Search Results (78)

Background/Objectives: The aetiology of Bell’s palsy remains unclear and is typically diagnosed by exclusion. This study investigated the potential role of neurotropic viruses and explored the relationship between facial nerve impairment and vestibular dysfunction to improve the understanding of the condition. Methods: Antibodies against herpes simplex virus (HSV) and varicella-zoster virus (VZV) were assessed using ELISA. Vestibular function was evaluated through computerised videonystagmography, rotatory chair, and clinical vestibulospinal assessments. Facial nerve lesion localisation was determined by stapedial reflex testing. Fisher’s exact test was used for statistical analysis. Results: Of 51 patients with Bell’s palsy, 62.7% exhibited vestibular dysfunction, and 70.6% were IgG-positive for at least one neurotropic virus. Vestibular impairment was significantly more common in seropositive patients. Statistically significant associations were observed between vestibular dysfunction and viral IgG seropositivity (p < 0.0001), the severity of vestibular dysfunction and facial paresis (p = 0.0126), and the side of vestibular impairment and the side of facial palsy (p < 0.0001), with 90.6% of cases showing ipsilateral involvement. Conclusions: These findings support the hypothesis that neurotropic viruses may act as a common pathological factor in both Bell’s palsy and associated vestibular dysfunction. Full article

Background/Objectives: Schwannoma is a rare tumor, typical in young adults, originating from the myelin sheath that surrounds Schwann cells. It can occur in any part of the Peripheral Nervous System (PNS). It develops in the head and neck region in 25–48% of cases, and the eighth pair of cranial nerves (vestibulocochlear nerves) are the most hit (vestibular schwannoma). Oral cavity involvement is exceedingly rare, accounting for about 1–2% of all cases. The most affected oral site is the tongue, especially its anterior third, while localization on the lip is one of the least common sites for the development of this lesion. Case Presentation: A lower lip schwannoma on a 17-year-old boy, present for about 7 years, was documented. Material and Methods: PubMed and Google Scholar were used as research engines; English scientific works published in the last 20 years (2005–2024) regarding oral cavity involvement, using the keywords “Schwannoma”, “Oral Schwannoma”, “Pediatric Oral Schwannoma”, and “Schwannoma of the lip”, were considered. Results: In total, 805 and 16,890 items were found on PubMed and Google Scholar search engines, respectively. After title, abstract, full text evaluation, and elimination of duplicates, 26 articles were included in the review process. Discussion: Clinically, oral schwannoma presents as an asymptomatic hard–elastic fluctuating mass, often misdiagnosed on the lip as a traumatic or inflammatory lesion (e.g., mucocele). Biopsy is mandatory, and histological examination reveals positivity to the neuronal marker S-100. Conclusions: Complete excision also prevents recurrence. Malignant transformation is extremely rare. Full article

(1) Background: There has been an ongoing concern for several decades that radiofrequencies emitted from mobile phones are related to brain cancer risk. We calculated temporal trends in brain cancer incidence rates in adults and children and compared them to mobile phone subscription data over the same time period. (2) Methods: We analyzed the Surveillance, Epidemiology and End Results (SEER 22) cancer database between 2000 and 2021. Age-standardized incidence rates (ASR) per 100,000 people were calculated and the annual percentage change (APC) for malignant and benign brain cancer and vestibular schwannomas (acoustic neuromas of the 8th cranial nerve) was established. The total number of mobile phone subscriptions in the United States was plotted for the period 1985–2024. (3) Results: The APC for adolescents and adults was −0.6 (p = 0.0004) for malignant tumors, −0.06 (p = 0.551) for temporal lobe tumors, and 1.9 (p = 0.00003) for benign tumors. The APC for benign acoustic neuroma was 0.09 (p = 0.8237), suggesting that mobile phone use is unlikely to be associated with this tumor type. There was a 1200-fold increase in the number of cell phone subscriptions during this period. (4) Conclusions: These findings suggest that mobile phone use does not appear to be associated with an increased risk of brain cancer, either malignant or benign. Full article

Introduction: Masseter vestibular evoked myogenic potentials (M-VEMPs) are a recent tool for assessing a vestibulo-trigeminal pathway departing from the saccule, similarly to cervical VEMPs (C-VEMPs), that evaluate saccular function via the sternocleidomastoid muscle. M-VEMPs may offer a complementary diagnostic value in vestibular neuritis (VN). Methods: This retrospective study analysed M-VEMPs and C-VEMPs in 28 monolateral patients and 1 bilateral (30 ears) diagnosed with VN between 2023 and 2024. Diagnostic evaluation included video head impulse tests (VHIT), caloric tests, ocular VEMPs, and, in a few cases, electromyography (EMG) of the sternocleidomastoid muscle. M-VEMPs were elicited using 500 Hz tone bursts at 97 dB nHL. Results were compared based on the topography of vestibular involvement and muscle response concordance. Results: M-VEMPs were always present in patients with superior VN and intact saccular function, showing consistent results with normal C-VEMPs. In some cases, with saccular dysfunction, M-VEMPs were preserved despite the absence of C-VEMPs, suggesting greater robustness. One patient with herpes zoster (HZ) involving both the VIII and trigeminal nerves showed absent M-VEMPs, indicating trigeminal pathway involvement. Edentulous patients showed reduced or absent M-VEMPs due to compromised masseter muscle electromyography activity. Conclusions: M-VEMPs are reliable and often concordant with C-VEMPs in VN but may reveal additional diagnostic information in discordant or complex cases. They are particularly useful in identifying trigeminal involvement but are limited in patients with poor masseter muscle function. Further studies are needed to clarify their full diagnostic potential. Full article

Background: Vagus nerve stimulation (VNS) is a frequently used neuromodulation method in recent years. While the mechanism of improvement in diseases such as epilepsy, dementia, and depression is being studied, its potential effect on vestibular dysfunction is also being investigated. The aim of our study was to investigate the effect of transcutaneous auricular VNS (taVNS) on the vestibular symptoms of unilateral vestibular hypofunction (UVH). Methods: Forty patients diagnosed with UVH were randomly divided into two groups. Group 1 received vestibular rehabilitation. Group 2 received taVNS and vestibular rehabilitation. Both groups received treatment one day a week for eight weeks. Before and after the treatment, balance of the participants was assessed with modified-CTSIB (m-CTSIB), limit of stability (LOS), Tandem and One-Leg Stance (OLS) tests; visual acuity was assessed with dynamic visual acuity (DVA), dizziness severity, and fatigue severity with a visual analog scale (VAS); kinesiophobia was assessed with the Tampa Scale for Kinesiophobia (TSK); depression and anxiety was assessed with the Hospital Anxiety and Depression Scale (HADS); and quality of life was assessed with the Dizziness Handicap Inventory (DHI). Results: At the end of eight weeks, patients in Group 2 showed significantly greater improvement in balance, dizziness, fatigue, kinesiophobia, anxiety, and depression. There was no significant difference in visual acuity and quality of life between the groups. Conclusions: The positive effects of taVNS on vestibular symptoms have been observed. As a new approach, taVNS can be included in the treatment of patients with UVH in addition to vestibular rehabilitation. Full article

Background and Clinical Significance: Vestibular schwannomas (VS) are benign tumors arising from Schwann cells of the eighth cranial nerve. They represent approximately 8% of all intracranial tumors and have an increasing incidence. Larger VS can cause brainstem compression and hydrocephalus, and magnetic resonance imaging (MRI) is the diagnostic modality of choice. Individuals with VS and an elevated body mass index (BMI) can have more postoperative complications due to their weight, which can also negatively impact the preoperative diagnostic process and planning, as well as the surgery itself, as compromises must be made since optimal positioning of the patient is often not feasible. Increased BMI is a recognized risk factor for cerebrospinal fluid (CSF) leak after microscopic resection of a VS. Case Presentation: This report presents a case of a patient with class III obesity who had to undergo a right VS resection with preexisting hydrocephalus and the obstacles encountered by the surgical team throughout the diagnostics process since MRI could not be performed and preoperative planning had to be based on computed tomography (CT) scan; operative treatment, where suboptimal patient placement was achieved for a planned retrosigmoid approach to the pontocerebellar angle (PCA) and postoperative rehabilitation, which was hindered by his high BMI (55 kg/m²) with several complications, such as CSF leak, due to his extreme weight. Conclusions: Despite barriers, optimal tumor resection was obtained with a long neurorehabilitation process, with a favorable outcome, emphasizing the role of a multidisciplinary team. Full article

Vestibular paroxysmia (VP) is a disabling medical condition characterized by a high recurrence rate of vertigo. VP is classically associated with the presence of contact between a vascular structure and the cochleovestibular nerve, a neurovascular cross compression (NVCC). Antiepileptic drugs are the first-line treatment for disabling symptoms. We conducted a systematic review to evaluate their efficacy in patients with VP, and whose imaging shows NVCC. All published studies in PubMed databases until October 2024 were included. A total of seven studies were selected. Carbamazepine and oxcarbazepine are by far the most widely used drugs, but there is still a lack of data showing the efficacy of antiepileptic drugs in a large sample of patients. This suggests that a future randomized controlled trial with a satisfactory sample size of VP patients with NVCC and comparing several drugs with neuroprotective properties is needed. Further, as imaging in some of the patients with obvious clinical signs does not always support this diagnosis, we discussed VP physiopathology and the different types of VP published in the literature, including those with no radiological support for NVCC. Full article

Purpose: This review aims to analyze the diagnostic methods used to evaluate inferior vestibular nerve neuritis. Methods: We performed an electronic search on the PubMed database for clinical studies investigating the diagnostic techniques used for inferior vestibular nerve neuritis. Results: We initially identified 114 records in our search. After applying the inclusion and exclusion criteria, we narrowed it down to 12 studies. These studies collectively examined a total of 642 patients diagnosed with vestibular nerve neuritis, 64 of whom had inferior vestibular neuritis. Conclusions: The inferior vestibular neuritis is an unfrequent form of vestibular neuritis, often misdiagnosed. The diagnosis of inferior vestibular neuritis (IVN) is based on clinical history and vestibular testing, specifically reduced posterior canal gain on video head impulse test (vHIT), absent cervical VEMP (cVEMP), normal caloric responses, and preserved ocular VEMP (oVEMP). This review highlights the gaps in current diagnostic strategies and emphasizes the need for integrating advanced vestibular testing methods to enhance diagnostic accuracy for inferior vestibular nerve neuritis. Future studies should address the standardization of diagnostic protocols to facilitate broader clinical application. Full article

Background: The vestibular postural control system affects standing stability on an unstable surface. However, it is unclear whether maintaining a standing position on different surfaces alters lateral vestibulospinal tract (LVST) excitability and body control responses following vestibular stimulation. This study aimed to investigate the relationship between the soleus H-reflex following galvanic vestibular stimulation (GVSH), a measure of LVST, and post-stimulus body movement responses while standing with eyes closed on different surfaces. Methods: Twelve healthy volunteers (mean age 20.4 ± 0.5 years, 7 females) performed eyes-closed standing GVSH on firm and foam surfaces. Body control responses in each condition were evaluated using an inertial measurement unit to monitor neck and pelvic movements, along with surface electromyography to assess muscle activity in the tibialis anterior and soleus muscles. Body responses to the GVS were averaged over up to a second after tibial nerve stimulation. Results: We observed a significant negative correlation between the H-wave amplitude of the GVSH on the firm surface and the tibialis anterior muscle activity following stimulation (r = −0.666, p = 0.018). No significant differences were observed during the eyes-closed standing GVSH on either firm or foam surfaces (p = 0.568). Conclusions: Postural maintenance in response to vestibular stimulation may contribute to body stability by regulating tibialis anterior muscle contraction via the LVST. Our findings may help elucidate the neural activity of vestibular function-related standing postural control responses. Full article

Gravitational changes have been shown to cause significant abnormalities in various body systems, including the cardiovascular, immune, vestibular, and musculoskeletal systems. While numerous studies have examined the response of the vestibular system to gravitational stimulation, research on functional changes in the peripheral inner ear remains limited. The inner ear comprises two closely related structures: the vestibule and cochlea. These components share similar structures and neural functions, highlighting the importance of investigating changes in auditory nerve cells in response to gravitational alterations. To address this gap, we studied the functional and structural changes in the inner ear following exposure to hypergravity stimuli. Our findings demonstrate changes in auditory brainstem responses (ABRs) in the cochlea. ABR recordings were used to analyze click thresholds, as well as the amplitude and latency of tone bursts. The click thresholds at all frequencies increased in the group exposed to hypergravity in the long term. Additionally, tone burst results revealed significantly reduced amplitudes at high frequencies and delayed latencies in the hypergravity models. Notably, greater hair cell loss was observed in the middle and basal turns of the cochlea, indicating that mid and high-frequency regions are more vulnerable to hypergravity stimulation. Furthermore, nerve damage on the cochlear surface was evident in subjects exposed to 4G stimulation for 4 weeks. These findings suggest that the inner ear and its neural activity can be functionally and structurally affected by prolonged exposure to hypergravity. Full article

Background: This study presents a comprehensive analysis of 135 cases of vestibular schwannoma (VS) treated between 2006 and 2022 at the National Institute of Neurology and Neurovascular Diseases in Bucharest, Romania. The investigation focuses on the clinical presentation, treatment outcomes, and demographic trends of VS patients, highlighting region-specific insights that fill critical gaps in Eastern European data. Methods: Patients were treated with either open surgery (93.3%) or gamma knife radiosurgery (6.6%). The study identifies predominant symptoms, including hearing impairment, facial palsy, and balance disorders, with variations observed across age and gender subgroups. Comorbidities such as hypertension and obesity were prevalent, and they influenced perioperative risks. Results: Post-treatment outcomes showed a significant correlation between clinical symptoms and treatment modalities, with a majority achieving favorable results. The findings emphasize the need for tailored approaches in VS management and underscore the importance of region-specific factors in influencing clinical outcomes. Conclusions: This study contributes to refining treatment strategies and improving healthcare delivery for VS patients in Romania and beyond. Full article

Background/Objectives: Vestibular schwannomas (VSs), also called acoustic neuromas, are benign tumors affecting the vestibulocochlear nerve, often leading to hearing loss and balance issues. This condition is particularly challenging in patients with neurofibromatosis type 2 (NF2), where VSs tend to develop bilaterally. Conventional treatments, such as surgery and radiotherapy, although effective, carry risks like hearing loss and nerve damage. Bevacizumab, a VEGF-targeting monoclonal antibody, has emerged as a less invasive treatment option, showing potential for tumor volume reduction and hearing preservation. This systematic review aims to assess the efficacy of bevacizumab in controlling tumor volume, preserving hearing, and identifying associated adverse events. Methods: A comprehensive systematic review was performed using PRISMA guidelines. PubMed and Cochrane Library databases were searched for studies evaluating the effects of bevacizumab on VS, focusing on key outcomes like tumor volume reduction, hearing preservation, and adverse events. Data extraction and quality assessment were independently conducted by two reviewers using the Newcastle-Ottawa Scale. Results: Nine studies involving 176 patients were included. Bevacizumab showed a partial tumor volume reduction (≥20%) in 40% of cases and disease stabilization in 50%, while 10% experienced tumor progression. Hearing outcomes revealed improvement in 36% of patients, stabilization in 46%, and deterioration in 18%. Severe adverse effects, including hypertension and thromboembolic events, occurred in 13% of patients, while 18% reported no side effects. Tumor regrowth was observed in some patients after treatment discontinuation, emphasizing the need for long-term monitoring. Conclusions: Bevacizumab demonstrates effectiveness in managing VS, particularly in NF2 patients, by reducing tumor size and preserving hearing in a substantial proportion of cases. However, the variability in patient response and the risk of adverse events underscore the need for individualized treatment approaches and further research, including randomized controlled trials, to optimize its clinical application. Full article

Objective: The aim of this observational retrospective study was to report quality of life (QoL) in patients with postoperative facial nerve (FN) palsy after vestibular schwannoma (VS) surgery, investigating clinical factors related to functional outcomes. Methods: Forty-eight consecutive patients (M:F 25:23; median age: 52.5 years) with facial palsy following surgery for sporadic VS were considered retrospectively. FN palsy was graded by using the Sunnybrook facial grading system (SBFGS), while postoperative QoL and subjective functional aspects were assessed by using the Penn Acoustic Neuroma Quality of Life (PANQOL) Scale, the Synkinesis Assessment Questionnaire, and questions on eating and drinking. Results: A significant correlation emerged between all Sunnybrook scores and median PANQOL domain regarding facial function. Increasing overall SBFGS scores were associated with reduced risk of slow chewing on the affected side (p = 0.004), lack of masticatory strength (p = 0.025), masticatory fatigue (p < 0.001), accumulation of food in the oral vestibule (p < 0.001), difficulty in drinking from a glass (p = 0.019), and fluid spillage while drinking (p = 0.016). Conclusions: This study suggests that the clinical evaluation of patients with FN palsy after VS surgery should be integrated with patient reports about functional outcomes and perceived QoL to help clinicians guide rehabilitation choices. Full article

Background: Facial nerve paralysis is a severe dysfunction after vestibular schwannoma (VS) surgery. Methods: This monocentric study analyzed 61 patients who underwent sporadic VS surgery in a standardized manner. The primary endpoint was the facial nerve outcome (FNO) at 3 months after VS surgery. FNO was dichotomized into “good” (House–Brackmann (HB) score ≤ 2) and “poor” (HB > 2). Results: Poor FNO was observed in 11 patients (18.0%) at 3 months after VS surgery. Radiomic tumor shape features were analyzed, and the AUC of elongation in the prediction of a poor HB at 3 months was 0.70 (95% CI: 0.56–0.85, p = 0.03) and the optimum threshold value (≤/>0.35) yielded a sensitivity and specificity of 64.0% and 75.4%, respectively. Multivariable logistic regression analyses considering the extent of resection (</≥93.4%), preoperative tumor volume (</≥2.6 cm³), age (</≥55), sex (female/male), and elongation (≤/>0.35) revealed that more elongated VSs (≤0.35; OR: 5.8; 95%CI: 1.2–28.2; p = 0.03) and those with an increased EoR (≥93.4%; OR: 6.5; 95%CI: 1.0–42.5; p = 0.05) are independently associated with poorer FNO at 3 months after surgery. Conclusions: Highly elongated VS shape seems to be a risk factor for worsened facial nerve outcome at 3 months after surgery for Koos grade 3 and 4 tumors. Full article

Sensorineural hearing loss can be caused by lesions to the inner ear during development. Understanding the events and signaling pathways that drive inner ear formation is crucial for determining the possible causes of congenital hearing loss. We have analyzed the innervation and expression of SOX2, JAGGED1, β-catenin (CTNNB1), and vitamin D receptor (VDR) in the inner ears of human conceptuses aged 5 to 10 weeks after fertilization (W) using immunohistochemistry. The prosensory domains of the human inner ear displayed SOX2 and JAGGED1 expression throughout the analyzed period, with SOX2 expression being more extensive in all the analyzed timepoints. Innervation of vestibular prosensory domains was present at 6 W and extensive at 10 W, while nerve fibers reached the base of the cochlear prosensory domain at 7–8 W. CTNNB1 and VDR expression was mostly membranous and present during all analyzed timepoints in the inner ear, being the strongest in the non-sensory epithelium. Their expression was stronger in the vestibular region compared to the cochlear duct. CTNNB1 and VDR expression displayed opposite expression trends during the analyzed period, but additional studies are needed to elucidate whether they interact during inner ear development. Full article