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Electronystagmography normative data for subjects over age 50 years
Otolaryngology Head and Neck Surgery P 198
August 1995
Scientific Posters
132
The Appropriateness of Magnetic Resonance Imaging in Sudden Sensorineural Hearing Loss PETERC. WEBER, MD, ROSS I. ZBAR, MD, and BRUCE J. GANTZ, MD, Charleston, S.C., and Iowa City, Iowa
Idiopathic sudden sensorineural hearing loss (SSNHL) is an enigmatic condition of unknown etiology. Although the treatment for SSNHL is controversial, the evaluation for an etiologic cause should not be. All patients are evaluated with a complete history, physical examination, audiologic examination, and blood draw to evaluate a complete blood cell count, general chemistry screen, thyroid function tests, ESR rate and fluorescent treponemal antibody, absorbed test. Magnetic resonance imaging (MRI) with gadolinium is essential in the evaluation of idiopathic SSNHL, even if there is a complete response to either treatment or no treatment. During the past year we treated 16 patients for idiopathic SSNHL with our protocol of intravenous dextran/Hypaque or oral high-dose steroids. Fifteen patients were evaluated immediately before treatment with an MRI scan. An additional patient had been treated successfully with high-dose steroids at an outside institution and came in for an evaluation. Of these 16 patients, three (18.75%) were found to have significant pathology on MRI scan. The patient who had been treated successfully on the outside was noted to have a 5 mm intracannicular acoustic neuroma, the second patient was found to have a multiple sclerosis lesion at the level of the superior olive, and the third patient, who had had a normal MRI scan 18 months previously, was now found to have a large 4 to 5 cm meningioma in the cerebropontine angle. We believe it is essential that all patients with idiopathic SSNHL be evaluated at some point during their treatment with an MRI scan with gadolinium. 133
Electronystagmography Normative Data for Subjects Over Age 50 Years MARIAN GIRARDI, MA, HORSTR, KONRAD, MD, GEORGE P. BAUER, MD, and LARRY F. HUGHES, PHD, Springfield, II1,,and Cincinnati, Ohio
The eye-tracking, positional/positioning, and caloric tests are the components of a standard electronystagmography test battery. Results assist in the clinical diagnosis of a peripheral versus central site of lesion and determine direction of a unilateral peripheral disorder. Much of the normative data currently used for interpretation of these test results were obtained from subjects under the age of 50 years. Our present population age mean is increasing, and an ever-growing number of patients with dizziness and vertigo who are referred for electronystagmography testing are over the age of 50 years. Using 284 volunteers from the community, we tested 78 vision- and hearing-screened, nonvertiginous subjects between the ages of 50 and 86 years with computer-assisted
electrenystagmography. These subjects were in excellent general health and none had a history of or demonstrated any signs or symptoms of dizziness, vertigo, loss of balance, or spontaneous nystagmus. A standard battery of electronystagmography tests was performed, including gaze fixation, spontaneous nystagmus, saccade, smooth pursuit, and optokinetic tests in the category of eye-tracking analysis; Dix-Hallpike (head center, left, and right) and supine positional tests; and, lastly, bilateral, bithermal caloric tests with a closed loop irrigator. ANOVA showed a significant difference between these normal subjects and current clinical thresholds for a number of electronystagmography tests. When performing electronystagmography tests on patients over the age of 50 years, normal changes related to aging may account for resuits exceeding threshold levels, and patients' results should be compared with values established for age-matched norreal subjects before the determination of a diagnosis. (A portion of this data has been presented previously at the 1993 AAO-HNS meeting [Research Forum], and another portion has been presented previously at the 1994 Association for Research in Otolaryngology meeting, both in poster sessions.) 134
Noise-Induced Hearing Loss and Individual Susceptibility to the Noise KYONG-MYONG CHON, MD, EUI-KYUNGGOH, MD, HWANJUNG ROH, MD, and BYEONG-IL PARK, MD, Pusan, South Korea
Although the number of patients with noise-induced hearing loss is gradually increasing, there is no specific method for treating these patients; prevention is the best way of avoiding the problem. We investigated the status of noise-induced hearing loss in workers who had jobs in a noisy environment in Pusan and the Kyungnam area of South Korea. The purpose of the study was to set up preventive indices for noise-induced hearing loss by investigating temporary threshold shift (TTS) and its recovery time after noise stimulation. The results were as follows: 1. Workers with noise-induced hearing loss occupied 27.1% among all workers. Noise-induced hearing loss was mostly established within 9 years after noise exposure and below 40 years of age. 2. Initially, noise-induced hearing loss was involved n o t only in the high-frequency range but also in the speech range simultaneously. 3. Among subjects with normal hearing, those who had a TTS over 41 dB and a recovery time over 10 minutes after noise stimulation and those who had a speech discrimination score below 76% and a recovery time over 6 minutes after noise stimulation had a high risk of developing noise-induced hearing loss. 4. Among subjects with noise-induced hearing loss, those who had a TTS over 25 dB and a recovery time over 10
August 1995
Scientific Posters
132
The Appropriateness of Magnetic Resonance Imaging in Sudden Sensorineural Hearing Loss PETERC. WEBER, MD, ROSS I. ZBAR, MD, and BRUCE J. GANTZ, MD, Charleston, S.C., and Iowa City, Iowa
Idiopathic sudden sensorineural hearing loss (SSNHL) is an enigmatic condition of unknown etiology. Although the treatment for SSNHL is controversial, the evaluation for an etiologic cause should not be. All patients are evaluated with a complete history, physical examination, audiologic examination, and blood draw to evaluate a complete blood cell count, general chemistry screen, thyroid function tests, ESR rate and fluorescent treponemal antibody, absorbed test. Magnetic resonance imaging (MRI) with gadolinium is essential in the evaluation of idiopathic SSNHL, even if there is a complete response to either treatment or no treatment. During the past year we treated 16 patients for idiopathic SSNHL with our protocol of intravenous dextran/Hypaque or oral high-dose steroids. Fifteen patients were evaluated immediately before treatment with an MRI scan. An additional patient had been treated successfully with high-dose steroids at an outside institution and came in for an evaluation. Of these 16 patients, three (18.75%) were found to have significant pathology on MRI scan. The patient who had been treated successfully on the outside was noted to have a 5 mm intracannicular acoustic neuroma, the second patient was found to have a multiple sclerosis lesion at the level of the superior olive, and the third patient, who had had a normal MRI scan 18 months previously, was now found to have a large 4 to 5 cm meningioma in the cerebropontine angle. We believe it is essential that all patients with idiopathic SSNHL be evaluated at some point during their treatment with an MRI scan with gadolinium. 133
Electronystagmography Normative Data for Subjects Over Age 50 Years MARIAN GIRARDI, MA, HORSTR, KONRAD, MD, GEORGE P. BAUER, MD, and LARRY F. HUGHES, PHD, Springfield, II1,,and Cincinnati, Ohio
The eye-tracking, positional/positioning, and caloric tests are the components of a standard electronystagmography test battery. Results assist in the clinical diagnosis of a peripheral versus central site of lesion and determine direction of a unilateral peripheral disorder. Much of the normative data currently used for interpretation of these test results were obtained from subjects under the age of 50 years. Our present population age mean is increasing, and an ever-growing number of patients with dizziness and vertigo who are referred for electronystagmography testing are over the age of 50 years. Using 284 volunteers from the community, we tested 78 vision- and hearing-screened, nonvertiginous subjects between the ages of 50 and 86 years with computer-assisted
electrenystagmography. These subjects were in excellent general health and none had a history of or demonstrated any signs or symptoms of dizziness, vertigo, loss of balance, or spontaneous nystagmus. A standard battery of electronystagmography tests was performed, including gaze fixation, spontaneous nystagmus, saccade, smooth pursuit, and optokinetic tests in the category of eye-tracking analysis; Dix-Hallpike (head center, left, and right) and supine positional tests; and, lastly, bilateral, bithermal caloric tests with a closed loop irrigator. ANOVA showed a significant difference between these normal subjects and current clinical thresholds for a number of electronystagmography tests. When performing electronystagmography tests on patients over the age of 50 years, normal changes related to aging may account for resuits exceeding threshold levels, and patients' results should be compared with values established for age-matched norreal subjects before the determination of a diagnosis. (A portion of this data has been presented previously at the 1993 AAO-HNS meeting [Research Forum], and another portion has been presented previously at the 1994 Association for Research in Otolaryngology meeting, both in poster sessions.) 134
Noise-Induced Hearing Loss and Individual Susceptibility to the Noise KYONG-MYONG CHON, MD, EUI-KYUNGGOH, MD, HWANJUNG ROH, MD, and BYEONG-IL PARK, MD, Pusan, South Korea
Although the number of patients with noise-induced hearing loss is gradually increasing, there is no specific method for treating these patients; prevention is the best way of avoiding the problem. We investigated the status of noise-induced hearing loss in workers who had jobs in a noisy environment in Pusan and the Kyungnam area of South Korea. The purpose of the study was to set up preventive indices for noise-induced hearing loss by investigating temporary threshold shift (TTS) and its recovery time after noise stimulation. The results were as follows: 1. Workers with noise-induced hearing loss occupied 27.1% among all workers. Noise-induced hearing loss was mostly established within 9 years after noise exposure and below 40 years of age. 2. Initially, noise-induced hearing loss was involved n o t only in the high-frequency range but also in the speech range simultaneously. 3. Among subjects with normal hearing, those who had a TTS over 41 dB and a recovery time over 10 minutes after noise stimulation and those who had a speech discrimination score below 76% and a recovery time over 6 minutes after noise stimulation had a high risk of developing noise-induced hearing loss. 4. Among subjects with noise-induced hearing loss, those who had a TTS over 25 dB and a recovery time over 10