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Traitement des acouphenes et serious game

SHIMP

Saccadic velocity in the new suppression head impulse test (SHIMP)

Enquête équilibre

Dossier les acouphènes

Les acouphènes dans la maladie de Meniere sont souvent invalidants. Fait essentiel, il ne s'agit pas de la perception de sons aigus mais de sons graves à type de sons purs dans les basses fréquences 500 Hz ou de chuintements.

L’Unité de Radiochirurgie Gamma Knife de la Région île-de-France (U2R).

>> Lire l'article sur le site de l'ARTC Association pour la Recherche sur les Tumeurs Cérébrales.

VIDEONYSTAGMOSCOPIE, VIDEONYSTAGMOGRAPHIE

La nouvelle approche d’un trouble de l’équilibration - Edition 1999

Auteurs : Philippe Courtat, Alain Sémont, Jean-Paul Deroubaix, Erick Hrebicek

Naissance, vie et mort du vestibule - Edition 2009

Auteurs : Andre Gentine, A. Charpiot, A.M. Eber, S. Riehm, D. Rohmer, H. Sick , F. Veillon

>> Pour commander ces monographies, cliquez-ici

La société Amplifon vous fera parvenir gratuitement un exemplaire par mail au format PDF.

Formations proposées par la société Amplifon

Les vertiges (niveau II)

Samedi 3 décembre 2011

Les vertiges (niveau I)

Samedi 9 juin 2012

Les vertiges (niveau II)

Samedi 1 décembre 2012

>> Pour vous renseigner sur ces formations, cliquez-ici

The neural basis for otolith testing by vibration and sound

Ian S. Curthoys

Vestibular Research Laboratory, School of Psychology, the University of Sydney, NSW, Australia.

>> Voir la newsletter

Carey JP, Minor LB.Department of Otolaryngology-Head & Neck Surgery, The Johns Hopkins University School of Medicine, Baltimore, Curr Opin Neurol. 2011 Feb;24(1):25-31. Maryland, USA. wchien1@jhmi.edu

Canal dehiscence. Chien WW

The aim is to review canal dehiscence involving the superior, lateral, and posterior semicircular canals. The main focus will be on superior semicircular canal dehiscence.

RECENT FINDINGS: Canal dehiscence involving the superior, lateral, and posterior semicircular canal can have different etiologies, including developmental abnormality, congenital defect, chronic otitis media with cholesteatoma, and high-riding jugular bulb. However, their clinical presentation can be very similar, with patients complaining of vertigo, oscillopsia, and sometimes hearing loss. Canal dehiscence causes an abnormal communication between the inner ear and the surrounding structures. This creates a third mobile window within the inner ear, disrupting its normal mechanics and causing symptoms.

SUMMARY: Superior semicircular canal dehiscence is now a well-established entity in the medical literature. Surgical repair is effective at relieving patients' vestibular symptoms. Lateral semicircular canal dehiscence is usually associated with chronic otitis media. Posterior semicircular canal dehiscence is a rare entity, with similar clinical presentations and treatment options as the other canal dehiscences.

Crane BT, Minor LB, Carey JP. Superior canal dehiscence plugging reduces dizziness handicap.Laryngoscope. 2008 Oct;118(10):1809-13.

Chiarovano E, Zamith F, Vidal PP, de Waele C. Ocular and cervical VEMPs: A study of 74 patients suffering from peripheral vestibular disorders.Clin Neurophysiol. 2011 Feb 7

Int J Pediatr Otorhinolaryngol. 2014 May;78(5):718-24. doi: 10.1016/j.ijporl.2014.02.009. Epub 2014 Feb 15.

Gioacchini FM¹, Alicandri-Ciufelli M², Kaleci S³, Magliulo G⁴, Re M⁵.

To systematically review and discuss the main pathologies associated with vertigo and dizziness in children, paying particular attention to recent advances in diagnosis and therapy. One appropriate string was run on PubMed to retrieve articles dealing with the topics mentioned above. A cross-check was performed on citations and full-text articles found using the selected inclusion and exclusion criteria. A non-comparative meta-analysis concerning the rate of singular vertiginous forms was performed.

Ten articles were identified comprising a total of 724 subjects. Overall, the articles we analyzed indicated benign paroxysmal vertigo of childhood (18.7%) and migraine-associated vertigo (17.6%) as the two main entities connected with vertigo and dizziness in children. Head trauma (14%) was the third most common cause of vertigo. The mean (95% CI) rate of every vertiginous form was also calculated in relation to the nine studies analyzed with vestibular migraine (27.82%), benign paroxysmal vertigo (15.68%) and vestibular neuritis (9.81%) being the three most common forms. There appeared to be a paucity of recent literature concerning the development of new diagnostic methods and therapies.

On the basis of the literature study, when evaluating a young patient with vertigo and dizziness, the otolaryngologist should be aware that, in children, these symptoms are often connected to different pathologies in comparison to the entities observed in the adult population. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved. 2. JAMA Otolaryngol Head Neck Surg. 2014 May;140(5):434-40.

Goudakos JK, Markou KD, Psillas G, Vital V, Tsaligopoulos M.

Abstract

IMPORTANCE The management of patients with unilateral acute vestibular neuritis (VN) has not been established to date. OBJECTIVE To compare the use of vestibular exercises vs corticosteroid therapy in the recovery of patients with acute VN. DESIGN, SETTING, AND PARTICIPANTS Prospective, single-blind, randomized clinical trial at a primary referral center. Among all patients with acute vertigo, those having VN were eligible for inclusion in the study. INTERVENTIONS Forty patients with acute VN were randomly assigned to perform vestibular exercises or to receive corticosteroid therapy. After a baseline examination, follow-up evaluations were performed at 1, 6, and 12 months. MAIN OUTCOMES AND MEASURES Efficacy outcomes included clinical, canal, and otolith recovery. Scores on the European Evaluation of Vertigo Scale and the Dizziness Handicap Inventory were used for the evaluation of clinical recovery. Findings of caloric irrigation and vestibular evoked myogenic potentials indicated canal and otolith improvement, respectively. RESULTS Comparing the 2 treatment groups, no statistically significant differences were found in clinical, canal, or otolith recovery. At the 6-month examination, the number of patients with complete disease resolution in the corticosteroids group was significantly higher than that in the vestibular exercises group. However, at the end of the follow-up period, 45%(9 of 20) of patients in the vestibular exercises group and 50% (10 of 20) of patients in the corticosteroids group had complete disease resolution (P > .05). CONCLUSIONS AND RELEVANCE Treating patients who have acute VN with vestibular exercises seems equivalently effective as treating them with corticosteroid therapy in clinical, caloric, and otolith recovery. Corticosteroid therapy seems to enhance earlier complete acute VN resolution, with no added benefit in the long-term prognosis.

Maladie de Ménière

Endocr Connect. 2014 Sep;3(3):127-31. doi: 10.1530/EC-14-0076. Epub 2014 Jul 23.

Novoa E1, Gärtner M2, Henzen C2.

The study aimed to assess the possible systemic effects of intratympanic dexamethasone (IT-Dex) on the hypothalamic-pituitary-adrenal (HPA) axis, inflammation, and bone metabolism. A prospective cohort study including 30 adult patients of a tertiary referral ENT clinic treated with 9.6 mg IT-Dex over a period of 10 days was carried out. Effects on plasma and salivary cortisol concentrations (basal and after low-dose (1 μg) ACTH stimulation), peripheral white blood cell count, and biomarkers for bone turnover were measured before (day 0) and after IT-Dex (day 16). Additional measurements for bone turnover were performed 5 months after therapy. Clinical information and medication with possible dexamethasone interaction were recorded. IT-Dex was well tolerated, and no effect was detected on the HPA axis (stimulated plasma and salivary cortisol concentration on day 0: 758±184 and 44.5±22.0 nmol/l; day 16: 718±154 and 39.8±12.4 nmol/l; P=0.58 and 0.24 respectively). Concentrations of osteocalcin (OC) and bone-specific alkaline phosphatase (BSAP) did not differ after dexamethasone (OC on days 0 and 16 respectively: 24.1±10.5 and 23.6±8.8 μg/l; BSAP on day 0, 16, and after 5 months respectively: 11.5±4.2, 10.3±3.4, and 12.6±5.06 μg/l); similarly, there was no difference in the peripheral white blood cell count (5.7×10(12)/l and 6.1×10(12)/l on days 0 and 16 respectively). IT-Dex therapy did not interfere with endogenous cortisol secretion or bone metabolism. © 2014 The authors.

OBJECTIVE: DESIGN: METHODS: RESULTS: CONCLUSIONS: KEYWORDS:

Ménière's disease; acute hearing loss; cortisol; dexamethasone; intratympanic; osteocalcin

Free PMC ArticleRelated citations2. Iran J Neurol. 2014;13(1):33-9.

Daneshi A1, Jahandideh H2, Pousti SB3, Mohammadi S3.

Ménière's disease has been remained as a difficult therapeutic challenge. The present study aimed to determine the effects of one-shot low-dosage intratympanic gentamicin on vertigo control, auditory outcomes and findings of computerized dynamic posturography and vestibular evoked myogenic potentials in patients with unilateral Ménière's disease.

In a prospective clinical study, 30 patients with unilateral Ménière's disease were treated with one-shot intratympanic injection of 20 milligrams gentamicin. Main outcome measures included clinical, audiometric, postural and vestibular outcomes evaluated 1 and 9 months after the treatment. Mean vertigo attacks frequency, pure tone average threshold and functional level scale significantly decreased after the treatment (P < 0.05). Effective vertigo control (class A and B) obtained in 95.8% of the patients. In total, 75% of patients reported decrease in both aural fullness and tinnitus. Vestibular evoked myogenic potentials became absent in all the patients but four of them. Posturographic scores were improved after the treatment.

One-shot low-dosage gentamicin was effective in controlling vertigo attacks in Ménière'sdisease and has useful effects on aural fullness and tinnitus of patients as well. Postural and vestibular tests only have adjunctive role for monitoring therapeutic responses in intratympanic gentamicin-therapy.

Dynamic Posturography; Gentamicin; Ménière's Disease; Vestibular Evoked Myogenic Potentials

Free PMC ArticleRelated citations3. Laryngoscope. 2014 Sep;124(9):2151-4. doi: 10.1002/lary.24716. Epub 2014 Apr 29.

Viana LM1, Bahmad F Jr, Rauch SD.

Vertigo attacks in most cases of Meniere's disease (MD) are successfully treated with lifestyle changes and medication. However, approximately 6% of patients with MD develop drop attacks (DAs), a potentially life-threatening condition. Traditional treatment for DAs has been surgical labyrinthectomy. The objective of this study was to assess the effectiveness of intratympanic gentamicin for DAs in patients with MD. Retrospective charts review.

All charts were reviewed from Meniere DA patients at our hospital during the 10-year period from 2002 to 2012 who had been treated with intratympanic gentamicin and had been followed for at least 1 year afterward. Twenty-four ears fulfilled inclusion criteria. The time for manifestation of DAs varied from 1 to 20 years after diagnosis (mean 10 years). A total of 83.3% of ears with intractable MD and DA achieved complete symptom control of DAs after the first intratympanic gentamicin cycle and 95.8% after the further injections. Among patients with no DA recurrence by the end of the study follow-up, the symptom-free interval varied from 12 to 120 months (mean: 43.5 months). All 15 patients with ≥ 24 months follow-up were still free of DAs. Elevated or absent vestibular evoked myogenic potential thresholds were more common in DA than in contralateral ears, and hearing loss was not a major complication of the treatment. Intratympanic gentamicin treatment appears to be a long-lasting and effective treatment for MD with DAs. 4. Laryngoscope, 124:2151-2154, 2014. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

Meniere's disease; drop attack; intratympanic gentamicin

Related citations4. Ann Med Health Sci Res. 2014 Jan;4(1):3-7. doi: 10.4103/2141-9248.126601.

Orji F.

Author information Abstract

Many physicians have observed that psychological factors play a significant role in the course of Meniere'sdisease (MD), with Meniere's patients being subject to anxiety and tension states. A lot of research attentions from a psychological point of view have been directed at MD, with earlier researchers focusing on psychosomatic causes of the illness as well as its somatopsychic result. However, the question whether MD is caused by psychological factors or whether the psychological manifestation in MD is as a result of the illness is still unresolved. The aim of this study is to provide an overview of interaction that exists between physical and emotional factors in the development of MD and its impact on the quality of life of the sufferers. A structured literature search was carried out, with no restrictions to the dates searched. A vicious circle of interaction seems to exist between the somatic organic symptoms of MD and resultant psychological stress. The frightening attacks of vertigo seem likely to produce and increase the level of anxiety thereby worsening the emotional state and the resultant anxiety provokes various symptoms probably through disorders of the autonomic nervous system occasioned by the increased levels of stress-related hormones.

Neurinome du VIII

J Neurol Surg B Skull Base. 2014 Aug;75(4):273-8. doi: 10.1055/s-0034-1371525. Epub 2014 Apr 17.

Bir SC, Ambekar S, Bollam P, Nanda A.

Objective We evaluated the long-term outcome of vestibular schwannoma (VS) treated with gamma kniferadiosurgery (GKRS) as a primary treatment as well as an adjunct therapy. Materials and Methods We performed a retrospective review (2000-2012) of 82 patients with VS who received GKRS. Of 82 patients, 20 patients with prior resection received GKRS treatment as an adjunct therapy. The remainder of the patients (62) received GKRS as a primary treatment. Results GKRS for VS showed significant variations in tumor growth control (decreased in 44 patients [54%], arrested growth in 30 patients [36%], and increased tumor size in 8 patients [10%]). Progression-free survival rates after GKRS at 3, 5, and 10 years were 98%, 95%, and 95%, respectively. Hearing, facial nerve function, and Karnofsky performance scale were significantly improved after GKRS compared with pretreated status (79 versus 90). Two patients (2.5%) required resection again due to tumor progression and worsening of signs and symptoms. Conclusion Long-term follow-up demonstrated that GKRS offers a high rate of tumor control, preservation of multiple nerve functions, and a good quality of life in both new and recurrent patients with VS.

KEYWORDS:

gamma knife radiosurgery; long-term outcome; vestibular schwannoma

Related citations2. J Neurosurg. 2013 Dec;119 Suppl:801-7.

Yang HC, Kano H, Awan NR, Lunsford LD, Niranjan A, Flickinger JC, Novotny J Jr, Bhatnagar JP, Kondziolka D.

Stereotactic radiosurgery (SRS) is an important management option for patients with small- and medium-sized vestibular schwannomas. To assess the potential role of SRS in larger tumors, the authors reviewed their recent experience.

Between 1994 and 2008, 65 patients with vestibular schwannomas between 3 and 4 cm in one extracanalicular maximum diameter (median tumor volume 9 ml) underwent Gamma Knife surgery. Seventeen patients (26%) had previously undergone resection. The median follow-up duration was 36 months (range 1-146 months). At the first planned imaging follow-up at 6 months, 5 tumors (8%) were slightly expanded, 53 (82%) were stable in size, and 7 (11%) were smaller. Two patients (3%) underwent resection within 6 months due to progressive symptoms. Two years later, with 63 tumors overall after the 2 post-SRS resections, 16 tumors (25%) had a volume reduction of more than 50%, 22 (35%) tumors had a volume reduction of 10–50%, 18 (29%) were stable in volume (volume change < 10%), and 7 (11%) had larger volumes (5 of the 7 patients underwent resection and 1 of the 7 underwent repeat SRS). Eighteen (82%) of 22 patients with serviceable hearing before SRS still had serviceable hearing after SRS more than 2 years later. Three patients (5%) developed symptomatic hydrocephalus and underwent placement of a ventriculoperitoneal shunt. In 4 patients (6%) trigeminal sensory dysfunction developed, and in 1 patient (2%) mild facial weakness (House-Brackmann Grade II) developed after SRS. In univariate analysis, patients who had a previous resection (p = 0.010), those with a tumor volume exceeding 10 ml (p = 0.05), and those with Koos Grade 4 tumors (p = 0.02) had less likelihood of tumor control after SRS.

Although microsurgical resection remains the primary management choice in patients with low comorbidities, most vestibular schwannomas with a maximum diameter less than 4 cm and without significant mass effect can be managed satisfactorily with Gamma Knife radiosurgery.

Related citations

3. J Neurosurg. 2013 Dec;119 Suppl:129-36.

Linskey ME.

Stereotactic radiosurgery (SRS) for vestibular schwannomas has evolved and improved over time. Although early short-term follow-up reports suggest that fractionation yields hearing preservation rates equivalent to modern single-dose SRS techniques, significant questions remain regarding long-term tumor control after the use of fractionation in a late responding tumor with a low proliferative index and α/β ratio. With single-dose SRS, critical hearing preservation variables include: 1) strict attention to prescription dose 3D conformality so that the ventral cochlear nucleus (VCN) receives ≤ 9 Gy; 2) careful delineation of the 3D tumor margin to exclude the cochlear nerve when visualizable with contrast-enhanced T2-weighted MR volumetric imaging techniques and exclusion the dura mater of the anterior border of the internal auditory canal; 3) a tumor margin dose prescription ≤ 12 Gy; 4) optimization of the tumor treatment gradient index without sacrificing coverage and conformality; and 5) strict attention to prescription dose 3D conformality so that the modiolus and the basal turn of the cochlea receive the lowest possible dose (ideally < 4-5.33 Gy). Testable correlates for the relative importance of the VCN versus cochlear dose given the tonotopic organization of each structure suggests that VCN toxicity should lead to preferential loss of low hearing frequencies, while cochlear toxicity should lead to preferential loss of high hearing frequencies. The potential after SRS for hearing toxicity from altered endolymph and/or perilymph fluid dynamics either via impaired fluid production and/or absorption has yet to be explored. Serous otitis media, ossicular or temporal bone osteonecrosis, and chondromalacia are not likely to be relevant factors or considerations for hearing preservation after SRS.

Related citations

4. J Neurosurg. 2013 Dec;119 Suppl:105-11.

Régis J, Carron R, Park MC, Soumare O, Delsanti C, Thomassin JM, Roche PH.

The roles of the wait-and-see strategy and proactive Gamma Knife surgery (GKS) in the treatment paradigm for small intracanalicular vestibular schwannomas (VSs) is still a matter of debate, especially when patients present with functional hearing. The authors compare these 2 methods.

Forty-seven patients (22 men and 25 women) harboring an intracanalicular VS were followed prospectively. The mean age of the patients at the time of inclusion was 54.4 years (range 20-71 years). The mean follow-up period was 43.8 ± 40 months (range 9-222 months). Failure was defined as significant tumor growth and/or hearing deterioration that required microsurgical or radiosurgical treatment. This population was compared with a control group of 34 patients harboring a unilateral intracanalicular VS who were consecutively treated by GKS and had functional hearing at the time of radiosurgery. Of the 47 patients in the wait-and-see group, treatment failure (tumor growth requiring treatment) was observed in 35 patients (74%), although conservative treatment is still ongoing for 12 patients. Treatment failure in the control (GKS) group occurred in only 1 (3%) of 34 patients. In the wait-and-see group, there was no change in tumor size in 10 patients (21%), tumor growth in 36 patients (77%), and a mild decrease in tumor size in 1 patient (2%). Forty patients in the wait-and-see group were available for a hearing level study, which demonstrated no change in Gardner-Robertson hearing class for 24 patients (60%). Fifteen patients (38%) experienced more than 10 db of hearing loss and 2 of them became deaf. At 3, 4, and 5 years, the useful hearing preservation rates were 75%, 52%, and 41% in the wait-and-see group and 77%, 70%, and 64% in the control group, respectively. Thus, the chances of maintaining functional hearing and avoiding further intervention were much higher in cases treated by GKS (79% and 60% at 2 and 5 years, respectively) than in cases managed by the wait-and-see strategy (43% and 14% at 2 and 5 years, respectively).

These data indicate that the wait-and-see policy exposes the patient to elevated risks of tumor growth and degradation of hearing. Both events may occur independently in the mid-term period. This information must be presented to the patient. A careful sequential follow-up may be adopted when the wait-and-see strategy is chosen, but proactive GKS is recommended when hearing is still useful at the time of diagnosis. This recommendation may be a main paradigm shift in the practice of treating intracanalicular VSs.

Related citations

5. J Neurosurg. 2013 Dec;119 Suppl:851-9.

Yang I, Sughrue ME, Han SJ, Aranda D, Pitts LH, Cheung SW, Parsa AT.

Gamma Knife surgery (GKS) has evolved into a practical alternative to open microsurgical resection in the treatment of patients with vestibular schwannoma (VS). Hearing preservation rates in GKS series suggest very favorable outcomes without the possible acute morbidity associated with open microsurgery. To mitigate institutional and practitioner bias, the authors performed an analytical review of the published literature on the GKS treatment of vestibular schwannoma patients. Their aim was to objectively characterize the prognostic factors that contribute to hearing preservation after GKS, as well as methodically summarize the reported literature describing hearing preservation after GKS for VS.

A comprehensive search of the English-language literature revealed a total of 254 published studies reporting assessable and quantifiable outcome data obtained in patients who underwent radiosurgeryfor VSs. Inclusion criteria for articles were 4-fold: 1) hearing preservation rates reported specifically for VS; 2) hearing status reported using the American Association of Otolaryngology-Head and Neck Surgery (AAO-HNS) or Gardner-Robertson classification; 3) documentation of initial tumor size; and 4) GKS was the only radiosurgical modality in the treatment. In the analysis only patients with AAO-HNS Class A or B or Gardner-Robertson Grade I or II status at the last follow-up visit were defined as having preserved hearing. Hearing preservation and outcome data were then aggregated and analyzed based on the radiation dose, tumor volume, and patient age. The 45 articles that met the authors' inclusion criteria represented 4234 patients in whom an overall hearing preservation rate was 51%, irrespective of radiation dose, patient age, or tumor volume. Practitioners who delivered an average ≤ 13-Gy dose of radiation reported a higher hearing preservation rate (60.5% at ≤ 13 Gy vs 50.4% at > 13 Gy; p = 0.0005). Patients with smaller tumors (average tumor volume ≤ 1.5 cm3) had a hearing preservation rate (62%) comparable with patients harboring larger tumors (61%) (p = 0.8968). Age was not a significant prognostic factor for hearing preservation rates as in older patients there was a trend toward improved hearing preservation rates (56% at < 65 years vs 71% at ≥ 65 years of age; p < 0.1134). The average overall follow-up in the studies reviewed was 44.4 ± 32 months (median 35 months).

These data provide a methodical overview of the literature regarding hearing preservation with GKS for VS and a less biased assessment of outcomes than single-institution studies. This objective analysis provides insight into advising patients of hearing preservation rates for GKS treatment of VSs that have been reported, as aggregated in the published literature. Analysis of the data suggests that an overall hearing preservation rate of ~ 51% can be expected approaching 3-4 years after radiosurgical treatment, and the analysis reveals that patients treated with ≤ 13 Gy were more likely to have preserved hearing than patients receiving larger doses of radiation. Furthermore, larger tumors and older patients do not appear to be at any increased risk for hearing loss after GKS for VS than younger patients or patients with smaller tumors.

Related citations

6. J Neurosurg. 2013 Dec;119 Suppl:204-6.

van Eck AT, Horstmann GA.

Gamma knife surgery (GKS) for vestibular schwannoma is still associated with an additional hearing loss of approximately 30%. The purpose of this study was to record the effect on hearing preservation of maintaining a margin dose of 13 Gy while reducing the maximum dose to 20 Gy. Seventy-eight of 95 patients who entered a prospective protocol with a follow up of at least 12 months (mean 22 months) were evaluated. The mean tumor volume was 2.28 cm3. After a mean follow-up duration of 22 months, the magnetic resonance imaging--based tumor control rate was 87%. In two cases a second procedure (surgery) was necessary. Thus, the clinical control rate was 97.5%. In two cases there was an increase in trigeminal dysesthesia. One patient suffered transient facial nerve impairment. Functional hearing was preserved in 83.4% of the patients with functional hearing preoperatively.

Reducing the maximum dose to 20 Gy seems to be an effective treatment, which probably increases preservation of functional hearing without sacrificing the high tumor control rates achieved inradiosurgery. Post-radiosurgery tumor swelling occurred in 25% of the cases and was not correlated with hearing deterioration.

Inform Prim Care. 2014;21(3):105-12. doi: 10.14236/jhi.v21i3.64.

Pietrzak E1, Cotea C2, Pullman S2.

Falls in older Australians are an increasingly costly public health issue, driving the development of novel modes of intervention, especially those that rely on computer-driven technologies.

The aim of this paper was to gain an understanding of the state of the art of research on smart homes and computer-based monitoring technologies to prevent and detect falls in the community-dwellingelderly.

Cochrane, Medline, Embase and Google databases were searched for articles on fall prevention in the elderly using pre-specified search terms. Additional papers were searched for in the reference lists of relevant reviews and by the process of 'snowballing'. Only studies that investigated outcomes related to falling such as fall prevention and detection, change in participants' fear of falling and attitudes towards monitoring technology were included. Nine papers fulfilled the inclusion criteria. The following outcomes were observed: (1) older adults' attitudes towards fall detectors and smart home technology are generally positive; (2) privacy concerns and intrusiveness of technology were perceived as less important to participants than their perception of health needs and (3) unfriendly and age-inappropriate design of the interface may be one of the deciding factors in not using the technology.

So far, there is little evidence that using smart home technology may assist in fall prevention or detection, but there are some indications that it may increase older adults' confidence and sense of security, thus possibly enabling aging in place.

Related citations2. Springerplus. 2014 Aug 29;3:483. doi: 10.1186/2193-1801-3-483. eCollection 2014.

Heckenbach K1, Ostermann T2, Schad F1, Kröz M1, Matthes H1.

The aim of this study was to investigate the relationship between fall risk increasing drugs (FRIDS) and the risk of falls in regard to fall-related chronic diseases. In total, 39 primary care physicians in Germany participated in the EvaMed Pharmacovigilance Network. Antihypertensives, non-steroidal anti-inflammatory drugs, hypnotics and sedatives, antidepressants and psycholeptics were labelled as FRIDS. A fall was defined according to a diagnosis in the chapter Injury or poisoning (S00-T14 in International Statistical Classification of Diseases 10th Revision (ICD-10)). Patients older than or equal to 65 years with at least two doctor's visits were included. FRIDS were prescribed for 1768 patients from a total of 5124 patients included in the analysis. FRIDS and seven chronic diseases were statistically significant associated with a higher risk of experiencing a fall. The risk was highest for patients with a diagnosis abnormalities of gait and mobility, vertigo, visual -impairment and weight loss, and increased by 50-90% with arthritis, diseases of arteries, arterioles and capillaries and heart failure. From patients (N = 425) with at least one diagnosis of fall, 219 patients were prescribed FRIDS. In 100 (45.7%) of cases the diagnoses for fall were made before and in 105 (47.9%) of cases at least a month after the prescription of FRIDS. 14 (6.4%) patients had a prescription of FRIDS and a diagnosis of fall within one month. Perceptual disorders, low walking speed and pain are prominent predictors for falls in the elderly. A prescription of FRIDS selects more vulnerable patients having a higher risk of falls. However, experiencing a fall is mainly due to the disease followed by treatment. Thus, not prescribing FRIDS will avoid only a small number of falls.

KEYWORDS:

Fall risk increasing drugs; Fall-related chronic diseases; Falls in elderly

Free PMC ArticleRelated citations3. Consult Pharm. 2014;29(6):413-7. doi: 10.4140/TCP.n.2014.413..

Glab KL1, Wooding FG, Tuiskula KA.

Author information Abstract

Accidental falls represent a major public health concern for the elderly population. The use of psychotropic medications, cardiovascular medications, and nonsteroidal anti-inflammatory drugs is associated with an increased risk of falling. The mechanisms by which these medications increase fall risk are not fully understood but may include orthostatic hypotension, sedation, sleep disturbance, confusion, dizziness, and other central nervous system problems. A better understanding of these mechanisms may help guide pharmacists' interventions in reducing falls by educating patients, monitoring symptoms, adjusting doses, or discontinuing drugs implicated in falls. This article provides a discussion of the mechanisms by which certain classes of medications may contribute to falls and pharmacotherapeutic recommendations for preventing them.

Related citations4. J Phys Ther Sci. 2014 Aug;26(8):1215-8. doi: 10.1589/jpts.26.1215. Epub 2014 Aug 30.

Lim HS1, Yoon S2.

[Purpose] This study aimed to provide useful information for fall prevention for the elderly by investigating how safely the elderly cross an obstacle after 8 weeks water exercise, and how much of the training effect remained 8 weeks after finishing the exercise. [Subjects] Eleven elderly participants participated in this study. [Methods] To identify the training and detraining effect of 8 weeks of water exercise, a 3-D motion analysis with 7 infrared cameras and one force plate, was performed. [Results] In most of all variables, statistically significant training and detraining effects at obstacle heights of 30% leg length were found. At obstacle heights of 40% leg length, statistically significant training effects were found but only improvement pattern of detraining effects were found for all variables. [Conclusion] The findings of this study indicate that 8 weeks of water exercise at the level of RPE 12-13 may help the elderly to safely cross obstacles at the most common height associated with falls (30% of leg length) for at least 8 weeks after training termination. The training effect, however, should not be expected to last for 8 weeks after the training at obstacle heights of 40% height of their leg length, which is a more difficult height for the elderly to cross.

KEYWORDS:

Detraining effect; Elderly fall; Training effect

Free PMC ArticleRelated citations5. J Gerontol A Biol Sci Med Sci. 2014 Sep 8. pii: glu148. [Epub ahead of print]

Callisaya ML1, Beare R2, Phan T2, Blizzard L3, Thrift AG4, Chen J5, Srikanth VK6.

Greater volume of cerebral white matter hyperintensities (WMH) of presumed vascular origin may affect postural control and gait. WMH measured at one time point predicts an increased risk of incident multiple falls. However, it is unknown whether WMH progression increases falls risk. We hypothesized that the progression of WMH would be associated with a greater risk of multiple falls.

A population-based sample aged more than 60 years was randomly selected from the electoral roll and followed up 2.5 years apart with two phases of measurement. Magnetic resonance imaging scans from both time points were subjected to automated segmentation to derive WMH volumes. Falls were recorded prospectively over 12 months after the second magnetic resonance imaging measurement. A generalized linear model was used to estimate the relative risk of multiple falls associated with WMH progression adjusted for confounders.

There were 187 people (mean age 70.4, SD 6.5) with a mean follow-up of 2.5 (SD 0.4) years. Over 12 months, 35 (18.7%) participants reported multiple falls. A greater progression of WMH was associated with an increased risk of multiple falls (adjusted relative risk 1.30, 95% confidence interval 1.00-1.70, p = .05) independent of baseline WMH volume, duration of follow-up, age, sex, and total intracranial volume. This association was unchanged when adjusted for medical history, peripheral sensorimotor factors, gait speed, cognition, medications, mood, and magnetic resonance imaging infarcts.

Greater WMH progression independently increased the risk of multiple falls. Interventions to slow the progression of WMH may be successful in reducing this risk. © The Author 2014. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Brain aging; Epidemiology; Falls; Imaging; White matter hyperintensities.

Related citations6. BMC Geriatr. 2014 Sep 8;14(1):100. [Epub ahead of print]

Ashari A, Hamid T, Hussain RM, Hill KD.

Turning is a common activity for older people, and is one of the activities commonly associated with falls during walking. Falls that occur while walking and turning have also been associated with an increased risk of hip fracture in older people. Despite the importance of stability during turning, there has been little focus on identifying this impairment in at risk older people, or in evaluating interventions aiming to improve this outcome. This study will evaluate the effectiveness of a 16 week tailored home based exercise program in older adults aged (50 years and above) who were identified as having unsteadiness during turning.

A single blind randomized controlled trial will be conducted, with assessors blind to group allocation. Study participants will be aged 50 years and above, living in the community and have been identified as having impaired turning ability [outside of age and gender normal limits on the Step Quick Turn (180 degree turn) task on the Neurocom(R) Balance Master with long plate]. After a comprehensive baseline assessment, those classified as having balance impairment while turning will be randomized to intervention or control group. The intervention group will receive a 16 week individualized balance and strength home exercise program, based on the Otago Exercise Program with additional exercises focused on improving turning ability. Intervention group will attend four visit to the assessment centre over 16 weeks period, for provision, monitoring, modification of the exercise and encourage ongoing participation. Participants in the control group will continue with their usual activities. All participants will be re-assessed on completion of the 16 week program. Primary outcome measures will be the Step Quick Turn Test and Timed-Up and Go test. Secondary outcomes will include other clinical measures of balance, psychological aspects of falls, incidence of falls and falls risk factors.

Results of this study will provide useful information for clinicians on the types of exercises to improve turning ability in older people with increased falls risk and the effectiveness of these exercises in improving outcomes.Trial Registration: ACTRN12613000855729.

Free full textRelated citationsNeurosurgery. 2014 Aug 29. [Epub ahead of print]

Anaizi A1, Gantwerker E, Pensak M, Theodosopoulos P.

Facial nerve preservation surgery for large vestibular schwannomas represents a novel strategy toward maintaining normal nerve function by allowing residual tumor adherent to this nerve or root-entry zone. To report, in a retrospective study, outcomes for large Koos grade 3 and 4 vestibular schwannomas. After surgical treatment for vestibular schwannomas (2003-2012) in 52 patients, outcomes included extent of resection, postoperative hearing, and facial nerve function. Extent of resection defined as gross total, near total, or subtotal were 7 (39%), 3 (17%), and 8 (44%) in 18 patients after retrosigmoid approaches and 10 (29.5%), 9 (26.5%), and 15 (44%) for 34 patients after translabyrinthine approaches, respectively. Hearing was preserved in 1 (20%) of 5 gross total resections, 0 of 2 near-total resections, and 1 (33%) of 3 subtotal resections. Good facial nerve function (House Brackman [HB] I and II) was achieved long-term in 16 (94%) of 17 gross total, 11 (92%) of 12 near total, and 21 (91%) of 23 subtotal resections. Long-term tumor control was 100% for gross total, 92% for near total, and 83% for subtotal resections. Postoperative radiation therapy was delivered to 9 subtotal-resection patients and 1 near-total resection patient. Follow-up averaged 33 months.

BACKGROUND:: OBJECTIVE:: METHODS:: RESULTS:: CONCLUSION::

Our findings support facial nerve preservation surgery in becoming the new standard foracoustic neuroma treatment. Maximizing resection and close postoperative radiographic follow-up enables early identification of tumors that will progress to radiosurgical treatment. This sequential approach can lead to combined optimal facial nerve function and effective tumor control rates.

Related citations2. J Neurosurg. 2013 Dec;119 Suppl:801-7.

Yang HC, Kano H, Awan NR, Lunsford LD, Niranjan A, Flickinger JC, Novotny J Jr, Bhatnagar JP, Kondziolka D.

Stereotactic radiosurgery (SRS) is an important management option for patients with small- and medium-sized vestibular schwannomas. To assess the potential role of SRS in larger tumors, the authors reviewed their recent experience. Between 1994 and 2008, 65 patients with vestibular schwannomas between 3 and 4 cm in one extracanalicular maximum diameter (median tumor volume 9 ml) underwent Gamma Knife surgery. Seventeen patients (26%) had previously undergone resection. The median follow-up duration was 36 months (range 1-146 months). At the first planned imaging follow-up at 6 months, 5 tumors (8%) were slightly expanded, 53 (82%) were stable in size, and 7 (11%) were smaller. Two patients (3%) underwent resection within 6 months due to progressive symptoms. Two years later, with 63 tumors overall after the 2 post-SRS resections, 16 tumors (25%) had a volume reduction of more than 50%, 22 (35%) tumors had a volume reduction of 10–50%, 18 (29%) were stable in volume (volume change < 10%), and 7 (11%) had larger volumes (5 of the 7 patients underwent resection and 1 of the 7 underwent repeat SRS). Eighteen (82%) of 22 patients with serviceable hearing before SRS still had serviceable hearing after SRS more than 2 years later. Three patients (5%) developed symptomatic hydrocephalus and underwent placement of a ventriculoperitoneal shunt. In 4 patients (6%) trigeminal sensory dysfunction developed, and in 1 patient (2%) mild facial weakness (House-Brackmann Grade II) developed after SRS. In univariate analysis, patients who had a previous resection (p = 0.010), those with a tumor volume exceeding 10 ml (p = 0.05), and those with Koos Grade 4 tumors (p = 0.02) had less likelihood of tumor control after SRS.

OBJECT: METHODS: RESULTS: CONCLUSIONS:

Although microsurgical resection remains the primary management choice in patients with low comorbidities, most vestibular schwannomas with a maximum diameter less than 4 cm and without significant mass effect can be managed satisfactorily with Gamma Knife radiosurgery.

Related citations

3. J Neurosurg. 2013 Dec;119 Suppl:E4.

Sughrue ME, Yang I, Han SJ, Aranda D, Kane AJ, Amoils M, Smith ZA, Parsa AT.

While many studies have been published outlining morbidity following radiosurgical treatment of vestibular schwannomas, significant interpractitioner and institutional variability still exists. For this reason, the authors conducted a systematic review of the literature for non-audiofacial-related morbidity after the treatment of vestibular schwannoma with radiosurgery. The authors performed a comprehensive search of the English-language literature to identify studies that published outcome data of patients undergoing radiosurgery treatment for vestibular schwannomas. In total, 254 articles were found that described more than 50,000 patients and were analyzed for satisfying the authors' inclusion criteria. Patients from these studies were then separated into 2 cohorts based on the marginal dose of radiation: ≤ 13 Gy and > 13 Gy. All tumors included in this study were < 25 mm in their largest diameter. A total of 63 articles met the criteria of the established search protocol, which combined for a total of 5631 patients. Patients receiving > 13 Gy were significantly more likely to develop trigeminal nerve neuropathy than those receiving < 13 Gy (p < 0.001). While we found no relationship between radiation dose and the rate of developing hydrocephalus (0.6% for both cohorts), patients with hydrocephalus who received doses > 13 Gy appeared to have a higher rate of symptomatic hydrocephalus requiring shunt treatment (96% [> 13 Gy] vs 56% [≤ 13 Gy], p < 0.001). The rates of vertigo or balance disturbance (1.1% [> 13 Gy] vs 1.8% [≤ 13 Gy], p = 0.001) and tinnitus (0.1% [> 13 Gy] vs 0.7% [≤ 13 Gy], p = 0.001) were significantly higher in the lower dose cohort than those in the higher dose cohort.

OBJECT: METHODS: RESULTS: CONCLUSIONS:

The results of our review of the literature provide a systematic summary of the published rates of nonaudiofacial morbidity following radiosurgery for vestibular schwannoma.

Related citations

4. J Neurosurg. 2013 Dec;119 Suppl:546-51.

Pollack AG, Marymont MH, Kalapurakal JA, Kepka A, Sathiaseelan V, Chandler JP.

The authors describe an acute facial and acoustic neuropathy following gamma knife surgery (GKS) for vestibular schwannoma (VS). This 39-year-old woman presenting with tinnitus underwent GKS for a small right-sided intracanalicular VS, receiving a maximal dose of 26 Gy and a tumor margin dose of 13 Gy to the 50% isodose line. Thirty-six hours following treatment she presented with nausea, vomiting, vertigo, diminished hearing, and a House-Brackmann Grade III facial palsy. She was started on intravenous glucocorticosteroid agents, and over the course of 2 weeks her facial function returned to House-Brackmann Grade I. Unfortunately, her hearing loss persisted. A magnetic resonance (MR) image obtained at the time of initial deterioration demonstrated a significant decrease in tumor enhancement but no change in tumor size or peritumoral edema. Subsequently, the patient experienced severe hemifacial spasms, which persisted for a period of 3 weeks and then progressed to a House-Brackmann Grade V facial palsy. During the next 3 months, the patient was treated with steroids and in time her facial function and hearing returned to baseline levels. Results of MR imaging revealed transient enlargement (3 mm) of the tumor, which subsequently returned to its baseline size. This change corresponded to the tumor volume increase from 270 to 336 mm3. The patient remains radiologically and neurologically stable at 10 months posttreatment. This is the first detailed report of acute facial and vestibulocochlear neurotoxicity following GKS for VS that improved with time. In addition, MR imaging findings were indicative of early neurotoxic changes. A review of possible risk factors and explanations of causative mechanisms is provided.

Related citations

5. J Neurosurg. 2013 Dec;119 Suppl:129-36.

Linskey ME.

Stereotactic radiosurgery (SRS) for vestibular schwannomas has evolved and improved over time. Although early short-term follow-up reports suggest that fractionation yields hearing preservation rates equivalent to modern single-dose SRS techniques, significant questions remain regarding long-term tumor control after the use of fractionation in a late responding tumor with a low proliferative index and α/β ratio. With single-dose SRS, critical hearing preservation variables include: 1) strict attention to prescription dose 3D conformality so that the ventral cochlear nucleus (VCN) receives ≤ 9 Gy; 2) careful delineation of the 3D tumor margin to exclude the cochlear nerve when visualizable with contrast-enhanced T2-weighted MR volumetric imaging techniques and exclusion the dura mater of the anterior border of the internal auditory canal; 3) a tumor margin dose prescription ≤ 12 Gy; 4) optimization of the tumor treatment gradient index without sacrificing coverage and conformality; and 5) strict attention to prescription dose 3D conformality so that the modiolus and the basal turn of the cochlea receive the lowest possible dose (ideally < 4-5.33 Gy). Testable correlates for the relative importance of the VCN versus cochlear dose given the tonotopic organization of each structure suggests that VCN toxicity should lead to preferential loss of low hearing frequencies, while cochlear toxicity should lead to preferential loss of high hearing frequencies. The potential after SRS for hearing toxicity from altered endolymph and/or perilymph fluid dynamics either via impaired fluid production and/or absorption has yet to be explored. Serous otitis media, ossicular or temporal bone osteonecrosis, and chondromalacia are not likely to be relevant factors or considerations for hearing preservation after SRS.

Related citations

6. J Neurosurg. 2013 Dec;119 Suppl:800-6.

Linskey ME, Johnstone PA, O'Leary M, Goetsch S.

The dosimetry of radiation exposure of healthy inner, middle, and external ear structures that leads to hearing loss, tinnitus, facial weakness, dizziness, vertigo, and imbalance after gamma knife surgery (GKS) for vestibular schwannomas (VSs) is unknown. The authors quantified the dose of radiation received by these structures after GKS for VS to assess the likelihood that these doses contributed to postradiosurgery complications. A retrospective study was performed using a prospectively acquired database of a consecutive series of 54 patients with VS who were treated with GKS during a 3.5-year period at an "open unit" gamma knife center. Point doses were measured for 18 healthy temporal bone structures in each patient, with the anatomical position of each sampling point confirmed by a fellowship-trained neurootologist. These values were compared against single-dose equivalents for the 5-year tolerance dose for a 5% risk of complications and the 5-year tolerance dose for a 50% risk of complications, which were calculated using known 2-Gy/fraction thresholds for chronic otitis, chondromalacia, and osseous necrosis, as well as the tumor margin dose and typical tumor margin prescription doses for patients in whom hearing preservation was attempted. External and middle ear doses were uniformly low. The intratemporal facial nerve is susceptible to unintentionally high radiation exposure at the fundus of the internal auditory canal, with higher than tumor margin doses detected in 26% of cases. In the cochlea, the basal turn near the modiolus and its inferior portion are most susceptible, with doses greater than 12 Gy detected in 10.8 and 14.8% of cases. In the vestibular labyrinth, the ampulated ends of the lateral and posterior semicircular canals are most susceptible, with doses greater than 12 Gy detected in 7.4 and 5.1% of cases.

OBJECT: METHODS: CONCLUSIONS:

Doses delivered to middle and external ear structures are unlikely to contribute to post-GKS complications, but unexpectedly high doses may be delivered to sensitive areas of the intratemporal facial nerve and inner ear. Unintentional delivery of high doses to the stria vascularis, the sensory neuroepithelium of the inner ear organs and/or their ganglia, may play a role in the development of post-GKS tinnitus, hearing loss, dizziness, vertigo, and imbalance. Minimizing treatment complications post-GKS for VS requires precise dose planning conformality with the three-dimensional surface of the tumor.

Related citations

Freyss G, Vitte E, Semont A, Tran ba Huy P, Gaillard P. Computation of eye-head movements in oscillopsic patients: modifications induced by reeducation. Adv Otorhinolaryngol. 1988;42:294-300.

Mbongo F, Patko T, Vidal PP, Vibert N, Tran Ba Huy P, de Waele C.

Postural control in patients with unilateral vestibular lesions is more impaired in the roll than in the pitch plane: a static and dynamic posturography study.Audiol Neurootol. 2005 Sep-Oct;10(5):291-302.

Mbongo F, Tran Huy P, Vidal PP, de Waele C. Relationship Between Dynamic Balance and Self-Reported Handicap in Patients Who Have Unilateral Peripheral Vestibular Loss. Otol Neurotol. 2007 Oct;28(7):905-910.

Wolfson L, Whipple R, Derby CA, Amerman P, Murphy T, Tobin JN, Nashner L. A dynamic posturography study of balance in healthy elderly. Neurology. 1992 Nov;42(11):2069-75.

Evaluation under real-life conditions of a stand-alone fall detector for the elderly subjects.

Bloch F, Gautier V, Noury N, Lundy JE, Poujaud J, Claessens YE, Rigaud AS.

Ann Phys Rehabil Med. 2011 Aug 22. [Epub ahead of print]

PMID: 21903502 [PubMed - as supplied by publisher]

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Epidemiological profile of 239 traumatic spinal cord injury cases over a period of 12 years in Tianjin, China.

Feng HY, Ning GZ, Feng SQ, Yu TQ, Zhou HX.

J Spinal Cord Med. 2011;34(4):388-394.

PMID: 21903012 [PubMed - as supplied by publisher]

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3.

Biological constraints that limit compensation of a common skeletal trait variant lead to inequivalence of tibial function among healthy young adults.

Jepsen KJ, Centi A, Duarte GF, Galloway K, Goldman H, Hampson N, Lappe JM, Cullen DM, Greeves J, Izard R, Nindl BC, Kraemer WJ, Negus CH, Evans RK.

J Bone Miner Res. 2011 Aug 26. doi: 10.1002/jbmr.497. [Epub ahead of print]

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The overestimation of performance: a specific bias of aging?

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Geriatr Psychol Neuropsychiatr Vieil. 2011 Sep 1;9(3):287-294.

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5.

Beyond to pattern of risk factors in elderly subjects.

Gaubert-Dahan ML, Cougnaud-Petit A, De Decker L, Annweiler C, Beauchet O, Berrut G.

Geriatr Psychol Neuropsychiatr Vieil. 2011 Sep 1;9(3):277-285.

PMID: 21896431 [PubMed - as supplied by publisher]

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Vitamin D in the elderly: 5 points to remember.

Annweiler C, Souberbielle JC, Schott AM, de Decker L, Berrut G, Beauchet O.

Geriatr Psychol Neuropsychiatr Vieil. 2011 Sep 1;9(3):259-267.

PMID: 21896429 [PubMed - as supplied by publisher]

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7.

Falls in the elderly: a current issue.

Berrut G.

Geriatr Psychol Neuropsychiatr Vieil. 2011 Sep 1;9(3):253-254. No abstract available.

PMID: 21896427 [PubMed - as supplied by publisher]

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8.

Singh's verbal autopsy questionnaire for the assessment of causes of death, social autopsy, tobacco autopsy and dietary autopsy, based on medical records and interview.

Singh RB, Fedacko J, Vargova V, Kumar A, Mohan V, Pella D, De Meester F, Wilson D.

Acta Cardiol. 2011 Aug;66(4):471-81.

PMID: 21894804 [PubMed - in process]

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9.

Fall related injuries: A retrospective medical review study in North India.

Jagnoor J, Keay L, Ganguli A, Dandona R, Thakur JS, Boufous S, Cumming R, Ivers RQ.

Injury. 2011 Sep 3. [Epub ahead of print]

PMID: 21893315 [PubMed - as supplied by publisher]

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10.

The cost of fall related presentations to the ED: A prospective, in-person, patient-tracking analysis of health resource utilization.

Woolcott JC, Khan KM, Mitrovic S, Anis AH, Marra CA.

Osteoporos Int. 2011 Sep 3. [Epub ahead of print]

PMID: 21892675 [PubMed - as supplied by publisher]

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11.

Pilot cluster randomised controlled trial of flooring to reduce injuries from falls in elderly care units: study protocol.

Drahota A, Gal D, Windsor J, Dixon S, Udell J, Ward D, Soilemezi D, Dean T, Severs M.

Inj Prev. 2011 Sep 2. [Epub ahead of print]

PMID: 21890580 [PubMed - as supplied by publisher]

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12.

[Update on current care guidelines: Hip fracture].

[No authors listed]

Duodecim. 2011;127(14):1508-9. Finnish.

PMID: 21888050 [PubMed - in process]

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13.

Predicting fractures in an international cohort using risk factor algorithms, without bone mineral density.

Sambrook PN, Flahive J, Hooven FH, Boonen S, Chapurlat R, Lindsay R, Nguyen TV, Díez-Perez A, Pfeilschifter J, Greenspan SL, Hosmer D, Netelenbos JC, Adachi JD, Watts NB, Cooper C, Roux C, Rossini M, Siris ES, Silverman S, Saag KG, Compston JE, Lacroix A, Gehlbach S.

J Bone Miner Res. 2011 Sep 1. doi: 10.1002/jbmr.503. [Epub ahead of print]

PMID: 21887705 [PubMed - as supplied by publisher]

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14.

Modifiable Risk Factors Identify People Who Transition from Non-fallers to Fallers in Community-Dwelling Older Adults: A Prospective Study.

Muir SW, Berg K, Chesworth BM, Klar N, Speechley M.

Physiother Can. 2010 Fall;62(4):358-67. Epub 2010 Oct 18.

PMID: 21886376 [PubMed - in process] Free PMC Article

Free full text

15.

Accidental deaths occurring in bed: Review of cases and proposal of preventive strategies.

Kibayashi K, Shimada R, Nakao K.

J Forensic Nurs. 2011 Sep;7(3):130-6. doi: 10.1111/j.1939-3938.2011.01109.x.

PMID: 21884400 [PubMed - in process]

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16.

Thiazide-Induced Hyponatraemia: Epidemiology and Clues to Pathogenesis.

Glover M, Clayton J.

Cardiovasc Ther. 2011 Jun 3. doi: 10.1111/j.1755-5922.2011.00286.x. [Epub ahead of print]

PMID: 21884020 [PubMed - as supplied by publisher]

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17.

A clinico-demographic analysis of maxillofacial trauma in the elderly.

Al-Qamachi LH, Laverick S, Jones DC.

Gerodontology. 2011 Aug 31. doi: 10.1111/j.1741-2358.2010.00431.x. [Epub ahead of print]

PMID: 21883419 [PubMed - as supplied by publisher]

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18.

Kinematic measures for assessing gait stability in elderly individuals: a systematic review.

Hamacher D, Singh NB, Van Dieën JH, Heller MO, Taylor WR.

J R Soc Interface. 2011 Aug 31. [Epub ahead of print]

PMID: 21880615 [PubMed - as supplied by publisher]

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19.

Epidemiology and management of end-stage renal disease in the elderly.

Brown EA, Johansson L.

Nat Rev Nephrol. 2011 Aug 30. doi: 10.1038/nrneph.2011.113. [Epub ahead of print]

PMID: 21878885 [PubMed - as supplied by publisher]

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20.

Older people's participation in and engagement with falls prevention interventions in community settings: an augment to the cochrane systematic review.

Nyman SR, Victor CR.

Age Ageing. 2011 Aug 28. [Epub ahead of print]

PMID: 21875865 [PubMed - as supplied by publisher]

Related citations

1. Evaluation under real-life conditions of a stand-alone fall detector for the elderly subjects. Bloch F, Gautier V, Noury N, Lundy JE, Poujaud J, Claessens YE, Rigaud AS. Ann Phys Rehabil Med. 2011 Aug 22. [Epub ahead of print] PMID: 21903502 [PubMed - as supplied by publisher] Related citations 2. Epidemiological profile of 239 traumatic spinal cord injury cases over a period of 12 years in Tianjin, China. Feng HY, Ning GZ, Feng SQ, Yu TQ, Zhou HX. J Spinal Cord Med. 2011;34(4):388-394. PMID: 21903012 [PubMed - as supplied by publisher] Related citations 3. Biological constraints that limit compensation of a common skeletal trait variant lead to inequivalence of tibial function among healthy young adults. Jepsen KJ, Centi A, Duarte GF, Galloway K, Goldman H, Hampson N, Lappe JM, Cullen DM, Greeves J, Izard R, Nindl BC, Kraemer WJ, Negus CH, Evans RK. J Bone Miner Res. 2011 Aug 26. doi: 10.1002/jbmr.497. [Epub ahead of print] PMID: 21898595 [PubMed - as supplied by publisher] Related citations 4. The overestimation of performance: a specific bias of aging? Noel M, Bernard A, Luyat M. Geriatr Psychol Neuropsychiatr Vieil. 2011 Sep 1;9(3):287-294. PMID: 21896432 [PubMed - as supplied by publisher] Related citations 5. Beyond to pattern of risk factors in elderly subjects. Gaubert-Dahan ML, Cougnaud-Petit A, De Decker L, Annweiler C, Beauchet O, Berrut G. Geriatr Psychol Neuropsychiatr Vieil. 2011 Sep 1;9(3):277-285. PMID: 21896431 [PubMed - as supplied by publisher] Related citations 6. Vitamin D in the elderly: 5 points to remember. Annweiler C, Souberbielle JC, Schott AM, de Decker L, Berrut G, Beauchet O. Geriatr Psychol Neuropsychiatr Vieil. 2011 Sep 1;9(3):259-267. PMID: 21896429 [PubMed - as supplied by publisher] Related citations 7. Falls in the elderly: a current issue. Berrut G. Geriatr Psychol Neuropsychiatr Vieil. 2011 Sep 1;9(3):253-254. No abstract available. PMID: 21896427 [PubMed - as supplied by publisher] Related citations 8. Singh's verbal autopsy questionnaire for the assessment of causes of death, social autopsy, tobacco autopsy and dietary autopsy, based on medical records and interview. Singh RB, Fedacko J, Vargova V, Kumar A, Mohan V, Pella D, De Meester F, Wilson D. Acta Cardiol. 2011 Aug;66(4):471-81. PMID: 21894804 [PubMed - in process] Related citations 9. Fall related injuries: A retrospective medical review study in North India. Jagnoor J, Keay L, Ganguli A, Dandona R, Thakur JS, Boufous S, Cumming R, Ivers RQ. Injury. 2011 Sep 3. [Epub ahead of print] PMID: 21893315 [PubMed - as supplied by publisher] Related citations 10. The cost of fall related presentations to the ED: A prospective, in-person, patient-tracking analysis of health resource utilization. Woolcott JC, Khan KM, Mitrovic S, Anis AH, Marra CA. Osteoporos Int. 2011 Sep 3. [Epub ahead of print] PMID: 21892675 [PubMed - as supplied by publisher] Related citations 11. Pilot cluster randomised controlled trial of flooring to reduce injuries from falls in elderly care units: study protocol. Drahota A, Gal D, Windsor J, Dixon S, Udell J, Ward D, Soilemezi D, Dean T, Severs M. Inj Prev. 2011 Sep 2. [Epub ahead of print] PMID: 21890580 [PubMed - as supplied by publisher] Related citations 12. [Update on current care guidelines: Hip fracture]. [No authors listed] Duodecim. 2011;127(14):1508-9. Finnish. PMID: 21888050 [PubMed - in process] Related citations 13. Predicting fractures in an international cohort using risk factor algorithms, without bone mineral density. Sambrook PN, Flahive J, Hooven FH, Boonen S, Chapurlat R, Lindsay R, Nguyen TV, Díez-Perez A, Pfeilschifter J, Greenspan SL, Hosmer D, Netelenbos JC, Adachi JD, Watts NB, Cooper C, Roux C, Rossini M, Siris ES, Silverman S, Saag KG, Compston JE, Lacroix A, Gehlbach S. J Bone Miner Res. 2011 Sep 1. doi: 10.1002/jbmr.503. [Epub ahead of print] PMID: 21887705 [PubMed - as supplied by publisher] Related citations 14. Modifiable Risk Factors Identify People Who Transition from Non-fallers to Fallers in Community-Dwelling Older Adults: A Prospective Study. Muir SW, Berg K, Chesworth BM, Klar N, Speechley M. Physiother Can. 2010 Fall;62(4):358-67. Epub 2010 Oct 18. PMID: 21886376 [PubMed - in process] Free PMC Article Free full text 15. Accidental deaths occurring in bed: Review of cases and proposal of preventive strategies. Kibayashi K, Shimada R, Nakao K. J Forensic Nurs. 2011 Sep;7(3):130-6. doi: 10.1111/j.1939-3938.2011.01109.x. PMID: 21884400 [PubMed - in process] Related citations 16. Thiazide-Induced Hyponatraemia: Epidemiology and Clues to Pathogenesis. Glover M, Clayton J. Cardiovasc Ther. 2011 Jun 3. doi: 10.1111/j.1755-5922.2011.00286.x. [Epub ahead of print] PMID: 21884020 [PubMed - as supplied by publisher] Related citations 17. A clinico-demographic analysis of maxillofacial trauma in the elderly. Al-Qamachi LH, Laverick S, Jones DC. Gerodontology. 2011 Aug 31. doi: 10.1111/j.1741-2358.2010.00431.x. [Epub ahead of print] PMID: 21883419 [PubMed - as supplied by publisher] Related citations 18. Kinematic measures for assessing gait stability in elderly individuals: a systematic review. Hamacher D, Singh NB, Van Dieën JH, Heller MO, Taylor WR. J R Soc Interface. 2011 Aug 31. [Epub ahead of print] PMID: 21880615 [PubMed - as supplied by publisher] Related citations 19. Epidemiology and management of end-stage renal disease in the elderly. Brown EA, Johansson L. Nat Rev Nephrol. 2011 Aug 30. doi: 10.1038/nrneph.2011.113. [Epub ahead of print] PMID: 21878885 [PubMed - as supplied by publisher] Related citations 20. Older people's participation in and engagement with falls prevention interventions in community settings: an augment to the cochrane systematic review. Nyman SR, Victor CR. Age Ageing. 2011 Aug 28. [Epub ahead of print] PMID: 21875865 [PubMed - as supplied by publisher] Related c

1.

Evaluation under real-life conditions of a stand-alone fall detector for the elderly subjects.

Bloch F, Gautier V, Noury N, Lundy JE, Poujaud J, Claessens YE, Rigaud AS.

Ann Phys Rehabil Med. 2011 Aug 22. [Epub ahead of print]

PMID: 21903502 [PubMed - as supplied by publisher]

Related citations

2.

Epidemiological profile of 239 traumatic spinal cord injury cases over a period of 12 years in Tianjin, China.

Feng HY, Ning GZ, Feng SQ, Yu TQ, Zhou HX.

J Spinal Cord Med. 2011;34(4):388-394.

PMID: 21903012 [PubMed - as supplied by publisher]

Related citations

3.

Biological constraints that limit compensation of a common skeletal trait variant lead to inequivalence of tibial function among healthy young adults.

Jepsen KJ, Centi A, Duarte GF, Galloway K, Goldman H, Hampson N, Lappe JM, Cullen DM, Greeves J, Izard R, Nindl BC, Kraemer WJ, Negus CH, Evans RK.

J Bone Miner Res. 2011 Aug 26. doi: 10.1002/jbmr.497. [Epub ahead of print]

PMID: 21898595 [PubMed - as supplied by publisher]

Related citations

4.

The overestimation of performance: a specific bias of aging?

Noel M, Bernard A, Luyat M.

Geriatr Psychol Neuropsychiatr Vieil. 2011 Sep 1;9(3):287-294.

PMID: 21896432 [PubMed - as supplied by publisher]

Related citations

5.

Beyond to pattern of risk factors in elderly subjects.

Gaubert-Dahan ML, Cougnaud-Petit A, De Decker L, Annweiler C, Beauchet O, Berrut G.

Geriatr Psychol Neuropsychiatr Vieil. 2011 Sep 1;9(3):277-285.

PMID: 21896431 [PubMed - as supplied by publisher]

Related citations

6.

Vitamin D in the elderly: 5 points to remember.

Annweiler C, Souberbielle JC, Schott AM, de Decker L, Berrut G, Beauchet O.

Geriatr Psychol Neuropsychiatr Vieil. 2011 Sep 1;9(3):259-267.

PMID: 21896429 [PubMed - as supplied by publisher]

Related citations

7.

Falls in the elderly: a current issue.

Berrut G.

Geriatr Psychol Neuropsychiatr Vieil. 2011 Sep 1;9(3):253-254. No abstract available.

PMID: 21896427 [PubMed - as supplied by publisher]

Related citations

8.

Singh's verbal autopsy questionnaire for the assessment of causes of death, social autopsy, tobacco autopsy and dietary autopsy, based on medical records and interview.

Singh RB, Fedacko J, Vargova V, Kumar A, Mohan V, Pella D, De Meester F, Wilson D.

Acta Cardiol. 2011 Aug;66(4):471-81.

PMID: 21894804 [PubMed - in process]

Related citations

9.

Fall related injuries: A retrospective medical review study in North India.

Jagnoor J, Keay L, Ganguli A, Dandona R, Thakur JS, Boufous S, Cumming R, Ivers RQ.

Injury. 2011 Sep 3. [Epub ahead of print]

PMID: 21893315 [PubMed - as supplied by publisher]

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10.

The cost of fall related presentations to the ED: A prospective, in-person, patient-tracking analysis of health resource utilization.

Woolcott JC, Khan KM, Mitrovic S, Anis AH, Marra CA.

Osteoporos Int. 2011 Sep 3. [Epub ahead of print]

PMID: 21892675 [PubMed - as supplied by publisher]

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11.

Pilot cluster randomised controlled trial of flooring to reduce injuries from falls in elderly care units: study protocol.

Drahota A, Gal D, Windsor J, Dixon S, Udell J, Ward D, Soilemezi D, Dean T, Severs M.

Inj Prev. 2011 Sep 2. [Epub ahead of print]

PMID: 21890580 [PubMed - as supplied by publisher]

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12.

[Update on current care guidelines: Hip fracture].

[No authors listed]

Duodecim. 2011;127(14):1508-9. Finnish.

PMID: 21888050 [PubMed - in process]

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13.

Predicting fractures in an international cohort using risk factor algorithms, without bone mineral density.

Sambrook PN, Flahive J, Hooven FH, Boonen S, Chapurlat R, Lindsay R, Nguyen TV, Díez-Perez A, Pfeilschifter J, Greenspan SL, Hosmer D, Netelenbos JC, Adachi JD, Watts NB, Cooper C, Roux C, Rossini M, Siris ES, Silverman S, Saag KG, Compston JE, Lacroix A, Gehlbach S.

J Bone Miner Res. 2011 Sep 1. doi: 10.1002/jbmr.503. [Epub ahead of print]

PMID: 21887705 [PubMed - as supplied by publisher]

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14.

Modifiable Risk Factors Identify People Who Transition from Non-fallers to Fallers in Community-Dwelling Older Adults: A Prospective Study.

Muir SW, Berg K, Chesworth BM, Klar N, Speechley M.

Physiother Can. 2010 Fall;62(4):358-67. Epub 2010 Oct 18.

PMID: 21886376 [PubMed - in process] Free PMC Article

Free full text

15.

Accidental deaths occurring in bed: Review of cases and proposal of preventive strategies.

Kibayashi K, Shimada R, Nakao K.

J Forensic Nurs. 2011 Sep;7(3):130-6. doi: 10.1111/j.1939-3938.2011.01109.x.

PMID: 21884400 [PubMed - in process]

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16.

Thiazide-Induced Hyponatraemia: Epidemiology and Clues to Pathogenesis.

Glover M, Clayton J.

Cardiovasc Ther. 2011 Jun 3. doi: 10.1111/j.1755-5922.2011.00286.x. [Epub ahead of print]

PMID: 21884020 [PubMed - as supplied by publisher]

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17.

A clinico-demographic analysis of maxillofacial trauma in the elderly.

Al-Qamachi LH, Laverick S, Jones DC.

Gerodontology. 2011 Aug 31. doi: 10.1111/j.1741-2358.2010.00431.x. [Epub ahead of print]

PMID: 21883419 [PubMed - as supplied by publisher]

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18.

Kinematic measures for assessing gait stability in elderly individuals: a systematic review.

Hamacher D, Singh NB, Van Dieën JH, Heller MO, Taylor WR.

J R Soc Interface. 2011 Aug 31. [Epub ahead of print]

PMID: 21880615 [PubMed - as supplied by publisher]

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19.

Epidemiology and management of end-stage renal disease in the elderly.

Brown EA, Johansson L.

Nat Rev Nephrol. 2011 Aug 30. doi: 10.1038/nrneph.2011.113. [Epub ahead of print]

PMID: 21878885 [PubMed - as supplied by publisher]

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20.

Older people's participation in and engagement with falls prevention interventions in community settings: an augment to the cochrane systematic review.

Nyman SR, Victor CR.

Age Ageing. 2011 Aug 28. [Epub ahead of print]

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itations

Restor Neurol Neurosci. 2010;28(1):37-46.

Vestibular function after acute vestibular neuritis.

Halmagyi GM, Weber KP, Curthoys IS.

Source

Department of Neurology, Royal Prince Alfred Hospital, Camperdown NSW 2050, Sydney, NSW, Australia. michael@icn.usyd.edu.au

Abstract

PURPOSE:

To review the extent and mechanism of the recovery of vestibular function after sudden, isolated, spontaneous, unilateral loss of most or all peripheral vestibular function - usually called acute vestibular neuritis.

METHODS:

Critical review of published literature and personal experience.

RESULTS:

The symptoms and signs of acute vestibular neuritis are vertigo, vomiting, nystagmus with ipsiversive slow-phases, ipsiversive lateropulsion and ocular tilt reaction (the static symptoms) and impairment of vestibulo-ocular reflexes from the ipsilesional semicircular canals on impulsive testing (the dynamic symptoms). Peripheral vestibular function might not improve and while static symptoms invariably resolve, albeit often not totally, dynamic symptoms only improve slightly if at all.

CONCLUSIONS:

The persistent loss of balance that some patients experience after acute vestibular neuritis can be due to inadequate central compensation or to incomplete peripheral recovery and vestibular rehabilitation has a role in the treatment of both.

PMID: 20086281 [PubMed - indexed for MEDLINE]

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Publication Types, MeSH Terms

2.

Semin Neurol. 2009 Nov;29(5):541-7. Epub 2009 Oct 15.

Vestibular evoked myogenic potentials (VEMPs): usefulness in clinical neurotology.

Brantberg K.

Source

Department of Audiology, Karolinska Hospital, Stockholm, Sweden. krister.brantberg@karolinska.se

Abstract

Testing vestibular evoked myogenic potentials (VEMPs) may be the most important new clinical test for evaluation of vestibular function developed during the past 100 years since the introduction of the caloric test. VEMPs are easily recordable and therefore suitable for everyday testing in clinical neurotology. VEMPs in response to air-conducted sound stimulation using surface electrodes over the sternocleidomastoid muscles reveal saccular function, inferior vestibular nerve function, and vestibulocollic connections. At present, VEMPs are of clinical importance for estimating the severity of peripheral vestibular damage due to different pathophysiologic processes such as Ménière's disease, vestibular neuritis, and vestibular schwannoma. VEMPs can also be used to document vestibular hypersensitivity to sounds (Tullio phenomenon). In addition, VEMP testing constitutes an electrophysiologic method that is able to detect subclinical lesions in central vestibular pathways in patients with multiple sclerosis. In the near future, testing ocular VEMPs (OVEMPs) in response to bone-conducted vibration may prove to be of clinical importance for the evaluation of utricular function.

Thieme Medical Publishers.

PMID: 19834866 [PubMed - indexed for MEDLINE]

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Publication Types, MeSH Terms

3.

Otol Neurotol. 2009 Sep;30(6):806-11.

Lessons from follow-up examinations in patients with vestibular neuritis: how to interpret findings from vestibular function tests at a compensated stage.

Park H, Shin J, Jeong Y, Kwak H, Lee Y.

Source

Department of Otorhinolaryngology-Head and Neck Surgery, Konkuk University School of Medicine, Seoul, Korea. hpark@kuh.ac.kr

Abstract

OBJECTIVES:

Most patients complaining of dizziness seek medical services in the interictal period, which is thought to be a compensated stage. Thus, we wanted to investigate the results of vestibular function tests (VFTs) at a compensated stage in patients with vestibular neuritis to determine the presence and the sides of vestibular hypofunction.

STUDY DESIGN:

Retrospective case series review.

METHODS:

We analyze the results of VFT including spontaneous nystagmus (SN), caloric, vibration-induced nystagmus (VIN), head-shaking nystagmus (HSN), and subjective visual vertical (SVV) tests in 38 patients (M/F = 23:15; age range, 15-85 yr) with vestibular neuritis observed at around 2 months after the onset of vertigo.

RESULTS:

Thirty-seven (97%) of 39 patients showed pathologic results in at least 1 test. Pathologic results, based on caloric, SN, VIN, HSN, and SVV tests, were observed in 29 (76%), 20 (53%), 24 (63%), 33 (87%), and 15 patients (39%). Twenty-nine showed pathologic canal paresis (CP) on the affected side and 9 patients (24%) showed normal CP. There was no patient with pathologic CP on the intact side. In 29 patients with pathologic CP, pathologic results, based on SN, VIN, HSN, and SVV tests, were observed in 16 (55%), 20 (69%), 26 (90%), and 13 patients (45%). Three (10%) of 29 patients showed pathologic VIN or HSN, indicating that the intact side is pathologic. In 9 patients with normal CP, pathologic results, based on SN, VIN, HSN, and SVV tests, were observed in 4 (44%), 4, 7 (78%), and 2 patients (22%). Five (56%) of 9 patients showed pathologic results on the intact side at least in 1 test, and the pathologic sides by each test were not the same.

CONCLUSION:

Our findings suggest that we can detect vestibular imbalance in patients with unilateral vestibular hypofunction through a set of VFTs even when CP is normal at a compensated stage. The CP side indicated by caloric test was the real affected side when CP was pathologic, even if the results of other tests were normal or rarely indicated that the intact side was pathologic. If CP was within reference range, other tests can show the previous presence of vestibular imbalance; however, they could not predict the side of the vestibular hypofunction. These data provide strong support for enrolling a set of VFT when evaluating a dizzy patient.

PMID: 19638945 [PubMed - indexed for MEDLINE]

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Publication Types, MeSH Terms

4.

Otolaryngol Clin North Am. 2011 Apr;44(2):361-5, viii.

Vestibular neuritis.

Goddard JC, Fayad JN.

Source

House Clinic, 2100 West Third Street, Los Angeles, CA 90057, USA.

Abstract

The epidemiology, diagnostic features, differential diagnosis, and treatment of vestibular neuritis are reviewed. The authors present considerations for physical examination, imaging, and management in both the acute and chronic phases of this disease. The authors also present a dizziness questionnaire in the Appendix of this publication.

Copyright © 2011 Elsevier Inc. All rights reserved.

PMID: 21474010 [PubMed - indexed for MEDLINE]

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Publication Types, MeSH Terms

5.

Cochrane Database Syst Rev. 2011 May 11;(5):CD008607.

Corticosteroids for the treatment of idiopathic acute vestibular dysfunction (vestibular neuritis).

Fishman JM, Burgess C, Waddell A.

Source

UCL Institute of Child Health, 30 Guilford Street, London, UK, WC1N 1EH.

Abstract

BACKGROUND:

Idiopathic acute vestibular dysfunction (vestibular neuritis) is the second most common cause of peripheral vertigo after benign paroxysmal positional vertigo (BPPV) and accounts for 7% of the patients who present at outpatient clinics specialising in the treatment of dizziness. The exact aetiology of the condition is unknown and the effects of corticosteroids on the condition and its recovery are uncertain.

OBJECTIVES:

To assess the effectiveness of corticosteroids in the management of patients with idiopathic acute vestibular dysfunction (vestibular neuritis).

SEARCH STRATEGY:

We searched the Cochrane ENT Group Trials Register; CENTRAL; PubMed; EMBASE; CINAHL; Web of Science; BIOSIS Previews; Cambridge Scientific Abstracts; ICTRP and additional sources for published and unpublished trials. The date of the most recent search was 28 December 2010.

SELECTION CRITERIA:

Randomised controlled trials comparing corticosteroids with placebo, no treatment or other active treatments, for adults diagnosed with idiopathic acute vestibular dysfunction.

DATA COLLECTION AND ANALYSIS:

Two authors independently selected studies from the search results and extracted data. Three authors independently assessed risk of bias.

MAIN RESULTS:

Four trials, involving a total of 149 participants, compared the effectiveness of oral corticosteroids against placebo. All the trials were small and of low methodological quality. Although there was an overall significant effect of corticosteroids compared with placebo medication on complete caloric recovery at one month (risk ratio (RR) of 2.81; 95% confidence interval (CI) 1.32 to 6.00, P = 0.007), no significant effect was seen on complete caloric recovery at 12 months (RR 1.58; 95% CI 0.45 to 5.62, P = 0.48), or on the extent of caloric recovery at either one month (mean difference (MD) 9.60%; 95% CI -20.66 to 39.86, P = 0.53) or at 12 months (MD 6.83%; 95% CI -27.69 to 41.36, P = 0.70). In addition, there was no significant difference between corticosteroids and placebo medication in the symptomatic recovery of vestibular function following idiopathic acute vestibular dysfunction with respect to vertigo at 24 hours (RR 0.39; 95% CI 0.04 to 3.57, P = 0.40) and use of the Dizziness Handicap Inventory score at one, three, six and 12 months.

AUTHORS' CONCLUSIONS:

Overall, there is currently insufficient evidence from these trials to support the administration of corticosteroids to patients with idiopathic acute vestibular dysfunction. We found no trials with a low risk of methodological bias that used the highest level of diagnostic criteria and outcome measures. We recommend that future studies should include health-related quality of life and symptom-based outcome measures, in addition to objective measures of vestibular improvement, such as caloric testing and electronystagmography.

1.

Clin Neurophysiol. 2010 May;121(5):636-51. Epub 2010 Jan 18.

Vestibular evoked myogenic potentials: past, present and future.

Rosengren SM, Welgampola MS, Colebatch JG.

Source

Prince of Wales Clinical School and Medical Research Institute, University of New South Wales, Randwick, Sydney, NSW 2031, Australia. s.rosengren@unsw.edu.au

Abstract

Since the first description of sound-evoked short-latency myogenic reflexes recorded from neck muscles, vestibular evoked myogenic potentials (VEMPs) have become an important part of the neuro-otological test battery. VEMPs provide a means of assessing otolith function: stimulation of the vestibular system with air-conducted sound activates predominantly saccular afferents, while bone-conducted vibration activates a combination of saccular and utricular afferents. The conventional method for recording the VEMP involves measuring electromyographic (EMG) activity from surface electrodes placed over the tonically-activated sternocleidomastoid (SCM) muscles. The "cervical VEMP" (cVEMP) is thus a manifestation of the vestibulo-collic reflex. However, recent research has shown that VEMPs can also be recorded from the extraocular muscles using surface electrodes placed near the eyes. These "ocular VEMPs" (oVEMPs) are a manifestation of the vestibulo-ocular reflex. Here we describe the historical development and neurophysiological properties of the cVEMP and oVEMP and provide recommendations for recording both reflexes. While the cVEMP has documented diagnostic utility in many disorders affecting vestibular function, relatively little is known as yet about the clinical value of the oVEMP. We therefore outline the known cVEMP and oVEMP characteristics in common central and peripheral disorders encountered in neuro-otology clinics.

Copyright 2009 International Federation of Clinical Neurophysiology. Published by Elsevier Ireland Ltd. All rights reserved.

Comment in

Clin Neurophysiol. 2010 May;121(5):631-3.

PMID: 20080441 [PubMed - indexed for MEDLINE]

Related citations

Publication Types, MeSH Terms

2.

Semin Neurol. 2009 Nov;29(5):541-7. Epub 2009 Oct 15.

Vestibular evoked myogenic potentials (VEMPs): usefulness in clinical neurotology.

Brantberg K.

Source

Department of Audiology, Karolinska Hospital, Stockholm, Sweden. krister.brantberg@karolinska.se

Abstract

Testing vestibular evoked myogenic potentials (VEMPs) may be the most important new clinical test for evaluation of vestibular function developed during the past 100 years since the introduction of the caloric test. VEMPs are easily recordable and therefore suitable for everyday testing in clinical neurotology. VEMPs in response to air-conducted sound stimulation using surface electrodes over the sternocleidomastoid muscles reveal saccular function, inferior vestibular nerve function, and vestibulocollic connections. At present, VEMPs are of clinical importance for estimating the severity of peripheral vestibular damage due to different pathophysiologic processes such as Ménière's disease, vestibular neuritis, and vestibular schwannoma. VEMPs can also be used to document vestibular hypersensitivity to sounds (Tullio phenomenon). In addition, VEMP testing constitutes an electrophysiologic method that is able to detect subclinical lesions in central vestibular pathways in patients with multiple sclerosis. In the near future, testing ocular VEMPs (OVEMPs) in response to bone-conducted vibration may prove to be of clinical importance for the evaluation of utricular function.

Thieme Medical Publishers.

PMID: 19834866 [PubMed - indexed for MEDLINE]

Related citations

Publication Types, MeSH Terms

3.

Neurology. 2005 May 24;64(10):1682-8.

Characteristics and clinical applications of vestibular-evoked myogenic potentials.

Welgampola MS, Colebatch JG.

Source

Institute of Neurological Sciences, Prince of Wales Hospital and School of Medicine, University of New South Wales, Sydney, Australia. m.welgampola@unsw.edu.au

Abstract

A recent technique of assessing vestibular function, the vestibular-evoked myogenic potential (VEMP), is an otolith-mediated, short-latency reflex recorded from averaged sternocleidomastoid electromyography in response to intense auditory clicks delivered via headphones. Since their first description 10 years ago, VEMPs are now being used by investigators worldwide, and characteristic changes observed with aging and in a variety of peripheral and central vestibulopathies have been described. Additional methods of evoking VEMPs, which use air- and bone-conducted short-tone bursts, forehead taps, and short-duration transmastoid direct current (DC) stimulation, have been described, and these complement the original technique. Click-evoked VEMPs are attenuated or absent in a proportion of patients with vestibular neuritis, herpes zoster oticus, late Meniere disease, and vestibular schwannomas; their amplitudes are increased and thresholds are pathologically lowered in superior semicircular canal dehiscence presenting with the Tullio phenomenon. VEMPs evoked by clicks and DC are useful when monitoring the efficacy of intratympanic gentamicin therapy used for chemical vestibular ablation. Prolonged p13 and n23 peak latencies and decreased amplitudes have been observed in association with central vestibulopathy. VEMPs evoked by clicks are a robust, reproducible screening test of otolith function. DC stimulation enables differentiation of labyrinthine from retrolabyrinthine lesions; bone-conducted stimuli permit VEMP recording despite conductive hearing loss and deliver a relatively larger vestibular stimulus for a given level of auditory perception.

PMID: 15911791 [PubMed - indexed for MEDLINE]

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Publication Types, MeSH Terms

4.

Curr Opin Neurol. 2006 Feb;19(1):21-5.

Function tests of the otolith or statolith system.

Kingma H.

Source

Division of Balance Disorders, Department of ENT, University Hospital Maastricht, Maastricht Research Institute Brain and Behaviour, Maastricht University, The Netherlands. hki@skno.azm.nl

Abstract

PURPOSE OF REVIEW:

This review aims to provide an overview of recent advances in tests to evaluate otolith function over the last 2 years.

RECENT FINDINGS:

Over the last 2 years, many papers have focused on the application of the vestibular evoked myogenic potentials (VEMP). Several aspects are under survey: a search for optimal stimuli, search for normative data, search for which labyrinthine function losses and what kind of pathologies induce abnormal VEMPs. The review shows that some fundamental problems still have to be solved to improve reproducibility and to increase sensitivity. Other research and modelling is performed to find out how the brain distinguishes tilts from translations. Several papers support routine implementation of subjective visual vertical (SVV) measurements (in rest and during centrifugation) in the standard vestibular test battery. Interesting reports mention short latency vestibulo-ocular reflex induced by taps and short auditory stimuli. One report mentions the impact of otolith dysfunction upon spontaneous nystagmus and head shaking nystagmus.

SUMMARY:

Although validation is still needed and in progress, the state of the art laboratory should consider the following tests for an evaluation of otolith function as relevant: slow tandem gait, VEMP, SVV during centrifugation.

PMID: 16415673 [PubMed - indexed for MEDLINE]

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Publication Types, MeSH Terms

5.

Am J Audiol. 2004 Dec;13(2):135-43.

Vestibular evoked myogenic potentials: history and overview.

Zhou G, Cox LC.

Source

Massachusetts Eye and Ear Infirmary, Boston, USA.

Abstract

Vestibular evoked myogenic potential (VEMP) testing is a relatively new diagnostic tool that is in the process of being investigated in patients with specific vestibular disorders. In this review, we will outline the history and provide a current review of VEMP research. Briefly, the VEMP is a biphasic response elicited by loud clicks or tone bursts recorded from the tonically contracted sternocleidomastoid muscle. Current data suggest that the VEMP is a vestibulo-collic reflex whose afferent limb arises from acoustically sensitive cells in the saccule, with signals conducted via the inferior vestibular nerve. We will review the history of the response and detail the anatomy and physiology associated with the test. We will discuss specific VEMP applications in the diagnosis of Meniere's disease, vestibular schwannoma, vestibular hypersensitivity disorders, vestibular neuritis, multiple sclerosis, and other brainstem lesions.

PMID: 15903139 [PubMed - indexed for MEDLINE]

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Publication Types, MeSH Terms

6.

Clin Otolaryngol. 2005 Feb;30(1):9-15.

Superior canal dehiscence: review of a new condition.

Banerjee A, Whyte A, Atlas MD.

Source

Department of ENT, James Cook University Hospital, Middlesbrough, UK. anirvan.banerjee@stees.nhs.uk

Abstract

A new cause of sound and pressure induced vertigo, superior canal dehisence, is described. Auditory manifestations include hyperacusis to bone-conducted sounds and conductive hearing loss with normal acoustic reflexes. The diagnosis is reached by a directed history, documentation of upward and torsional nystagmus evoked by sound and pressure, and radiology. Acoustic reflexes and VEMP (vestibular evoked myogenic potentials) aid in the identification of patients with an apparent conductive loss with normal acoustic reflexes or have an asymptomatic dehiscense on radiology. Treatment involves avoidance of the precipitating stimuli. Surgical treatment, by resurfacing the dehiscence, is considered in patients with more severe symptoms.

PMID: 15748182 [PubMed - indexed for MEDLINE]

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