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Search Results (411)

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Keywords = vertigo

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14 pages, 628 KiB  
Article
Variations in the Diagnosis and Management of Benign Paroxysmal Positional Vertigo Among Physician Specialties in Saudi Arabia: Influence of Clinical Experience and Case Exposure
by Sarah Alshehri, Abdullah Oudah Al Ahmree, Abdulaziz Qobty, Abdullah Musleh and Khalid A. Alahmari
Healthcare 2025, 13(15), 1887; https://doi.org/10.3390/healthcare13151887 - 1 Aug 2025
Viewed by 130
Abstract
Background/Objectives: Benign paroxysmal positional vertigo (BPPV) is the most prevalent vestibular disorder encountered in clinical settings and is highly responsive to evidence-based diagnostic and therapeutic interventions. However, variations in practice patterns among physician specialties can compromise timely diagnosis and effective treatment. Understanding [...] Read more.
Background/Objectives: Benign paroxysmal positional vertigo (BPPV) is the most prevalent vestibular disorder encountered in clinical settings and is highly responsive to evidence-based diagnostic and therapeutic interventions. However, variations in practice patterns among physician specialties can compromise timely diagnosis and effective treatment. Understanding these variations is essential for improving clinical outcomes and standardizing care. This study aimed to assess the diagnostic and treatment practices for BPPV among Ear, Nose, and Throat (ENT) specialists, neurologists, general practitioners, and family physicians in Saudi Arabia and to examine how these practices are influenced by clinical experience and patient case exposure. Methods: A cross-sectional, questionnaire-based study was conducted between April 2023 and March 2024 at King Khalid University, Abha, Saudi Arabia. A total of 413 physicians were recruited using purposive sampling. Data were analyzed using IBM SPSS version 24.0. Parametric tests, including one-way ANOVA and chi-square tests, were used to assess differences across groups. A p-value of <0.05 was considered statistically significant. Results: Overall, all physician groups exhibited limited adherence to guideline-recommended positional diagnostic and therapeutic maneuvers. However, ENT specialists and neurologists demonstrated relatively higher compliance, particularly in performing the Dix–Hallpike test, with 46.97% and 26.79% reporting “always” using the maneuver, respectively (p < 0.001, Cramér’s V = 0.22). Neurologists were the most consistent in conducting oculomotor examinations, with 73.68% reporting routine performance (p < 0.001, Cramér’s V = 0.35). Epley maneuver usage was highest among neurologists (86.36%) and ENT specialists (77.14%) compared to family physicians (50.60%) and GPs (67.50%) (p = 0.044). Physicians with 11–15 years of experience and >50 BPPV case exposures consistently showed a greater use of diagnostic maneuvers, repositioning techniques, and guideline-concordant medication use (betahistine 76.67%; p < 0.001). Continuing medical education (CME) participation and the avoidance of unnecessary imaging were also highest in this group (46.67% and 3.33%, respectively; p < 0.001). Conclusions: Significant inter-specialty differences exist in the management of BPPV in Saudi Arabia. Greater clinical experience and higher case exposure are associated with improved adherence to evidence-based practices. Targeted educational interventions are needed, particularly in primary care, to enhance guideline implementation. Full article
(This article belongs to the Special Issue Care and Treatment of Ear, Nose, and Throat)
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13 pages, 852 KiB  
Article
Role of Lung Function, Chronic Obstructive Pulmonary Disease on Hearing Impairment: Evidence for Causal Effects and Clinical Implications
by Lanlai Yuan, Feipeng Cui, Ge Yin, Mengwen Shi, Nadida Aximu, Yaohua Tian and Yu Sun
Audiol. Res. 2025, 15(4), 88; https://doi.org/10.3390/audiolres15040088 - 16 Jul 2025
Viewed by 316
Abstract
Objectives: Observational studies have shown that chronic obstructive pulmonary disease (COPD) is associated with an increased risk of hearing impairment. However, causality remains unclear, including with respect to lung function. This study aimed to investigate the associations of lung function and COPD [...] Read more.
Objectives: Observational studies have shown that chronic obstructive pulmonary disease (COPD) is associated with an increased risk of hearing impairment. However, causality remains unclear, including with respect to lung function. This study aimed to investigate the associations of lung function and COPD with hearing impairment in the UK Biobank and confirm potential causalities using Mendelian randomization (MR). Methods: Cross-sectional analyses were performed using logistic regression models in a subsample of the UK Biobank. Two-sample MR analyses were performed on summary statistics for forced expiratory volume in one second (FEV1), forced vital capacity (FVC), COPD, and sensorineural hearing loss. Results: FEV1 and FVC were negatively associated with hearing impairment, with odds ratios (95% confidence intervals) of 0.80 (0.77, 0.84) and 0.80 (0.76, 0.83), respectively. COPD was positively associated with hearing impairment, with an odds ratio (95% confidence interval) of 1.10 (1.02, 1.18). In the MR analyses, a negative association was found between FVC and sensorineural hearing loss, with an odds ratio (95% confidence interval) of 0.91 (0.83, 0.99). For FVE1 and COPD, no significant associations were found. Conclusions: The results of this study showed that FVC was causally associated with hearing impairment, suggesting a potential protective effect of FVC on hearing impairment. Full article
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19 pages, 514 KiB  
Article
Vestibular Dysfunction and the Leftward Deviation in the New Line Bisection Task Using Three-Dimensionally Transformed Rectangles
by Teru Kamogashira, Shinnosuke Asakura, Hideaki Funayama, Kenji Ito, Noriaki Sunaga, Nao Shikanai, Fumihiko Itagaki, Toshitaka Kataoka, Shizuka Shoji, Megumi Koizumi and Shinichi Ishimoto
Audiol. Res. 2025, 15(4), 86; https://doi.org/10.3390/audiolres15040086 - 15 Jul 2025
Viewed by 220
Abstract
Background/Objectives: The line bisection task (LBT) is a well-known test in which a horizontal line is presented in front of the subject and the subject is asked to draw a mark vertically bisecting the line. We developed the new LBT using three-dimensionally [...] Read more.
Background/Objectives: The line bisection task (LBT) is a well-known test in which a horizontal line is presented in front of the subject and the subject is asked to draw a mark vertically bisecting the line. We developed the new LBT using three-dimensionally transformed rectangles to enhance the sense of depth and evaluated the influence of vestibular dysfunction on the deviation. Methods: One hundred participants were recruited from patients referred to the vertigo outpatient clinic. The average deviation in the LBT was the leftward deviation in the figures viewed from the right side and the rightward deviation in the figures viewed from the left side, indicating that the figures were perceived three-dimensionally, with the division point deviating to the far side. Results: In multivariate analysis of variance (MANOVA) analyses, the significant leftward deviation was observed in the group with vestibular dysfunction in caloric testing, and the significant rightward deviation dependent on increasing age was also observed. In univariate analyses, the significant leftward deviation in the figure viewed from the left side (135 degrees) was observed in the group with vestibular dysfunction in caloric testing, and the significant leftward deviation was also observed in figures viewed from the center, left or right side (0, 15 and 165 degrees) in the group with vestibular dysfunction in vHIT evaluation. Conclusions: Vestibular dysfunction can alter the deviation in the new LBT, suggesting the potential of the new LBT as an assessment of vestibular dysfunction. Full article
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21 pages, 21520 KiB  
Article
The Role and Mechanism of GSDME-Dependent Pyroptosis in Cochlear Marginal Cells Injury by Cisplatin
by Wenyang Lei, Wenting Yu, Ting Li, Wei Tang, Shimin Zong and Hongjun Xiao
Biomedicines 2025, 13(7), 1680; https://doi.org/10.3390/biomedicines13071680 - 9 Jul 2025
Viewed by 353
Abstract
Background: Elucidating the mechanisms underlying cisplatin-induced ototoxicity is critical for the clinical management of hearing loss. While cisplatin is known to penetrate the inner ear via the blood-labyrinth barrier in the stria vascularis, its precise damaging effects on marginal cells (MCs) and subsequent [...] Read more.
Background: Elucidating the mechanisms underlying cisplatin-induced ototoxicity is critical for the clinical management of hearing loss. While cisplatin is known to penetrate the inner ear via the blood-labyrinth barrier in the stria vascularis, its precise damaging effects on marginal cells (MCs) and subsequent hearing impairment remain incompletely understood. Pyroptosis, a gasdermin-mediated inflammatory cell death pathway, may play a key role. This study investigated the involvement of gasdermin E (GSDME)-dependent pyroptosis in cisplatin-induced injury to MCs. Methods: An in vitro cisplatin-induced pyroptosis model was established in MCs. GSDME expression was downregulated using small interfering RNA (siRNA), and caspase-3 activity was inhibited pharmacologically. The critical threshold for pyroptosis induction was determined to be 5 μmol/L cisplatin exposure for 24 h, which activated the caspase-3/GSDME signaling pathway. Results: Cisplatin treatment upregulated GSDME and caspase-3 expression in MCs. Both inhibition of GSDME and pharmacological blockade of caspase-3 significantly attenuated cisplatin-induced cellular damage. Notably, caspase-3 suppression reduced GSDME expression, suggesting a positive regulatory relationship between these mediators. Conclusions: GSDME-mediated pyroptosis plays a pivotal role in cisplatin-induced marginal cell injury, with caspase-3 acting as an upstream regulator of GSDME expression. These findings provide a mechanistic foundation for developing novel therapeutic strategies against cisplatin ototoxicity. Full article
(This article belongs to the Section Cell Biology and Pathology)
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9 pages, 581 KiB  
Article
Psychometric Properties of the European Evaluation of Vertigo Scale (EEV) for a Spanish-Speaking Population: A Validation Study
by María Alharilla Montilla-Ibáñez, Rafael Lomas-Vega, María del Carmen López-Ruiz, Ángeles Díaz-Fernández, Alfonso Javier Ibáñez-Vera, Ana Belén Peinado-Rubia, Esteban Obrero-Gaitán and Ana Sedeño-Vidal
Audiol. Res. 2025, 15(4), 84; https://doi.org/10.3390/audiolres15040084 - 8 Jul 2025
Viewed by 591
Abstract
Background/Objectives: The objective of this study was to validate the Spanish version of the European Evaluation of Vertigo (EEV) and analyse its test–retest reliability, standard error of measurement (SEM), minimum detectable change (MDC), concurrent validity, and discriminant validity. Methods: A cross-sectional [...] Read more.
Background/Objectives: The objective of this study was to validate the Spanish version of the European Evaluation of Vertigo (EEV) and analyse its test–retest reliability, standard error of measurement (SEM), minimum detectable change (MDC), concurrent validity, and discriminant validity. Methods: A cross-sectional validation study was designed. Subjects were recruited from the Otolaryngology Service of the University Hospital of Jaen. Psychometric properties of the EEV were analysed, including the concurrent validity, the SEM, and the MDC. Discriminant validity was calculated using the receiver operating characteristic (ROC) curve. Results: The EEV test–retest reliability was nearly perfect (Kappa index = 0.97). The SEM and the MDC were set at 0.56 and 1.10, respectively. Regarding the discriminant validity, the area under the curve (AUC) was 0.831 (95% CI; 0.743–0.899) for the BPPV prediction, the AUC = 0.731 (95% CI; 0.633–0.815) for the disability prediction from the ABC-16 score, and the AUC = 0.846 (95% CI; 0.760–0.911) for the disability prediction from the ABC-6 score. Furthermore, a cut-off point greater than 12 was a good predictor of disability and the fall risk measured with the ABC scale, whereas a value of 11 points was a good predictor for discriminating BPPV patients. Conclusions: The Spanish version of the EEV is a valid and reliable instrument for evaluating the clinical symptoms of vestibular syndrome. This instrument demonstrated a nearly perfect test-retest reliability, a low measurement error, and good accuracy in discriminating between patients with vestibular disorders and those with BPPV. Full article
(This article belongs to the Special Issue A New Insight into Vestibular Exploration)
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24 pages, 614 KiB  
Review
Insights into Vestibular Migraine: Diagnostic Challenges, Differential Spectrum and Therapeutic Horizons
by Marlon Cantillo-Martínez, Joan Lorente-Piera, Raquel Manrique-Huarte, Margarita Sánchez-del-Río, Nicolás Pérez-Fernández, Carlos Chico-Vila, David Moreno-Ajona and Pablo Irimia
J. Clin. Med. 2025, 14(14), 4828; https://doi.org/10.3390/jcm14144828 - 8 Jul 2025
Viewed by 786
Abstract
Vestibular migraine (VM) commonly causes recurrent vertigo, but diagnosing and managing it can be difficult due to symptom overlap with other vestibular and headache disorders. This review provides a comprehensive update on VM, beginning with the diagnostic criteria established by the International Headache [...] Read more.
Vestibular migraine (VM) commonly causes recurrent vertigo, but diagnosing and managing it can be difficult due to symptom overlap with other vestibular and headache disorders. This review provides a comprehensive update on VM, beginning with the diagnostic criteria established by the International Headache Society and the Bárány Society, who have increased awareness of this condition. While the pathophysiology is not yet completely understood, there is evidence of a complex interaction between the nociceptive and vestibular systems. Treatment approaches are primarily empirical and lack robust, high-quality evidence. Often, antihistamines and benzodiazepines are used for quick symptom relief, while the efficacy of triptans is still uncertain. Preventive measures include lifestyle changes, vestibular rehabilitation, oral migraine prophylactics, Botulinum toxin type A, and, more recently, CGRP-targeted therapies. Due to diagnostic uncertainties and the absence of standardised treatment protocols, further research—particularly randomised controlled trials—is crucial for establishing evidence-based guidelines. Full article
(This article belongs to the Special Issue Migraine Headache: Symptoms, Diagnosis, and Current Treatment)
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25 pages, 3304 KiB  
Article
Diagnostics and Group Therapy in Patients with Persistent Postural-Perceptual Dizziness and Anxiety Disorder: Biomarkers and Neurofunctional Correlates of Underlying Treatment Effects
by Maximilian Maywald, Oliver Pogarell, Agnieszka Chrobok, Susanne Levai, Daniel Keeser, Nadja Tschentscher, Boris-Stephan Rauchmann, Sophia Stöcklein, Birgit Ertl-Wagner, Boris Papazov, Marco Paolini and Susanne Karch
Diagnostics 2025, 15(14), 1729; https://doi.org/10.3390/diagnostics15141729 - 8 Jul 2025
Viewed by 518
Abstract
Background: There is a certain degree of overlap between persistent postural-perceptual dizziness (PPPD) (ICD-11) and anxiety disorders (ANX) with regard to the phenomenological, pathological and neurobiological characteristics of both conditions. The implementation of an integrative psychotherapy programme may potentially result in the [...] Read more.
Background: There is a certain degree of overlap between persistent postural-perceptual dizziness (PPPD) (ICD-11) and anxiety disorders (ANX) with regard to the phenomenological, pathological and neurobiological characteristics of both conditions. The implementation of an integrative psychotherapy programme may potentially result in the generation of synergistic effects across both patient groups. Objectives: This study assessed (1) whether psychological mechanisms similarly influence symptom severity in PPPD and ANX group, (2) the effectiveness of psychotherapy, and (3) potential neurofunctional biomarkers. Methods: Patients with PPPD (n = 14) and ANX (n = 20) underwent an integrative psychotherapy programme with balance training and mindfulness-based interventions. Emotional and neutral pictures were presented during MRI scans before and after therapy, with healthy controls (HC = 29) for comparison. Clinical and psychological questionnaires were administered, and brain activity was analysed in key regions. Results: The only diagnostic difference in the direct comparison between patients with PPPD and with ANX were the vertigo intensity values before and after therapy. PPPD with comorbid anxiety disorder had significantly more fear of physical symptoms than patients without comorbid anxiety disorder. PPPD showed no change regarding vertigo intensity (VSS), anxiety, or depression scores, but reported decreased impact of vertigo on social functioning (VHQ), and improved personal control after therapy (IPQ). By contrast, anxiety, dizziness, depression, alexithymia, and IPQ scores were significantly reduced after therapy in the ANX group. Neuroimaging revealed decreased activity in the hippocampus and superior temporal gyri (STG) in the PPPD group post-therapy as compared to the pre-therapy measurement, while the ANX group showed reduced activity in the insula, thalamus, hippocampus, and inferior frontal gyrus. Compared to the ANX and HC groups, patients with PPPD showed increased activity in the supramarginal gyrus and STG, both of which could serve as biomarkers for PPPD patients but need to be further validated. Conclusions: Anxiety and vertigo may reinforce each other in PPPD, as symptoms persisted post-therapy, whereas ANX patients improved significantly. Nevertheless, there is some evidence for a successful management of symptoms in the PPPD group. Findings are limited by small sample size and require further research. Full article
(This article belongs to the Special Issue Diagnosis and Management of Postural Disorders)
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29 pages, 2523 KiB  
Review
Viscum coloratum (Komar.) Nakai: A Review of Botany, Phytochemistry, Pharmacology, Pharmacokinetics and Toxicology
by Han Di, Congcong Shen, Shengyu Zhang, Yanhong Wang and Feng Guan
Biomolecules 2025, 15(7), 974; https://doi.org/10.3390/biom15070974 - 7 Jul 2025
Viewed by 480
Abstract
Viscum coloratum (Komar.) Nakai (V. coloratum) is a traditional Chinese herbal medicine. It is used in treating rheumatism and paralysis, lumbar and knee soreness, weakness of the muscles and bones, excessive leakage of menstruation, leakage of blood in pregnancy, restlessness of [...] Read more.
Viscum coloratum (Komar.) Nakai (V. coloratum) is a traditional Chinese herbal medicine. It is used in treating rheumatism and paralysis, lumbar and knee soreness, weakness of the muscles and bones, excessive leakage of menstruation, leakage of blood in pregnancy, restlessness of the fetus, dizziness and vertigo. All information about V. coloratum was collected through databases such as PubMed, Google Scholar, Web of Science, and the China National Knowledge Infrastructure and supplemented by consulting classical Chinese medical books. To date, 111 compounds have been isolated and identified from V. coloratum, including flavonoids, phenylpropanoids, terpenoids, diarylheptanoids, alkaloids, other components, and macromolecular compounds, such as polysaccharides and lectins. These chemical components exhibit anti-inflammatory, anticancer, antioxidant, and anti-cardiovascular disease effects, among other beneficial effects. According to the reports, alkaloids, lectins, and other chemical components present in V. coloratum may induce toxicity due to excessive intake or accidental ingestion. However, there are few reports on the toxicology of V. coloratum, and there is a lack of studies on the toxicity of V. coloratum with known in vitro or preclinical activity. It is suggested that further studies on the toxicology of V. coloratum should be conducted in the future. In this paper, the botany, traditional uses, phytochemistry, pharmacology, and pharmacokinetics of V. coloratum are summarized, and the progress and shortcomings in toxicology are discussed, so as to provide a possible direction for future research on V. coloratum. Full article
(This article belongs to the Section Natural and Bio-derived Molecules)
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18 pages, 690 KiB  
Review
The Challenge of Diagnosing Labyrinthine Stroke—A Critical Review
by Alexander A. Tarnutzer, Sun-Uk Lee, Ji-Soo Kim and Diego Kaski
Brain Sci. 2025, 15(7), 725; https://doi.org/10.3390/brainsci15070725 - 7 Jul 2025
Viewed by 482
Abstract
Acute vertigo or dizziness that is accompanied by a sudden sensorineural hearing loss (SSNHL) often poses a diagnostic challenge. While a combined audiovestibular deficit makes an inner ear pathology most likely, this does not necessarily exclude a vascular pathology that may be a [...] Read more.
Acute vertigo or dizziness that is accompanied by a sudden sensorineural hearing loss (SSNHL) often poses a diagnostic challenge. While a combined audiovestibular deficit makes an inner ear pathology most likely, this does not necessarily exclude a vascular pathology that may be a harbinger of future sinister events. This is especially true for strokes within the territory of the anterior inferior cerebellar artery (AICA), because the labyrinth receives its vascular supply most often by branches of the AICA. Thus, acute labyrinthine ischemia may present in combination with focal neurologic deficits, but also in isolation or as a warning sign before focal stroke signs arise. How can labyrinthine ischemia be differentiated from an idiopathic SSNHL? In this critical review, we discuss both the pathophysiology and the differential diagnosis of acute audiovestibular deficits. We will also address the value of state-of-the-art MR imaging in visualizing labyrinthine ischemia. Finally, we will discuss treatment options and review the prognosis of acute audiovestibular deficits. Full article
(This article belongs to the Section Sensory and Motor Neuroscience)
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53 pages, 2879 KiB  
Systematic Review
Hypersensitivity in Orthodontics: A Systematic Review of Oral and Extra-Oral Reactions
by Alessandra Amato, Stefano Martina, Giuseppina De Benedetto, Ambrosina Michelotti, Massimo Amato and Federica Di Spirito
J. Clin. Med. 2025, 14(13), 4766; https://doi.org/10.3390/jcm14134766 - 5 Jul 2025
Viewed by 454
Abstract
Background/Objectives: This systematic review analyzed the epidemiologic and macro/microscopic features of manifestations of hypersensitivity reactions with oral and extra-oral involvement in orthodontic patients with fixed (FAs) or removable (RAs) appliances or clear aligners (CAs), and evaluated them based on patient and treatment [...] Read more.
Background/Objectives: This systematic review analyzed the epidemiologic and macro/microscopic features of manifestations of hypersensitivity reactions with oral and extra-oral involvement in orthodontic patients with fixed (FAs) or removable (RAs) appliances or clear aligners (CAs), and evaluated them based on patient and treatment characteristics to provide clinical recommendations. Methods: The study protocol followed the PRISMA guidelines and was registered on PROSPERO (CRD42024517942). Results: Thirty-one studies were qualitatively assessed and synthetized, involving 858 subjects (114 males and 714 females, 9–49 years old), of whom there were 86 with a history of allergy, and 743 wearing recorded appliances (FAs = 656, FAs and RAs = 81, intra- and extra-oral RAs = 3, CAs = 3), with a mean treatment duration of 21.5 months (6 weeks–40 months). Among 75 reports, 29 (38.67%), describing burning, gingival hyperplasia, erythema, and vesicles, had oral involvement, while 46 (61.33%) had skin, eye, and systemic involvement, with erythema, papules, conjunctival hyperemia, and vertigo. Positive allergy tests concomitant with the manifestations identified nickel 451 times, cobalt 6 times, titanium 5 times, and chromium 4 times. Management included antihistamines or corticosteroids and removing the offending materials, with treatment discontinuation/appliance substitution. Conclusions: Pre-treatment evaluations, including patient histories and allergy testing, are essential to identify potential allergens and select hypoallergenic materials like titanium or ceramic brackets; regular monitoring and early intervention during treatment are crucial to prevent severe outcomes. Full article
(This article belongs to the Special Issue Oral Health and Dental Care: Current Advances and Future Options)
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16 pages, 2054 KiB  
Article
Transformer-Based Detection and Clinical Evaluation System for Torsional Nystagmus
by Ju-Hyuck Han, Yong-Suk Kim, Jong Bin Lee, Hantai Kim, Jong-Yeup Kim and Yongseok Cho
Sensors 2025, 25(13), 4039; https://doi.org/10.3390/s25134039 - 28 Jun 2025
Viewed by 338
Abstract
Motivation: Benign paroxysmal positional vertigo (BPPV) is characterized by torsional nystagmus induced by changes in head position, where accurate quantitative assessment of subtle torsional eye movements is essential for precise diagnosis. Conventional videonystagmography (VNG) techniques face challenges in accurately capturing the rotational components [...] Read more.
Motivation: Benign paroxysmal positional vertigo (BPPV) is characterized by torsional nystagmus induced by changes in head position, where accurate quantitative assessment of subtle torsional eye movements is essential for precise diagnosis. Conventional videonystagmography (VNG) techniques face challenges in accurately capturing the rotational components of pupil movements, and existing automated methods typically exhibit limited performance in identifying torsional nystagmus. Methodology: The objective of this study was to develop an automated system capable of accurately and quantitatively detecting torsional nystagmus. We introduce the Torsion Transformer model, designed to directly estimate torsion angles from iris images. This model employs a self-supervised learning framework comprising two main components: a Decoder module, which learns rotational transformations from image data, and a Finder module, which subsequently estimates the torsion angle. The resulting torsion angle data, represented as time-series, are then analyzed using a 1-dimensional convolutional neural network (1D-CNN) classifier to detect the presence of nystagmus. The performance of the proposed method was evaluated using video recordings from 127 patients diagnosed with BPPV. Findings: Our Torsion Transformer model demonstrated robust performance, achieving a sensitivity of 89.99%, specificity of 86.36%, an F1-score of 88.82%, and an area under the receiver operating characteristic curve (AUROC) of 87.93%. These results indicate that the proposed model effectively quantifies torsional nystagmus, with performance levels comparable to established methods for detecting horizontal and vertical nystagmus. Thus, the Torsion Transformer shows considerable promise as a clinical decision support tool in the diagnosis of BPPV. Key Findings: Technical performance improvement in torsional nystagmus detection; System to support clinical decision-making for healthcare professionals. Full article
(This article belongs to the Section Biomedical Sensors)
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15 pages, 556 KiB  
Article
Sleep Assessment in Patients with Inner Ear Functional Disorders: A Prospective Cohort Study Investigating Sleep Quality Through Polygraphy Recordings
by Dorota Kuryga and Artur Niedzielski
Audiol. Res. 2025, 15(4), 76; https://doi.org/10.3390/audiolres15040076 - 24 Jun 2025
Viewed by 336
Abstract
Background/Objectives: The vestibulo-respiratory reflex regulates the tension of the respiratory muscles, which prevents apneas and awakenings during sleep. This study aimed to determine whether functional deficits in the inner ear disturb sleep quality. Methods: We compared sleep parameters in patients with their [...] Read more.
Background/Objectives: The vestibulo-respiratory reflex regulates the tension of the respiratory muscles, which prevents apneas and awakenings during sleep. This study aimed to determine whether functional deficits in the inner ear disturb sleep quality. Methods: We compared sleep parameters in patients with their first episode of acute inner ear deficit (Group A: sudden idiopathic vertigo attack, sudden sensorineural hearing loss), chronic functional inner ear impairment (Group B: chronic peripheral vertigo, permanent hearing loss), and in healthy individuals (Group C). Polygraphy recordings were performed twice, in Group A at the onset of acute otoneurological symptoms and the second time after their withdrawal with an interval of 1 to 13 days, in Group B after 1 to 6 days, and in Group C after 1 to 8 days. Results: In Group A during the symptomatic night, overall and central apnea-hypopnea indices were significantly higher and snoring time was longer. Group A also had higher central apnea-hypopnea index on the first night compared to healthy individuals. In chronic disorders, sleep recordings showed lower autonomic arousal index than in controls or symptomatic nights in Group A. Conclusions: These findings highlight the severity of sleep apnea indicators in Group A. Our results suggest that acute dysfunction of the inner ear substantially impacts central neuronal signaling responsible for regulating normal sleep-related breathing and leads to a deterioration in sleep quality in contrast to individuals with chronic inner ear impairments. It can also be assumed that people with chronic vertigo or hearing loss experience less interrupted sleep than healthy individuals. Full article
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11 pages, 967 KiB  
Article
Low-Dose Intratympanic Gentamicin Injections for Intractable Meniere’s Disease: How Many Are Optimal?
by Joon-Pyo Hong, Hayoung Byun and Min-Beom Kim
J. Clin. Med. 2025, 14(12), 4342; https://doi.org/10.3390/jcm14124342 - 18 Jun 2025
Viewed by 569
Abstract
Background/Objectives: To compare the outcomes of low-dose intratympanic gentamicin injection (ITGM) in managing intractable Meniere’s disease (MD) between patients receiving a single injection versus multiple injections, and to explore the optimal number of ITGM repetitions. Methods: This retrospective study was conducted at a [...] Read more.
Background/Objectives: To compare the outcomes of low-dose intratympanic gentamicin injection (ITGM) in managing intractable Meniere’s disease (MD) between patients receiving a single injection versus multiple injections, and to explore the optimal number of ITGM repetitions. Methods: This retrospective study was conducted at a single tertiary medical center. Clinical charts of patients diagnosed with definite MD between 2015 and 2020 and given low-dose ITGM for intractable vertigo attacks were reviewed. A total of 33 patients were divided into two groups based on the number of ITGM procedures: the single injection group (SG, n = 14) and the multiple injection group (MG, n = 19). In the MG, additional ITGM was performed up to four times. Audiograms, caloric responses, and video head impulse tests (vHIT) were reviewed at each repetition of ITGM. Results: After the first ITGM, both the SG and MG showed significant decreases in caloric responses and vHIT gains, without deterioration in hearing. In the MG group, a second ITGM was needed on average 8.1 ± 6.4 months after the initial ITGM due to persistent vertigo attacks. After the second ITGM, 8 out of 19 MG patients showed additional benefits in terms of reduced vertigo and further decreases in caloric responses. However, after the third and fourth ITGM, no further significant decline in vestibular function was observed, and there was no improvement in subjective dizziness. In the MG, gradual deterioration of hearing was observed. Conclusions: This finding suggests that performing additional low-dose ITGM in poorly responding or recurrent cases appears reasonable up to the second injection. For those who continue to experience vertigo episodes after two ITGM procedures, alternative therapeutic approaches should be considered to preserve hearing. Full article
(This article belongs to the Section Otolaryngology)
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13 pages, 801 KiB  
Article
Clinical and Instrumental Evaluation of Vestibular Function Before and After Cochlear Implantation in Adults
by Pasqualina Maria Picciotti, Tiziana Di Cesare, Daniela Rodolico, Walter Di Nardo and Jacopo Galli
Audiol. Res. 2025, 15(3), 71; https://doi.org/10.3390/audiolres15030071 - 15 Jun 2025
Cited by 1 | Viewed by 465
Abstract
Background/Objectives: Vestibular dysfunction is one of the main complications after cochlear implant (CI) surgery, and there are currently no standardized protocols for vestibular assessment in CI candidates. Our objectives were to investigate the incidence of vestibular impairment after CI surgery, anamnestic (age, known [...] Read more.
Background/Objectives: Vestibular dysfunction is one of the main complications after cochlear implant (CI) surgery, and there are currently no standardized protocols for vestibular assessment in CI candidates. Our objectives were to investigate the incidence of vestibular impairment after CI surgery, anamnestic (age, known systemic pathologies and cause of deafness) and surgical (intraoperative complications, malposition of the CI) risk factors, and the role of vestibular assessment in the selection of the suitable ear for implantation. Methods: We included 68 adult patients (80 ears) affected by moderate-to-profound SNHL undergoing CI. The dizziness handicap inventory (DHI), the video head impulse test (VHIT), the caloric test, and dynamic posturography (DP) were used to study the vestibular function and balance before and one month after CI. The DHI was also administered 24 h after surgery. Results: Despite significative impairment 24 h after surgery (29.6 ± 30), the mean DHI score returned to preoperative values (17.9 ± 26) after one month. Dizziness persisted in case of age ≥ 65 years old, surgical difficulties, simultaneous bilateral CI, Meniere’s disease and otosclerosis, comorbidities ≥ 3, anxiety/depression, and neurological diseases. The VHIT significantly worsened in 25% of ears, while the caloric test SPV nystagmus significantly decreased in 30% of ears. In cases of preoperative unilateral weakness, the implantation of the better ear was significantly related to higher DHI scores. Only 4/68 patients had a significant persistent reduction in the postural composite score after surgery, with an increased risk of falls. Conclusions: Medical history and vestibular assessment predict the risk of vestibular damage and help to choose the CI’s side and to manage vertigo after surgery. Full article
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Review
Sodium Channel Blockers for Vestibular Paroxysmia in Children
by Pierre Reynard, Hung Thai-Van, Eugenia Mustea, Alexandra Neagu, Samar A. Idriss and Eugen C. Ionescu
Audiol. Res. 2025, 15(3), 65; https://doi.org/10.3390/audiolres15030065 - 5 Jun 2025
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Abstract
Background/Objectives: As vestibular paroxysmia (VP) has recently been described in children, with an incidence of up to 4% of vertigo, and a promising therapeutic response to sodium-channel-blocking drugs has also been reported, the aim of this paper is to review the available literature [...] Read more.
Background/Objectives: As vestibular paroxysmia (VP) has recently been described in children, with an incidence of up to 4% of vertigo, and a promising therapeutic response to sodium-channel-blocking drugs has also been reported, the aim of this paper is to review the available literature on this topic and to provide the best possible guidance for diagnosis and treatment. Methods: PubMed, Medline, Cochrane, and Crossref databases were searched, and all studies on VP in children and sodium channel blockers were selected. Results: Only five articles reporting small case series or single case reports were identified. To date, oxcarbazepine (OXC) and carbamazepine (CBZ) are the only two molecules prescribed. The recommended doses were 300 to 360 mg/day and 50 to 200 mg/day for OXC and CBZ, respectively, for a total duration of 6 weeks. Fast efficacy (one week) was reported. Conclusions: VP has been identified in pediatric patients and appears to respond to sodium channel blockers in a manner similar to adults. Only a limited number of cases have been reported to date; thus, there is a need to raise awareness about this treatable cause of episodic vertigo in children. Full article
(This article belongs to the Special Issue Cochleo-Vestibular Diseases in the Pediatric Population)
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