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Vestibular dysfunction amongst adolescents: what do we know? A review

Saniasiaya J, Narayanan P

J Laryngol Otol, 2023 Jan;137(1):2-6.
PMID: 35616060 DOI: 10.1017/S0022215122001268

BACKGROUND: Vestibular dysfunction in children is a debilitating condition that results in countless pernicious effects, such as motor development delay, poor academic performance and psychosocial impairment. Yet, research pertaining to vestibular and balance disorders amongst adolescents is still lacking and remains an enigma.
METHODS: This paper outlines novel emerging aetiological factors contributing to vestibular dysfunction amongst adolescents by appraising published articles through a narrative review.
RESULTS: Underlying aetiological factors of vestibular dysfunction can be identified among adolescents with thorough evaluation. Proper diagnostic evaluation of vestibular dysfunction is imperative in providing optimal care and guiding appropriate treatment strategies. The available literature demonstrated multifactorial aetiological factors that contribute to vestibular dysfunction in adolescents.
CONCLUSION: Outlining the underlying aetiological factors of vestibular dysfunction is vital to ensure that patients receive appropriate care and treatment.

Matched MeSH terms: Vestibule, Labyrinth*
Fulltext Effects of plateau time on cervical vestibular evoked myogenic potential (cvemp) elicited by 500-hz tone burst

Mohd Fairul Syafiq Harun, Vijay Marimuthu

Jurnal Sains Kesihatan Malaysia, 2016;14(1):31-36.
MyJurnal

Cervical Vestibular Evoked Myogenic Potential (cVEMP) is a routine vestibular test which checks the integrity of
vestibulocollic reflex (VCR) pathway. Clinically, 500-Hz tone burst is widely used stimulus to evoke a cVEMP. Although
several studies have suggested different plateau times (PT) for eliciting cVEMPs, but not many have reported the optimal
PT for evoking cVEMP using 500 Hz tone burst stimuli. Therefore, the present study aimed to investigate the effect of
PT on cVEMPs elicited by 500 Hz tone burst at 95 dBnHL using four different PT (0, 2, 4 and 10 ms). Thirty healthy
adults with normal hearing and vestibular systems participated in this study. Results revealed that the P1 latency was
significantly longer for PT 10 ms compared to other PTs. N1 latency was significantly prolonged for long PT of 10 ms
compared to PT 2 ms. P2 latency showed no significant differences among PTs. The P1-N1 inter-amplitude values
however revealed no significant difference across all PTs. It was found that the P1-N1 inter-amplitude was severely
affected after 4 ms of PT. This study concluded that the PT of either 0 or 2 ms yielded the most robust cVEMP.

Matched MeSH terms: Vestibule, Labyrinth
Fulltext The effects of different types of stimulus and its test-retest reliability on cervical evoked myogenic potential (CVEMP) results

Mohamad Amir Faisal Mohd Saufi, Nur Hafizah Sulaiman, Sarah Rahmat

International Medical Journal Malaysia, 2017;16(11):11-0.
MyJurnal

The Cervical Vestibular Evoked Myogenic Potential (cVEMP) is used to
evaluate the integrity of saccule and inferior vestibular nerve. There are a lot of factors
affecting cVEMP results including stimulus types. This study was carried out to determine
the effects of different stimuli on cVEMP results and its test-retest reliability. (Copied from article).

Matched MeSH terms: Vestibule, Labyrinth
Bilateral Vestibular Atelectasis with Tullio's Phenomenon

Roy S, Kumarasamy G, Salim R

Indian J Otolaryngol Head Neck Surg, 2019 Nov;71(Suppl 2):1599-1602.
PMID: 31750223 DOI: 10.1007/s12070-019-01685-z

Vestibular dehiscence or atelectasis is a rarity known to cause vertigo. This pathology poses many challenges especially in diagnosis and treatment simply due to the scarcity of reported cases. The etiologic factors, disease pathophysiology and complications remain unclear. We report a young adult female who presented with unsteadiness for 2 years associated with headache. Tullio's phenomenon was observed which led to a finding of bilateral vestibular dehiscence involving the medial walls on high resolution computed tomography.

Matched MeSH terms: Vestibule, Labyrinth
Student-involved demonstration approach to teach the physiology of vestibular apparatus for undergraduate medical students

Narayanan SN, Kumar RS, Nayak S

Teach Learn Med, 2011 Jul-Sep;23(3):269-77.
PMID: 21745063 DOI: 10.1080/10401334.2011.586930

It is quite difficult to teach complex topics like the physiology of vestibular apparatus to undergraduate students. Understanding the orientation and mode of stimulation of receptors in vestibular apparatus is also quite challenging for the students. As faculty we attempt to use innovative methods to teach physiology and enhance student learning.

Matched MeSH terms: Vestibule, Labyrinth/physiology*
Fulltext Considerations when Analyzing Vestibular Evoked Myogenic Potential (VEMP) Outcomes Elicited by Chirp Stimulus in Healthy Participants

Zakaria MN, Zainun Z, Cheu Lih A

J Int Adv Otol, 2015 Dec;11(3):271-2.
PMID: 26915164 DOI: 10.5152/iao.2015.1703
Matched MeSH terms: Vestibule, Labyrinth/physiopathology*
Idiopathic paroxysmal kinesigenic choreoathetosis: precipitation of attacks by vestibular stimulation

Chew NK, Tan CT, Goh KJ

J Clin Neurosci, 2002 Sep;9(5):604-5.
PMID: 12383430

A 24-year-old woman presented with a 3.5-year history of paroxysmal dystonia that was precipitated by sudden movement, especially when she started to walk. It was characterised by shrugging of shoulders, flexion of the neck and thoracic spine, and stiffness of the right leg followed by falls. Each attack lasted for less than 5min. Inadequate sleep and stress were exacerbating factors. There was no similar family history. Physical examination and investigations were normal. The following manoeuvres that caused vestibular stimulation precipitated attacks: turning her head from side to side while standing still, sitting still on a rotating chair and an ice-water caloric test. She had partial responses to phenytoin and levodopa, and a good response to haloperidol. Vestibular stimulation as a precipitating factor in paroxysmal kinesigenic choreoathetosis has not been reported previously.

Matched MeSH terms: Vestibule, Labyrinth/physiology*
The influence of type of visual image and gender on the perception of horizontality: a subjective visual horizontal (SVH) study

Zakaria MN, Tahir A, Zainun Z, Salim R, Mohd Sakeri NS, Abdul Wahat NH

Acta Otolaryngol, 2021 Jan;141(1):62-65.
PMID: 32957810 DOI: 10.1080/00016489.2020.1817552

BACKGROUND: The graviceptive otolith function can be measured using subjective visual horizontal (SVH) testing. Nevertheless, more research efforts are required to understand the essential variables affecting SVH.
OBJECTIVE: The aim of the present study was to determine the effects of type of visual image and gender on subjective visual horizontal (SVH) perception among healthy adults.
MATERIALS AND METHODS: In this comparative study, 50 healthy young adults were enrolled. While in an upright body position, they were required to report their perception of horizontality for two types of visual images (solid line and arrow pattern) using a computerized SVH device.
RESULTS: The arrow pattern produced significantly bigger SVH angles than the solid line (p < .001). In contrast, no significant influence of gender was found on SVH results (p = .743), Based on the statistical outcomes, the preliminary normative data for SVH were established.
CONCLUSIONS AND SIGNIFICANCE: The arrow pattern (a more complex visual image) produced bigger SVH deviations than the simple solid line image. In contrast, the horizontality perception does not appear to be affected by gender. The preliminary normative SVH data gathered from the present study can be beneficial for clinical and future research applications.

Matched MeSH terms: Vestibule, Labyrinth/physiopathology*
Fulltext Sensitivity and specificity of vestibular evoked myogenic potential elicited by different tone bursts to diagnose peripheral vestibular disordered

Zuraida Zainun, Mohd Normani Zakaria, Din Suhaimi Sidek, Zalina Ismail

Malaysian Journal of Medicine and Health Sciences, 2014;10(2):9-17.
MyJurnal

Peripheral vestibular disorder (PVD) is serious and common. Clinically, giving an accurate diagnosis of PVD can be challenging. Vestibular evoked myogenic potential (VEMP) is an objective test to evaluate the integrity of vestibular organs, particularly saccule and/or inferior vestibular nerve. This study was performed to determine the sensitivity and specificity of VEMP using different stimuli. Fourty normal and 65 PVD subjects who fulfilled the inclusion criteria were recruited. While sitting comfortably, VEMP waveforms were recorded with active electrode on sternocleidomastoid muscle and negative electrode on upper forehead. Tone bursts (500, 750 and 1000 Hz) were delivered via headphones at 90 dBnHL and 5/s presentation rate. VEMP parameters for each stimulus (amplitude and latency of P1 and N1 peak) were analyzed accordingly. Receiver operating characteristic (ROC) was performed to determine the sensitivity and specificity of VEMP at different test frequencies. N1 amplitude of 750 Hz stimulus produced the most ideal sensitivity (65% on right and 63% on left) and specificity (83% on right and 78% on left). The importance of using a few tone bursts in VEMP test in order to minimize the false negative in cases might be encountered in clinics as the certain tone burst had inadequate sensitivity in detecting PVD cases. The 750 Hz stimulus produced the most ideal VEMP with adequate values of sensitivity and specificity, at least in this study.

Matched MeSH terms: Vestibule, Labyrinth
Fulltext Vestibulotoxicity Associated With Platinum-Based Chemotherapy in Survivors of Cancer: A Scoping Review

Prayuenyong P, Taylor JA, Pearson SE, Gomez R, Patel PM, Hall DA, et al.

Front Oncol, 2018;8:363.
PMID: 30319960 DOI: 10.3389/fonc.2018.00363

Background: Cochleotoxicity following the treatment with platinum-based chemotherapy is well documented. The potential for vestibulotoxicity is still unclear. This scoping review examined the extent of current research literature, summarized research findings and identified research gaps regarding vestibular-related adverse effects associated with platinum-based chemotherapy in survivors of cancer. Methods: Inclusion criteria followed the PICO principles: Participants, adult, and pediatric cancer patients of any cancer type; Intervention, platinum-based chemotherapy (such as cisplatin, carboplatin, and oxaliplatin); Control, none or any; Outcomes, vestibular-related adverse effects. English language articles published since 1978 were retrieved. Seventy-five eligible studies were identified from a systematic literature search, and relevant data were charted, collated, and summarized. Results: Testing for vestibulotoxicity predominately featured functional evaluation of the horizontal semicircular canal using the caloric and rotational tests. The rate of abnormal vestibular function test results after chemotherapy administration varied from 0 to 50%. The results of objective testing did not always correspond to patient symptoms. There is tentative support for patients with pre-existing loss of vestibular function to be more likely to experience vestibular toxicity after dosing with cisplatin. Conclusions: A number of studies reported significant evidence of vestibular toxicities associated with platinum-based chemotherapy, especially cisplatin. This scoping review emphasizes that vestibular toxicity needs more attention and comprehensive evaluation. Specifically, studies that analyse cumulative dose of platinum-based chemotherapy, affected sites of lesion in vestibular end organs, and the correlation and temporal patterns of cochlear and vestibular toxicity are needed.

Matched MeSH terms: Vestibule, Labyrinth
Gentamicin ototoxicity in continuous ambulatory peritoneal dialysis

Gendeh BS, Said H, Gibb AG, Aziz NS, Kong N, Zahir ZM

J Laryngol Otol, 1993 Aug;107(8):681-5.
PMID: 8409715 DOI: 10.1017/s0022215100124132

A prospective study was undertaken of 10 chronic renal failure patients on Continuous Ambulatory Peritoneal Dialysis (CAPD) complicated by repeated bouts of peritonitis treated with gentamicin. Each 10-day treatment course consisted of a 120 mg loading dose, followed by 16 mg in 21 of peritoneal dialysate, given four times a day. Serum gentamicin analysed by enzyme immunoassay showed a mean level of 5.2 micrograms/ml, (range 3.7 to 6.6 mg/ml) four hours after the loading dose. Similar levels, well within the therapeutic range, were maintained on the 3rd, 5th, 7th and 9th days of intraperitoneal gentamicin therapy, suggesting no accumulation of gentamicin in the serum. Pure tone audiometry, electronystagmography and clinical assessment were performed during each course of treatment. Although no evidence of ototoxicity was found during the first two courses of gentamicin, but disequilibrium and bobbing oscillopsia were present during the third and fourth courses of gentamicin. These findings could be explained by cumulative injury to the vestibular apparatus caused by repeated therapeutic insults.

Matched MeSH terms: Vestibule, Labyrinth/drug effects*