Inner ear therapy by local drug delivery

Acute Vestibular Disorders panel discussion

Advances in the diagnosis and management of chronic dizziness

We will introduce the latest findings from clinical research on meniere's disease and benign paroxysmal positional vertigo, as well as the latest findings from basic research on hair cells in the otolith organs

meniere disease

vertiginous symptoms in patients with meniere's disease (MD) are weather-related. Endolymphatic hydrops (EH) have been thought to be the pathological basis of MD. Endolymphatic space (ELS) volume can be evaluated using three-dimensional analysis of 3-tesla magnetic resonance imaging after intravenous injection of gadolinium enhancement. In patients with developed MD (average hearing levels in the affected ear of 40-70 db), a significant negative correlation was found between atmospheric pressure change and vestibular ELS rate on the affected side. Negative atmospheric pressure changes may influence vestibular ELS volume in patients with moderate hearing impairment

benign paroxysmal positional vertigo (BPPV)

posterior canal-type benign paroxysmal positional vertigo (pc-BPPV) is diagnosed when positional torsional nystagmus is induced by the dix-hallpike test (DHT). When the DHT is repeated, positional nystagmus disappears. This phenomenon is known as BPPV fatigue. In cases where positional nystagmus cannot be induced by the DHT because of BPPV fatigue occurring just before a medical examination, or where positional nystagmus is not observed during the first DHT, we cannot make a diagnosis of pc-BPPV because the DHT can no longer induce the positional nystagmus typical of pc-BPPV. We have succeeded to develop a new maneuver to rapidly restore positional nystagmus in cases of BPPV fatigue, thereby facilitating accurate diagnosis

modulation of the physiological function of hair cells in saccule

we investigate the influence of myosin regulatory light chain and myosin light chain kinase on the physiological function of inner ear hair cells. We confirmed the expression of NM2a/b and MYL9 on the apical surfaces of hair cells and of NM2a and MYL12a in hair bundles. We found that NM2 and MLCK inhibitors reduce the stiffness of hair bundles from the bullfrog's saccule. Moreover, MLCK inhibition inhibits the spontaneous oscillation of hair bundles and increases the resting open probability of transduction channels. In addition, MLCK inhibition elevates hearing thresholds in mice. We conclude that NM2 and the phosphorylation of RLC modulate the physiological function of hair cells and thereby help to set the normal operating conditions of hair bundles.

Mal de debarquement syndrome mal de debarquement syndrome

BPPV is a highly prevalent otoneurological pathology, characterized by brief and paroxysmal objective dizziness crises caused by head movements on the vertical and/or horizontal plane. The crises are repetitive and generally group together in a limited period of time (active phase) with a tendency to relapse after silent intervals of unpredictable duration (inactive phase) the peak incidence of this disorder affects subjects aged between 50 and 70 with a 2:1 ratio between females and males. This pathological picture is associated with a significant impact on healthcare spending and on the social aspect, since a percentage of 86% of patients suffering from this pathology interrupts adls (work and non-work). In recent years, diagnostics has been enriched by new procedures and accurate knowledge of the clinical manifestations of BPPV, as well as the acquisition of all new information in the context of the diagnostic process and therapeutic proposals, are fundamental for the optimal recovery of the patient's autonomy and also for savings in terms of time and costs.

Fitting, cochleo-vestibular interactions, multi-canal stimulation, ecaps, EEG and vestibular brainstem responses

DEFINITIONS OF PROBABLE AND DEFINITE VESTIBULAR MIGRAINE IS WELL DEFINED BY RELATED SOCIETİES. HOWEVER OBJECTIVE DIAGNIOSTIC CRITERIA FOR VESTIBULAR MIGRAINE WITH THE HELP OF VESTIBULAR STUDIES ARE NOT CLEAR YET. THERE ARE FEW STUDIES IN THE LITERATURE. THIS PRESENTATION AIMS TO SHOW THE POSSIBLE ROLE OF VESTIBULAR LABORATORY.