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.

Keywords

idiopathic sudden sensorineural hearing loss / sensory organization test / cervical vestibular-evoked myogenic potential / ocular vestibular-evoked myogenic potential

References

[1] StachlerRJ, ChandrasekharSS, ArcherSM, et al. . Clinical practice guideline: sudden hearing loss. Otolaryngol Head Neck Surg, 2012, 146: S1-S35 PMID: 22383545

[2] SchuknechtHF, KimuraRS, NaufalPM. The pathology of sudden deafness. Acta Otolaryngol, 1973, 76(2): 75-97 PMID: 4771957

[3] BelalA Jr. Pathology of vascular sensorineural hearing impairment. Laryngoscope, 1980, 90: 1831-1839 PMID: 7432065

[4] GussenR. Sudden deafness of vascular origin: a human temporal bone stdy. Ann Otol Rhinol Laryngol, 1976, 85: 94-100 PMID: 1259320

[5] McCabeBF. Autoimmune sensorineural hearing loss. Ann Otol Rhinol Laryngol, 1979, 88: 585-589 PMID: 496191

[6] SimmonsFB. Theory of membrane breaks in sudden hearing loss. Arch Otolaryngol, 1968, 88(1): 41-48 PMID: 5660028

[7] ShepardNT, JacobsonGP. The caloric irrigation test. Handb Clin Neurol, 2016, 137: 119-131 PMID: 27638067

[8] ColebatchJG, RosengrenSM, WelgampolaMS. Vestibular-evoked myogenic potentials. Handb Clin Neurol, 2016, 137: 133-155 PMID: 27638068

[9] RosengrenSM, WelgampolaMS, ColebatchJG. Vestibular evoked myogenic potentials: past, present and future. Clin Neurophysiol, 2010, 121(5): 636-651 PMID: 20080441

[10] KantnerC, GürkovR. Characteristics and clinical applications of ocular vestibular evoked myogenic potentials. Hear Res, 2012, 294(1-2): 55-63 PMID: 23123220

[11] PelosiS, SchusterD, JacobsonGP, et al. . Clinical characteristics associated with isolated unilateral utricular dysfunction. Am J Otolaryngol, 2013, 34(5): 490-495 PMID: 23759133

[12] FujimotoC, EgamiN, KinoshitaM, et al. . Factors affecting postural instability in Meniere’s disease. Otolaryngol Head Neck Surg, 2013, 149(5): 759-765 PMID: 23980034

[13] HorakFB, NashnerLM, DienerHC. Postural strategies associated with somatosensory and vestibular loss. Exp Brain Res, 1990, 82(1): 167-177 PMID: 2257901

[14] MirkaA, BlackFO. Clinical application of dynamic posturography for evaluating sensory integration and vestibular dysfunction. Neurol Clin, 1990, 8(2): 351-359 PMID: 2193216

[15] MonsellEM, FurmanJM, HerdmanSJ, et al. . Computerized dynamic platform posturography. Otolaryngol Head Neck Surg, 1997, 117(4): 394-398 PMID: 9339802

[16] IwasakiS, TakaiY, OzekiH, et al. . Extent of lesions in idiopathic sudden hearing loss with vertigo: study using click and galvanic vestibular evoked myogenic potentials. Arch Otolaryngol Head Neck Surg, 2005, 131(10): 857-862 PMID: 16230586

[17] KorresS, StamatiouGA, GkoritsaE, et al. . Prognosis of patients with idiopathic sudden hearing loss: role of vestibular assessment. J Laryngol Otol, 2011, 125(3): 251-257 PMID: 21054906

[18] FujimotoC, EgamiN, KinoshitaM, et al. . Involvement of vestibular organs in idiopathic sudden hearing loss with vertigo: an analysis using oVEMP and cVEMP testing. Clin Neurophysiol, 2015, 126(5): 1033-1038 PMID: 25200460

[19] NiuX, ZhangY, ZhangQ, et al. . The relationship between hearing loss and vestibular dysfunction in patients with sudden sensorineural hearing loss. Acta Otolaryngol, 2016, 136(3): 225-231 PMID: 26587580

[20] Po-Hung LiL, ShiaoAS, LinYY, et al. . Healthy-side dominance of cortical neuromagnetic responses in sudden hearing loss. Ann Neurol, 2003, 53(6): 810-815 PMID: 12783431

[21] SuzukiM, KouzakiH, NishidaY, et al. . Cortical representation of hearing restoration in patients with sudden deafness. Neuroreport, 2002, 13(14): 1829-1832 PMID: 12395134

[22] FanW, ZhangW, LiJ, et al. . Altered contralateral auditory cortical morphology in unilateral sudden sensorineural hearing loss. Otol Neurotol, 2015, 36(10): 1622-1627 PMID: 26595717 PMCID: 4658668

[23] Editorial Board of Chinese Journal of Otorhinolaryngology HeadNeck Surgery, Society of Otorhinolaryngology HeadNeck Surgery Chinese Medical Association.. Guideline of diagnosis and treatment of sudden deafness (2015). Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi (Chinese), 2015, 50(6): 443-447

[24] GoebelJA, WhiteJA, HeidenreichKD. SnowJB, WackymPA. Evaluation of the Vestibular System. Ballenger’s Otorhinolaryngology Head and Neck Surgery, 2008131-144

[25] BarinK. Shepard NeilT, Jacobson GaryP. Interpretation and Usefulness of Caloric Testing. Balance Function Assessment and Management, 2014319-345

[26] WelgampolaMS, ColebatchJG. Characteristics and clinical applications of vestibular-evoked myogenic potentials. Neurology, 2005, 64(10): 1682-1688 PMID: 15911791

[27] WangSJ, WengWJ, JawFS, et al. . Ocular and cervical vestibular-evoked myogenic potentials: a study to determine whether air-or bone-conducted stimuli are optimal. Ear Hear, 2010, 31(2): 283-288 PMID: 19812500

[28] GovenderS, RosengrenSM, ColebatchJG. The effect of gaze direction on the ocular vestibular evoked myogenic potential produced by air-conducted sound. Clin Neurophysiol, 2009, 120(7): 1386-1391 PMID: 19464947

[29] HsuYS, WangSJ, YoungYH. Ocular vestibular-evoked myogenic potentials in children using air conducted sound stimulation. Clin Neurophysiol, 2009, 120(7): 1381-1385 PMID: 19443267

[30] MurnaneOD, AkinFW, KellyKJ, et al. . Effects of stimulus and recording parameters on the air conduction ocular vestibular evoked myogenic potential. J Am Acad Audiol, 2011, 22(7): 469-480 PMID: 21993052

[31] McCaslinDL, JacobsonGP. Shepard NeilT, Jacobson GaryP. Vestibular-Evoked Myogenic Potentials. Balance Function Assessment and Management.d Plural Publishing Inc., 2014533-579

[32] NashnerLM. Shepard NeilT, Jacobson GaryP. Computerized Dynamic Posturography. Balance Function Assessment and Management, 2014451-479

[33] NashnerLM, BlackFO, WallC. Adaptation to altered support and visual conditions during stance: patients with vestibular deficits. J Neurosci, 1982, 2(5): 536-544 PMID: 6978930

[34] BlackFO, WallC, O’LearyDP. Computerized screening of the human vestibulospinal system. Ann Otol Rhinol Laryngol, 1978, 87: 853-860 PMID: 367245

[35] NouryKA, KatsarkasA. Sudden unilateral sensorineural hearing loss: a syndrome or a symptom?. J Otolaryngol, 1989, 18(6): 274-278 PMID: 2585590

[36] NakashimaT, YanagitaN. Outcome of sudden deafness with and without vertigo. Laryngoscope, 1993, 103(10): 1145-1149 PMID: 8412452

[37] ChoCS, ChoiYJ. Prognostic factors in sudden sensorineural hearing loss: a retrospective study using interaction effects. Braz J Otorhinolaryngol, 2013, 79(4): 466-470 PMID: 23929147

[38] MarkAS, FitzgeraldD. Segmental enhancement of the cochlea on contrast-enhanced MR: correlation with the frequency of hearing loss and possible sign of perilymphatic fistula and autoimmune labyrinthitis. AJNR Am J Neuroradiol, 1993, 14(4): 991-996 PMID: 8352175

[39] NakashimaT, YanagitaN. Hearing impairment in sudden deafness with and without vertigo. Equilibrium Res, 1991, 50(2): 186-192

[40] LiuB, LengYM, ShiH, et al. . Modified titration intratympanic gentamicin injection for unilateral intractable Ménière’s disease. J Huazhong Univ Sci Technolog Med Sci, 2015, 35(5): 747-751 PMID: 26489633

[41] TonndorfJ. Endolymphatic hydrops: mechanical causes of hearing loss. Arch Otorhinolaryngol, 1976, 212(4): 293-299 PMID: 990091

[42] HornerKC. Old theme and new reflections: hearing impairment associated with endolymphatic hydrops. Hear Res, 1991, 52(1): 147-156 PMID: 2061203

[43] GoebelJ O, MaraW, GianoliG. Anatomic considerations in vestibular neuritis. Otol Neurotol, 2001, 22(4): 512-518 PMID: 11449110

[44] InagakiT, CureogluS, MoritaN, et al. . Vestibular system changes in sudden deafness with and without vertigo: a human temporal bone study. Otol Neurotol, 2012, 33(7): 1151-1155 PMID: 22872175

[45] Manzari L, Burgess AM, Curthoys IS. Does unilateral utricular dysfunction cause horizontal spontaneous nystagmus? Eur Arch Otorhinolaryngol, 2012,269(11):2441–2445

[46] SchuknechtHF, DonovanED. The pathology of idiopathic sudden sensorineural hearing loss. Arch Otorhinolaryngol, 1986, 243(1): 1-15 PMID: 3707419

[47] KhetarpalU. Investigations into the cause of vertigo in sudden sensorineural hearing loss. Otolaryngol Head Neck Surg, 1991, 105(3): 360-371 PMID: 1945420

[48] HalmagyiGM, CurthoysIS. ClendanielR, HerdmanS. Otolith Function Tests. Vestibular Rehabilitation, 2014195-226