Summary
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.
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References
Stachler RJ, Chandrasekhar SS, Archer SM, et al. Clinical practice guideline: sudden hearing loss. Otolaryngol Head Neck Surg, 2012,146(3 suppl):S1–S35
Schuknecht HF, Kimura RS, Naufal PM. The pathology of sudden deafness. Acta Otolaryngol, 1973,76(2):75–97
Belal A Jr. Pathology of vascular sensorineural hearing impairment. Laryngoscope, 1980,90(11 Pt 1):1831–1839
Gussen R. Sudden deafness of vascular origin: a human temporal bone stdy. Ann Otol Rhinol Laryngol, 1976,85(1 Pt 1):94–100
McCabe BF. Autoimmune sensorineural hearing loss. Ann Otol Rhinol Laryngol, 1979,88(5 Pt 1):585–589
Simmons FB. Theory of membrane breaks in sudden hearing loss. Arch Otolaryngol, 1968,88(1):41–48
Shepard NT, Jacobson GP. The caloric irrigation test. Handb Clin Neurol, 2016, 137: 119–131
Colebatch JG, Rosengren SM, Welgampola MS. Vestibular-evoked myogenic potentials. Handb Clin Neurol, 2016, 137: 133–155
Rosengren SM, Welgampola MS, Colebatch JG. Vestibular evoked myogenic potentials: past, present and future. Clin Neurophysiol, 2010,121(5):636–651
Kantner C, Gürkov R. Characteristics and clinical applications of ocular vestibular evoked myogenic potentials. Hear Res, 2012,294(1-2):55–63
Pelosi S, Schuster D, Jacobson GP, et al. Clinical characteristics associated with isolated unilateral utricular dysfunction. Am J Otolaryngol, 2013,34(5):490–495
Fujimoto C, Egami N, Kinoshita M, et al. Factors affecting postural instability in Meniere’s disease. Otolaryngol Head Neck Surg, 2013,149(5):759–765
Horak FB, Nashner LM, Diener HC. Postural strategies associated with somatosensory and vestibular loss. Exp Brain Res, 1990,82(1):167–177
Mirka A, Black FO. Clinical application of dynamic posturography for evaluating sensory integration and vestibular dysfunction. Neurol Clin, 1990,8(2):351–359
Monsell EM, Furman JM, Herdman SJ, et al. Computerized dynamic platform posturography. Otolaryngol Head Neck Surg, 1997,117(4):394–398
Iwasaki S, Takai Y, Ozeki H, 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
Korres S, Stamatiou GA, Gkoritsa E, et al. Prognosis of patients with idiopathic sudden hearing loss: role of vestibular assessment. J Laryngol Otol, 2011,125(3):251–257
Fujimoto C, Egami N, Kinoshita M, 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
Niu X, Zhang Y, Zhang Q, et al. The relationship between hearing loss and vestibular dysfunction in patients with sudden sensorineural hearing loss. Acta Otolaryngol, 2016,136(3):225–231
Po-Hung Li L, Shiao AS, Lin YY, et al. Healthy-side dominance of cortical neuromagnetic responses in sudden hearing loss. Ann Neurol, 2003,53(6):810–815
Suzuki M, Kouzaki H, Nishida Y, et al. Cortical representation of hearing restoration in patients with sudden deafness. Neuroreport, 2002,13(14):1829–1832
Fan W, Zhang W, Li J, et al. Altered contralateral auditory cortical morphology in unilateral sudden sensorineural hearing loss. Otol Neurotol, 2015,36(10):1622–1627
Editorial Board of Chinese Journal of Otorhinolaryngology Head and Neck Surgery, Society of Otorhinolaryngology Head and Neck 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
Goebel JA, White JA, Heidenreich KD. Evaluation of the Vestibular System. In: Snow JB, Wackym PA, eds. Ballenger’s Otorhinolaryngology Head and Neck Surgery. B.C. Decker Inc., 2008:131–144.
Barin K. Interpretation and Usefulness of Caloric Testing. In: Shepard Neil T, Jacobson Gary P, eds. Balance Function Assessment and Management. Plural Publishing Inc., 2014: 319–345.
Welgampola MS, Colebatch JG. Characteristics and clinical applications of vestibular-evoked myogenic potentials. Neurology, 2005,64(10):1682–1688
Wang SJ, Weng WJ, Jaw FS, 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
Govender S, Rosengren SM, Colebatch JG. The effect of gaze direction on the ocular vestibular evoked myogenic potential produced by air-conducted sound. Clin Neurophysiol, 2009,120(7):1386–1391
Hsu YS, Wang SJ, Young YH. Ocular vestibular-evoked myogenic potentials in children using air conducted sound stimulation. Clin Neurophysiol, 2009,120(7):1381–1385
Murnane OD, Akin FW, Kelly KJ, 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
McCaslin DL, Jacobson GP. Vestibular-Evoked Myogenic Potentials. In: Shepard Neil T, Jacobson Gary P, eds. Balance Function Assessment and Management.d Plural Publishing Inc., 2014:533–579.
Nashner LM. Computerized Dynamic Posturography. In: Shepard Neil T, Jacobson Gary P, eds. Balance Function Assessment and Management. Plural Publishing Inc., 2014:451–479
Nashner LM, Black FO, Wall C. Adaptation to altered support and visual conditions during stance: patients with vestibular deficits. J Neurosci, 1982,2(5):536–544
Black FO, Wall C, O’Leary DP. Computerized screening of the human vestibulospinal system. Ann Otol Rhinol Laryngol, 1978,87(6 Pt 1):853–860
Noury KA, Katsarkas A. Sudden unilateral sensorineural hearing loss: a syndrome or a symptom? J Otolaryngol, 1989,18(6):274–278
Nakashima T, Yanagita N. Outcome of sudden deafness with and without vertigo. Laryngoscope, 1993,103(10):1145–1149
Cho CS, Choi YJ. Prognostic factors in sudden sensorineural hearing loss: a retrospective study using interaction effects. Braz J Otorhinolaryngol, 2013,79(4):466–470
Mark AS, Fitzgerald D. 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
Nakashima T, Yanagita N. Hearing impairment in sudden deafness with and without vertigo. Equilibrium Res, 1991,50(2):186–192
Liu B, Leng YM, Shi H, 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
Tonndorf J. Endolymphatic hydrops: mechanical causes of hearing loss. Arch Otorhinolaryngol, 1976,212(4):293–299
Horner KC. Old theme and new reflections: hearing impairment associated with endolymphatic hydrops. Hear Res, 1991,52(1):147–156
Goebel JA, O’ Mara W, Gianoli G. Anatomic considerations in vestibular neuritis. Otol Neurotol, 2001,22(4):512–518
Inagaki T, Cureoglu S, Morita N, et al. Vestibular system changes in sudden deafness with and without vertigo: a human temporal bone study. Otol Neurotol, 2012,33(7):1151–1155
Manzari L, Burgess AM, Curthoys IS. Does unilateral utricular dysfunction cause horizontal spontaneous nystagmus? Eur Arch Otorhinolaryngol, 2012,269(11):2441–2445
Schuknecht HF, Donovan ED. The pathology of idiopathic sudden sensorineural hearing loss. Arch Otorhinolaryngol, 1986,243(1):1–15
Khetarpal U. Investigations into the cause of vertigo in sudden sensorineural hearing loss. Otolaryngol Head Neck Surg, 1991,105(3):360–371
Halmagyi GM, Curthoys IS. Otolith Function Tests In: Clendaniel R, Herdman S, eds. Vestibular Rehabilitation. F. A. Davis Company, 2014:195–226.
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We are indebted to all the staff in Department of Otolaryngology, Wuhan Union Hospital of Tongji Medical College of Huazhong University of Science and Technology for their assistance in the collection and processing of materials.
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The two authors contributed equally to this work.
This project was supported by grants from the National Twelfth Five-Year Science and Technology Support Program of China (No. 2012BAI12B02), and the National Eleventh Five-Year Science and Technology Support Program of China (No. 2007BAI18B13).
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Liu, J., Zhou, Rh., Liu, B. et al. Assessment of balance and vestibular functions in patients with idiopathic sudden sensorineural hearing loss. J. Huazhong Univ. Sci. Technol. [Med. Sci.] 37, 264–270 (2017). https://doi.org/10.1007/s11596-017-1726-8
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DOI: https://doi.org/10.1007/s11596-017-1726-8