Objectives: To examine the prevalence and incidence, clinical presentation, societal impact and comorbid conditions of benign paroxysmal positional vertigo (BPPV) in the general population. Methods: Cross-sectional, nationally representative neurotological survey of the general adult population in Germany with a two stage sampling design: screening of 4869 participants from the German National Telephone Health Interview Survey 2003 (response rate 52%) for moderate or severe dizziness or vertigo, followed by validated neurotological interviews (n = 1003; response rate 87%). Diagnostic criteria for BPPV were at least five attacks of vestibular vertigo lasting Results: BPPV accounted for 8% of individuals with moderate or severe dizziness/vertigo. The lifetime prevalence of BPPV was 2.4%, the 1 year prevalence was 1.6% and the 1 year incidence was 0.6%. The median duration of an episode was 2 weeks. In 86% of affected individuals, BPPV led to medical consultation, interruption of daily activities or sick leave. In total, only 8% of affected participants received effective treatment. On multivariate analysis, age, migraine, hypertension, hyperlipidaemia and stroke were independently associated with BPPV. Conclusion: BPPV is a common vestibular disorder leading to significant morbidity, psychosocial impact and medical costs.

https://jnnp.bmj.com/content/jnnp/78/7/710.full.pdf

Epidemiology of benign paroxysmal positional vertigo. A population-based study

Objectives: To examine the prevalence and incidence, clinical presentation, societal impact and comorbid conditions of benign paroxysmal positional vertigo (BPPV) in the general population. Methods: Cross-sectional, nationally representative neurotological survey of the general adult population in Germany with a two stage sampling design: screening of 4869 participants from the German National Telephone Health Interview Survey 2003 (response rate 52%) for moderate or severe dizziness or vertigo, followed by validated neurotological interviews (n = 1003; response rate 87%). Diagnostic criteria for BPPV were at least five attacks of vestibular vertigo lasting < 1 min without concomitant neurological symptoms and invariably provoked by typical changes in head position. In a concurrent validation study (n = 61) conducted in two specialised dizziness clinics, BPPV was detected by our telephone interview with a specificity of 92% and a sensitivity of 88% (positive predictive value 88%, negative predictive value 92%). Results: BPPV accounted for 8% of individuals with moderate or severe dizziness/vertigo. The lifetime prevalence of BPPV was 2.4%, the 1 year prevalence was 1.6% and the 1 year incidence was 0.6%. The median duration of an episode was 2 weeks. In 86% of affected individuals, BPPV led to medical consultation, interruption of daily activities or sick leave. In total, only 8% of affected participants received effective treatment. On multivariate analysis, age, migraine, hypertension, hyperlipidaemia and stroke were independently associated with BPPV. Conclusion: BPPV is a common vestibular disorder leading to significant morbidity, psychosocial impact and medical costs.

Epidemiology of benign paroxysmal positional vertigo: a population based study. Editorial Commentary

The Joint Committee on Infant Hearing (JCIH) endorses early detection of, and intervention for infants with hearing loss (early hearing detection and intervention, [EHDI]) through integrated, interdisciplinary state and national systems of universal newborn hearing screening (UNHS), evaluation, and family-centered intervention. The goal of EHDI is to maximize linguistic and communicative competence and literacy development for children who are hard of hearing or deaf. Without appropriate opportunities to learn language, children who are hard of hearing or deaf will fall behind their hearing peers in language, cognition, and social-emotional development. Such delays may result in lower educational and employment levels in adulthood (Gallaudet University Center for Assessment and Demographic Study, 1998). Thus, all infants' hearing should be screened using objective, physiologic measures to identify those with congenital or neonatal onset hearing loss. Audiologic evaluation and medical evaluations should be in progress before 3 months of age. Infants with confirmed hearing loss should receive intervention before 6 months of age from health care and education professionals with expertise in hearing loss and deafness in infants and young children. Regardless of prior hearing screening outcomes, all infants who demonstrate risk indicators for delayed onset or progressive hearing loss should receive ongoing audiologic and medical monitoring for 3 years and at appropriate intervals thereafter to ensure prompt identification and intervention (American Speech-Language-Hearing Association [ASHA], 1997). EHDI systems should guarantee seamless transitions for infants and their families through this process.

Appropriate early intervention programs are family-centered, interdisciplinary, culturally competent, and build on informed choice for families (Baker-Hawkins and Easterbrooks, 1994). To achieve informed decision-making, families should have access to professional, educational, and consumer organizations; and they should have opportunities to interact with adults and children who are hard of hearing and deaf (Ogden, 1996; Thompson, 1994). Families should have access to general information on …

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Year 2000 Position Statement: Principles and Guidelines for Early Hearing Detection and Intervention Programs

1. The response to static tilts was studied in peripheral otolith neurons in the barbiturate-anesthetized squirrel monkey (Saimiri sciureus). Each unit was characterized by a functional polarization vector, which defines the axis of greatest sensitivity. A circumstantial criterion was used to assign units to the inferior (IN) or superior (SN) vestibular nerves. The former neurons should innervate the sacculus, the latter mainly the utriculus. Confirming pasting experiments, the polarization vectors for SN units lay near the plane of the utricular macula, those for IN units near the plane of the saccular macula. The polarization vectors for IN units were compared in two groups of animals. In one group, the vestibular nerve was intact; in the other, the superior nerve was sectioned. No differences were found and this, together with other observations, demonstrate that the sacculas in mammals functions mainly (if not solely) as an equilibrium organ. 2. The resting discharge of otolith neurons averages some 60 spikes/s, the sensitivity some 30-40 spikes/s-g. IN units tend to have slightly lower sensitivities than do SN units. IN units with upwardly directed (+Z) vectors have substantially higher resting discharges than do units with downwardly directed (-Z) vectors. The +Z units are also characterized by more linear force-response relations. 3. There is a strong positive relation between the resting discharge and sensitivity of units characterized by regular steady-state discharge patterns. A weaker, but statistically significant, relation is demonstrable for irregular units. It is suggested that the relation seen in regular units is the result of the neurons differing from one anothrer in terms of a receptor bias, a transduction gain, or both. Only the mechanism based on transduction gain is thought to be operative among the population of irregular units. 4. Centrifugal-force trapezoids were used to study the response adaptation to prolonged stimulation. Adaptation was more conspicious in irregular units and was characterized by perstimulus response declines and poststimulus secondary responses. For regular units, adaptive properties were similar during excitatory and inhibitory responses. For irregular units, response declines were larger during excitatory stimuli, secondary responses larger following inhibitory stimuli. Typically, response declines were most rapid at the start of the force plateau. A few units, all of them irregular, exhibited a delayed adaptation with response declines beginning only after a constant force had been maintained for 10-20 s. 5. Excitatory responses of regular units are almost always larger than inhibitory responses. This is so during both the dynamic and static portions of force trapezoids. A similar asymmetry is seen in the dynamic response of irregular units; static response asymmetries of the latter units are more variable.

Physiology of Peripheral Neurons Innervating Otolith Organs of the Squirrel Monkey. I. Response to Static Tilts and to Long-Duration Centrifugal Force

Background Balance dysfunction can be debilitating and can lead to catastrophic outcomes such as falls. The inner ear vestibular system is an important contributor to balance control. However, to our knowledge, the prevalence of vestibular dysfunction in the United States and the magnitude of the increased risk of falling associated with vestibular dysfunction have never been estimated. The objective of this study was to determine the prevalence of vestibular dysfunction among US adults, evaluate differences by sociodemographic characteristics, and estimate the association between vestibular dysfunction and risk of falls. Methods We included data from the 2001-2004 National Health and Nutrition Examination Surveys, which were cross-sectional surveys of US adults aged 40 years and older (n = 5086). The main outcome measure was vestibular function as measured by the modified Romberg Test of Standing Balance on Firm and Compliant Support Surfaces. Results From 2001 through 2004, 35.4% of US adults aged 40 years and older (69 million Americans) had vestibular dysfunction. Odds of vestibular dysfunction increased significantly with age, were 40.3% lower in individuals with more than a high school education, and were 70.0% higher among people with diabetes mellitus. Participants with vestibular dysfunction who were clinically symptomatic (ie, reported dizziness) had a 12-fold increase in the odds of falling. Conclusions Vestibular dysfunction, as measured by a simple postural metric, is common among US adults. Vestibular dysfunction significantly increases the likelihood of falls, which are among the most morbid and costly health conditions affecting older individuals. These data suggest the importance of diagnosing, treating, and potentially screening for vestibular deficits to reduce the burden of fall-related injuries and deaths in the United States.

https://jamanetwork.com/journals/jamainternalmedicine/articlepdf/773517/ioi90006_938_944.pdf

Disorders of Balance and Vestibular Function in US Adults: Data From the National Health and Nutrition Examination Survey, 2001-2004

Primary tumors of the facial nerve are relatively rare and have a variety of presenting symptoms. This article reviews 248 cases of facial neuroma in the world's literature and adds seven cases that were managed at the Baylor College of Medicine. Facial weakness was most common symptom, with facial spasm or tics, hearing loss, and masses in the external auditory canal also being frequently seen. At surgery, the tympanic, vertical, and labyrinthine segments were the most commonly involved areas. On the basis of this review, general principles have been drawn up to help the clinician in diagnosis and management of this (at times) difficult problem.

Intracranial and intratemporal facial neuroma.

A staging system for juvenile angiofibroma based on computerized tomographic findings is suggested. The need for such an endeavor has come about because of a lack of standardization of tumor data in both individual series and interinstitutional reports. The various stages reflect the number of anatomic sites occupied by a lesion rather than the actual tumor size. The “simpler” tumors are confined to the medial part of the skull base and are entirely extracranial. As a tumor extends laterally and/or intracranially, the staging designation, and therefore the treatment plan, changes accordingly. Presumably, with the application of consistent diagnostic tools and standardized stage designations, the analysis of both morbidity and treatment data will become more meaningful.

Radiographic staging of juvenile angiofibroma

• We retrospectively studied tumors of the parapharyngeal space treated at the Baylor College of Medicine Affiliated Hospital System, Houston, from 1972 to 1985. Of the 42 lesions, 30 (71.4%) were benign and 12 (28.6%) were malignant. Tumors of neurogenic origin were present in 17 (40.5%). Tumors of salivary gland origin were present in 16 (38.1%): ten were benign, six were malignant. Nine (21.4%) of the patients presented with miscellaneous lesions, six of which proved to be malignant. We have found that a preoperative arteriogram is no longer routinely indicated. High-resolution computed tomography is now the best initial diagnostic study because it helps determine the size and extent of the tumor, differentiate tumors of parotid and extraparotid origin, demonstrate degree of tumor vascularity, and separate benign from malignant lesions. (Arch Otolaryngol1985;111:753-757)

https://jamanetwork.com/HttpHandlers/ArticlePdfHandler.ashx?journal=OTOL&articleId=612773&pdfFileName=archotol_111_11_011.pdf

Tumors of the Parapharyngeal Space

Objective To determine the basis for the large, age-related asymmetries in dichotic listening performance scores reported by Jerger et al. (1994). Design Behavioral and electrophysiologic responses to dichotic listening tasks in both verbal and nonverbal paradigms were obtained in four groups of subjects: young adults with normal hearing, elderly persons with presbyacusis, elderly persons with presbyacusis and marked dichotic deficits, and patients with lesions of the corpus callosum. Results In comparison with the young group the two elderly groups showed an increasing left-ear deficit on the verbal task, and an increasing right-ear deficit on the nonverbal paradigm. The pattern of results obtained in the elderly persons with marked dichotic deficits was similar to the pattern of results in the group with callosal lesions. Conclusions With age, there may be a significant loss of efficiency of interhemispheric transfer of auditory information through the corpus callosum. Such age-related deficit might have important implications for the effective use of binaural information by elderly persons.

Dichotic listening, event-related potentials, and interhemispheric transfer in the elderly.

A retrospective review of 29 cases of infratemporal facial nerve injuries included 18 temporal bone fractures, 7 gunshot wounds, and 4 iatrogenic complications. Surgical exploration confirmed involvement of the fallopian canal in the perigeniculate region in 14 longitudinal and 3 transverse or mixed fractures of the petrous pyramid. Gunshot and iatrogenic injuries usually occurred within the tympanic and vertical segments of the facial canal and at the stylomastoid foramen. When hearing is salvageable, the middle fossa approach provides the best access to the perigeniculate region of the facial nerve. In the presence of severe sensorineural hearing loss, the transmastold-translabyrinthine approach is the most appropriate for total facial nerve exploration. Grade I to III results can be anticipated in timely decompression of lesions caused by edema or intraneural hemorrhage. Undetectable at the time of surgery, stretch and compression injuries with disruption of the endoneural tubules often lead to subopti...

Bobby R. Alford

Papers

Intracranial and intratemporal facial neuroma.

Radiographic staging of juvenile angiofibroma

Tumors of the Parapharyngeal Space

Dichotic listening, event-related potentials, and interhemispheric transfer in the elderly.

Traumatic Infratemporal Facial Nerve Injury: Management Rationale for Preservation of Function