan University from October 2014 to December 2021. A self-designed symptom checklist was used to assess 15 MD-related symptoms and construct contemporaneous networks with all 15 symptoms in R software. Qgraph package and Fruchterman-Reingold layout were used for network visualization. Bootstrapping methods were performed to assess network accuracy and stability, and three centrality indices were adopted to describe relationships among symptoms. Results Symptom networks showed good accuracy and stability. "Anxiety and nervousness"(98.2%), "aural fullness"(84.4%) and "tinnitus"(82.7%) were the common symptom in MD patients, while "tinnitus", "aural fullness" and "decline in word recognition", were more serious. MD patients with longer disease duration had higher prevalence and severity for all symptoms (P < 0.05). Symptom networks showed good accuracy and stability. "Decline in word recognition," "fatigue," and "anxiety and nervousness" were at the center of the symptom networks, which had the largest strength values and closeness. "Decline in word recognition," "headache," and "spatial discrimination and poor orientation" were the symptoms with the highest betweenness with the strongest bridging effect. The ≥1-year disease group exhibited higher centralities for "drop attack" and "anxiety and nervousness," and a lower centrality for "headache" compared with the <1-year disease group. Conclusions The symptom networks of MD patients with varying disease durations were revealed. Clinicians and nurses must provide precision interventions tailored to modifying symptom severity and centrality. Nursing interventions should focus on word recognition issues and associated discomfort in MD patients with multiple symptoms.
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Affiliation(s)
- Xuejiao Cao
- School of Nursing, Fudan University, Shanghai, China
| | - Yue Zhou
- Department of Emergency Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Tang Li
- Business School, Nanjing University, Nanjing, China
| | - Chennan Wang
- School of Nursing, Fudan University, Shanghai, China
| | - Peixia Wu
- Department of Nursing, Eye and ENT Hospital of Fudan University, Shanghai, China
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Kasimu M, Tuersun M, Maimaitituerxun Y, Abulizi W, Li S, Fulati N. Abnormal Rhomboid Lip and Choroid Plexus Should be Valued in Microvascular Decompression for Vestibulocochlear Diseases. World Neurosurg 2024; 181:e607-e614. [PMID: 37898278 DOI: 10.1016/j.wneu.2023.10.099] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/22/2023] [Indexed: 10/30/2023]
Abstract
BACKGROUND Surgical outcomes for functional vestibulocochlear diseases vary, and the influencing factors are not fully understood. The role of a rhomboid lip (RL) and choroid plexus (CP) in microvascular decompression (MVD) of the vestibulocochlear nerve has not been studied. This study aims to evaluate the surgical efficacy of MVD for vestibulocochlear diseases, with and without addressing the RL and CP, to enhance our understanding of their etiology. METHODS A total of 15 patients who underwent MVD for the vestibulocochlear nerve between 2013 and 2022 were retrospectively identified and followed up. The patients were classified into 4 categories: vestibular paroxysmia (VP), benign positional paroxysmal vertigo (BPPV), and Meniere disease (MD). The fourth was a "tinnitus" group. The relief of symptoms, recurrence, satisfaction after surgery, available relevant imaging studies, and intraoperative observation data were evaluated. RESULTS Following MVD, 6 of the 7 patients in the VP group, the 1 patient in the BPPV group, and 1 of 2 patients in the MD group were completely relieved of vertigo. The seventh VP patient showed significant improvement. The 5 patients in the "tinnitus" group remained unchanged. Retrospectively, 4 patients from the VP, BPPV, and MD groups who underwent RL incision and CP excision were also free of vertigo, although vascular compression was not confirmed in these cases. CONCLUSIONS MVD is generally considered a useful treatment for VP and could also be effective in managing recurrent vertigo caused by BPPV and MD. Our results highlight the potential role of an abnormal RL and CP in the development of vertigo symptoms. Patients presenting with "tinnitus" require further investigation and might not be suitable for MVD.
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Affiliation(s)
- Maimaitijiang Kasimu
- Department of Functional Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China.
| | - Maidina Tuersun
- Department of Functional Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Yiliyasijiang Maimaitituerxun
- Department of Functional Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Wulamuaili Abulizi
- Department of Functional Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Shu Li
- Department of Functional Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
| | - Nijiati Fulati
- Department of Functional Neurosurgery, Neurosurgery Centre, The First Affiliated Hospital of Xinjiang Medical University, Ürümqi, China
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Goswami A, Rahman SNR, Pawde DM, Shunmugaperumal T. Analytical Quality by Design-Driven RP-HPLC Method Conditions to Concomitantly Determine Cinnarizine and Morin Hydrate in Combined Drug Solution and Dual Drug-Loaded Formulations. J AOAC Int 2023; 106:1154-1164. [PMID: 37279742 DOI: 10.1093/jaoacint/qsad068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2023] [Revised: 05/27/2023] [Accepted: 05/27/2023] [Indexed: 06/08/2023]
Abstract
BACKGROUND The replacement of traditional oils with a camphor and menthol-based eutectic mixture is done to prepare oil-less emulsion-like dispersions for co-delivery of cinnarizine (CNZ) and morin hydrate (MH) for managing Meniére's disease (MD). Since two drugs are loaded into the dispersions, the development of a suitable reverse phase-high performance liquid chromatography (RP-HPLC) method for their simultaneous analysis becomes inevitable. OBJECTIVE By applying the analytical quality by design (AQbD) approach, the RP-HPLC method conditions were optimized for the concomitant determination of two drugs. METHODS The systematic AQbD started with identifying critical method attributes (CMA) through an Ishikawa fishbone diagram, risk estimation matrix, and risk priority number-based failure mode effect analysis followed by screening using fractional factorial design and optimization by face-centered central composite design. The concomitant determination of two drugs by the optimized RP-HPLC method condition was substantiated via specificity checking using combined drug solution, drug entrapment efficiency, and in vitro release of the two drugs from emulsion-like dispersions. RESULTS The AQbD optimized RP-HPLC method conditions revealed the retention time for CNZ and MH at 5.017 and 5.323, respectively. The studied validation parameters were found within the ICH-prescribed limits. Exposing the individual drug solutions to acidic and basic hydrolytic conditions yielded extra chromatographic peaks for MH, probably due to the degradation of MH. The DEE % values of 87.40 ± 4.70 and 74.79 ± 2.94, respectively, were noticed for CNZ and MH in emulsion-like dispersions. More than 98% CNZ and MH release was occurred from emulsion-like dispersions within 30 min post-dissolution in artificial perilymph. CONCLUSIONS Overall, the AQbD approach could be helpful for systematic optimization of RP-HPLC method conditions to estimate concomitantly other therapeutic moieties. HIGHLIGHTS The proposed article shows the successful application of AQbD for the optimization of RP-HPLC method conditions to concomitantly estimate CNZ and MH in combined drug solution and dual-drug-loaded emulsion-like dispersions.
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Affiliation(s)
- Abhinab Goswami
- National Institute of Pharmaceutical Education and Research-Guwahati, Department of Pharmaceutics, Sila Katamur (Halugurisuk), Changsari, Kamrup, Guwahati, Assam 781101, India
| | - Syed Nazrin R Rahman
- National Institute of Pharmaceutical Education and Research-Guwahati, Department of Pharmaceutics, Sila Katamur (Halugurisuk), Changsari, Kamrup, Guwahati, Assam 781101, India
| | - Datta M Pawde
- National Institute of Pharmaceutical Education and Research-Guwahati, Department of Pharmaceutics, Sila Katamur (Halugurisuk), Changsari, Kamrup, Guwahati, Assam 781101, India
| | - Tamilvanan Shunmugaperumal
- National Institute of Pharmaceutical Education and Research-Guwahati, Department of Pharmaceutics, Sila Katamur (Halugurisuk), Changsari, Kamrup, Guwahati, Assam 781101, India
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Koukoulithras I, Drousia G, Kolokotsios S, Plexousakis M, Stamouli A, Roussos C, Xanthi E. A Holistic Approach to a Dizzy Patient: A Practical Update. Cureus 2022; 14:e27681. [PMID: 36106247 PMCID: PMC9447938 DOI: 10.7759/cureus.27681] [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] [Accepted: 08/04/2022] [Indexed: 11/07/2022] Open
Abstract
Dizziness is one of the most common symptoms encountered by physicians daily. It is divided into four categories: vertigo, disequilibrium, presyncope, and psychogenic dizziness. It is essential to distinguish these four symptoms because the causes, prognosis, and treatment differ. Vertigo constitutes a disease of the central or peripheral nervous system. Central origin vertigo may be a life-threatening situation and must be detected as soon as possible because it includes diseases such as stroke, hemorrhage, tumors, and multiple sclerosis. Peripheral origin vertigo includes benign diseases, which may be fully treatable such as vestibular migraine, benign paroxysmal positional vertigo, vestibular neuritis, Ménière’s disease, and cervical vertigo. The HINTS (head impulse, nystagmus, test of skew) examination is essential to distinguish central from peripheral causes. A detailed history including the duration of vertigo (episodic or continuous), its trigger, and a clinical examination step by step following the appropriate protocol could help to make a definite and accurate diagnosis and treatment. Due to a lack of expertise in dizziness and inappropriate treatment, many patients are admitted to dizziness clinics with long-standing dizziness. A holistic treatment combining medications, vestibular rehabilitation, physiotherapy, and psychotherapy should be initiated to improve the quality of life of these patients. So, this review aims to recommend a clinical protocol for approaching a dizzy patient with vertigo and to present in detail the epidemiology, pathophysiology, symptoms, diagnosis, and contemporary treatments of all causes of vertigo.
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The Relationship between Meniere's Disease and Acute Low-Tone Sensorineural Hearing Loss. EVIDENCE-BASED COMPLEMENTARY AND ALTERNATIVE MEDICINE 2022; 2022:4217131. [PMID: 35845601 PMCID: PMC9283040 DOI: 10.1155/2022/4217131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 06/14/2022] [Indexed: 11/17/2022]
Abstract
Objective To analyse the vestibular function characteristics of patients with Meniere's disease and acute hypophonic sensorineural hearing loss in order to find more reliable and objective ancillary tests that will reduce misdiagnosis and missed diagnoses. Methods From January 2021 to December 2021, 60 healthy adults who underwent physical examination in our hospital were included in the control group, 60 patients with Meniere's disease were included in Study Group A, and 60 patients with acute low-tone sensorineural hearing loss were recruited in Study Group B. All participants underwent the caloric test (CT), video-head impulse test (vHIT), headshaking test (HST), and vestibular-evoked myogenic potential (VEMP) testing, which includes ocular vestibular-evoked myogenic potential (oVEMP) and cervical vestibular-evoked myogenic potential (cVEMP). Results Statistical analyses of unilateral weakness and directional preponderance (DP) in the two groups of patients found no significant differences between the two groups (P > 0.05). There was no statistically significant difference in the abnormal rate of vHIT and HST results between the two study groups (P > 0.05). There was no significant difference in the wave latencies, interwave intervals, and amplitudes of cVEMP and oVEMP, among the three groups (P > 0.05). Conclusion This study found that factors affecting CT, vHIT, HST, and VEMP results included age, head posture and position during testing, stimulus type, manipulation method, and control of muscle tone, and also those that are related to the testing instrument, statistical software, and manipulation procedures, resulting in different excitation rates and testing parameters. The small sample size prevented a comprehensive assessment of the differences in vestibular function between patients with Meniere's disease and acute hypotonic sensorineural hearing loss, and a larger sample size will be investigated in the future to provide useful insight into the diagnosis, treatment and differentiation of Meniere's disease, and acute hypotonic sensorineural hearing loss.
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Zheng G, Liu Y, He J, Li S, Zhang Q, Duan M, Yang J, Jin Y. A Comparison of Local Endolymphatic Sac Decompression, Endolymphatic Mastoid Shunt, and Wide Endolymphatic Sac Decompression in the Treatment of Intractable Meniere's Disease: A Short-Term Follow-Up Investigation. Front Neurol 2022; 13:810352. [PMID: 35222247 PMCID: PMC8866956 DOI: 10.3389/fneur.2022.810352] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundMeniere's disease (MD) is an inner ear disorder, characterized by recurrent attacks of vertigo, low-frequency sensorineural hearing loss, tinnitus, and aural fullness. Endolymphatic sac surgery is an effective treatment to control vertigo attacks but without causing a hearing loss for intractable MD. However, the methods and effects of endolymphatic sac surgery have been controversial for many years, and the relationship between the vertigo control rates of different endolymphatic sac surgery methods is not well-documented.ObjectivesThis study compared the vertigo control rate, hearing outcome, and quality of life (QOL) among different endolymphatic sac surgery, such as local endolymphatic sac decompression (LESD), endolymphatic sac mastoid shunt (ESMS), and wide endolymphatic sac decompression (WESD).Materials and MethodsWe retrospectively analyzed the patients who underwent endolymphatic sac surgery from January 2008 to June 2019. The control rate of vertigo and QOL scores were compared after 2 years of follow-up. The QOL was scored with validation of the MD patient-oriented symptom-severity index (MDPOSI). The pure tone thresholds of all patients at pre- and postoperation were also compared.ResultsIn total, 83 MD patients with complete follow-up data were included in the study, i.e., 20 patients with LESD, 28 patients with ESMS, and 35 patients with WESD. Results showed a better vertigo control with WESD than the other groups (70% with LESD, 71.4% with ESMS, and 88.6% with WESD). The QOL was improved after surgery in all groups in which the difference was statistically significant (QOL, preoperative vs. postoperative, 38.2 vs. 10.1 with LESD, 37.8 vs. 9.6 with ESMS, and 37.6 vs. 8.3 with WESD), respectively. After endolymphatic sac surgery, the hearing was well-preserved in the three groups [pure tone averages (PTAs), dB, preoperative vs. postoperative, 41.0 ± 19.3 vs. 40.8 ± 17.9 with LESD, 39.7 ± 16.4 vs. 40.8 ± 18.2 with ESMS, and 38.5 ± 18.7 vs. 36.6 ± 19.5 with WESD].ConclusionWide endolymphatic sac decompression has a higher vertigo control rate, better improvement of QOL, and relatively higher hearing stability or improvement rate after surgery in patients with MD compared with LESD and ESMS.
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Affiliation(s)
- Guiliang Zheng
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Yupeng Liu
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Jingchun He
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Shuna Li
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Qing Zhang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
| | - Maoli Duan
- Ear Nose and Throat Patient Area, Trauma and Reparative Medicine Theme, Karolinska University Hospital, Stockholm, Sweden
- Division of Ear, Nose, and Throat Diseases, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- *Correspondence: Maoli Duan
| | - Jun Yang
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
- Jun Yang
| | - Yulian Jin
- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
- Shanghai Jiaotong University School of Medicine Ear Institute, Shanghai, China
- Shanghai Key Laboratory of Translational Medicine on Ear and Nose Diseases, Shanghai, China
- Yulian Jin
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Noyalet L, Ilgen L, Bürklein M, Shehata-Dieler W, Taeger J, Hagen R, Neun T, Zabler S, Althoff D, Rak K. Vestibular Aqueduct Morphology and Meniere's Disease—Development of the “Vestibular Aqueduct Score” by 3D Analysis. Front Surg 2022; 9:747517. [PMID: 35187054 PMCID: PMC8854222 DOI: 10.3389/fsurg.2022.747517] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Accepted: 01/03/2022] [Indexed: 11/13/2022] Open
Abstract
Improved radiological examinations with newly developed 3D models may increase understanding of Meniere's disease (MD). The morphology and course of the vestibular aqueduct (VA) in the temporal bone might be related to the severity of MD. The presented study explored, if the VA of MD and non-MD patients can be grouped relative to its angle to the semicircular canals (SCC) and length using a 3D model. Scans of temporal bone specimens (TBS) were performed using micro-CT and micro flat panel volume computed tomography (mfpVCT). Furthermore, scans were carried out in patients and TBS by computed tomography (CT). The angle between the VA and the three SCC, as well as the length of the VA were measured. From these data, a 3D model was constructed to develop the vestibular aqueduct score (VAS). Using different imaging modalities it was demonstrated that angle measurements of the VA are reliable and can be effectively used for detailed diagnostic investigation. To test the clinical relevance, the VAS was applied on MD and on non-MD patients. Length and angle values from MD patients differed from non-MD patients. In MD patients, significantly higher numbers of VAs could be assigned to a distinct group of the VAS. In addition, it was tested, whether the outcome of a treatment option for MD can be correlated to the VAS.
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Affiliation(s)
- Laurent Noyalet
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Würzburg, Würzburg, Germany
| | - Lukas Ilgen
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Würzburg, Würzburg, Germany
| | - Miriam Bürklein
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Würzburg, Würzburg, Germany
| | - Wafaa Shehata-Dieler
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Würzburg, Würzburg, Germany
| | - Johannes Taeger
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Würzburg, Würzburg, Germany
| | - Rudolf Hagen
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Würzburg, Würzburg, Germany
| | - Tilmann Neun
- Institute for Diagnostic and Interventional Neuroradiology, University of Würzburg, Würzburg, Germany
| | - Simon Zabler
- Department of X-ray Microscopy, University of Würzburg, Würzburg, Germany
| | - Daniel Althoff
- Fraunhofer Development Center for X-ray Technology, Würzburg, Germany
| | - Kristen Rak
- Department of Oto-Rhino-Laryngology, Plastic, Aesthetic and Reconstructive Head and Neck Surgery and the Comprehensive Hearing Center, University of Würzburg, Würzburg, Germany
- *Correspondence: Kristen Rak
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Lee DH, Han J, Jang MJ, Suh MW, Lee JH, Oh SH, Park MK. Association between Meniere's disease and air pollution in South Korea. Sci Rep 2021; 11:13128. [PMID: 34162905 PMCID: PMC8222348 DOI: 10.1038/s41598-021-92355-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2021] [Accepted: 06/02/2021] [Indexed: 12/12/2022] Open
Abstract
Meniere's disease is thought to be a disorder of the inner ear function, affected by genetic and environmental factors. Several recent studies have shown that air pollution could affect middle and inner ear diseases. The purpose of this study was to investigate the relationship between the Meniere's disease occurrence and air pollution status in Korea. This study used a time-stratified case-crossover design. Hospital visit data by Meniere's disease were collected from the Korea National Health Insurance Service-National Sample Cohort (NHIS-NSC) database. Daily air pollution data for sulfur dioxide (SO2), nitrogen dioxide (NO2), carbon monoxide (CO), ozone (O3), and particulate matter (PM10: ≤ 10 μm in diameter, and PM2.5: ≤ 2.5 μm in diameter) were collected from the National Ambient air quality Monitoring Information System (NAMIS) database. We used two-stage analysis to assess the association between degree of air pollution and the occurrence of Meniere's disease. In the first stage, region-specific analysis was conducted to estimate the odds ratios (ORs) of Meniere's disease risk associated with each air pollutant exposure by using conditional logistic regression for matched case-control sets in 16 regions. In the second stage, region-specific ORs from the first stage were combined and the pooled effect estimates were derived through fixed and random effect meta-analysis. Subgroup analysis was conducted for age, sex, seasonality, and urbanization of residence. In total, 29,646 (32.1% males and 67.9% females) Meniere's disease cases were identified from Korea NHIS-NSC database between 2008 and 2015. Overall, SO2, NO2, CO, and PM10 showed significant correlation with Meniere's disease risk at immediate lags, and weaker correlation at delayed lags, whereas O3 showed slightly negative correlation at the immediate lag (lag0) and PM2.5 did not show strong correlation (SO2: 1.04 [95% confidence interval: 1.01, 1.06]; NO2: 1.08 [1.06, 1.11]; CO: 1.04 [1.02, 1.06]; O3: 0.96 [0.93, 0.99]: statistically significant ORs at lag0 are listed). These positive and negative associations between Meniere's disease and each air pollutant were generally stronger in the age of 40-64, female, summer (June-August) season, and urban subgroups. Our results showed that hospital visits for Meniere's disease were associated with the measured concentrations of ambient air pollutants SO2, NO2, CO, and PM10. Further studies are required to confirm these associations and find their mechanisms.
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Affiliation(s)
- Dong-Han Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University Medical Center, Seoul, Republic of Korea
| | - Jiyeon Han
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, South Korea
| | - Myoung-Jin Jang
- Medical Research Collaborating Center, Seoul National University Hospital, Seoul, South Korea
| | - Myung-Whan Suh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
| | - Jun Ho Lee
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
| | - Seung Ha Oh
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
- Sensory Organ Research Institute, Seoul National University Medical Research Center, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea
| | - Moo Kyun Park
- Department of Otorhinolaryngology-Head and Neck Surgery, Seoul National University College of Medicine, Seoul National University Hospital, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea.
- Sensory Organ Research Institute, Seoul National University Medical Research Center, 101 Daehak-ro Jongno-gu, Seoul, 03080, Republic of Korea.
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Association between Ménière's disease and thyroid diseases: a nested case-control study. Sci Rep 2020; 10:18224. [PMID: 33106572 PMCID: PMC7588449 DOI: 10.1038/s41598-020-75404-y] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Accepted: 10/15/2020] [Indexed: 12/12/2022] Open
Abstract
The association of thyroid disease and Ménière’s disease would suggest that both are autoimmune diseases. This study aimed to investigate the relation of goiter, hypothyroidism, thyroiditis, hyperthyroidism, and autoimmune thyroiditis with Ménière’s disease. The Korean National Health Insurance Service-Health Screening Cohort data from 2002 through 2015 were used. The 8183 adult patients with Ménière’s disease were 1:4 matched with the 32,732 individuals of the control group for age, sex, income, and region of residence. The previous histories of thyroid disorders including goiter, hypothyroidism, thyroiditis, and hyperthyroidism were investigated using conditional logistic regression analyses. Subgroup analyses were conducted, including for age and sex. Smoking, alcohol consumption, obesity, Charlson Comorbidity Index, histories of benign paroxysmal vertigo, vestibular neuronitis, other peripheral vertigo, thyroid cancer, and levothyroxine medication were adjusted in the models. The histories of goiter (5.7% vs. 4.2%), hypothyroidism (4.7% vs. 3.6%), thyroiditis (2.1% vs. 1.6%), hyperthyroidism (3.6% vs. 2.5%), and autoimmune thyroiditis (0.99% vs. 0.67%) were higher in the Meniere’s disease group than in the control group (all P < 0.05). The histories of goiter, hypothyroidism, and hyperthyroidism were associated with Ménière’s disease (adjusted odds ratio (OR) = 1.19 [95% confidence interval (CI) = 1.04–1.36] for goiter, 1.21 [95% CI 1.02–1.44] for hypothyroidism, and 1.27 [95% CI 1.09–1.49] for hyperthyroidism, each of P < 0.05). In subgroup analyses, hypothyroidism was associated with Ménière’s disease in < 65-year-old women. Hyperthyroidism was related with Ménière’s disease in women overall. Thyroid diseases of goiter, hypothyroidism, and hyperthyroidism were associated with Ménière’s disease.
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Phillips JS, Newman JL, Cox SJ, FitzGerald J. Nystagmus during an acute Ménière's attack: from prodrome to recovery. Int J Audiol 2020; 60:70-74. [PMID: 32731785 DOI: 10.1080/14992027.2020.1799252] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We are currently undertaking a clinical investigation to evaluate the diagnostic capability of a system for detecting periods of pathological dizziness. This article presents an analysis of the data captured during an acute attack of Ménière's disease. DESIGN The Continuous Ambulatory Vestibular Assessment (CAVA) device is worn by patients in the community, and continuously records eye and head movement data (vestibular telemetry). STUDY SAMPLE A 53-year-old lady with a fifteen-year history of left-sided unilateral Ménière's disease. RESULTS The patient wore the device nearly continuously for thirty days. The data revealed a three-hour long attack of vertigo consisting of four separate phases of nystagmus. The duration, beat-direction and slow phase velocity of the nystagmus evolved through time. The first phase contained isolated nystagmus beats which preceded the patient's record of the vertigo attack onset but coincided with anticipation of an impending vertigo attack. CONCLUSIONS CAVA provides a unique insight into the physiological parameters present during episodes of dizziness. Here, it has provided the first full example of an acute Ménière's attack, including a period of prodrome. These findings have implications for the prediction of vertigo attack onset, for the diagnosis of Ménière's disease and other diseases resulting in dizziness.
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Affiliation(s)
- John S Phillips
- Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
| | | | | | - John FitzGerald
- Norfolk & Norwich University Hospitals NHS Foundation Trust, Norwich, UK
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Benign paroxysmal positional vertigo in Meniere's disease: systematic review and meta-analysis of frequency and clinical characteristics. J Neurol 2019; 268:1608-1614. [PMID: 31410549 DOI: 10.1007/s00415-019-09502-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 08/05/2019] [Accepted: 08/07/2019] [Indexed: 10/26/2022]
Abstract
There is a recognized association of Meniere's disease (MD) and benign paroxysmal positional vertigo (BPPV). However, the frequency and clinical characteristics of BPPV in MD are unclear. The aim of this review was to determine the mean frequency and clinical features of BPPV in MD. Three databases were searched: MEDLINE, PubMed and Google Academia. Studies reporting the frequency of BPPV in MD were pooled. A total of 4198 references were identified, of which 20 studies were considered eligible. The pooled frequency of BPPV in MD was 14% (95% CI 9-18%). It was 38% (95% CI 26-49%) in longitudinal studies and 8% (95% CI 6-11%) in cross-sectional ones. BPPV comorbid with MD was mostly observed in the ear affected by hydrops, in females, in patients with more advanced disease. Canalolithiasis of the horizontal semicircular canal was more common in patients with BPPV associated with MD than in idiopathic BPPV. BPPV in MD was more prone to recurrence and required more canal repositioning maneuvers.
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