Assessment of balance and vestibular functions in patients with idiopathic sudden sensorineural hearing loss

Abstract

This study investigated the relationship among the severity of hearing impairment, vestibular function and balance function in patients with idiopathic sudden sensorineural hearing loss (ISSNHL). A total of 35 ISSNHL patients (including 21 patients with vertigo) were enrolled. All of the patients underwent audiometry, sensory organization test (SOT), caloric test, cervical vestibular-evoked myogenic potential (cVEMP) test and ocular vestibular-evoked myogenic potential (oVEMP) test. Significant relationship was found between vertigo and hearing loss grade (P=0.009), and between SOT VEST grade and hearing loss grade (P=0.001). The abnormal rate of oVEMP test was the highest, followed by the abnormal rates of caloric and cVEMP tests, not only in patients with vertigo but also in those without vertigo. The vestibular end organs were more susceptible to damage in patients with vertigo (compared with patients without vertigo). Significant relationship was found between presence of vertigo and SOT VEST grade (P=0.010). We demonstrated that vestibular end organs may be impaired not only in patients with vertigo but also in patients without vertigo. The cochlear and vestibular impairment could be more serious in patients with vertigo than in those without vertigo. Vertigo does not necessarily bear a causal relationship with the impairment of the vestibular end organs. SOT VEST grade could be used to reflect the presence of vertigo state in the ISSNHL patients. Apart from audiometry, the function of peripheral vestibular end organs and balance function should be evaluated to comprehensively understand ISSNHL. Better assessment of the condition will help us in clinical diagnosis, treatment and prognosis evaluation of ISSNHL.

Vestibular Dysfunctions in Sudden Sensorineural Hearing Loss: A Systematic Review and Meta-analysis

“…Of the remaining 25 investigations, 7 articles were excluded from the final analysis due to duplicated data containing the same participants or to not providing sufficient information to calculate these variables. Finally, a total of 18 eligible articles met our inclusion criteria and were included in the final meta-analysis ( 7 , 8 , 14 , 17 – 19 , 24 – 35 ) (Figure 1 ).…”

“…The main demographic features and clinical characteristics of the patients are listed in Table 1 . Of the 18 studies included, 15 were retrospective studies ( 7 , 14 , 17 – 19 , 24 – 33 ), 2 were prospective studies ( 8 , 35 ), and 1 was a prospective/retrospective study ( 34 ), and the studies covered a total population of 1,468 subjects. The mean age ranged from 44 to 62 years, with the proportion of females ranging from 35 to 74%.…”

“…The occurrence rate of vertigo was also summarized as a list. Concerning the types of vestibular examinations, the caloric test was performed in 16 studies ( 7 , 8 , 14 , 17 – 19 , 24 – 33 ), the cVEMP test was performedin 13 studies ( 7 , 8 , 14 , 17 – 19 , 24 – 28 , 34 , 35 ), and the oVEMP test was performed in 5 studies ( 17 , 24 , 26 , 27 , 34 ). In all 18 investigations, hearing recovery for abnormal and normal caloric response was provided in 7 studies ( 18 , 19 , 27 , 29 – 31 , 33 ), the number of patients with hearing improvement with abnormal and normal cVEMP response was provided in 4 studies ( 18 , 19 , 25 , 27 ), and 1 study provided hearing outcomes for abnormal and normal oVEMP responses ( 27 ).…”

Vestibular prognosis in idiopathic sudden sensorineural hearing loss with vestibular dysfunction treated with oral or intratympanic glucocorticoids: a protocol for randomized controlled trial

“…The recording procedure is the same as that in cVEMP, and the lowest intensity with a characteristic waveform is defined as threshold. We define the abnormal result of oVEMP as (1) absence of meaningful waveform (where the waveforms with negative-positive peak, N1-P1, could be recognized and well repeatable); (2) the threshold out of range compared with age-specific normative data; and (3) amplitude asymmetry ratio (AR) ≥ 40% [19,20].…”

Vestibular prognosis in idiopathic sudden sensorineural hearing loss with vestibular dysfunction treated with oral or intratympanic glucocorticoids: a protocol for randomized controlled trial

“…The recording procedure is the same as that in cVEMP and the lowest intensity with a characteristic waveform is defined as threshold. We define the abnormal result of oVEMP as 1) absence of meaningful waveform (where the waveforms with negative-positive peak, N1-P1, could be recognized and well repeatable); 2) the threshold out of range compared with age-specific normative data; 3) amplitude asymmetry ratio (AR) ≥40% (20,21).…”