Video Head Impulse Testing.
Authors: Welgampola MS, Taylor RL, Halmagyi GM
Abstract
The bedside head impulse, first described nearly 20 years ago, is the single most useful clinical test of the human vestibulo-ocular reflex (VOR). The video head impulse test (vHIT), its laboratory counterpart, now enables the objective assessment of the VOR. We examine how the vHIT can be utilized in three common clinical scenarios: the acute vestibular syndrome, recurrent spontaneous vertigo, and chronic imbalance. Combined with vestibular evoked myogenic potentials (VEMPs), vHIT enables assessment of all five vestibular end-organs by a clinician wi...
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Vestibular Neuritis: Recent Advances in Etiology, Diagnostic Evaluation, and Treatment.
Authors: Le TN, Westerberg BD, Lea J
Abstract
Purpose of Chapter: This chapter highlights the recent advances in etiology, diagnostic evaluation, and management of vestibular neuritis (VN). Recent Findings: The viral hypothesis has been strengthened with new evidence as the main etiology of VN. Recent evidence indicates that bedside oculomotor findings play a critical role in differentiating VN from stroke. The implementation of cervical and ocular vestibular evoked myogenic potential, and video head impulse test in vestibular function testing has made it possible to diagnose selective damage of the vestib...
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Otolith Function Testing.
Authors: Taylor RL, Welgampola MS
Abstract
Two technically simple tests, vestibular evoked myogenic potential (VEMP) and subjective visual vertical/horizontal (SVV/H) test, have the potential to transform otolith function testing from the research laboratory to the outpatient clinic. Cervical- and ocular-VEMPs are short latency surface potentials produced through the activation of saccular and utricular afferents by sound and vibration. They are tests of dynamic otolith function. The SVV/H test in peripheral lesions probes static asymmetries in utricular function and represents a perceptual error in percei...
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Vestibular Testing-Rotary Chair and Dynamic Visual Acuity Tests.
Authors: Gimmon Y, Schubert MC
Abstract
The human vestibular system is exquisitely sensitive to detect linear and rotational head acceleration signals, processed in the brainstem and subsequently relayed to the extraocular motor neurons to generate a compensatory eye rotation. This vestibulo-ocular reflex (VOR) ensures clear and stable vision during head rotation, enabling humans to keep gaze on their desired target. In this chapter, we describe the rotary chair - one physiologic measure of the VOR, and the dynamic visual acuity (DVA) test - one behavioral measure of the VOR. Advances in the use of each me...
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Aminoglycoside Vestibulotoxicity.
Authors: Rutka J
Abstract
Many pharmaceuticals have ototoxicity (both cochlear and/or vestibular) as part of their adverse medication profile. The aminoglycoside class of antimicrobials has been especially well studied in this regard. Many questions remain unanswered as to how to best monitor and prevent this complication. A bilateral vestibular loss profoundly affects an individual's quality of life, physical activities, and overall independence. Paradoxically, the effects of gentamicin ototoxicity have provided further insight into the workings of the vestibular system, especially the vestibulo-ocular re...
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Benign Paroxysmal Positional Vertigo.
Authors: Instrum RS, Parnes LS
Abstract
Purpose of Chapter: This chapter discusses the recent progress made in understanding the pathophysiology, diagnosis, and treatment of benign paroxysmal positional vertigo (BPPV). Recent Findings: Recent evidence supports the canalolithiasis model as the pathophysiological mechanism and predominant subtype of BPPV. Scanning electron micrographs of extracted posterior semicircular canal contents show free-floating otoconia of utricular origin. Calcium homeostasis has also been shown to contribute to the pathogenesis of the disorder by creating an environment in which o...
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Assessment of the Vestibular System: History and Physical Examination.
Authors: Welgampola MS, Bradshaw AP, Halmagyi GM
Abstract
So common is vertigo that diverse healthcare professionals, from audiologists to orthopedic surgeons, will eventually encounter it in their patients, if not in themselves. So treatable are vestibular disorders that it is an immense advantage to know how to assess the vestibular system. This review summarizes the history and physical examination that will help diagnose common vestibular disorders presenting with vertigo.
PMID: 30947199 [PubMed - in process] (Source: Advances in Oto-Rhino-Laryngology)
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Videonystagmography and Posturography.
Authors: Falls C
Abstract
Videonystagmography (VNG) and posturography are two vestibular assessment techniques that are still in use today. VNG: VNG allows clinicians to observe and record eye movements in real-time. Compared with electronystagmography (ENG), VNG tracings are more detailed and can capture subtle clinical findings. The utility of the monothermal caloric screen has been proposed in various studies. When appropriate cut-offs are used, the monothermal screen can be completed with a low false-negative rate. Air is often used as a medium for caloric testing, though not without some controversy. ...
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Psychiatric Considerations in the Management of Dizzy Patients.
Authors: Staab JP
Abstract
Research over the last 4 decades has revealed a great deal of information about psychiatric and functional causes, consequences, and comorbidity of vestibular syndromes. Primary care clinicians, neurologists, and otologists who are willing to set aside the 20th century notion of "psychogenic dizziness" and incorporate 21st century concepts about 5 behavioral entities into their practices will be rewarded for their efforts with a marked improvement in diagnostic acumen and therapeutic effectiveness. Panic attacks may cause or contribute to acute or episodic vestibular symptoms. Ge...
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Systemic Disease Considerations in the Management of the Dizzy Patient.
Authors: Rea PA, Ronan N
Abstract
Patients with symptoms of dizziness may present to a wide range of medical services. Awareness of the full breadth of possible diagnoses is thus helpful in managing dizzy patients. This chapter provides a comprehensive review of systemic diseases that may contribute to the complex symptom of dizziness and provide a review of recent advances in each field.
PMID: 30947210 [PubMed - in process] (Source: Advances in Oto-Rhino-Laryngology)
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Special Considerations for the Pediatric Patient.
Authors: Cushing SL, Papsin BC
Abstract
Children frequently present with complaints of vertigo and/or disequilibrium. The etiology of such diagnoses include inner ear pathology, migraine and its variants, lesions of the central nervous system as well as mental health disorders, among others. The ability to reliably evaluate vestibular end-organ function is central to accurate diagnosis, however, examining children can be challenging. The current chapter will focus on the approach to assessing vestibular end-organ function in children, as well as the causes of vestibular impairment that are unique to this p...
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
An Overview of Central Vertigo Disorders.
Authors: Ranalli P
Abstract
Head motion recorded by the vestibular labyrinths is conveyed to specific brainstem and cerebellar structures that relay velocity information to eye muscles to stabilize vision, and to the axial and limb muscles necessary to stabilize balance. Neural networks enhance and extend the primary vestibular signal, and create adaptation to movement when appropriate. Pathological lesions to one or more of these structures may cause central vertigo and imbalance, and may be localized by specific forms of nystagmus and other abnormal neurological signs. Vertigo treatment may be directed t...
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
The Aging Vestibular System: Dizziness and Imbalance in the Elderly.
Authors: Jahn K
Abstract
Aging in vestibular structures with loss of hair cells in the inner ear starts early in life, but vestibular function usually remains relatively unimpaired up to advanced ages. However, dizziness and imbalance are common in the elderly and have substantial impact on the quality of life. Dizziness interferes with the everyday activities of 30% of persons over age 70. As causes can be multiple, including vestibular and non-vestibular components, it is crucial to detect the factors leading to dizziness and imbalance to maintain mobility and avoid secondary complications like falls and...
Source: Advances in Oto-Rhino-Laryngology - April 6, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Quality of Life Outcomes following Treatment of Hypopharyngeal Cancer.
Authors: Mahalingam S, Spielmann P
Abstract
Quality of life (QoL) is an important consideration in the management of individuals with head and neck cancer. The poor prognosis and significant impact of treatment modalities on function of the salivary glands, larynx and pharynx combine to make hypopharyngeal carcinoma a particularly challenging condition to treat. The impact of diagnosis and treatment on health related QoL is substantial. There is increased understanding that organ preservation does not necessarily correlate with function preservation as was previously expected. The impact on QoL, of chemora...
Source: Advances in Oto-Rhino-Laryngology - April 4, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
Future Perspectives in Hypopharyngeal Cancer Care.
Authors: Eckel HE, Bradley PJ
Abstract
Recent advances in minimal access surgery have shown promise in the treatment of limited hypopharyngeal lesions. In spite of their functionally excellent results in individual patients, it currently remains unlikely that these approaches will gain a more major universal impact on hypopharyngeal cancer care. In advanced stage hypopharyngeal cancer, the use of the traditional radical surgery, such as laryngo-pharyngectomy, is no longer accepted by many patients. In recent years, most would rather opt for less mutilating treatment, preferring a non-surgical option. Patie...
Source: Advances in Oto-Rhino-Laryngology - April 4, 2019 Category: ENT & OMF Tags: Adv Otorhinolaryngol Source Type: research
