Publications by authors named "Robby Vanspauwen"

31 Publications

The MO-meatocanalplasty: long-term results in the narrow external auditory canal with recurrent otitis externa or the inability to wear a hearing aid.

Eur Arch Otorhinolaryngol 2021 Feb 20. Epub 2021 Feb 20.

Department of Otorhinolaryngology and Head and Neck Surgery, Sint-Augustinus Hospital, European Institute for ORL-HNS, Oosterveldlaan 24, 2610, Wilrijk, Antwerp, Belgium.

Objective: The MO-meatocanalplasty is the oblique modification of the M-meatoplasty. The MO-meatocanalplasty was designed to address the superior quadrants of the meatus and the bony canal without the need for a retro-auricular incision. This retrospective analysis was performed to evaluate the long-term results of the MO-meatocanalplasty in patients with a narrow external auditory canal (EAC) with recurrent otitis externa or in patients unable to wear a hearing aid.

Methods: Twenty-two ears in twenty consecutive patients who received a MO-meatocanalplasty for a narrow EAC with recurrent otitis externa or the inability to wear a hearing aid were analysed retrospectively. There were no patients included with any type of previous or planned second stage tympanoplasty procedures. A follow-up period of 3 years was analysed for postoperative recurrent narrowing, the self-cleaning capacity of the EAC, the recurrence of otitis externa, the inability to wear a hearing aid, change in hearing level and for all types of aesthetical complaints.

Results: The MO-meatocanalplasty procedure was effective in 82% (n = 18). Postoperative recurrent narrowing was detected in 9% (n = 2). Insufficient self-cleaning capacity of the EAC was 9.1% (n = 2). The ability to wear a hearing aid was restored in all patients with the need for a hearing aid. No aesthetical complaints were reported.

Conclusion: The MO-meatocanalplasty is an effective, safe and aesthetical accepted procedure to address the narrow meatus and external auditory canal. With this procedure, there is no need for a retro-auricular incision in order to create a well aerated, dry and self-cleaning EAC in patients with a narrow EAC with recurrent otitis externa or in patient with the inability to wear a hearing aid.
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http://dx.doi.org/10.1007/s00405-020-06599-zDOI Listing
February 2021

The relationship between cochleovestibular function tests and endolymphatic hydrops grading on MRI in patients with Menière's disease.

Eur Arch Otorhinolaryngol 2021 Jan 25. Epub 2021 Jan 25.

European Institute for ORL-HNS, Sint-Augustinus, GZA Hospital, Antwerp, Belgium.

Purpose: In this retrospective study the relationship between cochleovestibular function and a magnetic resonance imaging (MRI-) based classification system of endolymphatic hydrops was investigated.

Methods: Seventy-eight patients with unilateral definite Menière's disease who underwent MRI were included. The parameters of Pure Tone Audiometry (PTA), caloric irrigation test, cervical vestibular evoked myogenic potentials, and video Head Impulse Test were compared between the grades of endolymphatic hydrops (EH) and perilymphatic enhancement (PE) on MRI.

Results: The low-frequency PTA was significantly different between cochlear EH grades I and II (p = 0.036; Grade I: mean (Standard Deviation, SD) = 51 decibel Hearing Level (dB HL) (18 dB HL); Grade II: mean (SD) = 60 dB HL (16 dB HL)), and vestibular EH grades 0 and III (p = 0.018; Grade 0: mean (SD) = 43 dB HL (21 dB HL); Grade III: mean = 60 dB HL (10 dB HL)). The ipsilateral caloric sum of ears with vestibular EH grade I (n = 6) was increased with regards to vestibular EH grades 0 (p = 0.001), II (p < 0.001), and III (p < 0.001) (Grade 0: mean (SD) = 24°/s (15°/s); Grade I: mean (SD) = 47°/s (11°/s); Grade II: mean (SD) = 21°/s (13°/s); Grade III: mean (SD) = 16°/s (8°/s)).

Conclusion: According to these results we can conclude that only the highest grades of cochlear and vestibular EH seem to be associated with decreased cochleovestibular functioning.
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http://dx.doi.org/10.1007/s00405-021-06610-1DOI Listing
January 2021

Vestibular Infant Screening (VIS)-Flanders: results after 1.5 years of vestibular screening in hearing-impaired children.

Sci Rep 2020 12 3;10(1):21011. Epub 2020 Dec 3.

Faculty of Medicine and Health Sciences, Department of Rehabilitation Sciences, Ghent University, 9000, Ghent, Belgium.

Due to the close anatomical relationship between the auditory and vestibular end organs, hearing-impaired children have a higher risk for vestibular dysfunction, which can affect their (motor) development. Unfortunately, vestibular dysfunction often goes unnoticed, as vestibular assessment in these children is not standard of care nowadays. To timely detect vestibular dysfunction, the Vestibular Infant Screening-Flanders (VIS-Flanders) project has implemented a basic vestibular screening test for hearing-impaired infants in Flanders (Belgium) with a participation rate of 86.7% during the first year and a half. The cervical Vestibular Evoked Myogenic Potentials (cVEMP) test was applied as vestibular screening tool to map the occurrence of vestibular (mainly saccular) dysfunction in this population. At the age of 6 months, 184 infants were screened. No refers on vestibular screening were observed in infants with permanent conductive hearing loss. In infants with permanent sensorineural hearing loss, a cVEMP refer rate of 9.5% was observed. Failure was significantly more common in infants with severe-profound compared to those with mild-moderate sensorineural hearing loss (risk ratio = 9.8). Since this is the first regional study with a large sample size and successful participation rate, the VIS-Flanders project aims to set an example for other regions worldwide.
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http://dx.doi.org/10.1038/s41598-020-78049-zDOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7713061PMC
December 2020

The bony obliteration tympanoplasty in cholesteatoma: safety, hygiene and hearing outcome: allograft versus autograft tympanic membrane reconstruction.

Eur Arch Otorhinolaryngol 2020 Aug 5. Epub 2020 Aug 5.

European Institute for ORL-HNS, GZA Hospitals Antwerp, Oosterveldlaan 24, 2610, Wilrijk, Belgium.

Objective: To evaluate early results on hygiene, safety and functional outcome in a population undergoing a canal wall up technique with bony obliteration of the mastoid and epitympanic space (CWU-BOT) for extensive cholesteatoma, performed by a single surgeon. This study compares different techniques of tympanic membrane reconstruction, viz. allografts and autografts.

Patients: A consecutive series of 61 ears with acquired cholesteatoma treated with primary or revision CWU-BOT surgery from 2009 to 2014.

Intervention: Obliteration was performed by the use of cortical bone-chips and bone pâté. Patients were followed up with micro-otoscopy and MRI with diffusion-weighted imaging. Ossicular reconstruction was performed using a remodelled autologous or allogenic incus or malleus.

Main Outcome Measures: Residual and recurrence rate and short- and mid-term hearing outcome prior to any revision tympanoplasty were analysed, the effect of type of tympanic membrane reconstruction was considered.

Results: 44 Ears were primary cholesteatoma cases, 17 cases were referred for revision surgery. Mean postoperative follow up was 45 months (SD 18.08) and mean follow-up until the last non-EP DW MRI 42 months (SD 17.72). Recurrent disease was present in 3%, no residual disease was present. An AC gain was seen in 75% of all ears undergoing ossicular reconstruction.

Conclusion: Reproducible safety, hygiene and hearing results with limited recurrence and residual disease can be obtained by younger otologic surgeons performing the BOT-CWU for extensive cholesteatoma while using a variety of grafts for tympano-ossicular reconstruction. The tympano-ossicular allograft nevertheless shows superior hearing results when a mobile intact stapes is present.

Level Of Evidence: Level 4.
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http://dx.doi.org/10.1007/s00405-020-06258-3DOI Listing
August 2020

The Antwerp Vestibular Compensation Index (AVeCI): an index for vestibular compensation estimation, based on functional balance performance.

Eur Arch Otorhinolaryngol 2020 Aug 5. Epub 2020 Aug 5.

Department of Rehabilitation Sciences and Physiotherapy/Movant, Faculty of Medicine and Health Sciences, University of Antwerp, Universiteitsplein 1, 2610, Wilrijk, Belgium.

Purpose: To create an index that is a measure of the amount of vestibular compensation and for which only functional balance performance is needed.

Methods: The medical charts of 62 eligible peripheral vestibular dysfunction (PVD) patients were analyzed retrospectively. To be included, the following vestibulo-ocular reflex (VOR) and balance performance data had to be available: (1) caloric and sinusoidal harmonic acceleration test (SHA) and (2) standing balance sum-eyes closed (SBS-EC), Timed Up and Go Test and Dynamic Gait Index. Patients were divided into three groups: normal caloric- and SHA test (group 1), abnormal caloric- and normal SHA test (group 2, PVD compensated) and abnormal caloric- and SHA test (group 3, PVD uncompensated). Next to the use of non-parametric tests to study the VOR and balance variables, logistic regression was used to identify the balance measures that predict whether PVD patients were compensated or uncompensated. This resulted also in the construction of a continuous measure representing the degree of compensation.

Results: Logistic regression identified SBS-EC and age to classify uncompensated from compensated patients with sensitivity of 83.9% and specificity of 72.4%. Then an index was created, called the Antwerp Vestibular Compensation Index, AVeCI = - 50 + age × 0.486 + SBS-EC × 0.421. A patient belongs to the uncompensated group when AVeCI < 0 and to the compensated group when AVeCI > 0, with respective group means of - 5 and 5.

Conclusion: AVeCI stages the degree of compensation of PVD patients and can serve to evaluate rehabilitation effects.
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http://dx.doi.org/10.1007/s00405-020-06192-4DOI Listing
August 2020

The Sensitivity of the cVEMP Test in Detecting A Superior Semicircular Canal Dehiscence and the Influence of a Coexisting Incudal Lysis: A Case Report.

J Int Adv Otol 2020 Apr;16(1):123-126

Department of ENT, European Institute for Otorhinolaryngology, Sint-Augustinus Hospital, Wilrijk, Belgium.

In this case report, the air-conducted cervical vestibular evoked myogenic potentials (AC cVEMP) test was only sensitive for the left superior semicircular canal dehiscence (SCD), even though the contralateral SCD was of equal length (2.5 mm). Furthermore, a lysis of the processus lenticularis incudis caused a real conductive hearing loss in the left ear. A diminished left AC cVEMP was thus expected, but the opposite was shown (increased corrected amplitude, lowered detection threshold). The patient only experienced hearing loss, so middle ear surgery was performed to repair the lysis. The postoperative AC cVEMP showed a further "uncovering" of the SCD with increased corrected amplitude on the left but no vestibular symptoms. The significance of an SCD should be interpreted with caution, even when the AC cVEMP and the imaging are significant. Furthermore, AC cVEMPs should not be considered as evidence for the absence or presence of conductive hearing loss.
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http://dx.doi.org/10.5152/iao.2019.6790DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7224441PMC
April 2020

Health Related Quality of Life after the Bony Obliteration Tympanoplasty for COM with Cholesteatoma using the COMQ12 - A Disease Specific PROM.

J Int Adv Otol 2019 Dec;15(3):396-399

Department of ENT, European Institute for Otorhinolaryngology, Sint-Augustinus Hospital, Wilrijk, Belgium.

Objectives: This study aimed to investigate the effect of canal wall up with bony obliteration tympanoplasty (CWU-BOT) on the health-related quality of life (HRQOL) in patients with chronic otitis media with cholesteatoma by using the chronic otitis media questionnaire 12 (COMQ-12).

Materials And Methods: This study is a retrospective analysis of the COMQ-12 of 26 patients who completed the COMQ-12 before and after a CWU-BOT with eradication of cholesteatoma followed by obliteration of the mastoid and paratympanic space with bone chips and bone pâté and reconstruction of the tympanic membrane and ossicular chain.

Results: All patients were operated upon in our institute between 2014 and 2017. The median score of the 12 questions was preoperatively and postoperatively calculated, and then compared. A large effect was observed in the total score and the questions about running ear, discharge, and visits to the general practitioner. A medium positive size effect was observed in the questions about hearing in noisy surroundings, discomfort, dizziness, tinnitus, medication use, and the mental aspect of the patient. In the questions about the hearing at home and quality of life and impact on work, we noted a small positive size effect. In 50% of patients, the HRQOL became normal; the remaining 50% improved to a level very close to normal.

Conclusion: Canal wall up with bony obliteration tympanoplasty (CWU-BOT) showed a clear decrease in the severity of the symptoms, life and work impact, and health care after surgery.
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http://dx.doi.org/10.5152/iao.2019.7266DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6937169PMC
December 2019

Electrical Vestibular Stimulation in Humans: A Narrative Review.

Audiol Neurootol 2020 18;25(1-2):6-24. Epub 2019 Sep 18.

European Institute for Otorhinolaryngology, GZA Hospitals Antwerp, Wilrijk, Belgium.

Background: In patients with bilateral vestibulopathy, the regular treatment options, such as medication, surgery, and/or vestibular rehabilitation, do not always suffice. Therefore, the focus in this field of vestibular research shifted to electrical vestibular stimulation (EVS) and the development of a system capable of artificially restoring the vestibular function. Key Message: Currently, three approaches are being investigated: vestibular co-stimulation with a cochlear implant (CI), EVS with a vestibular implant (VI), and galvanic vestibular stimulation (GVS). All three applications show promising results but due to conceptual differences and the experimental state, a consensus on which application is the most ideal for which type of patient is still missing.

Summary: Vestibular co-stimulation with a CI is based on "spread of excitation," which is a phenomenon that occurs when the currents from the CI spread to the surrounding structures and stimulate them. It has been shown that CI activation can indeed result in stimulation of the vestibular structures. Therefore, the question was raised whether vestibular co-stimulation can be functionally used in patients with bilateral vestibulopathy. A more direct vestibular stimulation method can be accomplished by implantation and activation of a VI. The concept of the VI is based on the technology and principles of the CI. Different VI prototypes are currently being evaluated regarding feasibility and functionality. So far, all of them were capable of activating different types of vestibular reflexes. A third stimulation method is GVS, which requires the use of surface electrodes instead of an implanted electrode array. However, as the currents are sent through the skull from one mastoid to the other, GVS is rather unspecific. It should be mentioned though, that the reported spread of excitation in both CI and VI use also seems to induce a more unspecific stimulation. Although all three applications of EVS were shown to be effective, it has yet to be defined which option is more desirable based on applicability and efficiency. It is possible and even likely that there is a place for all three approaches, given the diversity of the patient population who serves to gain from such technologies.
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http://dx.doi.org/10.1159/000502407DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC7050666PMC
September 2020

Cochlear Erosion due to a Facial Nerve Schwannoma.

J Int Adv Otol 2019 Aug;15(2):330-332

Department of ENT-HNS, European Institute for Otorhinolaryngology-Head and Neck Surgery and Skull Base Surgery, Sint Augustinus Hospital, GZA, Antwerp, Belgium.

Facial nerve schwannomas are rare benign neoplasms. We report a case of a 60-year-old woman who initially presented with vestibular complaints. Magnetic resonance imaging (MRI) revealed a facial nerve schwannoma centered on the right geniculate ganglion extending in the labyrinthine segment. The patient consulted again after 2 months because she developed a sudden and severe right-sided sensorineural hearing loss. MRI showed no progression or pathological enhancement in the membranous labyrinth. A cone beam computed tomography (CT) of the temporal bone was performed and revealed a large erosion at the region of the geniculate ganglion in open communication with the middle turn of the cochlea. This case report demonstrates the importance of CT in facial nerve schwannomas for evaluating the impact on the surrounding structures.
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http://dx.doi.org/10.5152/iao.2019.5304DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6750781PMC
August 2019

Validity and Test-Retest Reliability of the Dutch Version of the Chronic Otitis Media Benefit Inventory.

J Int Adv Otol 2019 Apr;15(1):34-37

Department of Otorhinolaryngology, Head and Neck surgery, Sint-Augustinus Hospital, Antwerp, Belgium.

Objectives: We aimed to test the validity and test-retest reliability of the Dutch translation of the Chronic Otitis Media Benefit Inventory (COMBI) questionnaire.

Materials And Methods: In total, 30 chronic otitis media (COM) patients with a previous ear surgery completed the questionnaire; 30 patients with a negative medical history of COM complaints and with previous non-otologic surgery as the control group completed the questionnaire. For estimating the test-retest reliability, patients of the COM group completed the questionnaire twice; the scores were compared to those of the control group to test the validity.

Results: The overall COMBI score ranged as 32-60 in the patient test group, 32-60 in the patient retest group, and 35-40 in the control group. A mean (standard deviation) score of 43.87 (6.81) in the patient test group, 44.4 (6.83) in the patient retest group, and 36.7 (1.29) in the control group was noted. Post-intervention, the COM patients had a significantly higher absolute COMBI score compared to the control group. The diagnostic accuracy was investigated, and a cut-off score of 38.5 was found to have a high sensitivity and specificity in distinguishing a significant positive change from an insignificant change after the intervention. The average-measures intra-class correlation coefficient for absolute agreement (ICCAA) was 0.985 (95% confidence interval: 0.969-0.993), indicating an excellent test-retest reliability in the control group.

Conclusion: The Dutch version of the COMBI questionnaire has a good validity, diagnostic accuracy, and test-retest reliability.
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http://dx.doi.org/10.5152/iao.2019.6339DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6483420PMC
April 2019

The value of four stage vestibular hydrops grading and asymmetric perilymphatic enhancement in the diagnosis of Menière's disease on MRI.

Neuroradiology 2019 Apr 5;61(4):421-429. Epub 2019 Feb 5.

Department of Radiology, GZA Hospitals Antwerp, Oosterveldlaan 24, 2610, Wilrijk, Belgium.

Purpose: There is still a clinical-radiologic discrepancy in patients with Menière's disease (MD). Therefore, the purpose of this study was to investigate the reliability of current MRI endolymphatic hydrops (EH) criteria according to Baráth in a larger study population and the clinical utility of new imaging signs such as a supplementary fourth low-grade vestibular EH and the degree of perilymphatic enhancement (PE) in patients with Menière's disease (MD).

Methods: This retrospective study included 148 patients with probable or definite MD according to the 2015 American Academy of Otolaryngology, Head and Neck Surgery criteria who underwent a 4-h delayed intravenous Gd-enhanced 3D-FLAIR MRI between January 2015 and December 2016. Vestibular EH, vestibular PE, cochlear EH, and cochlear PE were reviewed twice by three experienced readers. Cohen's Kappa and multivariate logistic regression were used for analysis.

Results: The intra- and inter-reader reliability for the grading of vestibular-cochlear EH and PE was excellent (0.7 < kappa < 0.9). The two most distinctive characteristics to identify MD are cochlear PE and vestibular EH which combined gave a sensitivity and specificity of 79.5 and 93.6%. By addition of a lower grade vestibular EH, the sensitivity improved to 84.6% without losing specificity (92.3%). Cochlear EH nor vestibular PE showed added-value.

Conclusions: MRI using vestibular-cochlear EH and PE grading system is a reliable technique. A four-stage vestibular EH grading system in combination with cochlear PE assessment gives the best diagnostic accuracy to detect MD.
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http://dx.doi.org/10.1007/s00234-019-02155-7DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6431299PMC
April 2019

The Value of Diffusion-Weighted MRI in the Long-term follow-up After Subtotal Petrosectomy for Extensive Cholesteatoma and Chronic Suppurative Otitis Media.

Otol Neurotol 2019 01;40(1):e25-e31

European Institute for Otorhinolaryngology-Head and Neck Surgery.

Objective: To report the long-term follow-up with diffusion-weighted magnetic resonance imaging (DW MRI) after subtotal petrosectomy (SP) with blind sac closure of the external auditory canal for extensive cholesteatoma and chronic suppurative otitis media.

Study Design: Retrospective clinical record study.

Setting: Tertiary referral center.

Patients: Thirty-one patients (31 ears) with extensive cholesteatoma and 17 patients (19 ears) with chronic suppurative otitis media without cholesteatoma who underwent SP between July 1995 and December 2015.

Interventions: All 48 patients were followed clinically and with DW MRI to rule out residual cholesteatoma.

Main Outcome Measure: Residual cholesteatoma, indicated by a marked hyperintensity on non-echoplanar (non-EP) DW MRI.

Results: In the cholesteatoma group the mean interval between surgery and the latest DW MRI was 3.9 years. Seven patients presented with a residual cholesteatoma pearl. The mean interval between surgery and detection of residual disease was 3.7 years. In the chronic suppurative otitis media group the mean interval between surgery and the latest DW MRI was 5.3 years. Residual cholesteatoma was found in three patients. Mean interval between surgery and the detection of disease was 4.5 years.

Conclusions: This study shows the importance of DW MRI in the follow-up after SP for cholesteatoma and chronic suppurative otitis media. A little higher residual cholesteatoma rate was found compared with earlier studies, where patients were followed only clinically. One may wonder whether reintervention is always needed or whether in selected cases with small pearls, one may still observe these by a watchful waiting policy with DW MRI.
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http://dx.doi.org/10.1097/MAO.0000000000002049DOI Listing
January 2019

The Bony Obliteration Tympanoplasty in Pediatric Cholesteatoma: Long-term Hearing Results.

Otol Neurotol 2018 07;39(6):715-723

Department of Otorhinolaryngology-Head and Neck Surgery, The European Institute for Otorhinolaryngology-Head and Neck Surgery, Sint-Augustinus Hospital, Antwerp, Belgium.

Objective: To present the hearing results of a 5-year longitudinal study in a pediatric population undergoing surgery for extensive cholesteatoma using a canal wall up (CWU) approach with bony obliteration of the mastoid and epitympanic space, with a standard residual rate of 5.8%, a recurrence rate of 2.9%, and all ears waterproof, free of otorrhea and all external ear canals patent and self-cleaning.

Study Design: Retrospective consecutive study.

Patients: Thirty-three children (≤18 yr) undergoing surgery for cholesteatoma (34 ears) between 1997 and 2009.

Interventions: Therapeutic.

Setting: Tertiary referral center.

Main Outcome Measures: Hearing and gain in hearing at 1- and 5-year postsurgery: (1) pure-tone average (PTA), (2) pure-tone average high frequency, (3) pure-tone average including 3 kHz, (4) bone conduction at corresponding frequency averages, (5) gain at corresponding air conduction and bone conduction (gain at corresponding air conduction) frequency averages. (6) The Amsterdam Hearing Evaluation Plots were used to study the individual cases.

Results: The Amsterdam Hearing Evaluation Plots at 5-year showed in 58.8% of patients a positive gain air conduction. In 23.5% a successful functional result was achieved, defined as an air-bone gap closure to 20 dBHL or less. In 6 patients (17.6%) a limited bone conduction deterioration was shown all limited to maximum 20 dBHL.

Conclusion: The CWU bony obliteration tympanoplasty in a consecutive series of pediatric extensive cholesteatoma shows a similar to slightly improved hearing outcome as compared with CWU surgery without BOT. Although the series shows a clearly reduced reoperation rate and a significantly improved safety and hygienic outcome as compared with CWU without BOT, better hearing outcomes remain desirable in this group of children.
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http://dx.doi.org/10.1097/MAO.0000000000001846DOI Listing
July 2018

Dizziness and (Fear of) Falling in The Elderly: A Few Facts.

Authors:
Robby Vanspauwen

J Int Adv Otol 2018 Apr;14(1):1-2

Department of ENT, European Institute for ORL-HNS - Sint-Augustinus Hospital, Antwerp, Belgium.

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http://dx.doi.org/10.5152/iao.2018.0201815DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC6354480PMC
April 2018

Surgical Treatment of Acquired Atresia of the External Auditory Ear Canal.

Int Arch Otorhinolaryngol 2017 Oct 28;21(4):343-346. Epub 2017 Feb 28.

Department of ENT, European Institute for ORL, Wilrijk, Antwerp, Belgium.

 Acquired atresia of the external auditory canal is characterized by the formation of fibrous tissue in the medial part. The causes include chronic otitis externa, perforated chronic otitis media, postoperative or idiopathic healing problems. Acquired atresia presents with hearing loss and can be associated with otorrhea.  We analyzed the results of surgery after six months and two years by checking (1) pre- and postoperative hearing thresholds; (2) presence of otorrhea; and (3) whether a dry and patent ear canal is achieved.  We conducted this retrospective study at a tertiary referral center. In total, 27 ears underwent treatment with resection of the fibrotic plug followed by transplantation of a split-thickness skin graft covering the bare bone and tympanic membrane. When necessary, we combined this with a myringoplasty and a (meato-) canalplasty.  Otorrhea was present in 59.3% of the patients initially and in 14.8% at six months and 11% at two years postoperative. A dry and patent ear canal was obtained in 55.6% after six months and in 89% of the patients after two years (  = 27). The pure tone average before surgery was 39.1 dBHL (SD = 20 dBHL), at six months 31.4 dBHL (SD = 16.4 dBHL), and at 24 months postop 30.9 dBHL (SD = 17.1 dBHL). We observed a statistically significant improvement of hearing in 63% of the patients at six months (  = 0.005) and in 65% after two years (  = 0.022).  Treatment of acquired atresia remains a challenge. Using the appropriate surgical technique, including skin-grafting and regular postoperative check-up, rendered excellent results regarding otorrhea and a moderate improvement of hearing was achieved in 65% of the patients after two years.
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http://dx.doi.org/10.1055/s-0037-1598604DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC5629087PMC
October 2017

'Standard' versus 'nose reference' electrode placement for measuring oVEMPs with air-conducted sound: Test-retest reliability and preliminary patient results.

Clin Neurophysiol 2017 02 5;128(2):312-322. Epub 2016 Dec 5.

Faculty of Medicine and Health Sciences, Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium; Faculty of Sciences, Department of Biomedical Physics, University of Antwerp, Antwerp, Belgium.

Objectives: This study compared two electrode placements ('standard' versus 'nose reference' placement) for measuring oVEMPs, elicited by air-conducted 500Hz tone bursts. The test-retest reliability of both positions was evaluated and additionally both electrode placements were applied on a group of vestibular patients.

Methods: Eighteen healthy volunteers (range of 20-25years) participated in the first part and were retested after one week for evaluation of the test-retest reliability. Eleven patients (range of 41-74years) with a variety of vestibular pathologies were tested once.

Results: In the normal group, the nose reference electrode placement resulted in significantly larger peak-to-peak amplitudes (p<0.001), shorter n10 (p=0.001) and p15 (p<0.001) latencies and smaller 95% prediction intervals for the Inter-Ocular Ratio (IOR) ([-68, 68] for the standard position versus [-32, 32] for the nose reference position). Furthermore, an excellent amplitude and IOR test-retest reliability was observed with the nose reference configuration, as shown by the intraclass correlation coefficient (ICC), the coefficient of variation of the method error (CV) and the minimal detectable differences (MDD). In the patient group, the same significant amplitude difference was found. Moreover, three patients presented with absent oVEMPs when recorded with the standard placement, whereas the nose reference placement could evoke a detectable oVEMP response.

Conclusions: This study demonstrated that a nose reference electrode position results in larger oVEMP amplitudes and achieves a better reliability for the most important clinical parameters (amplitude and IOR). Our patient data substantiate the possible clinical benefit of this position, but further systematic patient verification is required.

Significance: The nose reference electrode position facilitates the detection of generally very small oVEMP responses and shows a high test-retest reliability, showing promising potential for future use in the vestibular clinic.
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http://dx.doi.org/10.1016/j.clinph.2016.11.023DOI Listing
February 2017

Comparison of Different Electrode Configurations for the oVEMP With Bone-Conducted Vibration.

Ear Hear 2017 Mar/Apr;38(2):205-211

1ENT Department, Sint-Augustinus Hospital Antwerp, European Institute for ORL-HNS, Antwerp, Belgium; 2Antwerp University Research center for Equilibrium and Aerospace (AUREA), ENT Department, University Hospital Antwerp, Antwerp, Belgium; 3Faculty of Medicine and Health Sciences, Department of Otorhinolaryngology, Ghent University, Ghent, Belgium; and 4Faculty of Medicine and Health Sciences, Department of Speech, Language and Hearing Sciences, Ghent University, Ghent, Belgium.

Objectives: This study was performed to compare three electrode configurations for the ocular vestibular evoked myogenic potentials (oVEMPs)-"standard," "sternum," and "nose"-by making use of bone-conducted stimuli (at the level of Fz with a minishaker). In the second part, we compared the test-retest reliability of the standard and nose electrode configuration on the oVEMP parameters.

Design: This study had a prospective design. Fourteen healthy subjects participated in the first part (4 males, 10 females; average age = 23.4 (SD = 2.6) years; age range 19.9 to 28.3 years) and second part (3 males, 11 females; average age = 22.7 (SD = 2.4) years; age range 20.0 to 28.0 years) of the study. OVEMPs were recorded making use of a hand-held bone conduction vibrator (minishaker). Tone bursts of 500 Hz (rise/fall time = 2 msec; plateau time = 2 msec; repetition rate = 5.1 Hz) were applied at a constant stimulus intensity level of 140 dB FL.

Results: PART 1: The n10-p15 amplitude obtained with the standard electrode configuration (mean = 15.8 μV; SD = 6.3 μV) was significantly smaller than the amplitude measured with the nose (Z = -3.3; p = 0.001; mean = 35.0 μV; SD = 19.1 μV) and sternum (Z = -3.3; p = 0.001; mean = 27.1 μV; SD = 12.2 μV) electrode configuration. The p15 latency obtained with the nose electrode configuration (mean = 14.2 msec; SD = 0.54 msec) was significantly shorter than the p15 latency measured with the standard (Z = -3.08; p = 0.002) (mean = 14.9 msec; SD = 0.75 msec) and sternum (Z = -2.98; p = 0.003; mean = 15.4 msec; SD = 1.07 msec) electrode configuration. There were no differences between the n10 latencies of the three electrode configurations. The 95% prediction intervals (given by the mean ± 1.96 * SD) for the different interocular ratio values were [-41.2; 41.2], [-37.2; 37.2], and [-25.9; 25.9] for standard, sternum, and nose electrode configurations, respectively. PART 2: Intraclass correlation (ICC) values calculated for the oVEMP parameters obtained with the standard electrode configuration showed fair to good reliability for the parameters n10-p15 amplitude (ICC = 0.51), n10 (ICC = 0.52), and p15 (ICC = 0.60) latencies. The ICC values obtained for the parameters acquired with the nose electrode configuration demonstrated a poor reliability for the n10 latency (ICC = 0.37), a fair to good reliability for the p15 latency (ICC = 0.47) and an excellent reliability for the n10-p15 amplitude (ICC = 0.85).

Conclusions: This study showed the possible benefits from alternative electrode configurations for measuring bone-conducted-evoked oVEMPs in comparison with the standard electrode configuration. The nose configuration seems promising, but further research is required to justify clinical use of this placement.
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http://dx.doi.org/10.1097/AUD.0000000000000372DOI Listing
February 2018

Mobile Communication Devices, Ambient Noise, and Acoustic Voice Measures.

J Voice 2017 Mar 29;31(2):248.e11-248.e23. Epub 2016 Sep 29.

Department of Otorhinolaryngology and Head and Neck Surgery, European Institute of ORL, Sint-Augustinus General Hospital, Antwerp, Belgium.

Objectives: The ability to move with mobile communication devices (MCDs; ie, smartphones and tablet computers) may induce differences in microphone-to-mouth positioning and use in noise-packed environments, and thus influence reliability of acoustic voice measurements. This study investigated differences in various acoustic voice measures between six recording equipments in backgrounds with low and increasing noise levels.

Methods: One chain of continuous speech and sustained vowel from 50 subjects with voice disorders (all separated by silence intervals) was radiated and re-recorded in an anechoic chamber with five MCDs and one high-quality recording system. These recordings were acquired in one condition without ambient noise and in four conditions with increased ambient noise. A total of 10 acoustic voice markers were obtained in the program Praat. Differences between MCDs and noise condition were assessed with Friedman repeated-measures test and posthoc Wilcoxon signed-rank tests, both for related samples, after Bonferroni correction.

Results: (1) Except median fundamental frequency and seven nonsignificant differences, MCD samples have significantly higher acoustic markers than clinical reference samples in minimal environmental noise. (2) Except median fundamental frequency, jitter local, and jitter rap, all acoustic measures on samples recorded with the reference system experienced significant influence from room noise levels.

Conclusions: Fundamental frequency is resistant to recording system, environmental noise, and their combination. All other measures, however, were impacted by both recording system and noise condition, and especially by their combination, often already in the reference/baseline condition without added ambient noise. Caution is therefore warranted regarding implementation of MCDs as clinical recording tools, particularly when applied for treatment outcomes assessments.
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http://dx.doi.org/10.1016/j.jvoice.2016.07.023DOI Listing
March 2017

The Neural Correlates of Chronic Symptoms of Vertigo Proneness in Humans.

PLoS One 2016 18;11(4):e0152309. Epub 2016 Apr 18.

Lab for Clinical & Integrative Neuroscience, School of Behavioral and Brain Sciences, The University of Texas at Dallas, Dallas, United States of America.

Vestibular signals are of significant importance for variable functions including gaze stabilization, spatial perception, navigation, cognition, and bodily self-consciousness. The vestibular network governs functions that might be impaired in patients affected with vestibular dysfunction. It is currently unclear how different brain regions/networks process vestibular information and integrate the information into a unified spatial percept related to somatosensory awareness and whether people with recurrent balance complaints have a neural signature as a trait affecting their development of chronic symptoms of vertigo. Pivotal evidence points to a vestibular-related brain network in humans that is widely distributed in nature. By using resting state source localized electroencephalography in non-vertiginous state, electrophysiological changes in activity and functional connectivity of 23 patients with balance complaints where chronic symptoms of vertigo and dizziness are among the most common reported complaints are analyzed and compared to healthy subjects. The analyses showed increased alpha2 activity within the posterior cingulate cortex and the precuneues/cuneus and reduced beta3 and gamma activity within the pregenual and subgenual anterior cingulate cortex for the subjects with balance complaints. These electrophysiological variations were correlated with reported chronic symptoms of vertigo intensity. A region of interest analysis found reduced functional connectivity for gamma activity within the vestibular cortex, precuneus, frontal eye field, intra-parietal sulcus, orbitofrontal cortex, and the dorsal anterior cingulate cortex. In addition, there was a positive correlation between chronic symptoms of vertigo intensity and increased alpha-gamma nesting in the left frontal eye field. When compared to healthy subjects, there is evidence of electrophysiological changes in the brain of patients with balance complaints even outside chronic symptoms of vertigo episodes. This suggests that these patients have a neural signature or trait that makes them prone to developing chronic balance problems.
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http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0152309PLOS
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4835222PMC
August 2016

Validity and Test-Retest Reliability of the Dutch Version of the Chronic Otitis Media Questionnaire 12 (COMQ-12).

J Int Adv Otol 2015 Dec;11(3):248-52

European Institute for ORL-HNS, Department of ENT-HNS Sint-Augustinus Hospital, Antwerp, Belgium.

Objective: To test the validity and test-retest reliability of the Dutch translation of the Chronic Otitis Media Questionnaire 12 (COMQ-12).

Materials And Methods: Thirty-five healthy individuals with no history of chronic otitis media (COM) received the questionnaire as well as a group of 35 patients with complaints of COM. The healthy participants had to complete the questionnaire twice (control group 1 and control group 2) to estimate the test-retest reliability, and their scores were compared with those of the patients (group 3) to test the validity.

Results: The overall COMQ-12 score in control group 1 ranged from 0 to 11, in control group 2 from 0 to 6, and in group 3 from 7 to 46. The mean score in control group 1 was 1.43 [standard deviation (SD) 2.30], 1.34 in control group 2 (SD 2.06), and 27.80 in group 3 (SD 10.51). A comparison of the absolute COMQ-12 scores of the two control groups and the patient group showed a significantly higher COMQ-12 score in patients with COM than in controls. The diagnostic accuracy was investigated, and a COMQ-12 cut-off score of 8 was found to have a near-perfect sensitivity and specificity in distinguishing between the presence and absence of COM. The single-measures intraclass correlation coefficient for absolute agreement (ICCAA) was 0.859 (with a 95% confidence interval from 0.738 to 0.926). This clearly exceeded the ICC threshold for acceptable reliability (ICC≥0.75) and therefore confirmed that there was reasonable test-retest reliability when applying the questionnaire to control subjects.

Conclusion: The Dutch version of the COMQ-12 has good validity, diagnostic accuracy, and test-retest reliability.
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http://dx.doi.org/10.5152/iao.2015.1701DOI Listing
December 2015

Outcome evaluation of the dizziness handicap inventory in an outpatient vestibular clinic.

J Vestib Res 2016 ;26(5-6):479-486

Department of ENT, Sint-Augustinus Hospital Antwerp, European Institute for ORL-HNS, Oosterveldlaan, Wilrijk, Antwerp, Belgium.

Background: The DHI is a widely used questionnaire for the evaluation of the self-reported disability in patients with dizziness and balance problems.

Objective: To investigate the relationship between the DHI scores and demographic, symptomatic and diagnostic parameters.

Methods: Retrospective study in 568 patients with balance problems.

Results: We observed a total of 61.3% of patients with moderate (DHI total score between 30 and 59) to severe (DHI total score between 60 and 100) disability.Patients with long-standing complaints (lasting longer than 3 months) experience their self-reported disability to a greater extent than patients with new onset pathology (illness duration of one month and less). Moreover, patients suffering from continuous complaints have a larger DHI score than patients with shorter symptom duration. The first effect (new onset vs. long-standing pathology) is primarily caused by emotional factors, the latter effect (symptom duration) is attributable to functional and physical factors, not to emotional aspects. Patients with daily and weekly complaints have larger DHI scores than patients who reported only one episode. Female patients reported larger DHI scores than males. We found no effect of age, diagnostic group (no diagnosis, episodic, acute or chronic vestibular syndrome) or reported symptoms on the DHI scores.

Conclusions: The information retrieved from the DHI questionnaire is complementary to the information obtained from clinical investigation and diagnostic tests and therefore is an essential tool in a vestibular clinic.
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http://dx.doi.org/10.3233/VES-160600DOI Listing
February 2018

Space motion sickness countermeasures: a pharmacological double-blind, placebo-controlled study.

Aviat Space Environ Med 2014 Jun;85(6):638-44

Introduction: Space motion sickness (SMS), caused by a canal-otolith conflict, is currently treated with intramuscular promethazine. However, the drug has an inconsistent efficacy against SMS. We hypothesize that pharmacological depression of the semicircular canals (SCC) might relieve SMS. The aim of the present study was to identify the effects of meclizine (25 mg), dimenhydrinate (40 mg) combined with cinnarizine (25 mg), and promethazine (25 mg) combined with d-amphetamine (10 mg) on the SCCs and the otoliths.

Methods: This double-blind, placebo-controlled study was performed on 20 healthy men. Function of the SCC was evaluated by means of an electronystagmography, whereas utricular function was assessed by a unilateral centrifugation test. A cervical vestibular evoked myogenic potentials test evaluated saccular function.

Results: Meclizine (0.54 +/- 0.05 vs. 0.38 +/- 0.06) and dimenhydrinate with cinnarizine (0.54 +/- 0.05 vs. 0.45 +/- 0.05) decreased the vestibulo-ocular reflex gain. Promethazine with d-amphetamine decreased the latency of the saccadic eye response (right eye: 185 +/- 3.8 ms vs. 165 +/- 4.5 ms; left eye: 181 +/- 4.9 ms vs. 165 +/- 4.8 ms) and also increased the phase of ocular counterrolling measured during unilateral centrifugation (0.32 +/- 0.35 degrees vs. 1.5 +/- 0.45 degrees).

Discussion: It is hypothesized that meclizine and dimenhydrinate with cinnarizine affect the medial vestibular nucleus. Promethazine is a vestibular suppressor, but study results show that d-amphetamine counterbalances this depression and abolishes the effect of fatigue on the saccadic reaction time The hypothesis that a SCC-suppression alleviates SMS should be further evaluated.
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http://dx.doi.org/10.3357/asem.3865.2014DOI Listing
June 2014

Transmastoid repair of superior semicircular canal dehiscence.

J Neurol Surg B Skull Base 2012 Aug;73(4):225-9

Department of Otolaryngology, Royal Victorian Eye and Ear Hospital, Melbourne, Victoria, Australia.

Objective/Hypothesis Superior semicircular canal (Sup SC) dehiscence syndrome is a rare condition, causing a variety of auditory and vestibular symptoms. The traditional surgical management is a middle cranial fossa, extradural approach to resurface the Sup SC. Recently, a transmastoid approach for plugging of the Sup SC has been developed. We present further data supporting the use of the transmastoid approach in preference to the middle fossa approach. Design This is a retrospective multi-institutional case series. Method We included 10 patients in this case series from two tertiary otology institutions. Sup SC dehiscence was confirmed by correlation of clinical symptoms with positive audiometric, vestibular evoked myogenic potential, and computed tomography findings. A transmastoid approach was used for plugging of the Sup SC. Either a single fenestration was created at the site of dehiscence or separate fenestrations sited ampullopetal and ampullofugal to the dehiscence. Results All patients who underwent this procedure had good symptom control and hearing preservation postoperatively. Conclusion In patients with adequate temporal bone pneumatization, the transmastoid approach provides a safe and effective alternative to the middle cranial fossa approach. This series has demonstrated excellent symptom control and preservation of hearing with the transmastoid approach.
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http://dx.doi.org/10.1055/s-0032-1312713DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC3424037PMC
August 2012

Baclofen affects the semicircular canals but not the otoliths in humans.

Acta Otolaryngol 2013 Aug 30;133(8):846-52. Epub 2013 Apr 30.

Antwerp University Research Center for Equilibrium and Aerospace (AUREA), University of Antwerp, Antwerp, Belgium.

Conclusion: This study showed that GABAB agonist baclofen (10 mg) affects the semicircular canals (SCCs), both centrally and peripherally, but does not influence the otolithic function.

Objectives: The aim of the study was to identify the effects of baclofen on the complete vestibular system, i.e. semicircular canals, saccules and utricles.

Methods: The study had a double-blind, placebo-controlled, repeated measures design and was conducted on healthy male volunteers. With electronystagmography (ENG), the SCC function was evaluated, whereas utricular function was determined by means of unilateral centrifugation (UC). Cervical vestibular evoked myogenic potentials (cVEMPs) tested saccular integrity.

Results: Baclofen caused a significant increase of the vestibulo-ocular reflex (VOR) phase and a significant decrease of the total caloric response (TCR), both measured during ENG. The drug also decreased the maximal contribution of the SCCs to ocular counter-rolling (OCR) evaluated during UC. No effects on saccules and utricules were observed.
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http://dx.doi.org/10.3109/00016489.2013.782615DOI Listing
August 2013

Pharmaceutical countermeasures have opposite effects on the utricles and semicircular canals in man.

Audiol Neurootol 2012 19;17(4):235-42. Epub 2012 Apr 19.

Antwerp University Research Centre for Equilibrium and Aerospace (AUREA), Edegem, Belgium.

Introduction: Sensory conflicts in the vestibular system lead to motion sickness of which space motion sickness (SMS) is a special case. SMS affects up to 70% of the astronauts during the first 3 days in space. The search for effective countermeasures has led to several nonpharmacological and pharmacological approaches. The current study focuses on the effects of lorazepam (1 mg), meclizine (25 mg), promethazine (25 mg), and scopolamine (0.4 mg) on the vestibular system, with special focus on the canal and otolith functions separately.

Methods: The study had a placebo-controlled, single blind, repeated measures design. Sixteen healthy volunteers were subjected to a total of 7 test sessions, the first and last being without intake of medication. Semicircular canal function was evaluated by means of electronystagmography and otolith function with unilateral centrifugation. The horizontal semicircular canal function was characterized by the vestibulo-ocular reflex (VOR) gain measured during earth vertical axis rotation as well as the total caloric response. The function of the utricles was represented by the utricular sensitivity, reflecting the ocular counter roll relative to the virtual induced head tilt.

Results: Promethazine significantly decreased the semicircular canal and utricular parameters. Both scopolamine and lorazepam caused only a decrease in the utricular sensitivity, whereas meclizine only decreased the semicircular canal-induced VOR gain.

Discussion: The results show that the drugs affected different areas of the vestibular system and that the effects can thus be attributed to the specific pharmacological properties of each drug. Meclizine, as an antihistaminergic and weak anticholinergic drug, only affected the VOR gain, suggesting a central action on the medial vestibular nucleus. The same site of action is suggested for the anticholinergic scopolamine since acetylcholine receptors are present and utricular fibers terminate here. The global vestibular suppression caused by promethazine is probably a consequence of its anticholinergic, antihistaminergic, and antidopaminergic properties. Based on the fact that lorazepam increased the affinity of gamma-aminobutyric acid (GABA) for the GABA(A)-receptor and its effects on the utriculi, the site of action seems to be the lateral vestibular nucleus.

Conclusion: Meclizine, scopolamine, and lorazepam selectively suppress specific parts of the vestibular system. Selective suppression of different parts of the vestibular system may be more beneficial for alleviating (space) motion sickness than general suppressive agents. Additionally, this knowledge may help the clinician in his therapeutic management of patients with either semicircular canal or otolith dysfunction.
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http://dx.doi.org/10.1159/000337273DOI Listing
October 2012

No effects of anti-motion sickness drugs on vestibular evoked myogenic potentials outcome parameters.

Otol Neurotol 2011 Apr;32(3):497-503

Antwerp University Research Center for Equilibrium and Aerospace, University of Antwerp, Antwerp, Belgium.

Objective: To investigate the effects of meclizine (50 mg), baclofen (10 mg), cinnarizine (20 mg) + dimenhydrinate (40 mg), and promethazine (25 mg) + dextro-amphetamine (5 mg) on the parameters of the vestibular evoked myogenic potential (VEMP) test.

Study Design: Double-blind placebo-controlled prospective randomized trial.

Setting: University hospital.

Subjects: Twenty-four (first block: baclofen versus placebo) and 20 healthy male subjects (second block: meclizine, cinnarizine + dimenhydrinate and promethazine + dextro-amphetamine versus placebo).

Interventions: VEMP test.

Main Outcome Measures: Threshold, p13 and n23 latencies, p13-n23 latency difference, p13-n23 peak-to-peak amplitude, mean rectified voltage of the sternocleidomastoid muscle contraction and the corrected amplitude.

Results: There were no clinically significant pharmacologic effects on the VEMP outcome parameters. However, there was a statistically significant left-right asymmetry after intake of the combination promethazine + d-amphetamine for the parameters p13 and latency difference.

Conclusion: The absence of clinically significant effects can be explained by the predominant presence of the target receptors for the applied drugs in the medial vestibular nucleus, which receives the lowest grade of saccular projections. It also can be hypothesized that the VEMP methodology and techniques in general do not allow determining pharmacologic effects in a healthy group of subjects because of a too small discriminative power. The left-right asymmetry can be explained by a depressive action of the drugs on the central compensation mechanisms. Because there were no significant differences between the VEMP parameters obtained after intake of the placebos of both blocks, we concluded that there were no training effects.
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http://dx.doi.org/10.1097/MAO.0b013e31820d94d0DOI Listing
April 2011

Respiratory sinus arrhythmia on the ESA-short-arm human centrifuge.

IEEE Eng Med Biol Mag 2009 Nov-Dec;28(6):86-91

Signal and Image Centre, Electrical Engineering Department, Royal Military Academy, 30 Avenue de la Renaissance, B-1000 Brussels, Belgium.

In this article, we investigated the hypothesis that the effects of hypergravity on respiratory sinus arrhythmia (RSA) can mimic the effects observed after spaceflight cardiovascular deconditioning. Artificial gravity along the head-to-feet axis on a short-arm centrifuge induces gravity gradients. This physiological condition of significantly higher g at the feet than at the heart level is specific and likely induces blood sequestration in the lower limbs. After spaceflight, astronauts are in a condition of cardiovascular deconditioning, where blood pooling in the lower part of the body and autonomic adaptation are factors contributing to orthostatic intolerance and changes in heart-rate variability (HRV). ECG and respiration were recorded during imposed and controlled breathing (ICB) protocols, which were repeated at different levels of artificial gravity as well as during supine and standing control conditions, and the changes were analyzed.
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http://dx.doi.org/10.1109/MEMB.2009.934618DOI Listing
March 2010

Conscientiousness in patients with Ménière's disease.

Otol Neurotol 2007 Apr;28(3):365-8

Antwerp University Research centre for Equilibrium and Aerospace, University Department of Otorhinolaryngology and Head and Neck Surgery, Antwerp University Hospital, University of Antwerp, Edegem, Belgium.

Objective: To assess whether a conscientious personality profile is more prevalent in patients with Ménière's disease (MD) in comparison with other vertigo patients. Second, to investigate a sex effect and compare the obtained conscientiousness scores with published normative values.

Patients: A total of 108 patients were included and subdivided into one of five pathology groups: MD, benign paroxysmal positional vertigo, vestibular neuritis, vestibular schwannoma, and posttraumatic nonbenign paroxysmal positional vertigo.

Intervention: The conscientiousness domain of the self-reporting NEO Five-Factor Inventory questionnaire.

Main Outcome Measure: Conscientiousness score.

Results: There was no significant difference between the diagnostic groups or a sex effect. MD patients had a higher score than published normal values.

Conclusion: As assessed with the NEO Five-Factor Inventory questionnaire, MD patients do not demonstrate a higher conscientious personality profile in comparison with other vertigo patients. Therefore, this limits the clinical use of the personality profile to discriminate between patient groups.
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http://dx.doi.org/10.1097/mao.0b013e31802e3c67DOI Listing
April 2007

Vestibular function testing.

Curr Opin Neurol 2007 Feb;20(1):19-24

Antwerp University Research Center for Equilibrium and Aerospace, Department of ENT, University of Antwerp, Antwerp, Belgium.

Purpose Of Review: This review provides an overview of vestibular function testing and highlights the new techniques that have emerged during the past 5 years.

Recent Findings: Since the introduction of video-oculography as an alternative to electro-oculography for the assessment of vestibular-induced eye movements, the investigation of the utricle has become a part of vestibular function testing, using unilateral centrifugation. Vestibular evoked myogenic potentials have become an important test for assessing saccular function, although further standardization and methodological issues remain to be clarified. Galvanic stimulation of the labyrinth also is an evolving test that may become useful diagnostically.

Summary: A basic vestibular function testing battery that includes ocular motor tests, caloric testing, positional testing, and earth-vertical axis rotational testing focuses on the horizontal semicircular canal. Newer methods to investigate the otolith organs are being developed. These new tests, when combined with standard testing, will provide a more comprehensive assessment of the complex vestibular organ.
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http://dx.doi.org/10.1097/WCO.0b013e3280140808DOI Listing
February 2007