Neurotology

Inferior vestibular neuritis in a fighter pilot: A case report

June 11, 2013     Xie Su Jiang, MD, PhD; Jia Hong Bo, PhD; Xu Po, MS; and Zheng Ying Juan, BSC
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Abstract

Spatial disorientation in airplane pilots is a leading factor in many fatal flying accidents. Spatial orientation is the product of integrative inputs from the proprioceptive, vestibular, and visual systems. One condition that can lead to sudden pilot incapacitation in flight is vestibular neuritis. Vestibular neuritis is commonly diagnosed by a finding of unilateral vestibular failure, such as a loss of caloric response. However, because caloric response testing reflects the function of only the superior part of the vestibular nerve, it cannot detect cases of neuritis in only the inferior part of the nerve. We describe the case of a Chinese naval command fighter pilot who exhibited symptoms suggestive of vestibular neuritis but whose caloric response test results were normal. Further testing showed a unilateral loss of vestibular evoked myogenic potentials (VEMPs). We believe that this pilot had pure inferior nerve vestibular neuritis. VEMP testing plays a major role in the diagnosis of inferior nerve vestibular neuritis in pilots. We also discuss this issue in terms of aeromedical concerns.

Bilateral multicanal benign paroxysmal positional vertigo coexisting with a vestibular schwannoma: Case report

January 1, 2011     Selmin Karatayli-Ozgursoy, MD, Greta C. Stamper, AuD, Larry B. Lundy, MD, and David A. Zapala, PhD
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Abstract

We describe a rarely encountered case of coexisting bilateral multicanal benign paroxysmal positional vertigo (BPPV) and vestibular schwannoma in a 56-year-old woman. The patient had presented with a 10-year history of dizziness and imbalance, and her vestibular findings were perplexing. We decided on a working diagnosis of BPPV and began treatment. After several months of canalith repositioning maneuvers had failed to resolve her symptoms, we obtained magnetic resonance imaging, which revealed the presence of the vestibular schwannoma. This case serves as a reminder of the importance of differentiating between central and peripheral vestibular disorders, as well as central and anterior canal BPPV-induced down-beating nystagmus in order to establish the correct diagnosis and initiate appropriate treatment.

The clinical reliability of vestibular evoked myogenic potentials

March 31, 2010     Matthew L. Bush, MD, Raleigh O. Jones, MD, and Jennifer B. Shinn, PhD
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Abstract

Vestibular evoked myogenic potential (VEMP) testing has gained popularity as a diagnostic modality in otolaryngology and audiology. To maximize the utility of this test, examiners need the availability of ideal test settings and reliable norms. We conducted a prospective study of 8 subjects with no history of neurotologic symptoms to examine the test-retest consistency of VEMP testing and to analyze the impact of stimulus type and muscle tension monitoring. All subjects underwent VEMP testing with two stimuli: a 500-Hz tone and a click. With each stimulus, testing was completed with and without monitoring of sternocleidomastoid muscle tension. All subjects participated in an initial testing session and then returned for a repeat testing session 2 to 4 weeks later. We measured the amplitude of primary waveforms P13 (first positive peak) and N23 (first negative peak) and analyzed the reliability and reproducibility of the mean amplitude asymmetry of these VEMP peaks. The P13 component of the VEMP (specificity: 86.25%) demonstrated a more stable amplitude than did the N23 component (specificity: 70.50%). Therefore, our statistical analysis of the effect of stimulus type and muscle tension monitoring on test-retest reliability was limited to the P13 waveform. We found that neither the type of stimulus nor the presence or absence of muscle tension monitoring had any statistically significant effect on amplitude asymmetry. We concluded that in VEMP testing, the P13 component was more specific than the N23 component in identifying normal subjects and that the P13 component provided consistent results across test sessions, regardless of the type of stimulus or the presence or absence of muscle tension monitoring.

Pediatric neurotology

July 31, 2009     Kenneth H. Brookler, MD, MS, FRCSC
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Dizziness in a SCUBA diver

April 30, 2009     Kenneth H. Brookler, MD, MS, FRCSC
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Can a disorder of the vestibular system underlie an etiology for migraine?

April 30, 2008     Kenneth H. Brookler, MD, FRCSC
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Clinical findings in a patient with aural fullness

February 1, 2008     Kenneth H. Brookler, MD, FRCSC
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Tympanometry

October 31, 2007     Mohamed Hamid, MD, PhD and Kenneth H. Brookler, MD, FRCSC
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Clinical management of a patient with a 12-year history of a balance disorder

July 31, 2007     Kenneth H. Brookler, MD, FRCSC; Mohamed A. Hamid, MD, PhD
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A 69-year-old man presented with a 12-year history of balance difficulties. He had been admitted to a hospital 12 years earlier for treatment of nausea, vomiting, and left-upper-quadrant pain, and he was given intravenous fluids and antibiotics. Treatment alleviated his symptoms, but he noticed that once he was out of bed, he was unable to maintain his balance and had to hold on to the IV pole. Ever since then, his symptoms had persisted.

 

ENG, sinusoidal vertical-axis rotation testing, and MRI in a patient with disequilibrium and nausea

February 1, 2007     Kenneth H. Brookler, MD; Mohamed A. Hamid, MD, PhD
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Audiometry: Masking

September 30, 2006     Mohamed A. Hamid, MD, PhD; Kenneth H. Brookler, MD
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