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There is no comprehensive and up-to-date overview of audiovestibular approach to the posterior fossa tumors in the literature. This paper reviewed the literature relating to tumors at the posterior cranial fossa to find red flags alerting a posterior fossa lesion from audiovestibular perspectives. This review was developed from articles published in those journals listed on the journal citation reports. Through the PubMed database, Embase, Google Scholar, and Cochrane library, 60 articles were finally obtained based on the PRISMA guidelines for reporting reviews. The presence of one red flag indicates a positive predictive value of 33% for detecting a posterior fossa lesion. Clinical features, namely, 1) mid-frequency sudden sensorineural hearing loss (SNHL), 2) bilateral sudden SNHL, and 3) rebound nystagmus may indicate a posterior fossa lesion, representing one, two, and three red flags, respectively. Those with 1) mid-frequency sudden SNHL, 2) bilateral sudden SNHL, and 3) rebound nystagmus trigger one, two, and three red flags, respectively, alerting clinicians the possibility of a posterior fossa lesion, which warrant MR imaging to exclude life-threatening or treatable conditions. Patients with posterior fossa tumors may have potential life-threatening outcome. [ABSTRACT FROM AUTHOR]

This study investigated the role of serum osmolality in Meniere's disease (MD) patients with acute sensorineural hearing loss (SNHL). Retrospective study. Twenty definite MD patients with acute unilateral SNHL were treated with an osmotic diuretic (Isosorbide, 100 mL daily) and assigned to Group A. Another 20 age- and sex-matched definite MD patients with acute SNHL were not given Isosorbide and assigned to Group B. Both groups underwent audiometry and blood examination for serum osmolality before and after treatment. Group A revealed a significant increase in serum osmolality after treatment. The optimal cut-off values for increased serum osmolality in Group A were +1.5 mOSM/L for predicting hearing improvement at frequencies of 250–1000 Hz, and +2.5 mOSM/L at 2000–4000 Hz. Comparing increased levels of serum osmolality (> +2.0 vs. ≤ +2.0 mOSM/L), Isosorbide dosing at 3.0 L vs. 1.0 L, significantly differed in the odds ratio (OR). Isosorbide at a total dosage of 3.0 L thus improves the hearing threshold by >10 dB at frequencies of 250–2000 Hz. The Isosorbide at a total dosage of 3.0 L may increase serum osmolality by > +2.0 mOSM/L, and improve the hearing threshold for hydropic ears at least >10 dB at low- and mid-frequencies. [ABSTRACT FROM AUTHOR]

This study compared sudden deafness (SD) cases in 20-year age bands to investigate their causes and treatment outcome. Retrospective study. 178 unilateral SD patients were divided into four 20-year age-groups, namely Groups I (aged 0–19 years, n = 6), II (aged 20–39 years, n = 33), III (aged 40–59 years, n = 63), and IV (aged 60–79 years, n = 76). An inner ear test battery and/or serology assay were performed. Incidence of SD in relation to overall neurotological cases did not significantly differ among the four groups. Groups I and II showed two or three audiographic patterns, while Groups III and IV had six audiographic patterns indicating that the aetiology of Groups I and II may be of the same origin, while Groups III and IV had multiple aetiologies. The hearing improvement rate was significantly higher in Groups III (62%) and IV (62%) than in Groups I (16%) and II (33%). SD inevitably affects individuals of all ages. Significant differences in the audiographic patterns and speculative causes may account for various outcomes of treatment in each 20-year age band. Those SD patients aged 40–59 and 60–79 years showed significantly better treatment outcomes than those aged 0–19 and 20–39 years. [ABSTRACT FROM AUTHOR]

The declining order of abnormality rates in inner ear test battery of patients with Meniere's disease (MD) is consistent with the decreasing sequence of prevalence of hydrops formation in temporal bone donors of MD. This study investigated inner ear deficits in MD patients with falls, without falls, and after sac operation to compare their inner ear deficits. Twenty MD patients with falls (Group A), 20 MD patients without falls (Group B), and 20 MD patients after sac operation (Group C) were enrolled. All patients underwent an inner ear test battery. Group A (with falls) revealed a declining sequence of abnormality rates running from audiometry (92%), cervical vestibular-evoked myogenic potential (cVEMP) test (71%), caloric test (42%) to ocular VEMP (oVEMP) test (38%). In contrast, Group B (without falls) displayed a different declining sequence of abnormality rates running from audiometry, cVEMP test, and oVEMP test to caloric test. Similarly, Group C also displayed the same declining sequence of inner ear deficits to Group A, indicating that Groups A and C may share a similar mechanism. Comparing the declining sequence of inner ear deficits in two inner ear disorders may help determine whether both disorders share a similar mechanism. [ABSTRACT FROM AUTHOR]

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Aim: This study investigated the evolution of vestibular disorders in dizzy older adults from young‐old to middle‐old to oldest‐old individuals, which has been less examined in detail so far. Methods: A total of 3714 older patients with vertigo/dizziness in a university hospital were retrospectively reviewed and divided into three groups; namely, the young‐old group aged 65–74 years (n = 2307), the middle‐old group aged 75–84 years (n = 1176) and the oldest‐old group aged ≥85 years (n = 231). All patients underwent an inner ear test battery comprising audiometry, caloric test, cervical and ocular vestibular‐evoked myogenic potential tests, and foam posturography. Results: The ratios between peripheral and central vestibular disorders ranged from the young‐old (60:40%) and middle‐old (36:64%) to the oldest‐old (25:75%) groups. These results show a decreasing sequence in the prevalence of peripheral vestibular disorders (i.e. benign paroxysmal positional vertigo or Meniereʼs disease), and an increasing sequence in that of central vestibular disorders (i.e. vertebrobasilar artery insufficiency) from young‐old to middle‐old to oldest‐old patients. Furthermore, the mean Romberg quotients (value from eyes closed divided by that from eyes open) of the sway area on the foam pad were 1.99 ± 0.93, 2.10 ± 1.06 and 2.62 ± 1.78 in the young‐old, middle‐old and oldest‐old groups, respectively, showing a significant difference among them. Conclusions: Older patients with central vestibular disorders might be more prone to imbalance and falls than those with peripheral vestibular disorders, partly because patients in the latter group retain other reflex systems; that is, the visuomotor reflex to stabilize the gaze and maintain balance. Hence, adequate vision is important in maintaining balance for older adults with vertigo/dizziness. Geriatr Gerontol Int 2020; 20: 42–46. [ABSTRACT FROM AUTHOR]

Conclusion:Like NAC ameliorates hearing loss from acoustic trauma in the inner ear, NAC may also rescue hearing loss from sudden deafness confined to the inner ear. Objective:This study assesses the effect ofN-acetyl-L-cysteine (NAC) as a single therapy for sudden deafness. Methods:Thirty-five sudden deafness patients with neither systemic disorders nor central signs in electronystagmography were treated with NAC alone and assigned to Group A. For comparison, another 35 sudden deafness patients treated by corticosteroids and plasma expander were assigned to Group B. There were no significant differences between the two groups in terms of age, sex, laterality, and pre-treatment mean hearing level. All patients underwent an inner ear test battery comprising audiometry, and ocular vestibular-evoked myogenic potential (oVEMP), cervical VEMP (cVEMP), and caloric tests. Results:Groups A and B did not significantly differ in the pre-treatment mean hearing level, and percentages of abnormal oVEMP, cVEMP, and caloric tests, indicating that the involvement severity of sudden deafness between the two groups was similar. However, Group A (43 ± 27 dB) showed significantly greater mean hearing gain than Group B (21 ± 28 dB), and Group A (91%) revealed better improved rate of hearing than Group B (57%). [ABSTRACT FROM PUBLISHER]

Conclusion: An inner ear test battery may suggest bilateral involvement and aid in 'grading' of potential disease in a patient with actively symptomatic Meniere's disease (MD). Objectives: This study applied an inner ear test battery in patients with bilateral MD to map the inner ear deficits in each ear. Methods: From 2009 to 2012, 100 (20%) of 498 MD patients were diagnosed with bilateral involvement, which was defined as established MD in one ear, and the opposite ear had inner ear symptoms combined with documented hearing loss. Each patient underwent audiometry, and ocular vestibular-evoked myogenic potential (oVEMP), cervical VEMP (cVEMP), and caloric tests. Results: Grading of inner ear deficits was based on the number of abnormal results in the inner ear test battery. Of 100 patients with bilateral MD, 54% had the same grade and 46% had different grades in their 2 ears. On the other hand, based on four-tone average, 79% had the same Meniere stage and 21% had different stages in their two ears. The difference between ears with asymmetric grades (46%) and ears with asymmetric stages (21%) accounts for 25% of bilateral MD patients, which may be caused by the saccular hydrops in the opposite ear. [ABSTRACT FROM AUTHOR]

Conclusion: The ocular vestibular-evoked myogenic potential (oVEMP) test yields the same information as the rotational test in sleep-deprived subjects as evidenced by increased vestibulo-ocular reflex (VOR) asymmetry. However, the duration of sleep deprivation (12 h) and testing time required for the oVEMP test are shorter than for the rotational test. Objective: This study utilized the oVEMP test in sleep-deprived subjects to investigate the effect of short-duration sleep deprivation on the VOR system. Methods: Twenty healthy resident physicians underwent oVEMP and cervical VEMP (cVEMP) tests twice in a randomized order; one test battery was performed after a normal sleep, and the other was performed after a night duty at the emergency service, which meant a state of 12 h sleep deprivation. Results: All 20 subjects had clear oVEMPs regardless of whether testing was performed after a normal sleep or 12 h sleep deprivation condition. Significant differences were not identified between the two sleep conditions in terms of characteristic parameters, i.e. latencies and amplitude of oVEMPs. However, the mean asymmetry ratio after sleep deprivation (20 ± 13%) was significantly larger than that after normal sleep (8 ± 12%). Conversely, the cVEMP parameters did not differ significantly between the two sleep conditions. [ABSTRACT FROM AUTHOR]

Conclusion: Although the affected territory in the posterior/anterior inferior cerebellar artery (PICA/AICA) infarction could not be meticulously demonstrated by magnetic resonance imaging (MRI), it could be picked up by the results of a vestibular test battery comprising caloric, ocular vestibular evoked myogenic potential (oVEMP), and cervical VEMP (cVEMP) tests. Objectives: This study applied audiometry and caloric, oVEMP, and cVEMP tests to map affected territory in patients with PICA/AICA infarction. Methods: Fourteen patients, including 11 with PICA infarction and 3 with AICA infarction, were enrolled in this study during the last 8 years. Each patient underwent audiometry, caloric test, oVEMP test, and cVEMP test. Results: In the PICA group, 8 (36%) of 22 ears had a mean hearing level >25 dB. All six ears (100%) in the AICA group had abnormal hearing, and thus both groups revealed a significant difference. Conversely, significant differences were not observed in the vestibular test battery between the PICA and AICA groups. MRI demonstrated infarction at the brainstem for six patients, while one patient also had cerebellar involvement, indicated by loss of visual suppression on caloric nystagmus. Six patients showed infarction at the cerebellum, and four of them had brainstem affliction based on abnormal oVEMP/cVEMP test results. [ABSTRACT FROM AUTHOR]

Conclusion: Simultaneous galvanic vestibular stimulation (GVS)-cervical vestibular-evoked myogenic potential (cVEMP) and GVS-ocular (oVEMP) tests yielded similar information to that obtained in individual tests. Objective: This study compared the characteristic parameters of cVEMPs and oVEMPs via GVS between individual and simultaneous recording patterns in healthy and elderly subjects. Consequently, the effectiveness of simultaneous GVS-cVEMP and GVS-oVEMP tests was assessed. Methods: A total of 24 healthy and 16 elderly subjects were enrolled in this study. All participants underwent individual cVEMP, individual oVEMP, and simultaneous cVEMP and oVEMP testing via GVS mode in a random order. The response rates and characteristic parameters of cVEMPs and oVEMPs between individual and simultaneous tests, including latencies, intervals, and amplitudes, were measured. Results: The VEMP parameters, including latencies, intervals, and amplitudes, all demonstrated no significant differences between individual and simultaneous tests ( p > 0.05, paired t test), either in healthy or elderly subjects. Pearson's correlation analyses also revealed significant positive correlations in all parameters between these two tests ( p < 0.05). [ABSTRACT FROM AUTHOR]

Conclusion: Patients with sudden deafness who had abnormal ocular vestibular-evoked myogenic potential (oVEMP)/cervical VEMP (cVEMP) responses but retained caloric function may subsequently develop secondary hydrops with a mean interval of 8 years. Objective: This study applied the inner ear test battery in patients who had sudden deafness previously to elucidate how secondary endolymphatic hydrops occurs years after sudden deafness. Methods: Twenty patients who had experienced recent vertiginous attacks several years after sudden deafness (group A) and 20 patients without rotational vertiginous episode for at least 5 years following sudden deafness (group B) were enrolled. All patients underwent an inner ear test battery comprising audiometry, caloric test, and oVEMP and cVEMP tests. Results: The mean interval from initial sudden deafness to vertiginous attack in group A was 8 years, with a mean hearing level of 66 ± 20 dB, which did not significantly differ from 61 ± 20 dB in group B. For the vestibular test results, the percentages of abnormal cVEMP, oVEMP, and caloric tests in group A were 65%, 70%, and 25%, respectively. Compared to the respective 70%, 60%, and 75% abnormalities in group B, only the caloric test differed significantly. [ABSTRACT FROM AUTHOR]

Conclusion: The ocular vestibular-evoked myogenic potential (oVEMP) test with eyes up condition may help differentiate facial paresis with and without vestibular nerve deficit, while the oVEMP test with the eyes closed condition is not reliable for testing patients with facial paresis. Objective: This study investigated the influence of facial paresis on oVEMPs via the eyes up versus eyes closed conditions. Methods: Twenty patients with unilateral facial paresis underwent a battery of audiovestibular function tests. The oVEMP test was performed via bone-conducted vibration stimuli with the eyes up and eyes closed conditions used in a randomized order. Results: Under the eyes up condition, the rate of abnormal oVEMP tests in the lesion ear was 30%, significantly higher than the 0% in the opposite healthy ear, indicating that the lesion ear not the recorded eye is responsible for abnormal oVEMPs. However, abnormal oVEMP test results of lesion ears under the eyes closed condition did not significantly differ from those of opposite healthy ears. Analysis of caloric and oVEMP test results indicated that both tests obtained normal responses from 10 ears, and abnormal responses from 5 ears. The caloric and oVEMP test results were significantly correlated. [ABSTRACT FROM AUTHOR]

Conclusion: The age-related changes in ocular vestibular-evoked myogenic potentials (oVEMPs) elicited by galvanic vestibular stimulation (GVS) and bone-conducted vibration (BCV) might be attributed to the morphological degeneration of the vestibular system. Objective: This study employed GVS and BCV modes for eliciting oVEMPs in healthy subjects to explore the effect of aging on the vestibulo-ocular reflex (VOR) pathway. Methods: Sixty-nine healthy subjects (aged 22-69 years) were divided into 5 groups of 12-19 subjects by decades of age. All subjects underwent oVEMPs using GVS and BCV modes. The prevalence and parameters of oVEMPs, including nI latency, pI latency, nI-pI interval, and nI-pI amplitude were measured and compared. Results: The prevalences of GVS-oVEMPs had nonsignificant differences among all age groups, whereas that of BCV-oVEMPs in the over-60 group was significantly lower than those in the under-60 groups. In GVS-oVEMPs, the group over 60 years had significantly longer nI, pI latencies, and smaller amplitudes when compared with those under 60 years. In BCV-oVEMPs, the nI and pI latencies in the over-60 group were significantly longer than those of the under-60 groups, while the nI-pI amplitudes of groups over 50 years were significantly smaller than those of groups under 50 years. All oVEMP parameters exhibited significant differences between GVS- and BCV-oVEMPs in each age group. [ABSTRACT FROM AUTHOR]

Conclusion: Patients with recurrent sudden deafness demonstrating normal vestibular-evoked myogenic potentials (VEMPs) in the lesion ear of the second episode may indicate a good hearing outcome. Objective: This study retrospectively reviewed our experience of patients with recurrent sudden deafness during the past 20 years. Methods: Sixteen (1.4 %) of 1156 patients with sudden deafness were diagnosed as having a recurrent episode, including ipsilateral type in 7 and contralateral type in 9. All patients underwent an audiovestibular test battery and blood and MRI examinations. After 2000, nine patients underwent the VEMP test. Results: In the ipsilateral type, the mean interval between two episodes was 2 ± 2 years, which did not differ significantly from 3 ± 3 years in the contralateral type. There were no significant differences in relation to age at onset of the second episode, inter-episode interval, gender, presence of vertigo, and abnormal caloric results. However, abnormal rate of VEMP test in the contralateral type (five of five patients) was significantly higher than that in the ipsilateral type (none of four patients). At the second episode, all four patients with normal VEMPs on the lesion ear had improved hearing, while four of five patients with absent or delayed VEMPs showed unchanged hearing. Altogether, the hearing improvement rate in both types of recurrent sudden deafness was 50%. [ABSTRACT FROM AUTHOR]

Conclusion: The ocular vestibular evoked myogenic potential (o-VEMP) test results correlate significantly with caloric test results for patients with acoustic neuroma (AN), but not for patients with Meniere's disease (MD), indicating that the o-VEMP test may replace the caloric test for evaluating the vestibular nerve from which the AN arises. Conversely, the caloric, o-VEMP, and cervical VEMP (c-VEMP) tests should be performed to map lesion sites in the vestibular labyrinth. Objective: This study performed caloric, o-VEMP, and c-VEMP tests on patients with central and peripheral vestibular disorders to investigate their relationships. Methods: In all, 66 patients comprising 16 with unilateral AN and 50 with unilateral definiteMD were enrolled. All patients underwent caloric, o-VEMP, and c-VEMP tests. Results: In the AN group, the caloric test identified canal paresis and caloric areflexia in 10 ears, while the o-VEMP and c-VEMP tests identified abnormal (absent or delayed) responses in 12 and 11 ears, respectively. A significant correlation existed between caloric and o-VEMP test results, but not between caloric and c-VEMP test results, or between o-VEMP and c-VEMP test results. For theMDgroup, abnormal caloric, o-VEMP, and c-VEMP test results were obtained for 24%, 44%, and 38% of hydropic ears, respectively. No correlation existed between any two test results [ABSTRACT FROM AUTHOR]