Journal of the Acoustical Society of America, Dec 1, 1986
obtained for: ( 1 ) left monaural stimulation; (2) right monaural stimulation; and (3) binaural s... more obtained for: ( 1 ) left monaural stimulation; (2) right monaural stimulation; and (3) binaural stimulation. Individual binaural interaction waveforms were derived as described above. A shift of the major component of the binaural interaction between the adult and infant was observed. The largest BIC occurs in the adult at the time of P30 and N40 with a 41% interaction at P30 and a 21% interaction at N40. The morphology of the infant middle latency potentials differs significantly from the adult form by the narrowness of an N13 component and the lack of a clearly defined P30. N40 does not occur in the infant. The major interaction in the infant occurs at the time of N20, showing an interaction of 45%. This difference probably reflects changes in the middle latency components between adults and infants, with the adult showing a predominant P30-N40 component. [Work supported in part by the National Institutes of Health and the National Foundation March of Dimes. ] 9:45 W6. The use of paired clicks to examine forward masking in auditory brainstem responses.
The Sensory Organization Test (SOT) of Computerized Dynamic Posturography (EquiTest™ equipment) i... more The Sensory Organization Test (SOT) of Computerized Dynamic Posturography (EquiTest™ equipment) is a valuable tool for investigating how an individual uses balance system sensory input (vestibular, vision, proprioception/somatosensory) to maintain quiet stance; however, it is limited as a screening tool for identifying peripheral vestibular system dysfunction. Previous research has shown that adding horizontal head-shake to portions of the standard SOT battery improved the identification of peripheral vestibular system asymmetry; however, flaws in the methods were noted. The objective of this work was to evaluate the sensitivity and specificity of the modified head-shake SOT (HS-SOT) protocol for identification of peripheral vestibular system lesion. Fifteen patients with chief complaint of instability, vertigo, and/or lightheadedness, with and without a caloric unilateral weakness (UW) and fifteen age-matched healthy controls were included in the final analysis. Ten of the 15 patients demonstrated a caloric UW ≥ 25%. Participants completed standard conditions 2 and 5 of SOT with head still and during four horizontal head-shaking tasks (i.e.
Impairments of the vestibular-ocular reflex (VOR) lead to a decline in visual acuity during head ... more Impairments of the vestibular-ocular reflex (VOR) lead to a decline in visual acuity during head movements. Dynamic visual acuity (DVA) testing is a sensitive assessment tool for detecting VOR impairments. DVA evaluates accuracy of visual acuity during fixed velocity head movements. In contrast, the Gaze Stabilization test (GST) is a new functional evaluation of the VOR that identifies a person's maximum head velocity (in degrees per second) a person can maintain with stable vision of a target (i.e. optotype). The objective of this study was to evaluate the effect of age on the GST in participants without vestibular disease. The study was conducted in a vestibular and balance laboratory at a tertiary medical center. A total of 87 healthy adult volunteers were included in this study. The main outcome measure was the association between age and both GST maximum head velocity in the yaw (right/left) plane and velocity symmetry. A significant negative correlation was found between age and maximum head velocity (r = -0.469, p < 0.001). Our results suggest that age should be considered when interpreting GST results in the yaw plane, however standardization of testing methods should be established as variation in results has been reported in the literature.
EMGs were recorded from the gastrocnemius and anterior tibialis muscles of 77 adult subjects in r... more EMGs were recorded from the gastrocnemius and anterior tibialis muscles of 77 adult subjects in response to perturbation of stance by upward toe tilts. Subjects aged 22-88 y were initially grouped in seven decades (20s-80s). Each presented a history free of ear disease, eye disease not correctable by lenses, neurological disease, and persistent difficulty with balance or dizziness. All demonstrated functionally normal balance for their age on routine dynamic posturography. EMG recordings yielded onset and offset latencies, durations, and integrated amplitudes of the short and medium latency responses of the gastrocnemius and the long latency responses of the anterior tibialis. Analysis of the data revealed statistically significant left-right differences in amplitude of response and statistically significant height, gender, and age effects. Procedural issues were discussed; data were summarized for normative purposes; and suggestions were made for dealing with statistically significant differences in a clinical environment.
Journal of The American Academy of Audiology, Oct 1, 2017
KLJ provided consulting for Otometrics regarding the clinical use of vestibular evoked myogenic p... more KLJ provided consulting for Otometrics regarding the clinical use of vestibular evoked myogenic potential testing and video head impulse testing (vHIT) during this time frame. Boys Town Nation Research Hospital was a beta site for the Interacoustics EyeSeeCam. University of Nebraska Lincoln (JAH lab) was a beta site for MicroMedical vHIT system and Key opinion site with GN Otometrics.
Background: Uncompensated vestibular hypofunction results in postural instability, visual blurrin... more Background: Uncompensated vestibular hypofunction results in postural instability, visual blurring with head movement, and subjective complaints of dizziness and/or imbalance. We sought to answer the question, "Is vestibular exercise effective at enhancing recovery of function in people with peripheral (unilateral or bilateral) vestibular hypofunction?" Methods: A systematic review of the literature was performed in 5 databases published after 1985 and 5 additional sources for relevant publications were searched. Article types included meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case control series, and case series for human subjects, published in English. One hundred thirtyfive articles were identified as relevant to this clinical practice guideline. Results/Discussion: Based on strong evidence and a preponderance of benefit over harm, clinicians should offer vestibular rehabilitation to persons with unilateral and bilateral vestibular hypofunction with impairments and functional limitations related to the vestibular deficit. Based on strong evidence and a preponderance of harm over benefit, clinicians should not include voluntary saccadic or smooth-pursuit eye movements in isolation (ie, without head movement) as specific exercises for gaze stability. Based on moderate evidence, clinicians may offer specific exercise techniques to target identified impairments or functional limitations. Based on moderate evidence and in consideration of patient preference, clinicians may provide supervised vestibular rehabilitation. Based on expert opinion extrapolated from the evidence, clinicians may prescribe a minimum of 3 times per day for the performance of gaze stability exercises as 1 component of a home exercise program. Based on expert opinion extrapolated from the evidence (range of supervised visits: 2-38 weeks, mean = 10 weeks), clinicians may consider providing adequate supervised vestibular rehabilitation sessions for the patient to understand the goals of the program and how to manage and progress themselves independently. As a general guide, persons without significant comorbidities that affect mobility and with acute or subacute unilateral vestibular hypofunction may need
Numerous reports indicate that the cochlea remains responsive to electrical stimulation following... more Numerous reports indicate that the cochlea remains responsive to electrical stimulation following labyrinthectomy. We report a case of a 47-year-old woman with a severe to profound sensorineural hearing loss from birth, who developed episodic vertigo with symptoms suggestive of delayed onset endolymphatic hydrops. Following 8 months of failed medical and vestibular rehabilitation management, a right-sided labyrinthectomy combined with cochlear implantation was performed without complication. Postoperatively the patient was free of vertigo. Attempts to activate the patient's device between 4 to 12 weeks after surgery were unsuccessful as stimulation of the electrodes resulted in discomfort. However, all 20 electrodes elicited comfortable hearing sensations 16 weeks postsurgery. One year after the successful activation, the patient demonstrated improved sound awareness and speech recognition with the implant when compared with preoperative performance with a hearing aid. This case...
Objective-Test performance of a focused dizziness questionnaire's ability to discriminate between... more Objective-Test performance of a focused dizziness questionnaire's ability to discriminate between peripheral and non-peripheral causes of vertigo. Interventions-A 32-question survey was given to participants. Balance specialists were blinded and a diagnosis was established for all participating patients within 6 months. Main outcomes-Multinomial logistic regression was used to evaluate questionnaire performance in predicting final diagnosis and differentiating between peripheral and nonperipheral vertigo. Univariate and multivariable stepwise logistic regression were used to identify questions as significant predictors of the ultimate diagnosis. C-index was used to evaluate performance and discriminative power of the multivariable models. Results-437 patients participated in the study. Eight participants without confirmed diagnoses were excluded and 429 were included in the analysis. Multinomial regression revealed that the model had good overall predictive accuracy of 78.5% for the final diagnosis and 75.5% for differentiating between peripheral and non-peripheral vertigo. Univariate logistic regression identified significant predictors of three main categories of vertigo: peripheral, central and other. Predictors were entered into forward stepwise multivariable logistic regression. The discriminative
Dynamic posturography comprises a series of balance control tests which help physicians overcome ... more Dynamic posturography comprises a series of balance control tests which help physicians overcome numerous diagnostic and treatment challenges arising when examining patients complaining of a debilitating balance disorder. These challenges include the specific differential diagnosis, documentation of symptoms and assessment of functional disability. It must be determined whether the cause of the disability is an organic sensory deficit, a central nervous system (CNS) lesion or a non-organic (that is, possibly psychogenic or just overtly simulated) disorder. This review is targeted towards providing the reader (a) an overview of the effects sensori-motor deficits have on balance control, specifically vestibulo-spinal and proprioceptive reflex deficits; and, (b) how these effects may be assessed objectively in a clinical setting to differentiate between various organic and non-organic balance-disorders. The techniques used to study these effects are based on the analysis of both rapid ...
Vestibular rehabilitation is based on the use of adaptive and compensatory mechanisms already exi... more Vestibular rehabilitation is based on the use of adaptive and compensatory mechanisms already existing in the human brain. Research using animals provides a great deal of information on the neural mechanisms responsible for these functions and suggests strategies that should be helpful in rehabilitation of patients with disequilibrium and balance disorders. Research in animals and human beings suggests that rehabilitation should be specifically designed, depending on the patients' deficits. It also suggests that to be effective it needs to be started soon after impairment and that vestibulosuppressive medication may reduce recovery. Studies are now underway to evaluate the effectiveness of vestibular rehabilitation on several groups of patients and to answer some fundamental questions about the mechanisms and the effectiveness of these treatment methods. Current information suggests that vestibular rehabilitation is an effective method of therapy for many patients with disequili...
Educational objectives: To understand the role of ENG, posturography, and rotational chair testin... more Educational objectives: To understand the role of ENG, posturography, and rotational chair testing in the evaluation of patients with dizziness and to understand the physiologic rationale for vestibular rehabilitation therapy and the criteria for patient selection.
Vertigo and Imbalance: Clinical Neurophysiologyof the Vestibular System, 2010
... representative sample of the literature ( [Nashner, 1993b] , [Shepard et al., 1993] , [Weber ... more ... representative sample of the literature ( [Nashner, 1993b] , [Shepard et al., 1993] , [Weber and Cass, 1993] , [Shepard and Telian, 1996] , [Monsell et al., 1997] , [Allum and Shepard, 1999] , [Rose and Clark, 2000] , [Jacobson, 2002] , [Barclay-Goddard et al., 2004] , [Furman et al ...
This study examined the clinical use of the computerized gaze stabilization test (GST) as a scree... more This study examined the clinical use of the computerized gaze stabilization test (GST) as a screener for falls. Design: Cross-sectional, descriptive. Setting: Tertiary medical center. Subjects: Fifteen older community-dwelling adults with a history of falls and 15 controls without a history of falls were recruited for participation in the study. Main Outcome Measures: Participants performed GST with yaw plane head movements. The GST velocity was measured and compared with the dynamic gait index (DGI). Receiver operating characteristic (ROC) curves and area under the ROC curve (AUC) identified GST velocity cut points for identification of fallers based on history of falls and as compared with DGI score. Results: Our results suggested that GST can discriminate between individuals at risk for falls versus those not at risk. ROC analysis identified an AUC of 0.92 (e100.5 degrees per second criterion value) for GST based on history of falls and an AUC of 0.85 (e100.5 degrees per second criterion value) based on DGI for classifying falling risk. When GST and DGI scores were combined, the protocol identified an AUC of 1.0 (100% sensitivity, 100% specificity) for identifying falling risk. Conclusion: There were significant head movement velocity differences from participants classified by history of falls and the DGI. Therefore, GST may serve as a potential falling risk assessment measure for older individuals with a history of falls. It is recommended that GST be used in a combined protocol with DGI to accurately identify individuals with falling risk rather than used in isolation.
N oonan syndrome of multiple congenital anomalies is estimated to affect between 1 in 1000 to 1 a... more N oonan syndrome of multiple congenital anomalies is estimated to affect between 1 in 1000 to 1 and 2500 live births. 1,2 Cardinal features of Noonan syndrome are craniofacial abnormalities, short stature, webbed neck, and chest wall and cardiac abnormalities. 3 The most common craniofacial features of Noonan syndrome include hypertelorism, downward-slanting palpebral fissures, deeply grooved philtrum, high-arched palate, and micrognathia. External otologic features include low-set, posteriorly rotated ears and excessively folded auricular helixes. Phenotypically, Noonan syndrome has remarkable similarities to Turner syndrome (45 XO), which accounts for the earlier use of the term male Turner syndrome. Although Noonan syndrome appears to follow an autosomal-dominant pattern of inheritance, no major chromosomal abnormality is evident. To date, no candidate gene or genes have been identified that may be associated with this syndrome. CASE REPORT A 15-year-old boy with Noonan syndrome and a mixed conductive and sensorineural hearing loss had undergone several prior uneventful myringotomies for bilateral otitis media with effusion. At a routine follow-up visit the left tympanostomy tube was absent, and the thickened tympanic membrane was retracted. Audiologic assessment displayed a bilateral mixed pattem of hearing loss with a conductive component of 40 to 50 dB in the better-hearing left ear (Fig. 1). A tympanogram showed decreased compliance on the left. A repeat left tympanostomy tube placement was planned.
Journal of the American Academy of Audiology, 2009
Background: A vestibulospinal test known as the Fukuda stepping test (FST) has been suggested to ... more Background: A vestibulospinal test known as the Fukuda stepping test (FST) has been suggested to be a measure of asymmetrical labyrinthine function. However, an extensive review of the performance of this test to identify a peripheral vestibular lesion has not been reported. Purpose: The purpose of this study was to evaluate the sensitivity and specificity of the standard FST and a head shaking variation for identification of a peripheral vestibular system lesion. Research Design: In this retrospective review, we compared performance on the FST with and without a head shaking component to electronystagmography (ENG) caloric irrigation unilateral weakness results. Study Sample: We studied these factors in 736 chronic dizzy patients. Results: Receiving operating characteristics (ROC) analysis and area under the curve (AUC) indicated no significant benefit to performance from the head shaking variation compared to the standard FST in identifying labyrinthine weakness as classified by c...
Journal of the Acoustical Society of America, Dec 1, 1986
obtained for: ( 1 ) left monaural stimulation; (2) right monaural stimulation; and (3) binaural s... more obtained for: ( 1 ) left monaural stimulation; (2) right monaural stimulation; and (3) binaural stimulation. Individual binaural interaction waveforms were derived as described above. A shift of the major component of the binaural interaction between the adult and infant was observed. The largest BIC occurs in the adult at the time of P30 and N40 with a 41% interaction at P30 and a 21% interaction at N40. The morphology of the infant middle latency potentials differs significantly from the adult form by the narrowness of an N13 component and the lack of a clearly defined P30. N40 does not occur in the infant. The major interaction in the infant occurs at the time of N20, showing an interaction of 45%. This difference probably reflects changes in the middle latency components between adults and infants, with the adult showing a predominant P30-N40 component. [Work supported in part by the National Institutes of Health and the National Foundation March of Dimes. ] 9:45 W6. The use of paired clicks to examine forward masking in auditory brainstem responses.
The Sensory Organization Test (SOT) of Computerized Dynamic Posturography (EquiTest™ equipment) i... more The Sensory Organization Test (SOT) of Computerized Dynamic Posturography (EquiTest™ equipment) is a valuable tool for investigating how an individual uses balance system sensory input (vestibular, vision, proprioception/somatosensory) to maintain quiet stance; however, it is limited as a screening tool for identifying peripheral vestibular system dysfunction. Previous research has shown that adding horizontal head-shake to portions of the standard SOT battery improved the identification of peripheral vestibular system asymmetry; however, flaws in the methods were noted. The objective of this work was to evaluate the sensitivity and specificity of the modified head-shake SOT (HS-SOT) protocol for identification of peripheral vestibular system lesion. Fifteen patients with chief complaint of instability, vertigo, and/or lightheadedness, with and without a caloric unilateral weakness (UW) and fifteen age-matched healthy controls were included in the final analysis. Ten of the 15 patients demonstrated a caloric UW ≥ 25%. Participants completed standard conditions 2 and 5 of SOT with head still and during four horizontal head-shaking tasks (i.e.
Impairments of the vestibular-ocular reflex (VOR) lead to a decline in visual acuity during head ... more Impairments of the vestibular-ocular reflex (VOR) lead to a decline in visual acuity during head movements. Dynamic visual acuity (DVA) testing is a sensitive assessment tool for detecting VOR impairments. DVA evaluates accuracy of visual acuity during fixed velocity head movements. In contrast, the Gaze Stabilization test (GST) is a new functional evaluation of the VOR that identifies a person's maximum head velocity (in degrees per second) a person can maintain with stable vision of a target (i.e. optotype). The objective of this study was to evaluate the effect of age on the GST in participants without vestibular disease. The study was conducted in a vestibular and balance laboratory at a tertiary medical center. A total of 87 healthy adult volunteers were included in this study. The main outcome measure was the association between age and both GST maximum head velocity in the yaw (right/left) plane and velocity symmetry. A significant negative correlation was found between age and maximum head velocity (r = -0.469, p < 0.001). Our results suggest that age should be considered when interpreting GST results in the yaw plane, however standardization of testing methods should be established as variation in results has been reported in the literature.
EMGs were recorded from the gastrocnemius and anterior tibialis muscles of 77 adult subjects in r... more EMGs were recorded from the gastrocnemius and anterior tibialis muscles of 77 adult subjects in response to perturbation of stance by upward toe tilts. Subjects aged 22-88 y were initially grouped in seven decades (20s-80s). Each presented a history free of ear disease, eye disease not correctable by lenses, neurological disease, and persistent difficulty with balance or dizziness. All demonstrated functionally normal balance for their age on routine dynamic posturography. EMG recordings yielded onset and offset latencies, durations, and integrated amplitudes of the short and medium latency responses of the gastrocnemius and the long latency responses of the anterior tibialis. Analysis of the data revealed statistically significant left-right differences in amplitude of response and statistically significant height, gender, and age effects. Procedural issues were discussed; data were summarized for normative purposes; and suggestions were made for dealing with statistically significant differences in a clinical environment.
Journal of The American Academy of Audiology, Oct 1, 2017
KLJ provided consulting for Otometrics regarding the clinical use of vestibular evoked myogenic p... more KLJ provided consulting for Otometrics regarding the clinical use of vestibular evoked myogenic potential testing and video head impulse testing (vHIT) during this time frame. Boys Town Nation Research Hospital was a beta site for the Interacoustics EyeSeeCam. University of Nebraska Lincoln (JAH lab) was a beta site for MicroMedical vHIT system and Key opinion site with GN Otometrics.
Background: Uncompensated vestibular hypofunction results in postural instability, visual blurrin... more Background: Uncompensated vestibular hypofunction results in postural instability, visual blurring with head movement, and subjective complaints of dizziness and/or imbalance. We sought to answer the question, "Is vestibular exercise effective at enhancing recovery of function in people with peripheral (unilateral or bilateral) vestibular hypofunction?" Methods: A systematic review of the literature was performed in 5 databases published after 1985 and 5 additional sources for relevant publications were searched. Article types included meta-analyses, systematic reviews, randomized controlled trials, cohort studies, case control series, and case series for human subjects, published in English. One hundred thirtyfive articles were identified as relevant to this clinical practice guideline. Results/Discussion: Based on strong evidence and a preponderance of benefit over harm, clinicians should offer vestibular rehabilitation to persons with unilateral and bilateral vestibular hypofunction with impairments and functional limitations related to the vestibular deficit. Based on strong evidence and a preponderance of harm over benefit, clinicians should not include voluntary saccadic or smooth-pursuit eye movements in isolation (ie, without head movement) as specific exercises for gaze stability. Based on moderate evidence, clinicians may offer specific exercise techniques to target identified impairments or functional limitations. Based on moderate evidence and in consideration of patient preference, clinicians may provide supervised vestibular rehabilitation. Based on expert opinion extrapolated from the evidence, clinicians may prescribe a minimum of 3 times per day for the performance of gaze stability exercises as 1 component of a home exercise program. Based on expert opinion extrapolated from the evidence (range of supervised visits: 2-38 weeks, mean = 10 weeks), clinicians may consider providing adequate supervised vestibular rehabilitation sessions for the patient to understand the goals of the program and how to manage and progress themselves independently. As a general guide, persons without significant comorbidities that affect mobility and with acute or subacute unilateral vestibular hypofunction may need
Numerous reports indicate that the cochlea remains responsive to electrical stimulation following... more Numerous reports indicate that the cochlea remains responsive to electrical stimulation following labyrinthectomy. We report a case of a 47-year-old woman with a severe to profound sensorineural hearing loss from birth, who developed episodic vertigo with symptoms suggestive of delayed onset endolymphatic hydrops. Following 8 months of failed medical and vestibular rehabilitation management, a right-sided labyrinthectomy combined with cochlear implantation was performed without complication. Postoperatively the patient was free of vertigo. Attempts to activate the patient's device between 4 to 12 weeks after surgery were unsuccessful as stimulation of the electrodes resulted in discomfort. However, all 20 electrodes elicited comfortable hearing sensations 16 weeks postsurgery. One year after the successful activation, the patient demonstrated improved sound awareness and speech recognition with the implant when compared with preoperative performance with a hearing aid. This case...
Objective-Test performance of a focused dizziness questionnaire's ability to discriminate between... more Objective-Test performance of a focused dizziness questionnaire's ability to discriminate between peripheral and non-peripheral causes of vertigo. Interventions-A 32-question survey was given to participants. Balance specialists were blinded and a diagnosis was established for all participating patients within 6 months. Main outcomes-Multinomial logistic regression was used to evaluate questionnaire performance in predicting final diagnosis and differentiating between peripheral and nonperipheral vertigo. Univariate and multivariable stepwise logistic regression were used to identify questions as significant predictors of the ultimate diagnosis. C-index was used to evaluate performance and discriminative power of the multivariable models. Results-437 patients participated in the study. Eight participants without confirmed diagnoses were excluded and 429 were included in the analysis. Multinomial regression revealed that the model had good overall predictive accuracy of 78.5% for the final diagnosis and 75.5% for differentiating between peripheral and non-peripheral vertigo. Univariate logistic regression identified significant predictors of three main categories of vertigo: peripheral, central and other. Predictors were entered into forward stepwise multivariable logistic regression. The discriminative
Dynamic posturography comprises a series of balance control tests which help physicians overcome ... more Dynamic posturography comprises a series of balance control tests which help physicians overcome numerous diagnostic and treatment challenges arising when examining patients complaining of a debilitating balance disorder. These challenges include the specific differential diagnosis, documentation of symptoms and assessment of functional disability. It must be determined whether the cause of the disability is an organic sensory deficit, a central nervous system (CNS) lesion or a non-organic (that is, possibly psychogenic or just overtly simulated) disorder. This review is targeted towards providing the reader (a) an overview of the effects sensori-motor deficits have on balance control, specifically vestibulo-spinal and proprioceptive reflex deficits; and, (b) how these effects may be assessed objectively in a clinical setting to differentiate between various organic and non-organic balance-disorders. The techniques used to study these effects are based on the analysis of both rapid ...
Vestibular rehabilitation is based on the use of adaptive and compensatory mechanisms already exi... more Vestibular rehabilitation is based on the use of adaptive and compensatory mechanisms already existing in the human brain. Research using animals provides a great deal of information on the neural mechanisms responsible for these functions and suggests strategies that should be helpful in rehabilitation of patients with disequilibrium and balance disorders. Research in animals and human beings suggests that rehabilitation should be specifically designed, depending on the patients' deficits. It also suggests that to be effective it needs to be started soon after impairment and that vestibulosuppressive medication may reduce recovery. Studies are now underway to evaluate the effectiveness of vestibular rehabilitation on several groups of patients and to answer some fundamental questions about the mechanisms and the effectiveness of these treatment methods. Current information suggests that vestibular rehabilitation is an effective method of therapy for many patients with disequili...
Educational objectives: To understand the role of ENG, posturography, and rotational chair testin... more Educational objectives: To understand the role of ENG, posturography, and rotational chair testing in the evaluation of patients with dizziness and to understand the physiologic rationale for vestibular rehabilitation therapy and the criteria for patient selection.
Vertigo and Imbalance: Clinical Neurophysiologyof the Vestibular System, 2010
... representative sample of the literature ( [Nashner, 1993b] , [Shepard et al., 1993] , [Weber ... more ... representative sample of the literature ( [Nashner, 1993b] , [Shepard et al., 1993] , [Weber and Cass, 1993] , [Shepard and Telian, 1996] , [Monsell et al., 1997] , [Allum and Shepard, 1999] , [Rose and Clark, 2000] , [Jacobson, 2002] , [Barclay-Goddard et al., 2004] , [Furman et al ...
This study examined the clinical use of the computerized gaze stabilization test (GST) as a scree... more This study examined the clinical use of the computerized gaze stabilization test (GST) as a screener for falls. Design: Cross-sectional, descriptive. Setting: Tertiary medical center. Subjects: Fifteen older community-dwelling adults with a history of falls and 15 controls without a history of falls were recruited for participation in the study. Main Outcome Measures: Participants performed GST with yaw plane head movements. The GST velocity was measured and compared with the dynamic gait index (DGI). Receiver operating characteristic (ROC) curves and area under the ROC curve (AUC) identified GST velocity cut points for identification of fallers based on history of falls and as compared with DGI score. Results: Our results suggested that GST can discriminate between individuals at risk for falls versus those not at risk. ROC analysis identified an AUC of 0.92 (e100.5 degrees per second criterion value) for GST based on history of falls and an AUC of 0.85 (e100.5 degrees per second criterion value) based on DGI for classifying falling risk. When GST and DGI scores were combined, the protocol identified an AUC of 1.0 (100% sensitivity, 100% specificity) for identifying falling risk. Conclusion: There were significant head movement velocity differences from participants classified by history of falls and the DGI. Therefore, GST may serve as a potential falling risk assessment measure for older individuals with a history of falls. It is recommended that GST be used in a combined protocol with DGI to accurately identify individuals with falling risk rather than used in isolation.
N oonan syndrome of multiple congenital anomalies is estimated to affect between 1 in 1000 to 1 a... more N oonan syndrome of multiple congenital anomalies is estimated to affect between 1 in 1000 to 1 and 2500 live births. 1,2 Cardinal features of Noonan syndrome are craniofacial abnormalities, short stature, webbed neck, and chest wall and cardiac abnormalities. 3 The most common craniofacial features of Noonan syndrome include hypertelorism, downward-slanting palpebral fissures, deeply grooved philtrum, high-arched palate, and micrognathia. External otologic features include low-set, posteriorly rotated ears and excessively folded auricular helixes. Phenotypically, Noonan syndrome has remarkable similarities to Turner syndrome (45 XO), which accounts for the earlier use of the term male Turner syndrome. Although Noonan syndrome appears to follow an autosomal-dominant pattern of inheritance, no major chromosomal abnormality is evident. To date, no candidate gene or genes have been identified that may be associated with this syndrome. CASE REPORT A 15-year-old boy with Noonan syndrome and a mixed conductive and sensorineural hearing loss had undergone several prior uneventful myringotomies for bilateral otitis media with effusion. At a routine follow-up visit the left tympanostomy tube was absent, and the thickened tympanic membrane was retracted. Audiologic assessment displayed a bilateral mixed pattem of hearing loss with a conductive component of 40 to 50 dB in the better-hearing left ear (Fig. 1). A tympanogram showed decreased compliance on the left. A repeat left tympanostomy tube placement was planned.
Journal of the American Academy of Audiology, 2009
Background: A vestibulospinal test known as the Fukuda stepping test (FST) has been suggested to ... more Background: A vestibulospinal test known as the Fukuda stepping test (FST) has been suggested to be a measure of asymmetrical labyrinthine function. However, an extensive review of the performance of this test to identify a peripheral vestibular lesion has not been reported. Purpose: The purpose of this study was to evaluate the sensitivity and specificity of the standard FST and a head shaking variation for identification of a peripheral vestibular system lesion. Research Design: In this retrospective review, we compared performance on the FST with and without a head shaking component to electronystagmography (ENG) caloric irrigation unilateral weakness results. Study Sample: We studied these factors in 736 chronic dizzy patients. Results: Receiving operating characteristics (ROC) analysis and area under the curve (AUC) indicated no significant benefit to performance from the head shaking variation compared to the standard FST in identifying labyrinthine weakness as classified by c...
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Papers by Neil Shepard