Vestibular Paroxysmia in Vestibular Neuritis: A Case Report

Ori, Michele; Gambacorta, Valeria; Ricci, Giampietro; Faralli, Mario

doi:10.4081/audiores.2018.206

Cited by 3 publications

(3 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The other female patient had neuromyelitis optica spectrum disorder, and she gradually developed optic neuritis, extremity numbness, and Sjogren's syndrome by the age of 37. As previously reported in the literature, neuroinflammatory and demyelinating disorders may induce ectopic neural electrical activity (Smith & McDonald 1982;Schwaber & Whetsell 1992;Ori et al 2018;Laakso et al 2020). The present study results suggest that the neurovascular conflict was responsible for the majority of, but not all, cases of typewriter tinnitus.…”

Section: Discussionsupporting

confidence: 83%

Typewriter Tinnitus: Value of ABR as a Diagnostic and Prognostic Indicator

et al. 2023

View full text Add to dashboard Cite

Introduction: Typewriter tinnitus refers to a special kind of staccato tinnitus, which is mostly described by patients as Morse code, popcorn, or machine-gun. It has been accepted that the mechanism of typewriter tinnitus is caused by the neurovascular compression of the cochleovestibular nerve. Patients who suffered from typewriter tinnitus have exhibited a good response to carbamazepine or oxcarbazepine, but there is a risk of recurrence after treatment cessation. The present study aims to determine the value of auditory brainstem response (ABR) in diagnosing typewriter tinnitus and predicting relapse after drug withdrawal. Methods: Patients who presented with typewriter tinnitus from March 2019 to March 2022 were included for the present retrospective study. The auditory and vestibular test results and drug treatment effects were collected and analyzed. Patients with idiopathic unilateral subjective tinnitus, who were matched by age to patients with typewriter tinnitus at a ratio of 2:1, were consecutively recruited for the control group. Results: Eighteen patients with typewriter tinnitus and 38 controls were included. Ears with typewriter tinnitus had longer interpeak latency (IPL) I-III, and wave III and V latencies, and a higher ratio of IPL I-III ≥2.3 ms based on ABR, when compared to the unaffected side and controls (p<0.05). Seventeen patients with typewriter tinnitus responded positively to medication. Among these patients, seven patients had a relapse after drug cessation, while 10 patients did not have a relapse. The relapse group had significantly longer IPL I-III and wave V latency, older age, and poorer hearing, when compared to the nonrelapse group (p < 0.05). Furthermore, IPL I-III had the largest area under the receiver operating characteristic curve, and the optimal cutoff was 2.4 ms (sensitivity, 100.0%; specificity, 66.7%). There were no significant differences in other demography or other clinical test results between the relapse and nonrelapse groups (p > 0.05). Ramsay Hunt syndrome and neuromyelitis optica spectrum disorders were identified in two cases. Conclusion: Prolonged IPL I-III based on ABR can help in the diagnosis of typewriter tinnitus and its prognosis after treatment cessation. Patients with IPL I-III greater than 2.4 ms, older age and poorer hearing are more likely to relapse. In addition to the neurovascular conflict of the cochleovestibular nerve, the etiologies of neuroinflammation and demyelinating diseases are also possible for typewriter tinnitus.

show abstract

Section: Discussionsupporting

confidence: 83%

Typewriter Tinnitus: Value of ABR as a Diagnostic and Prognostic Indicator

et al. 2023

View full text Add to dashboard Cite

show abstract

“…The ephaptic effect consists of the exchange of information between adjacent nerve fibers (in the case of microdemyelination), resulting from the formation of an artificial synapse through their coupling. Beyond nerve fibers, the ephaptic effect can involve neurons: neurons are electrogenic and produce electric fields that can affect the electrical excitability of neighboring neurons almost instantaneously (electric field coupling) [ 4 , 11 , 12 , 13 , 14 ]. In order to propose a pathogenetic model useful for the interpretation of the semiological findings evoked by hyperventilation, for simplicity, we considered the ephaptic effect and the transient loss of vestibular compensation as opposing mechanisms, i.e., excitatory and inhibitory, respectively.…”

Section: Discussionmentioning

confidence: 99%

Evolution of Hyperventilation-Induced Nystagmus in Acute Unilateral Vestibulopathy—Interpretative Model and Etiopathogenetic Hypotheses

Frati,

D’Orazio,

Gambacorta

et al. 2024

Audiology Research

Self Cite

View full text Add to dashboard Cite

Hyperventilation induces metabolic changes that can elicit nystagmus (hyperventilation-induced nystagmus, HVIN) in various vestibular disorders, revealing vestibular imbalance and bringing out central or peripheral asymmetries. In acute unilateral vestibulopathy (AUVP, namely vestibular neuritis), hyperventilation can induce different patterns of nystagmus (excitatory, inhibitory, or negative), disclosing or modifying existing static vestibular asymmetries through its ability to invalidate compensation or increase peripheral excitability. In this context, we followed the evolutionary stages of HVIN in AUVP across 35 consecutive patients, with the goal of assessing alterations in the oculomotor pattern caused by hyperventilation over time. In the acute phase, the incidence of the excitatory pattern (and the strongly excitatory one, consisting of a reversal nystagmus evoked by hyperventilation) was significantly higher compared to the inhibitory pattern; then, a progressive reduction in the incidence of the excitatory pattern and a concomitant gradual increase in the incidence of the inhibitory one were observed in the follow-up period. Assuming the role of the ephaptic effect and the transient loss of vestibular compensation as opposing mechanisms, i.e., excitatory and inhibitory, respectively, the oculomotor pattern evoked by hyperventilation is the result of the interaction of these two factors. The data obtained allowed us to hypothesize an interpretative model regarding the pathogenetic aspects of responses evoked by hyperventilation and the etiologies of the disease: according to our hypotheses, the excitatory pattern implies a neuritic (viral) form of AUVP; instead, the inhibitory (and negative) one can be an expression of both the neuritic (viral) and vascular forms of the disease.

show abstract

“…The possible ambiguous symptomatology of VP may require an ENT specialist to differentiate this pathology from Ménière's disease or migraine-induced vestibular disorder [29]. Complaints of VP may be accompanied by auditory symptoms -most often tinnitus, less often sensorineural hearing loss, and visual symptoms (nystagmus, often induced by hyperventilation and oscillopsia) [30][31][32][33][34][35]. Brand et al also described a correlation, in 56% of the patients they studied, between VP and a fear of heights [36].…”

Section: Introductionmentioning

confidence: 99%

Literature review and two study cases of vestibular paroxysmia from an otorhinolaryngology centre

Jankowska,

Pietrzak,

Rosiak

et al. 2023

J Hear Sci

View full text Add to dashboard Cite

IntroductionVestibular paroxysmia is a rare disorder of the balance system manifested by recurrent attacks of vertigo, the etiology of which is associated with compression of a blood vessel on the vestibulocochlear nerve. The exact mechanism for triggering the symptoms is not fully understood. The condition occurs in all age groups and without gender predilection. The purpose of the study was to review the literature on vestibular paroxysmia, discuss criteria for the diagnosis of the disease, diagnostic management, proposed therapy, and present clinical cases from the authors’ own practice.Material and methodsA review of the scientific literature was conducted via the PubMed database using the keywords “vestibular paroxysmia,” “neurovascular conflict cochlear nerve,” and “neurovascular conflict vestibular nerve”. PRISMA guidelines for systematic reviews were applied.ResultsThere were 146 publications found; after analysis of titles and abstracts, 56 were included in the review; another 10 manuscripts were identified during reference review. Among them, 11 studies were devoted to diagnostic imaging, 19 described the clinical course of the condition based on retrospective studies, 15 were case reports, and 11 other reports and reviews. Following evaluation of this literature, two clinical cases of vestibular paroxysm from the authors’ own practice are described. These cases are presented along with their diagnosis and therapy.ConclusionsImaging studies are of significant value in diagnosing many vascular–neural conflicts, but for vestibular paroxysmia the diagnosis is made on the basis of clinical symptoms and according to the division proposed by the Bárány Society in 2016. Pharmacological therapy is recommended, and response to therapy is one of the criteria for diagnosing the condition. Surgical treatment is reserved for the most severe cases.

show abstract

Vestibular Paroxysmia in Vestibular Neuritis: A Case Report

Cited by 3 publications

References 12 publications

Typewriter Tinnitus: Value of ABR as a Diagnostic and Prognostic Indicator

Typewriter Tinnitus: Value of ABR as a Diagnostic and Prognostic Indicator

Evolution of Hyperventilation-Induced Nystagmus in Acute Unilateral Vestibulopathy—Interpretative Model and Etiopathogenetic Hypotheses

Literature review and two study cases of vestibular paroxysmia from an otorhinolaryngology centre

Contact Info

Product

Resources

About