Citations

Purpose: The purpose of this study is to explore the use of mobile device technology to measure postural stability and to assess the preliminary effect of an added dynamic vestibular task in the 4-Stage Balance Test (4SBT) in adults over 65 years. It was hypothesized that adding a dynamic vestibular task would make the 4SBT more sensitive in identifying fall risk. Method: Twenty-eight adults aged 70–100 years completed the 4SBT with and without an added vestibular challenge (i.e., with and without a headshake). Postural sway was measured using a mobile device. Participants also completed the Stay Independent Questionnaire (SIQ) and provided self-reported fall and health history. Differences in sway score were compared between conditions. Correlational analyses assessed the association between fall history, fall risk, and sway scores. Results: The addition of a headshake task significantly increased postural sway across all 4SBT stages. Self-reported fall risk was not predicted by sway score; however, significant correlations were observed between self-reported fall risk and sway in more challenging balance conditions, and these relationships were largely unchanged with the added dynamic vestibular task. Although sway score did not reliably distinguish between individuals who did and did not report a fall, fall history was moderately associated with self-reported fall risk and fear of falling. Conclusions: Significant correlations were observed between SIQ and sway score measured in the more challenging balance conditions. These relationships generally remained stable even with the added dynamic vestibular task, suggesting that the SIQ may reflect real-world balance challenges involving vestibular input. Self-reported fear of falling or perceived fall risk likely captures aspects of imbalance not directly reflected in sway scores. Further research with larger, more diverse samples is warranted to assess added the clinical utility of sway score beyond perceived aspects of imbalance to identify fall risk.

Background/Objectives: Traditional hearing aid noise reduction algorithms offer no additional benefit in noisy situations for bimodal cochlear implant (CI) users with a CI in one ear and a hearing aid (HA) in the other. Recent breakthroughs in deep neural network (DNN)-based noise reduction have improved speech understanding for hearing aid users in noisy environments. These advancements could also boost speech perception in noise for bimodal CI users. This study investigated the effectiveness of DNN-based noise reduction in the HAs used by bimodal CI patients. Methods: Eleven bimodal CI patients, aged 71–89 years old, were fit with a Phonak Audéo Sphere Infinio 90 HA in their non-implanted ear and were provided with a Calm Situation program and Spheric Speech in Loud Noise program that uses DNN-based noise reduction. Sentence recognition scores were measured using AzBio sentences in quiet and in noise with the CI alone, hearing aid alone, and bimodally with both the Calm Situation and DNN HA programs. Results: The DNN program in the hearing aid significantly improved bimodal performance in noise, with sentence recognition scores reaching 79% compared to 60% with Calm Situation (a 19% average benefit, p < 0.001). When compared to the CI-alone condition in multi-talker babble, the DNN HA program offered a 40% bimodal benefit, significantly higher than the 21% score seen with the Calm Situation program. Conclusions: DNN-based noise reduction in HA significantly improves speech understanding in noise for bimodal CI users. Utilization of this technology is a promising option to address patients’ common complaint of speech understanding in noise.

Objectives To compare electrical stimulation and speech perception in vestibular schwannoma (VS) patients across treatment modalities and standard cochlear implant (CI) patients. Study Design Retrospective review. Setting Tertiary academic center. Patients Sixty-seven CI ears consisting of 23 standard CI controls and 44 VS patients with ipsilateral CI. VS patients were separated by treatment modality: 24 microsurgical resection, 15 radiation therapy, and 5 observation. Eleven VS patients with CI did not receive auditory sensation from electrical stimulation. Interventions VS microsurgical resection, radiation therapy, and observation. Main Outcome Measures Threshold (T-levels), comfort (C-levels), consonant-nucleus-consonant (CNC) word score, and AzBio sentence recognition scores. Results Patients who underwent microsurgical resection required significantly higher (p < 0.001) T-levels and C-levels compared with the standard CI group. Stimulation levels in the VS radiation therapy and observation groups were higher but not significantly different compared with standard CI controls. Overall rate of CI nonstimulation across all VS patients was 25%: 38% for microsurgery and 13% for radiation. Average CNC score for microsurgery group was 18% compared with 44% for radiation, 55% for observation, and 68.5% for standard CI controls. CNC word and AzBio scores were significantly lower (p < 0.001) for the microsurgery group compared with standard CI group. Conclusions Resection may negatively affect auditory nerve function, leading to higher stimulation levels, increased risk of nonstimulation, and poorer postoperative CI speech outcomes compared with observation or radiosurgery. When medically appropriate, nonsurgical VS management may be used to allow for optimization of CI programming and postoperative hearing outcomes.

Purpose: Chronic dizziness and imbalance is often difficult to rehabilitate based on the complex set of systems involved. Recently, transcutaneous vagus nerve stimulation (tVNS) has been investigated as a noninvasive means to reduce symptoms associated with vestibular impairment, chronic dizziness, and neurological conditions affecting balance control. The purpose of this integrative review is to examine available data describing therapeutic efficacy and proposed mechanisms of tVNS in adult patients with dizziness and imbalance. Method: PubMed, Europe PMC, and Google Scholar searches were conducted using the following search terms from 1987 to 2024: “vagal nerve stimulat*” OR “vagus nerve stimulat*” OR “transcutaneous vagus nerve stimulat*” OR “tVNS” AND “dizziness,” “vertigo.” Articles were imported for screening and review through Rayyan. Articles discussing the use of tVNS to study metrics related to vestibular and balance function in adult humans were selected for full-text review. Results: Eleven articles were identified as meeting the inclusion criteria and are classified according to the neurotological class studied and level of evidence provided. Available data show that tVNS may benefit patients with dizziness and imbalance based on subjective metrics including quality of life and reduction in dizziness handicap. Less-controlled case study evidence suggests that additional benefit from tVNS may manifest in changes to vestibulo-ocular reflex function. Conclusion: Although tVNS exposure has provided variable degrees of benefit in both subjective (e.g., quality of life) and objective (e.g., changes in vestibulo-ocular reflex function and gait) contexts, the degree to which distinct mechanisms can explain these benefits is unclear.

Tools used for the identification, evaluation, and monitoring of concussion have not been sufficiently studied in youth or real-world settings. Normative and reliability data on sideline concussion assessment measures in the youth athlete population is needed. Pre-season normative data for 515 athletes (93.5% male) aged 5 to 16 on the Standardized Assessment of Concussion (SAC/SAC-Child), modified Balance Errors Scoring System (mBESS), Timed Tandem Gait (TTG), and the King–Devick Test (KDT) are provided. A total of 212 non-injured athletes repeated the measures post-season to assess test–retest reliability. Mean performance on the SAC-C, mBESS, TTG, and KDT tended to improve with age. KDT was the only measure that demonstrated good to excellent stability across age ranges (ICC = 0.758 to 0.941). Concentration was the only SAC/SAC-C subtest to demonstrate moderate test–retest stability (ICC = 0.503 to 0.706). TTG demonstrated moderate to good (ICC = 0.666 to 0.811) reliability. mBESS demonstrated poor to moderate reliability (ICC = −0.309 to 0.651). Commonly used measures of concussion vary regarding test–retest reliability in youth. The data support the use of at least annual sport concussion baseline assessments in the pediatric population to account for the evolution in performance as the child ages. Understanding the variation in the stability and the evolution of baseline performance will enable improved identification of possible injury.

Abstract Background We describe a 42-year-old patient with reported “shaking” vision referred due to concerns of possible vestibular system dysfunction. The patient has known history of Usher syndrome type I, bilateral cochlear implants, and severe vision impairment. Purpose This case describes an unusual nystagmus previously only reported in individuals with central demyelinating disorders, significant light deprivation, or in congenital/early-onset visual pathway impairment. Research Design Case study. Data Collection and Analysis Retrospective chart review of vestibular function. Results Vestibular function was likely absent in this case. There was no evidence of vestibular (jerk) nystagmus for sinusoidal harmonic acceleration stimuli or repeatable responses for cervical vestibular evoked myogenic potentials. Significant pendular low-amplitude high-frequency oscillations of approximately 6 Hz were present for horizontal and vertical tracings throughout testing. Conclusion Nystagmus may not always be associated with vestibular system impairment. In this case, the patient's reported “shaking” vision was attributed to pendular low-amplitude high-frequency nystagmus and hypothesized to relate to long-standing significant vision impairment. This presentation is unusual in adults and has historically been associated with individuals with significant central pathology or in those with long duration light deprivation.

Objectives: An unexpectedly low word recognition (WR) score may be taken as evidence of increased risk for retrocochlear tumor. We sought to develop evidence for or against using a standardized WR (sWR) score in detecting retrocochlear tumors. The sWR is a z score expressing the difference between an observed WR score and a Speech Intelligibility Index–based predicted WR score. We retrospectively compared the sensitivity and specificity of pure-tone asymmetry-based logistic regression models that incorporated either the sWR or the raw WR scores in detecting tumor cases. Two pure-tone asymmetry calculations were used: the 4-frequency pure-tone asymmetry (AAO) calculation of the American Academy of Otolaryngology–Head and Neck Surgery and a 6-frequency pure-tone asymmetry (6-FPTA) calculation previously optimized to detect retrocochlear tumors. We hypothesized that a regression model incorporating the 6-FPTA calculation and the sWR would more accurately detect retrocochlear tumors. Design: Retrospective data from all patients seen in the audiology clinic at Mayo Clinic in Florida in 2016 were reviewed. Cases with retrocochlear tumors were compared with a reference group with noise- or age-related hearing loss or idiopathic sensorineural hearing loss. Two pure-tone–based logistic regression models were created (6-FPTA and AAO). Into these base models, WR variables (WR, sWR, WR asymmetry [WRΔ], and sWR asymmetry [sWRΔ]) were added. Tumor detection performance for each regression model was compared twice: first, using all qualifying cases (61 tumor cases; 2332 reference group cases), and second, using a data set filtered to exclude hearing asymmetries greater than would be expected from noise-related or age-related hearing loss (25 tumor cases; 2208 reference group cases). The area under the curve and the DeLong test for significant receiver operating curve differences were used as outcome measures. Results: The 6-FPTA model significantly outperformed the AAO model—with or without the addition of WR or WRΔ variables. Including sWR into the AAO base regression model significantly improved disease detection performance. Including sWR into the 6-FPTA model significantly improved disease detection performance when large hearing asymmetries were excluded. In the data set that included large pure-tone asymmetries, area under the curve values for the 6-FPTA + sWR and AAO + sWR models were not significantly better than the base 6-FPTA model. Conclusions: The results favor the superiority of the sWR computational method in identifying reduced WR scores in retrocochlear cases. The utility would be greatest where undetected tumor cases are embedded in a population heavily representing age- or noise-related hearing loss. The results also demonstrate the superiority of the 6-FPTA model in identifying tumor cases. The 2 computational methods may be combined (ie, the 6-FPTA + sWR model) into an automated tool for detecting retrocochlear disease in audiology and community otolaryngology clinics. The 4-frequency AAO-based regression model was the weakest detection method considered. Including raw WR scores into the model did not improve performance, whereas including sWR into the model did improve tumor detection performance. This further supports the contribution of the sWR computational method for recognizing low WR scores in retrocochlear disease cases.

Abstract Background Vestibular migraine (VM) is one of the common causes of episodic dizziness, but it is underdiagnosed and poorly understood. Previous research suggests that otolith reflex pathway performance is often impaired in this patient group, leading to altered perception of roll plane stimuli. Clinically, this perception can be measured with subjective visual vertical (SVV) testing. Purpose The aim of this study is to compare static SVV performance (absolute mean SVV tilt, variance) in a cohort of patients diagnosed with VM to results obtained from clinically derived normative data. Study Design Retrospective case review. Study Sample Ninety-four consecutive patients between 18 and 65 years of age diagnosed with VM were included in this comparison to clinically derived normative data. Data Collection and Analysis Retrospective chart review was completed. Demographic data, symptom report, and vestibular laboratory results were documented. SVV performance was documented in terms of absolute mean SVV tilt and response variance. Results Abnormal mean SVV tilt was described in 54% (n = 51) of patients with VM. Including abnormal response variance increased those identified with abnormal presentation to 67% (n = 63). Laboratory findings were insignificant for semicircular canal function, but of those with abnormal ocular vestibular myogenic potential results (n = 30), 77% (n = 23) demonstrated both abnormal SVV and utriculo-ocular reflex performance. There were no associations noted for SVV performance and demographic or other self-report variables. Conclusion Absolute mean SVV tilt and response variance are often abnormal in patients diagnosed with VM. These findings support theories suggesting atypical intralabyrinthine integration within the vestibular nuclei and cerebellar nodular pathways.